Ignoring pain and swelling in the left leg for eight years resulted in a 4 kg tumor for 64-year-old Mahendra Meghani (Name changed), 64, from Ratnagiri district in Maharashtra. Meghani, who weighed 81 kg, was diabetic, obese and had swelling in the left leg since 2012. This impacted his quality of life and he was facing difficulty even in doing his daily routine activities.
Delay in treatment due to lockdown worsened his condition. However, a team of experts from Zen Multispecialty Hospital, Chembur, provided treatment to him, removed the tumor and gave him a fresh lease of life.
The patient initially neglected and did not consult a doctor, but when the swelling began to grow in size and cause discomfort, he consulted a local doctor who advised him to get evaluated. He deferred the evaluation due to Covid-19 pandemic.
Things turned awry when he developed dull pain and redness over the swelling, causing difficulty in his day to day activities. He needed assistance for even his routine activities. Subsequently, he was referred to Zen Multispecialty Hospital wherein he was treated.
Dr. Tanveer Abdul Majeed, Surgical Oncologist, Zen Multispecialty Hospital, said, “On admission, he complained of discomfort, swelling in the thigh, and pain which was aggravated due to movement. He weighed about 81 kgs and had undergone preoperative biopsy suggestive of Atypical Lipoma, the cause of which is unknown.”
Dr Majeed added, “On examination, there was a huge mass occupying the whole of the front and lateral aspect of left thigh occupying the whole thigh from the hip to the knee joint with dilated veins over it, however, redness and warmth were more pronounced over the lower end of swelling just above the knee joint.”
The mass measured about 43 by 20 by 13 cms and was adherent to muscles of the left thigh. Preoperative MRI revealed swelling as described which was going in between the muscles of the anterior and lateral compartment of the thigh sparing but in close proximity to blood vessels and nerves of the left thigh, showing variegated appearance with vascular enhancement comprising of solid areas suggestive of cancerous change.
After preoperative evaluation and optimization on October 20, 2020, he underwent wide excision of Liposarcoma under general anesthesia.
Dr Majeed explained, “A lazy S incision over the left thigh was taken, skin flaps were raised with adequate soft tissue cover over the tumor. Complete wide excision of the tumor was performed taking care to prevent damage to blood vessels and nerves without compromising adequate oncological clearance.”
Dr Majeed said that a part of vastus medialis and rectus femoris muscle was sacrificed along with exterior patellar reticulum enbloc all along the knee joint cavity was safeguarded.
“Since the attachment of vastus intermedius was sacrificed this was followed by musculoplasty to reattach the detached muscle for adequate extensor functioning,” he added.
The surgery lasted for a grueling 3 hours and there was 350 ml blood loss. The patient was subjected to rigorous rehabilitation in the post-operative period with quadriceps and hamstring exercise to prevent muscle wasting and strengthening his knee muscle for early recovery, so as to enable him to start walking in a week's time. He was discharged after 7 days of operation.