Multiple incomplete surgical and procedural interventions correlate with hyperprogression of a pleomorphic dermal sarcoma – a case report

Abstract Complete surgical resection is the cornerstone of curative-intent treatment for solid malignancies. However, residual disease—whether microscopic or gross—remains in a substantial proportion of cases. Emerging preclinical and clinical data suggest that surgical or procedural trauma in the presence of residual malignancy may be associated with accelerated tumour progression, yet this phenomenon remains poorly characterized in humans. We report the case of a 70-year-old woman with pleomorphic dermal sarcoma who underwent multiple surgical and interventional procedures without complete tumour clearance. Following interventions in which gross residual disease remained in situ, the patient experienced rapid local tumor regrowth and fulminant metastases. Quantitative assessment of tumour growth kinetics demonstrated marked acceleration following procedures that left macroscopic disease, consistent with hyperprogression. This case adds to a growing body of evidence suggesting that surgical or procedural manipulation in the presence of gross residual malignancy may be associated with accelerated disease progression.