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This was a challenging case of an 11month old male baby suffering from Spindle Cell Carcinoma. One who knows what this diagnosis relates to will understand the depth and risk of the case. A question to arise in one’s mind is, how to deal with a critical case of an 11month old child. Difficult isn’t it? This is another challenge for you all. Scratch your brains, try your level best to answer the quiz with honesty and sincere efforts. The case when answered will definitely enhance your knowledge and endow with confidence to deal with such cases.
All the best – Dr. Amarsinha Nikam
Case history is as follows…….
This boy was operated for SPINDLE CELL TUMOR twice on the (Rt) leg (at the age of 6 months and 9 months). The swelling which was soft and movable like a cyst was first noticed when he was 4 months old.
The surgeons found fibromatosis in the swelling with malignant tendency and decided to operate it. Accordingly it was excised along with a large area of surrounding healthy tissue. The surgeon warned the parents that there was a chance of recurrence and there was also a risk of metastasis.
He was given all routine vaccinations. After the second operation, the scar was still raw and acrid and a honey-like discharge was oozing from the scar. There was intense itching making him cry loudly trying to scratch the part continuously.
Before 15 days of his consultation, he had high grade fever with febrile convulsions with twitching of the whole body.
Sarcomas mostly occur in the 1st & 2nd decade of life…differing from carcinomas, they grow rapidly and dissemination occurs earlier through the blood stream. (They have a rich, fibrous and vascular tissue due to which the thin walled veins may burst disseminating the malignant cells directly in the blood stream favoring easy metastasis.). Fibro sarcoma occurs in muscle sheaths and scars and is present as elastic, slowly growing swelling with dilated veins over the tumor. The treatment is extensive excision, followed by radiotherapy but some cases may even require amputation.
His complaints were:
- Scar on the (Rt) leg as operated twice for the spindle cell tumor.
– Itching++ (Wants to scratch continuously).
– Acrid, honey like discharge (making edges raw) oozing from operated site.
– No other specific complaint.
- Past History :
– L.S.C.S. baby (excess birth weight.)
– H/o recurrent coryza. Took allopathic treatment (suppression).
– H/o Vaccination given.
– H/o febrile convulsion 15 days back.
- Physical Generals :
§ Appetite : Increased, wants feeding multiple times.
§ Desire : Milk, Mother’s Milk, Sweets++, Boiled eggs.
§ Aversion : Pungent.
§ Thirst : Small quantity at small intervals – thirsty.
§ Perspiration : Profuse on head.
§ Ears : Itching+.
§ Sleep : 9:00 pm to 5:00 am. Very irritable if woken up in the half-sleep. Mouth opens during sleep.
Day time sleep 10 am – 2 pm.
§ Thermal : Towards chilly.
Case history was given by his parents………..
How is his nature?
He is our younger son. His elder sister is very mild as compared to him. He beats her if she takes his toys. He is a very angry child.
How do you know that he is angry?
When he is angry he groans loudly and threatens with closed fists as if he would beat the person who has taken his things. He is restless and never remains in one place for long time.
Have you noticed any particular habit or trait?
He likes to bite everything, which is within his reach. We thought that it was due to his teething process but he bites more than other normal children. He likes to be taken for a round in the open air and also likes to watch TV. He is happy when fast music is on.
Anything that he fears?
He is afraid of the dark. He is careful while playing. He is very cautious that he does not fall or get hurt in any way.
How does he behave with strangers?
He is very adamant and will not go to any unknown person. If somebody tries to carry him forcefully he shouts and kicks with his whole strength so that nobody dares to do it again.
He requires much sleep. He gets very angry if we try to wake him up. If he wakes up on his own, he is calm. Even in the afternoon when he sleeps we have to take care that nobody makes a loud noise to disturb him, or else he cries for an entire hour.