Catalin Sandu is a 25 year old young doctor who recently graduated from the “Carol Davila” University of Medicine and Pharmacy in Bucharest, Romania. He is our friend and classmate and is now facing the hardest exam of his life.
In May 2011, a growth was discovered in the left iliac fossa, considered to be a hematoma caused by a light trauma. Ultrasonographic and CT examinations were performed in July, the readings of which were consistent with the prior diagnosis of hematoma. The decision was to follow up the dynamics of symptoms and postpone the surgical procedure until pain exacerbation. At the end of July an evacuatory puncture was performed and a surgical drain inserted and kept for 3 weeks. The symptoms diminished at first only to increase dramatically at the end of August. Cata needed higher and higher doses of painkillers. Preparing for the Medical License Exam became a true burden. All of us who saw him with this occasion became worried when we saw how much weight he had loss and how tired he looked. We were all thinking it must have been the stress. No one could predict the tragedy that was about to take over our friend’s life.
September 15th, the day after the Medical License Exam, Catalin’s doctors decided for the surgical intervention. The gelatinous aspect of the resected piece raised suspicion for a sarcoma. The intervention had radical intent, consisting of complete excision of the neoplastic mass and safety margins. The tumor hadn’t invaded the abdominal cavity and was described as localized. Hystopathological Examination and Immunohistochemistry revealed the final diagnosis: Desmoplastic Small Round Cell Tumor (DSRCT). It is an extremely rare type of sarcoma, this being the first and only case diagnosed in Romania. Since 1989, when the first case was described in the world, there have been only 200 reported cases.
Only five medical centers in the world have the necessary experience to treat this extremely aggressive kind of sarcoma, a type of Ewing’s sarcoma of the soft tissue, with a 5 year survival rate of 15%. Four weeks after the surgery, a PET CT exam showed a 13/7 cm tumor relapse, extended to the iliac bone, which makes his pain unbearable. Oncological therapy must be initiated promptly, as the tumor is obviously extremely aggressive, draining Catalin’s physical and mental energy.
Date 18 October 2011