Radiation Associated Undifferentiated Pleomorphic Sarcoma of the Neck 2 Decades After External Beam Radiation for Medullary Thyroid Carcinoma: A Case Report and Literature Review.
Tanya Odisho, Sedighe Esmaeilzade, Alexander Laskaris et al.
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Case in brief
A 54-year-old man developed a painless neck mass 22 years after receiving 59.4 Gy radiation for medullary thyroid carcinoma. Imaging revealed a 1.9-cm lesion within the previous radiation field, and excision confirmed a 4-cm grade 3 undifferentiated pleomorphic sarcoma. Positive margins precluded further surgical intervention, leading to a recommendation for close surveillance and genetic testing.
What made this case unusual
The case highlights the development of high-grade undifferentiated pleomorphic sarcoma two decades post-radiation, which is atypical given the usual timeframe of 5 to 20 years for radiation-associated sarcomas.
Diagnostic / clinical pearl
Clinicians should maintain a high index of suspicion for secondary malignancies, such as radiation-associated sarcomas, in patients with a history of radiation therapy, especially when new masses arise in previously irradiated areas.
Why it matters
This case underscores the challenges in managing high-grade sarcomas in irradiated fields, where achieving negative margins is particularly difficult, impacting treatment outcomes.