Oncology & Cancer Case Reports

Retroperitoneal Spindle Cell Sarcoma Unresponsive to Conventional Approach, Managed with Individualized Homeopathy: A Case Report

Shahin Mahmud¹, Seema Mahesh^2,3* and George Vithoulkas^{3,4 *}Correspondence: Seema Mahesh, International Academy of Classical Homeopathy, Alonissos, Centre for Classical Homeopathy, Bengaluru, India, Greece, Email:

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Introduction

Primary Spindle Cell Sarcoma (SCS) is a rare type of connective tissue tumour, that can originate from the connective tissue around organs, between muscles, and beneath the skin [1]. The retroperitoneum is the second most common site for primary malignant soft tissue tumors, [2]. With mesenchymal lesions in this region being more likely to be malignant. Few cases of undifferentiated soft tissue SCS are available in the medical literature [3]. Most SCSs have an enigmatic aetiology but have been linked to radiation exposure in certain cases [4, 5]. Symptoms of SCS arise from gastrointestinal, urinary, or vascular impairment [2]. Perioperative radiation therapy has gained attention for its efficacy in addition to surgery for retroperitoneal sarcoma. In 2010, three new medications for treating soft tissue sarcoma were approved after phase III trials, but surgery remains the mainstay of treatment currently [6, 7].

We report the case of a 41-years-old male, who was diagnosed with SCS and managed with individualized classical homeopathy. There are no other comparable cases where retroperitoneal SCS was managed with homeopathy in the published literature to the best of the authors’ knowledge. The objective of this case report is to present and discuss a metastatic and advanced case of retroperitoneal SCS managed with an unconventional treatment method.

Case Presentation

A 41-years-old Bengali male presented to homeopathic consultation on 2^nd June 2019, with the diagnosis of retroperitoneal spindle cell sarcoma.

History of presenting complaints

Since December 2018, the patient suffered recurrent pain in the abdomen with hardness accompanied by great prostration, anorexia, nausea and lowgrade fever of 99°F-100°F. A rapid emaciation ensued.

The examining physician advised ultrasonogram of abdomen on 21 January 2021, along with routine tests like complete blood count, urine routine and microscopy, and serum electrolytes (Figure 1).

Figure 1: 1A) Ultrasound scan abdomen dated 21/01/2019, 1B) Findings: Right paraumbilical neoplastic mass (retroperitoneal tumour) with enlarged regional lymph nodes with bilateral mild hydronephrosis.

The scan showed a right paraumbilical neoplastic mass (retroperitoneal tumour) with enlarged regional lymph nodes, with bilateral mild hydronephrosis.

On finding the mass, they proceeded to perform CT guided Fine Needle Aspiration Cytology (FNAC) which showed the following microscopic features:

Smears prepared from the aspirate are moderately cellular containing many moderately differentiated atypical spindly cells in clusters and singles in a background of red blood corpuscles. Significant findings present. Findings consistent with atypical spindle cell tumour (Figure 2).

Figure 2: 2A) CT guided FNAC dated 21/01/2019; 2B) Microscopic features: Smears prepared from the aspirate are moderately cellular containing many moderately differentiated atypical spindly cells in clusters and singles in a background of red blood corpuscles significant findings present. 2C) Findings consistent with atypical spindle cell tumour.

Diagnosis

Spindle cell sarcoma (ICD10: C48.0) [8].

Conventional therapy before homeopathy

The treating physician did not see a point in surgery as there was already metastasis and advised chemotherapy instead. Chemotherapy included Blecocin 15 mg, Etoposid 166 mg, and Cisplatin 50 mg.

During the course of treatment from January to June 2019, the patient was also given Fusid plus, Furotil 500 mg, Anadol SR 100 mg, Maxpro 20 mg, Platinex 50 mg, Topoxin 100 mg, Bleonix 15 mg, Naurif, Roxadex, Ranitid, Esloric 100 mg, Cosec 20 mg, Rivotril 0.5 mg, Motigut 10 mg, V-plex, Ulcar 150 mg, Alagin 50 mg, Turbocef 500 mg, ACE 500 mg as and when required.

They had used 5% Dexoride 1000 ml, Saloride 500 ml for hydration and electrolytes imbalance management.

Despite conventional therapy, he deteriorated gradually, and after 4 cycles of chemotherapy, patient drastically deteriorated in his general health condition with severe side-effects including complete anorexia, inability to move due to prostration, sudden emaciation, was even unable to speak properly, without any apparent improvement or reduction in the sarcomatous growth.

Ultrasound on 5^th March 2019 showed extensively large growth of sarcoma measuring 12 cm × 9 cm occupying mid-epigastric and lumbar region, along with hydronephrosis in both kidneys, and bilateral obstructive uropathy and cystitis.

Hepato-splenomegaly was noted by another CT scan on 23^rd April 2019 along with invasion of the lumbar vertebrae by the lesion, causing fragmentation and anterior collapsing of L3 vertebra (Figure 3).

Figure 3: 3A) and 3B) Ultrasound scan (5/3/209). 3C) CT scan (23/4/2019) of abdomen during conventional treatment (chemotherapy). Findings: The tumour persisted through the treatment and invasion of lumbar vertebrae by the tumour.

At this point, being doubtful about the recovery, the physician allowed the patient to return home. Then, the patient resorted to homeopathy, and stopped all his previous medications and therapies.

Past medical history

The patient had skin eruptions (unidentified) and gastrointestinal disturbances in childhood.

Family medical history

The patient’s father had dyspnoea, urinary complaints, rheumatic affections and benign lipomatous tumours. His mother had rheumatism, and his brother had a history of rheumatic fever. His older sister had asthma.

