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E.G.

E.G. 54 year - old female Housewife. History. 1994: C alcifi ed leiomyoma at the r ight foot  Excision 1997: Recurrence in the same place  Excision

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E.G.

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  1. E.G. 54 year-old female Housewife

  2. History • 1994: Calcified leiomyoma at the right foot Excision • 1997: Recurrence in the same place  Excision • 2001: Recurrence in same the place  Synovial sarcoma .  Excision • 2003: Three metastases in the left lung  Resection • 2004: A new metastasis in the left lung  Resection .  6 cycles of ifosfomide+doxorubicine • 2005: New metastases in lungs  15 cycles of . methotrexate

  3. Symptoms28.4.2006 • Dyspnea • Cough • Wheezing

  4. Suggestion? • Bronchoscopy • Radiotherapy • Resection of metastases

  5. Bronchoscopy • Radiotherapy • Resection of metastases

  6. 28.4.06

  7. Suggestion? • Open surgery • Stent • LASER • APC • Cryotherapy • Electro-surgical snare

  8. Open surgery • Stent • LASER • APC • Cryotherapy • Electro-surgical snare

  9. 28.4.06

  10. Control after 2 weeks 12.5.06

  11. After 25 days Wheezing and hemoptysis 07.6.06

  12. 7.6.06

  13. Suggestion? • Brachytherapy • External radiotherapy • Surgery

  14. Brachytherapy • External radiotherapy • Surgery

  15. 20.6.06  750 cGy 27.6.06  750 cGy 05.7.06  750 cGy Brachytherapy

  16. Control after brachytherapy Radiation bronchitis 15.11.06

  17. Cyanosis, hypotension Referral to the emergency unit28.2.07 Pulmonary embolus Excitus

  18. Conclusion • Metastatic synovial sarcoma growing rapidly from a single focus without invading the surrounding structures • Positive impact to survival and quality of life with local therapies

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