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Open Access Indonesian Journal of Medical Reviews
Published by HM Publisher
ISSN : -     EISSN : 28076257     DOI : https://doi.org/10.37275/oaijmr
Core Subject : Health,
Health Professions Medicine & Pharmacology
Open Access Indonesian Journal of Medical Reviews (OAIJMR) is a bi-monthly, international, peer-review, and open access journal dedicated to various disciplines of medicine, biology and life sciences. The journal publishes all type of review articles, narrative review, meta-analysis, systematic review, mini-reviews and book review.
Arjuna Subject : Kedokteran - Kedokteran (Lain-Lain)
Articles 195 Documents
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Impact of Systemic Glycemic Control (HbA1c Levels) on Long-Term Outcomes of Anti-VEGF Therapy for Diabetic Macular Edema: A Systematic Review and Meta-Analysis of Observational Studies Ramzi Amin; Widya Wira Putri
Open Access Indonesian Journal of Medical Reviews Vol. 4 No. 6 (2024): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v4i6.733

Abstract

Diabetic macular edema (DME) is a leading cause of vision impairment in diabetic patients. Intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy is the standard first-line treatment, but response variability exists. Systemic glycemic control, measured by Hemoglobin A1c (HbA1c), is crucial in diabetes management, yet its specific impact on long-term anti-VEGF outcomes in DME requires synthesized evidence from real-world settings. This meta-analysis aimed to evaluate the association between baseline HbA1c levels and long-term (≥12 months) visual and anatomical outcomes following anti-VEGF therapy for DME in observational studies. A systematic literature search was conducted across PubMed, EMBASE, and Cochrane Library databases for observational studies published between January 2013 and December 2023, reporting on baseline HbA1c levels and visual acuity (VA) and/or central retinal thickness (CRT) outcomes at 12 months or longer in DME patients treated with anti-VEGF agents. Primary outcomes were the mean difference in Best-Corrected Visual Acuity (BCVA) change (ETDRS letters) and CRT reduction (microns) between patients with 'better' (HbA1c < 7.5% or lower strata) versus 'poorer' (HbA1c ≥ 7.5% or higher strata) baseline glycemic control at ≥12 months. Heterogeneity was assessed using the I² statistic. Six observational cohort studies, encompassing a total of 1850 patients, met the inclusion criteria. Follow-up durations ranged from 12 to 36 months. The quality assessment indicated moderate-to-high quality across the studies (NOS scores 6-8). Meta-analysis indicated that patients with better baseline glycemic control (HbA1c < 7.5%) achieved significantly greater improvement in BCVA compared to those with poorer control (HbA1c ≥ 7.5%) at ≥12 months (Weighted Mean Difference [WMD]: 4.82 ETDRS letters; 95% Confidence Interval [CI]: 2.95 to 6.69; P < 0.0001). Significant heterogeneity was observed (I² = 68%). Similarly, patients with better baseline HbA1c showed a trend towards greater CRT reduction, although the difference was not statistically significant (WMD: -25.5 µm; 95% CI: -55.2 to 4.2; P = 0.09; I² = 75%). Subgroup analyses suggested the association was consistent across different anti-VEGF agents used. In Conclusion, this meta-analysis of observational data suggests that better baseline glycemic control (lower HbA1c levels) is significantly associated with superior long-term visual acuity gains following anti-VEGF therapy for DME. While a similar trend was observed for anatomical improvement (CRT reduction), it did not reach statistical significance. These findings highlight the critical importance of optimizing systemic glycemic control alongside local anti-VEGF treatment to maximize long-term visual outcomes in patients with DME.
Internal Limiting Membrane (ILM) Peeling versus No Peeling during Vitrectomy for Idiopathic Epiretinal Membrane: A Meta-Analysis of Visual Outcomes and Recurrence Rates Ramzi Amin; Mistur Rozian
Open Access Indonesian Journal of Medical Reviews Vol. 4 No. 5 (2024): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v4i5.734

Abstract

The benefit of internal limiting membrane (ILM) peeling during pars plana vitrectomy (PPV) for idiopathic epiretinal membrane (ERM) remains a subject of debate. While proponents suggest ILM peeling reduces ERM recurrence and may improve anatomical outcomes, opponents highlight potential risks such as mechanical retinal trauma, visual field defects, and dissociative optic nerve fiber layer defects (DONFL). This meta-analysis aimed to synthesize current evidence comparing the efficacy and safety of PPV with ILM peeling versus PPV without ILM peeling for idiopathic ERM, focusing on postoperative best-corrected visual acuity (BCVA) and ERM recurrence rates. A systematic literature search was conducted using PubMed, Scopus, Web of Science, and the Cochrane Library databases for studies published between January 2013 and December 2023. We included randomized controlled trials (RCTs) and comparative cohort studies comparing PPV with ILM peeling (Peel group) to PPV without ILM peeling (No-Peel group) for primary idiopathic ERM. Studies reporting BCVA (in logMAR) and/or ERM recurrence rates with a minimum follow-up of 6 months were included. Data were extracted independently by two reviewers. The primary outcomes were the mean difference (MD) in final BCVA (logMAR) and the pooled risk ratio (RR) for ERM recurrence. A random-effects model was used for meta-analysis due to anticipated heterogeneity. Heterogeneity was assessed using the I² statistic. Quality assessment was performed using the Cochrane Risk of Bias tool (for RCTs) and the Newcastle-Ottawa Scale (for cohort studies). Seven studies involving a total of 855 eyes (430 Peel, 425 No-Peel) met the inclusion criteria. The mean follow-up duration ranged from 12 to 36 months. The meta-analysis revealed a statistically significant, albeit small, improvement in final BCVA favoring the Peel group (MD = -0.05 logMAR; 95% CI: -0.09 to -0.01; P = 0.02). Moderate heterogeneity was observed for this outcome (I² = 58%). The pooled analysis of recurrence rates demonstrated a significantly lower risk of ERM recurrence in the Peel group compared to the No-Peel group (RR = 0.18; 95% CI: 0.07 to 0.48; P < 0.001). Heterogeneity for this outcome was low (I² = 15%). Quality assessment indicated a generally moderate to high quality across the included studies, though some concerns regarding blinding and allocation concealment were noted in certain studies. In conclusion, ILM peeling during vitrectomy for idiopathic ERM appears to be associated with a statistically significant, though modest, improvement in final BCVA and a substantially lower rate of ERM recurrence compared to no peeling. The clinical significance of the small BCVA improvement requires careful consideration against potential risks associated with peeling.
Laparoscopic Management of Incarcerated Femoral Hernia with Bowel Necrosis: A Case Report Handito Sarwwotatwadhiko; Anung Noto Nugroho
Open Access Indonesian Journal of Medical Reviews Vol. 5 No. 5 (2025): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v5i5.736

