[SavageGlow]

Source. This case is out of Peterborough, England:

A 92-year-old, right-handed male presented to the oncology department with a three-month history of a rapidly enlarging, painless mass on the dorsum of his left hand. He had a past medical history of type 2 diabetes mellitus, hypertension, atrial fibrillation, and cerebral vascular disease. On examination of the hand, there was a 7 cm x 6 cm soft, non-tender, and immobile mass on the lateral aspect of the left hand, with no tethering to the overlying skin. There was a full range of movement of his wrist joint and fingers, and there were no neurological deficits. Repeat examination a few months later revealed that the mass had increased in size, ulcerated, and began to bleed (Figure 1).

An initial ultrasound scan demonstrated a large mass arising from the radial wrist, measuring approximately 6.4 cm x 5.3 cm x 2.7 cm. Before a biopsy was attempted, a computed tomography (CT) angiogram was performed to rule out any aneurysm within the mass. This demonstrated that the mass had increased in size (diameter of 8.5 cm) after two months. An ultrasound-guided biopsy of the hand mass was performed: this displayed moderately pleomorphic epithelioid spindle cells within a myxoid stroma containing thin-walled and compressed vessels. These features were suggestive of a spindle cell sarcoma.

A CT scan performed two months later demonstrated a mass lesion measuring 12.5 cm x 8 cm x 6 cm, centered around the level of the radiocarpal joint and enveloped the radial artery. A staging CT scan of the chest, abdomen, and pelvis revealed a single 4-mm nodule in the upper lobe of the right lung. This was thought to be a simple nodule, and, therefore, a surveillance CT scan of the chest was booked to take place in four months.

Because of extreme pain and bleeding from the tumor, neoadjuvant radiotherapy was given to reduce tumor size and relieve pain. However, despite the radiotherapy, there was no appreciable improvement in size or symptoms. After extensive multidisciplinary team discussions, a left above-the-elbow amputation with wide safety margins was performed to provide the patient with a better quality of life. Histopathology examination of the post-surgical specimen illustrated ovoid-spindle cells and pleomorphic tumor cells with no definite line of differentiation (mitotic count more than 20 per 10 high-power fields in some areas). The immunohistochemical examination demonstrated negative staining for S-100 and CD34, scanty staining for cytokeratin AE1/AE3 and patchy positive staining for desmin. These features confirmed a high-grade UPS.

Seven months later, the patient presented to the emergency department with a productive cough and confusion. A chest X-ray revealed extensive bilateral pulmonary metastases. In view of these findings, a palliative approach was deemed appropriate and a referral was made to the Macmillan Cancer Support Team.

[ride]

92. He's had a life. Have him crawl into a box, and wait.

[SavageGlow]

Originally Posted by ride ↗

92. He's had a life. Have him crawl into a box, and wait.

[kellyhound]

last stages of life and you have to deal with shit like this

[winvens]

Originally Posted by ride ↗

92. He's had a life. Have him crawl into a box, and wait.

I would inquire first whether or not he wants to battle that to gain more months or years.

Never assume people want to shuffle off this mortal coil so fast.

[winvens]