title: Soft tissue sarcoma at a dialysis access site in a transplant recipient.
abstract: Soft tissue sarcomas typically present as soft, painless masses on an extremity. Here, we present a patient with metastatic soft tissue sarcomas at his dialysis access site. This association with dialysis access has not been documented previously. A 62-year-old man presented with a nonhealing wound on his left upper extremity after excision of a pseudoaneurysmal arteriovenous fistula. The patient had received a second kidney transplant that was functioning well. Immunosuppression included tacrolimus, mycophenolate mofetil, and prednisone. He was induced with thymoglobulin twice. A biopsy was performed showing a high-grade pleomorphic sarcoma. A magnetic resonance image of his left upper extremity showed an 11 × 5.5 × 3 cm mass abutting the biceps and brachialis muscles. Also, we discovered several lesions in the axilla and the left side of the neck, which were suspicious for metastases. A positron emission tomography-computed tomography scan confirmed a left upper extremity soft tissue mass, with marked fluorodeoxyglucose uptake, in abnormally enlarged axillary, and supraclavicular lymph nodes of the left thorax, consistent with metastases. The patient underwent chemotherapy and radiation therapy. Soft tissue sarcomas are rare. A high index of suspicion is needed to make a diagnosis. This is the first reported case of a soft tissue sarcoma discovered at a dialysis access site. As with all malignancies, early diagnosis is key to patient survival. Thorough physical examinations and increased vigilance by physicians caring for immunosuppressed patients is invaluable.
authors: Albert Einstein Medical Center, Department of Surgery, Philadelphia, PA, USA. andrejas@einstein.edu
authors: Jason
authors: J
authors: Andre
authors: Afshin
authors: A
authors: Parsikia
authors: Corrado
authors: C
authors: Minimo
authors: Kamran
authors: K
authors: Khanmoradi
authors: Stalin
authors: S
authors: Campos
authors: Radi
authors: R
authors: Zaki
authors: Jorge
authors: J
authors: Ortiz
mesh_terms: D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D001706:Biopsy; D059248:Chemoradiotherapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D016030:Kidney Transplantation / Q000009:adverse effects*; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D060787:Neoplasm Grading; D049268:Positron-Emission Tomography; D006435:Renal Dialysis; D012509:Sarcoma / Q000175:diagnosis / Q000209:etiology* / Q000556:secondary / Q000628:therapy; D012983:Soft Tissue Neoplasms / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D034941:Upper Extremity / Q000098:blood supply*; D051598:Whole Body Imaging
chemical_list: D007166:Immunosuppressive Agents