A High School Volleyball Player With Thigh Swelling

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A High School Volleyball Player With Thigh Swelling - Page #4

Working Diagnosis: Synovial Sarcoma Treatment: Patient initially underwent several rounds of neoadjuvant chemotherapy along with radiation therapy. Radical surgical resection in January with negative margins Followed by adjuvant chemotherapy Chemotherapy was complicated by neutropenia, nausea/vomiting, heart thrombus now on xarelto Outcome: Patient is still undergoing chemotherapy and on anticoagulation, and is not participating in sports at this time She is a senior in high school and is on track to graduate Plans to attend college, not planning on playing collegiate sports Author's Comments: Rare cancer found in children, adolescents, and young adults with a mean age of 35 6-8% of soft tissue sarcomas, and is found in limbs about 66% of the time, but can be found anywhere in the body Poor prognostic predictors include: size >5 cm deep seated mitotic activity of >10 cells per high power field inadequate surgical resection/local recurrence patient age >20 years The main teaching point of this case is not to miss this diagnosis. When you are concerned for a mass and you are unsure exactly what it is, you are never wrong to order imaging. Editor's Comments: Careful physical exam is another teaching point in this case. Physical exam is used to narrow the differential diagnosis you made during history. As her sports medicine physician, we can work in conjuction with her oncologist and cardiologist for an exercise prescription appropriate for an anticoagulated teen receiving chemotherapy. Return To The Case Studies List.		Back
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