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Iatrogenic implantation of soft tissue sarcoma at skin graft donor site: Delayed manifestation of an avoidable complication.

Pai VD, Puri A, Epari S, Gulia A - South Asian J Cancer (2015 Apr-Jun)

View Article: PubMed Central - PubMed

Affiliation: Department of Surgical Oncology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India.

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He was additionally evaluated with a magnetic resonance imaging which revealed a 3 cm × 2 cm subcutaneous nodule at the donor site [Figure 1b]... A core needle biopsy was performed to confirm the diagnosis... The biopsy revealed high-grade spindle cell sarcoma consistent with metastasis from a known primary in the right thigh [Figure 1d]... A metastatic workup including a computed tomography scan of the chest and an ultrasound of the abdomen-pelvis did not reveal any other focus of disease... It may be an implantation tumor, a second primary unrelated to the index tumor or it may be a soft tissue deposit due to hematogenous spread... In our case, implantation seems the most probable mechanism as the patient did not have either locoregional recurrence or any other site of distant metastasis... Implantation of tumor at other sites that have been described include chest wall implantation following lung tumor biopsy, gastrostomy site implantation from the aero digestive tumor following percutaneous gastrostomy tube insertion and laparoscopic trocar site implantation from ovarian tumors... Though there is an isolated case report of osteogenic sarcoma developing at the bone graft donor site, an extensive review of literature did not reveal any previous report of implantation of sarcoma cells at the donor site of skin graft or flap... We had previously reported a case of giant cell tumor developing at the bone graft donor site secondary to iatrogenic implantation and suggested some of the precautionary measures which can be taken to avoid this complication... Similar precautions are warranted during harvesting flaps or skin grafts in oncologic reconstructions: A common draping for the primary tumor and flap donor site should be avoided Ulcerated or fungated tumors should be sealed with impermeable skin barriers to avoid tumor spillage in the operative field Harvesting of the flap should be started only after resection of the primary is complete to avoid cross contamination... Change of gloves is mandatory for all the surgeons and nurses after resection of the primary and before reconstruction begins Separate surgical trolley with a separate set of instruments including cautery tip should be used for both the procedures Hollow needles if used for infiltration during primary surgery should not be reused at flap donor sites Proper irrigation of the operative field at the end of resection decreases chances of implantation of the tumor cells Gentle handling of the tissues so that tumor cell dissemination can be minimized particularly in the case of necrotic tumors... Tumor recurrence due to implantation is a complication that can be easily avoided by adhering to simple precautions during surgery... Through this case report, we would like to reassert the importance of basic principles during cancer surgery to prevent an eminently avoidable complication that may result in long-term morbidity and mortality.

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(a) Histopathology of the primary tumor showing intermediate grade spindle cell sarcoma. (b) Magnetic resonance imaging. T2-weighted axial cut showing the subcutaneous recurrent nodule at donor site (red arrow). (c) Clinical profile of the patient showing the nodule at the donor site (black arrow). (d and e) Histopathology of excised nodule showing intermediate grade spindle cell sarcoma similar to the primary tumor
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Figure 1: (a) Histopathology of the primary tumor showing intermediate grade spindle cell sarcoma. (b) Magnetic resonance imaging. T2-weighted axial cut showing the subcutaneous recurrent nodule at donor site (red arrow). (c) Clinical profile of the patient showing the nodule at the donor site (black arrow). (d and e) Histopathology of excised nodule showing intermediate grade spindle cell sarcoma similar to the primary tumor

Mentions: A 33-year-old gentleman presented with a solitary swelling over left calf. On examination, he had a 3 cm × 2 cm, solitary swelling over a skin grafted area on the posterior aspect of left leg which was non tender, firm in consistency and had well-defined borders [Figure 1c]. Detailed evaluation revealed that the patient was operated for a non metastatic intermediate grade spindle cell sarcoma of the contralateral leg 8 years earlier [Figure 1a]. He underwent wide excision of the primary tumor with reconstruction of the defect with a cross leg flap at another hospital. The donor site over left calf was covered with a split-thickness skin graft harvested from the thigh of the same side. Postoperatively he received radiotherapy to the primary area. 8 years later, he developed a swelling over the left calf at the skin graft donor site.


