گزارش يك مورد از بروز ساركوم اپ يتليوئيد در بيمار با تظاهرات هرني اينگوينال

Report of Ephithelioid Sarcoma Occurance in a Patient with Inguinal Hernia Manifestation

ﺳﺎﺭﻛـﻮﻡ ﺍﭘﻲ ﺗﻠﻴـﻮﺋﻴﺪ ﺍﺯ ﺟﻤﻠﻪ ﺗﻮﻣـﻮﺭﻫﺎﻱ ﺑﺪﺧﻴﻢ ﻧﺴﺞ ﻧﺮﻡ ﺑﺪﻭﻥ ﻃﺒﻘﻪ ﺑﻨﺪﻱ ﻣﺸﺨـﺺ ﺍﺳﺖ ﻛﻪ ﺑﺎ ﻣـﻮﺭﻓﻮﻟـﻮﮊﻱ ﺧـﺎﺹ ﺑـﻪ ﻃـﻮﺭ ﺷـﺎﻳﻊ ﺩﺭ ﺑـﺎﻟﻐﻴﻦ ﺟـ ـﻮﺍﻥ ﺭﺥ ﻣﻲ ﺩﻫﺪ. ﻣﺤﻞ ﺷﺎﻳﻊ ﺩﺭﮔﻴـﺮﻱ، ﺩﻳﺴﺘـﺎﻝ ﺍﻧﺪﺍﻡ ﻫﺎ ﺍﺳﺖ ﺑﻪ ﻃﻮﺭﻱ ﻛﻪ ﺷﺎﻳﻌﺘﺮﻳﻦ ﺳﺎﺭﻛـﻮﻡ ﻧﺴﺞ ﻧﺮﻡ ﺩﺭ ﺩﺳﺖ ﻭ ﻣﭻ ﻣﻲ ﺑﺎﺷﺪ. ﺍﻳﻦ ﮔـﺰﺍﺭﺵ ﻣـﻮﺭﺩﻱ ﺩﺭ ﺭﺍﺑﻄﺔ ﺑﺎ ﻭﺟـﻮﺩ ﺗﻮﻣـﻮﺭ ﭘﺲ ﺍﺯ ﻋﻤﻞ ﺟﺮﺍﺣﻲ ﻫـﺮﻧﻲ ﺍﻳﻨﮕﻮﻳﻨﺎﻝ ﺩﺭ ﻣـﺮﺩ 32 ﺳﺎﻟﻪ ﺍﻱ ﻣﻲ ﺑﺎﺷﺪ ﻛـﻪ ﺩﺭ ﺍﺑﺘـ ـﺪﺍ ﺑـﻪ ﻋﻠـﺖ ﻣﺤـﻞ ﻧﺎ ﺷـﺎﻳﻊ ﻭ ﺗﻈﺎﻫـﺮﺍﺕ ﮔﻤـﺮﺍﻩ ﻛﻨﻨﺪﻩ ﺳﺎﻳﺮ ﺗﺸﺨﻴـﺺ ﻫﺎﻱ ﺍﻓﺘـﺮﺍﻗﻲ ﺍﺯ ﺟﻤﻠﻪ ﺁﺑﺴﻪ ﻭ ﺑﺪﺧﻴﻤـﻲ ﻫﺎﻱ GI ﻣﻄـﺮﺡ ﺷﺪ. ﺩﺭ ﺍﺩﺍﻣﻪ ﺑﺮﺭﺳﻲ ﻫﺎﻱ ﺗﻜﻤﻴﻠـﻲ ﺍﺯ ﺟﻤﻠﻪ ﻧﻤـﻮﻧﻪ ﺑﺮﺩﺍﺭﻱ ﺍﺯ ﺯﺧﻢ ﺗﺸﺨﻴﺺ ﻳﻚ ﺗﻮﻣﻮﺭ ﺗﻤﺎﻳﺰ ﻧﻴﺎﻓﺘﻪ ﺑﺎ ﺩﺭﺟـﺔ ﺑﺎﻻ ﻭ ﺑﺎ ﺍﺣﺘﻤﺎﻝ ﺯﻳﺎﺩ ﺳﺎﺭﻛﻮﻡ ﺍﭘﻲ ﺗﻠﻴـﻮﺋﻴﺪ ﻣﻄﺮﺡ ﮔﺮﺩﻳﺪ ﻛﻪ ﺩﺭ ﻳﺎﻓﺘﻪ ﻫﺎﻱ Immunohistochemical ﺍﺯ ﺟﻤﻠﻪ CD34 ﻭ ﺳﻴﺘـﻮﻛﺮﺍﺗﻴﻦ ﺗﺸﺨﻴﺺ ﻣﺮﺑﻮﻃﻪ ﺑﺎ ﺍﺣﺘﻤﺎﻝ ﺑﻴﺸﺘﺮﻱ ﺗﺄﻳﻴﺪ ﺷﺪ. ﻧﻜﺘﺔ ﺑﺎ ﺍﻫﻤﻴﺖ ﺩﺭ ﺍﻳﻦ ﻣﻮﺭﺩ ﻧﻘﺶ ﺗﺮﻭﻣﺎﻱ ﺟﺮﺍﺣﻲ ﺩﺭ ﺷﻌﻠﻪ ﻭﺭ ﺷﺪﻥ ﺑﻴﻤﺎﺭﻱ ﺍﺳﺖ. ﻣﻨﺎﺳﺐ ﺗﺮﻳﻦ ﺍﺳﺘﺮﺍﺗﮋﻱ ﺩﺭ ﺑﺮﺧﻮﺭﺩ ﺑﺎ ﺍﻳﻦ ﺗﻮﻣﻮﺭ ﺟﻬﺖ ﺩﺳﺖ ﻳﺎﻓﺘﻦ ﺑﻪ ﺑﻘﺎﺀ ﻧﺴﺒﺘﹰﺎ ﻃﻮﻻﻧﻲ ﺭﺯﻛﺴﻴﻮﻥ ﺗﻬﺎﺟﻤﻲ ﻭ ﻭﺳﻴﻊ ﺗﻮﻣﻮﺭ ﻭ ﺩﺭ ﺻﻮﺭﺕ ﻟﺰﻭﻡ ﺁﻣﭙﻮﺗﺎﺳﻴﻮﻥ ﻣﻲ ﺑﺎﺷﺪ.

Epithelioid sarcoma is one of the malignant soft tissue tumors of uncertain type has been applied to a morphologically distinctive neoplasm which characteristically affects the distal parts of the extremities of young adults. In fact epithelioid sarcoma is the most common soft tissue sarcoma in the hand and wrist. This article is a case report of the tumor followed by operation of inguinal hernia in 32 years old male. At first with uncommon manifestation and site of tumor another differential diagnosis was suggested such as abscess, GI malignacies. In supplementary evaluation and biopsy of ulcer the diagnosis focused on undifferentiated high grade epithelial tumor highly suggestive Epithelioid sarcoma. In Immunohisochemical finding, CD34 and, cytokeratin, this diagnosis was confirmed. The most important point was the role of surgical trauma in disease flare up. The best strategy in management of Ephithelioid Sarcoma is extensive resection amputation for relative long survival.