Nattergalen (Korea)

[Nattergalen]

Hello. My husband has ASPS. He is 37 years old.
He had a lump on his right upper arm. It grows so fast within 3 months and we feel heat on the lump. We had an operation on last month.

Here is our history.
2022.11. Diagnosis
2022.11. Wide excision

Below is clinical diagnosis.
----‐-‐‐-----------------------------
Primary tumor size :8.0*5.5*4.7cm.
Mitosis : 10/10HPF
Necrosis :present (40%)
Increased cellularity:marked
Nuclear pleomorphism : moderate
Angiolymphactic invasion : present
Extension: confinement to skeletal muscle
Tumor border : pushing
No metastasis in one lymph node (peritumoral LN: 0/1)
Resection margin : clear (proximal 0.3cm)
Related slide :none
--------------------------------------
Surgeon said, ASPS is not sensitive to chemotheraphy and the operation was perfect. So he didn't recommend chemo.

But Oncologist said, grade is high (big size + high mitosis + high Necrosis +grow rapid) so cytotoxic therapy is needed to prevent metastasis. He will try doxorubicin and ifosfamide.

We ask secondary opinion to other oncologists. 2 Oncologist said, No! Just keep tracking.

We don't decide to do chemo or not.
Usaually ASPS grow slow, but our tumor grows so fast. That points is our question. Is the same Profiles of primary and metastasis?

[D.ap]

Hello Nattergalen,
I’m sure sorry to hear of your husbands diagnosis but I’m glad to hear that his primary was removed .
Has he had other scans performed? Of his lungs and brain and bones ? To see if there is currently metastic spread ?

It sounds like the surgeon removed successfully the primary and in my opinion ,the pathology report says that it was contained and hadn’t spread in his arm.
How ever ,
Alveolar soft part sarcoma metastasizes early , probably well before it presents with symptoms,
so yes there more than likely is metastatic spread .

Are you asking if the metastasis are the same molecular makeup as your husbands primary was determined to be ? As fast growing or the same mitotic level? And that’s why the oncologist feels that chemo is best for your husband even tho asps is normally not affected by chemo ? My understanding is that it is know as an indolent sarcoma. Slow dividing cellular wise . But I’m certainly not a doctor.
Maybe the size of the primary made it grow faster ?

[Nattergalen]

Thank you for your immediate reply.

We did PET-CT and chest CT.
PET-CT is clear.
Actually, we got chest CT twice.
Previous CT was before diagnosis, it was clear.
Second CT was after diagnosis, there was a tiny nodule on lung.
The Interval of CTs was about 3weeks. During the interval, My husband got the covid-19. So they are not sure of lung metastasis. In Korea, ASPS patient doesn't take a brain MRI. Maybe doctors think, lung metastasis first, and then spread to other parts.

I wonder lung metastasis grow and spread so fast because primary grows fast.

[D.ap]

Hello Nattergalen,
Was the CT with contrast ?
Here’s a link to asps scan scheduling as well as discussion.

https://cureasps.org/forum/viewtopic.php?p=5498#p5498