Iatrogenic implantation of soft tissue sarcoma at skin graft donor site: Delayed manifestation of an avoidable complication.

Pai VD, Puri A, Epari S, Gulia A - South Asian J Cancer (2015 Apr-Jun)

(a) Histopathology of the primary tumor showing intermediate grade spindle cell sarcoma. (b) Magnetic resonance imaging. T2-weighted axial cut showing the subcutaneous recurrent nodule at donor site (red arrow). (c) Clinical profile of the patient showing the nodule at the donor site (black arrow). (d and e) Histopathology of excised nodule showing intermediate grade spindle cell sarcoma similar to the primary tumor
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4418075&req=5

Figure 1: (a) Histopathology of the primary tumor showing intermediate grade spindle cell sarcoma. (b) Magnetic resonance imaging. T2-weighted axial cut showing the subcutaneous recurrent nodule at donor site (red arrow). (c) Clinical profile of the patient showing the nodule at the donor site (black arrow). (d and e) Histopathology of excised nodule showing intermediate grade spindle cell sarcoma similar to the primary tumor
Mentions: A 33-year-old gentleman presented with a solitary swelling over left calf. On examination, he had a 3 cm × 2 cm, solitary swelling over a skin grafted area on the posterior aspect of left leg which was non tender, firm in consistency and had well-defined borders [Figure 1c]. Detailed evaluation revealed that the patient was operated for a non metastatic intermediate grade spindle cell sarcoma of the contralateral leg 8 years earlier [Figure 1a]. He underwent wide excision of the primary tumor with reconstruction of the defect with a cross leg flap at another hospital. The donor site over left calf was covered with a split-thickness skin graft harvested from the thigh of the same side. Postoperatively he received radiotherapy to the primary area. 8 years later, he developed a swelling over the left calf at the skin graft donor site.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgical Oncology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

He was additionally evaluated with a magnetic resonance imaging which revealed a 3 cm × 2 cm subcutaneous nodule at the donor site [Figure 1b]... A core needle biopsy was performed to confirm the diagnosis... The biopsy revealed high-grade spindle cell sarcoma consistent with metastasis from a known primary in the right thigh [Figure 1d]... A metastatic workup including a computed tomography scan of the chest and an ultrasound of the abdomen-pelvis did not reveal any other focus of disease... It may be an implantation tumor, a second primary unrelated to the index tumor or it may be a soft tissue deposit due to hematogenous spread... In our case, implantation seems the most probable mechanism as the patient did not have either locoregional recurrence or any other site of distant metastasis... Implantation of tumor at other sites that have been described include chest wall implantation following lung tumor biopsy, gastrostomy site implantation from the aero digestive tumor following percutaneous gastrostomy tube insertion and laparoscopic trocar site implantation from ovarian tumors... Though there is an isolated case report of osteogenic sarcoma developing at the bone graft donor site, an extensive review of literature did not reveal any previous report of implantation of sarcoma cells at the donor site of skin graft or flap... We had previously reported a case of giant cell tumor developing at the bone graft donor site secondary to iatrogenic implantation and suggested some of the precautionary measures which can be taken to avoid this complication... Similar precautions are warranted during harvesting flaps or skin grafts in oncologic reconstructions: A common draping for the primary tumor and flap donor site should be avoided Ulcerated or fungated tumors should be sealed with impermeable skin barriers to avoid tumor spillage in the operative field Harvesting of the flap should be started only after resection of the primary is complete to avoid cross contamination... Change of gloves is mandatory for all the surgeons and nurses after resection of the primary and before reconstruction begins Separate surgical trolley with a separate set of instruments including cautery tip should be used for both the procedures Hollow needles if used for infiltration during primary surgery should not be reused at flap donor sites Proper irrigation of the operative field at the end of resection decreases chances of implantation of the tumor cells Gentle handling of the tissues so that tumor cell dissemination can be minimized particularly in the case of necrotic tumors... Tumor recurrence due to implantation is a complication that can be easily avoided by adhering to simple precautions during surgery... Through this case report, we would like to reassert the importance of basic principles during cancer surgery to prevent an eminently avoidable complication that may result in long-term morbidity and mortality.

No MeSH data available.


Related in: MedlinePlus