1994 年 9 巻 2 号 p. 217-224
Report of Two Cases
-A metastatic Angiosarcoma Case and A Case of Recurrent Squamous Cell Carcinoma
Case 1: A 64-year-old woman was referred to us with multiple faint red masses on her scalp in June 1988. Wide excision including whole scalp and the periosteum beneath the affected area was done. The defect was covered with split thickness skin grafts. Postoperatively, the patient received radiotherapy and chemotherapy with rIL-2. One year and two months later she developed a subcutaneous tumor of left preauricular region. The patient accordingly received total parotidectomy combined with excision of the overlying skin and of temporal and zygomatic branches of facial nerve, and neck lymph node dissection. Pathologically, parotid lymph node metastasis was confirmed, but no neck lymph node metastasis was observed (0/32). The defect was reconstructed by pectoralis major musculocutaneous flap, followed by radiation therapy to the parotid area and neck. The patient is alive and well 4 years 7 months after the primary operation.
Case 2: A 58-year-old man was first seen by us in March 1989 at Obihiro Kosei Hospital with multiple abscesses and suppurating sinuses involving the buttocks. In May 1989 excision of the skin and subcutaneous tissues including sinuses was performed. The defect was covered with split thickness skin grafts. The graft healed well. One month later, however, abscesses and sinuses of right buttock recurred, resulting elevated fungating tumor masses. Biopsy of the tumor showed squamous cell carcinoma. In January 1990, whole tumor was removed with rectum after a colostomy was made. The tissue defect was covered with gluteus maximus musculocutaneous flap and split thickness skin grafts, followed by radiation therapy and chemotherapy with Peplomycin and Carboquone. One year later, pus discharge was observed, and recurrence of S.C.C. was confirmed pathologically. CT and MRI findings demonstrated the tumor recurrence involved prostate, upper urethra, posterior wall of bladder, and sacrum. In May 1991, total pelvic exenteration combined with sacral resection was performed at Hokkaido University Hospital. The resultant tissue defect was reconstructed with free latissimus dorsi musculocutaneous flap, followed by chemotherapy with Bleomycin. The patient was alive and well 2 years 8 months after the total pelvic exenteration.