Differential diagnosis

It can be challenging to distinguish benign lesions from SCS. This differential diagnosis can be resolved based on the pathological investigations and clinical findings [9]. In this case, CT scan, USG of the abdomen, and histopathology confirmed the diagnosis.

Homeopathic consultation

The patient was bedridden for 5 months since the initial diagnosis was made. At the time of the homeopathic consultation, he had severe neurological, gastrointestinal, urinary, and glandular complaints, including constant fever, tingling in the entire body, urinary obstruction/excessive urination, severe lower back pain, extreme sensation of being cold, black discoloration of both legs, distressing cough, general swelling with pedal oedema, and swelling and hardness of inguinal glands. He was also anaemic and was transfused 1 unit of whole blood, every month for the past 3 months. He was too weak to describe his complaints in detail and was assisted by his relatives in this.

The patient sought homeopathic consultation on 2^nd June 2019. Investigation into his stresses revealed that he had suffered repeated events causing grief in the past. He was under severe financial stress for the last 20 years and was grief-ridden from family discord and deprivation of his ancestral property. He felt jealousy and indignation towards his brothers who had deprived him of his inheritance.

Classical homeopathy takes into account mental, emotional, and physical causes along with the manifestations of the disease [10]. The remedy that fits this integral picture is then selected.

Prescription on 2^nd June 2019

Lachesis 200CH, twice a day for 10 days.

Three pills were diluted in 4 ounces of water through a homeopathic process called succession. One teaspoon of this solution constituted one dose for the patient. Initially, the patient was instructed to take the dose twice a day. It was advised to reduce the frequency to once a day if the patient experienced noticeable relief. Additionally, the patient had to shake the remedy bottle 10 times before taking the remedy each time. The first prescription was based on the psychological suffering of jealousy and a tendency for loquaciousness confirmed by patient’s relatives as well as some of the prominent keynotes of the remedy, such as aggravation during and after sleep, and intolerance of tight clothing [11].

Follow up and outcome

The detailed follow up of the case is given in table 1.

A CT scan of the abdomen on January 9, 2020, showed that the retroperitoneal mass had resolved, with no signs of metastatic lesions (Figure 4). Though the resolution occurred within 7 months of starting homeopathy, a long follow-up of 4 years, is provided to ensure stability of the condition. During this period, the patient’s symptoms resolved, his weakness improved, and his quality of life was elevated (Table 1).

Figure 4: 4A) CT abdomen dated 9/1/2020; 4B) Findings: Normal CT scan.

Table 1. Follow up of patient through homeopathic treatment.

Discussion

Initially, the patient was bedridden due to his advanced pathology and metastatic complications in other vital organs. The prognosis was unfavourable through conventional treatment as patient was deteriorating.

With homeopathy, Lachesis, and later Lycopodium, helped over a six-month period, resulting in improvement of clinical symptomatology and resolution of the pathology as evidenced by the CT scan of the abdomen. An aggravation of some of the patient’s symptoms occurred during the initial part of the treatment, an expected, positive prognostic phenomenon during homeopathic treatment [10]. This resolved, followed by remarkable improvement in his health. Homeopathic treatment expects certain changes as evidence of improvement, which this case demonstrates. With improvement in the main pathology, frequent acute episodes with fever began showing up, which conforms to 'The continuum of a unified theory of diseases’ propounded by Prof. George Vithoulkas and the research studies by Mahesh cr _j. [12-14]. According to this, his previously compromised immunity now had the power to mount acute inflammatory response to common infective agents. The reappearance of some of his previous symptoms, which were suppressed by other treatments, before the onset of the malignant disease, also conforms to Hering’s law of cure in Homeopathy [15].

Following the loss of his ancestor's estates and a financial strain of many years, the patient became sick, which confirms the earlier research findings that prolonged stress can be carcinogenic [16]. A strong link between important life events, psychological stress, and the development of cancer has been established [17, 18]. The recognition that cancer is not solely a physical disease but also influences a person's psychology, lifestyle, and general health, highlights the necessity for an integrated approach to cancer treatment.

The Modified Naranjo Criteria for Assessing Casual Attribution of Clinical Outcome to Homeopathic Intervention (MONARCH) score was 12/13, indicating that the benefit was most probably from the therapy (Table 2). Auto resolution of SCS has not been recorded thus far, indicating that such a development in this case is unlikely.

Table 2. Modified Naranjo criteria for assessing casual attribution of clinical outcome to homeopathic intervention.

The limitation, in this case is the poor quality of the initial images as the patient only had pictures on his phone and had lost the hard copies. Bangladesh’s sociopolitical and economic situation restricts the availability of high-end resources for digital preservation of such records and the authors reproduced them as well as were possible. However, in a developing country such as Bangladesh, with high quality medical care being difficult to approach, alternative medicine systems play a big role in providing help to the needful. This case demonstrates such an alternative.

Conclusion

This case of metastatic retroperitoneal spindle cell sarcoma on a progressive course, where conventional medicine had little effect, was benefited with individualized classical homeopathy. The 41-years-old Bengali male underwent radiological investigations before and after the treatment showing resolution of the tumour within 7 months of starting the therapy and remained cancer free and generally well over the 4-years follow up period. Further scientific studies are necessary to determine the relevance of classical individualized homeopathy in such pathologies.

Acknowledgements

The authors acknowledge the co-operation of the patient and his attendants in bringing this case report to light.

Informed Consent Statement

ShM treated the patient, collected the data, drafted the manuscript, and did the referencing.SM reviewed the case report, edited the references, and edited the manuscript. GV is the supervisor and guarantor of the work.

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