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Klaus Dragon Heiman
Jun 18, 2018
Plexiform Fibrohistiocytic Tumors (PFHT) Metastic: A very rare soft tissue sarcoma of intermediate grade malignancy-under 175 cases are on record since 1988, less than 4% becoming aggressively metastic-moving to regional lymph nodes and pulmonary system.Sarcoma is a cancer of the connective tissue--including muscle, bone, fat, nerve, cartilage, blood vessel and deep skin tissue. This specific disease is considered an "orphan cancer" because very little is know about it, and how best to treat it besides surgical treatments. Many times, orphan sarcoma's such as PFHT are misdiagnosed.
Our story began in January 2007 when we found a pea size lump in Klaus' mouth-now he lives with multiple bi-lateral lung mets. We live life, hope and pray for a cure. Klaus' metastatic sarcoma was misdiagnosed for a very long time before proper surgical treatment was taken. A confusing aspect of this rare sarcoma is the fact that in pathology, there is an overlap of PFHT (malignant) with Cellular Neurothekeoma (benign). This key point was an area, which caused our original medical team to make safe calls instead of hard calls, which are needed in sarcoma management. As parents, we did not know that PFHT was considered a sarcoma until August 2008. We did not know the #1 goal for treatment & cure for rare sarcoma's such as PFHT is to obtain clear and wide surgical margins in the 1st surgery. If upon review of the surgical pathology-clear margins are not obtained-you MUST go back and obtain clear margins. Klaus unfortunately did not have clear margins on surgeries #1 and #2 with our original medical team. The location of the first disease was challenging to surgically treat, but we as parents, were never informed of PFHT being a sarcoma. We never knew there could be two choices in his care: 1) be aggressive & obtain clear margin, or 2) watch & wait. The only medical advise shared with us was "not to worry-watch & wait-this is not something to be concerned with-the disease was encapsulated". In retrospect, we know this type of sarcoma management is incorrect in regards to the diagnosis of PFHT--even with the confusion of the benign Cellular Neurothekeoma. We want other families to learn from our journey and make informed choices to keep this disease from spreading as it has in our son. Because of the opportunities of the Internet, we have connected with 3 families around the globe with children diagnosed with PFHT. All 3 medical teams knew enough about this sarcoma to go back after the original surgery & re-excise & obtain clear/wide margins. Klaus' original team unfortunately did not have this expertise or knowledge. During our 18 months under care of the original team, Klaus' body was not monitored with an MRI or CT of his head/neck or lungs to look for metastic spread. After 17 months and 2 surgeries, we finally met our 1st oncologist for an evaluation. MEDICAL TIME LINE: *January 2007-pea size lump found in gum of lower left jaw *May 2007-1st surgery removing lump-margins not clear, confusing pathology *January 2008-reoccurence noted but watchful waiting advised--not surgery *May 2008-Parent's decide to push hospital to remove lump and suspicious lymph node against advise of medical team. Pathology confusing again. Disease confirmed in lymph node. Medical team advised no further treatment--margins not clear. ****At this point, we began to search for experts in sarcoma for help. Consulting with 30 doctors and institutions across the USA & world. Making sure we are not missing anything to cure this. Discussing surgery, radiation and chemo. *August 2008-Klaus' care is moved to Rocky Mountain Pediatric Hematology Oncology at Presbyterian/St. Luke's in Denver, CO--Dr. Jennifer Clark. Tracking lymph nodes, oral structure and lungs. *January 2009-Enlarged lymph node & new lump in mouth noted so together we consulted with multiple sarcoma institutes in USA. *March 2009--3rd surgery--found 2 more tumors wrapping around critical facial nerves. Because of complexities, surgeon was unable to remove all disease.**We decide to seek care from a specialist in sarcoma & pediatrics--Memorial Sloan Kettering Cancer Center in NYC. *May 19th, 2009--4th surgery--12 1/2 hours. Disease had spread throughout his jaw, eroding his jaw bone, going thru nerve channels. Surgeons removed the lower left mandible, two nerves, 6 teeth, facial muscles. Replaced the jaw & the tissue lost with his fibula, a complete neck dissection. Disease was tumors, large & small microscopic disease, lymphovascular (disease in the walls of the blood vessels to the lymph system) Finally, clear margins were reported but one small spot. *December 2009-5th surgery to remove infected gum tissue & tooth-jeopardizing his jaw. Clear pathology. *March 2010-6th surgery-a lung thoracotomy-disease confirmed in his lungs. Multiple bilateral lung mets. *March 2011-7th surgery-dental reconstruction surgery--3 implants set with dental bridge on top.
We constantly review the risks,benefits of chemo, radiation, & surgeries for a cure. Unfortunately, these options have more toxic side effects compared to living with this chronic condition.