Alveolar soft part sarcoma presenting with back pain

Description

A 35-year-old man was referred to the Sarcoma service with a 2-year history of worsening back pain, left-sided radicular pain and a mass on CT scan. In the 6 months following the onset of the back pain, he developed progressive numbness and paraesthesia in the L2 dermatome. This was worse on standing. On clinical examination, power was unaffected but somewhat limited by pain. No 'red flag' symptoms were present (table 1). The CT scan demonstrated a large retroperitoneal mass on the left with invasion into the L2 vertebra (figure 1 and 2) and bilateral pulmonary metastases. USS-guided biopsy revealed high grade alveolar soft part sarcoma. He was started on palliative radiotherapy (30 Gy and 10 fractions) and given six cycles of doxorubicin and ifosfamide. Imaging at 8 months postdiagnosis has indicated stable disease.

Table 1

'Red flag' symptoms of back pain4...

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