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Case Reports
. 2024 Nov 30;16(11):e74837.
doi: 10.7759/cureus.74837. eCollection 2024 Nov.

Monitoring Response Using Circulating Tumor DNA in Undifferentiated Pleomorphic Sarcoma: A Case Report

Amanda B Siy  1 , Maggie Zhou  2 , Ana Carolina A Boncompagni  1 , Gregory Charville  3 , George Poultsides  4 , Kristen N Ganjoo  1
Affiliations
Case Reports

Monitoring Response Using Circulating Tumor DNA in Undifferentiated Pleomorphic Sarcoma: A Case Report

Amanda B Siy et al. Cureus. .

Abstract

Circulating tumor DNA (ctDNA) can be used to assess treatment response in patients with undifferentiated pleomorphic sarcoma (UPS). The importance of this is explored in our case of a 75-year-old man who was diagnosed with UPS of the right kidney. After a right nephrectomy and tumor resection, the patient was recovering well with initially undetectable, and then slightly elevated, circulating tumor DNA. Abdominal pain started shortly before a scheduled magnetic resonance imaging (MRI) which revealed a large mass in the resection bed invading the liver. The patient was treated with gemcitabine and docetaxel chemotherapy, and the ctDNA level rose dramatically before gradually decreasing and eventually becoming undetectable. At surgery, pathologic examination of the re-resection specimen revealed a complete pathological response. ctDNA monitoring may be a useful tool for early detection of response to chemotherapy in patients with UPS.

Keywords: chemotherapy response; gemcitabine and docetaxel; magnetic resonance imaging; signatera ctdna; undifferentiated pleomorphic sarcoma.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. CT image.
Orange arrows indicate evidence of mass measuring approximately 15.9 x 12.8 x 16.6 cm involving the right kidney. A, Axial. B, Sagittal, C, Coronal.
Figure 2
Figure 2. Representative photomicrograph at 400x magnification.
On histological examination, the tumor consisted of a proliferation of markedly atypical spindle cells characterized by nuclear enlargement, pleomorphism, and hyperchromasia.
Figure 3
Figure 3. MRI image.
Orange arrows indicate a 20 x 12.5 x 4 cm solid and cystic heterogeneously enhancing mass. A shows the coronal view of the mass. B shows the axial view of the mass.
Figure 4
Figure 4. Signatera ctDNA results showing a peak in mean tumor molecules per milliliter after third dose of chemotherapy and then substantial decline after continuing chemotherapy.
ctDNA: circulating tumor DNA, MTM: mean tumor molecule.
Figure 5
Figure 5. A 20 x 12.5 x 4 cm, solid and cystic heterogeneously enhancing mass invading the posterior right hepatic lobe and extending into the right retroperitoneum, right colon, and right hemi diaphragm.
Figure 6
Figure 6. Representative photomicrograph at 400x magnification.
Following adjuvant therapy, the tumor, which was extensively sampled for microscopic examination, was entirely necrotic.
See this image and copyright information in PMC

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