Abstract

Femoral hernias, though representing less than 5% of all abdominal wall hernias, pose a significant clinical challenge due to their anatomical constraints and high complication rates. Exhibiting a pronounced female predominance, these hernias carry a substantial risk of incarceration and strangulation, estimated between 5-20%, stemming from the narrow and unyielding nature of the femoral canal. This anatomical predisposition frequently mandates urgent surgical intervention to prevent bowel ischemia and necrosis. Diagnostic difficulties often arise, particularly in occult presentations lacking a discernible groin mass. The advent of laparoscopy has revolutionized the approach, offering distinct advantages in both the diagnosis of clinically obscure hernias and the execution of minimally invasive repair, potentially improving patient outcomes. We present the case of a 63-year-old female who arrived at the emergency department complaining of a three-day duration of severe, intermittent abdominal pain associated with obstipation, progressive abdominal distension, nausea, and vomiting. Clinical examination revealed marked abdominal distension but failed to identify any palpable mass in the inguinal or femoral regions. Plain abdominal radiography indicated findings consistent with small bowel obstruction. Consequently, an exploratory laparoscopy was undertaken. Intraoperatively, an incarcerated right femoral hernia was discovered, containing a 4 cm segment of ileum that exhibited frank necrosis. A completely laparoscopic procedure involving small bowel resection, creation of a side-to-side ileoileal anastomosis, and subsequent repair of the femoral hernia defect using primary purse-string sutures was performed successfully. In conclusion, the laparoscopic approach was indispensable for the accurate diagnosis and effective management of this complex case involving an occult, incarcerated femoral hernia with resultant bowel necrosis. Employing a minimally invasive strategy facilitated simultaneous bowel resection and hernia repair, offering potential benefits including diminished postoperative discomfort, expedited recovery, and possibly lower long-term recurrence rates relative to traditional open surgical techniques. This case reinforces the critical importance of considering femoral hernia in the differential diagnosis of female patients presenting with acute small bowel obstruction, even in the absence of classical external signs. Furthermore, it underscores the feasibility and efficacy of a purely laparoscopic approach for managing such complex surgical emergencies.
Intra-abdominal Mixed Germ Cell Tumor (Seminoma and Choriocarcinoma) in an Adult with Cryptorchidism: A Rare Case Report and Surgical Approach Proginova Dian Yudatama; Syaeful Agung Wibodo
Open Access Indonesian Journal of Medical Reviews Vol. 5 No. 4 (2025): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v5i4.737

Abstract

Intra-abdominal testicular germ cell tumors (TGCTs) arising from cryptorchid testes represent a rare but clinically significant entity in adult urology. Cryptorchidism, or undescended testis (UDT), persists as the most prominent risk factor for testicular malignancy, and its delayed diagnosis, particularly when testes reside intra-abdominally, frequently leads to complex presentations often discovered at an advanced stage. This report details the case of a young adult male diagnosed with a voluminous intra-abdominal mixed germ cell tumor, incorporating both seminoma and highly aggressive choriocarcinoma components, originating from a previously unrecognized undescended testis, highlighting the multifaceted challenges in diagnosis and management. A 29-year-old Indonesian male presented with a constellation of symptoms including persistent abdominal pain, progressive bloating, and patient-acknowledged abdominal mass. Pertinent clinical findings included bilaterally non-palpable testes within the scrotum and a large, firm, tender intra-abdominal mass upon examination. Contrast-enhanced computed tomography (CT) delineated a massive abdominopelvic tumor consistent with a primary testicular neoplasm, critically associated with significant para-aortic lymphadenopathy and confirming bilateral intra-abdominal undescended testes. Serological investigation revealed a markedly elevated alpha-fetoprotein (AFP) level (>400.00 ng/mL), strongly suggesting a non-seminomatous component. Consequently, the patient underwent an exploratory laparotomy, which confirmed the CT findings and revealed the tumor originating from the left intra-abdominal testis. A comprehensive surgical resection involving bilateral radical orchiectomy was performed, yielding a specimen measuring 20x15x15 cm and weighing 2.865 kg. Subsequent histopathological examination definitively classified the tumor as a mixed germ cell tumor with distinct seminoma and choriocarcinoma elements arising from the left testis; the contralateral right testis exhibited only atrophic changes consistent with UDT. In conclusion, the confluence of adult presentation, bilateral cryptorchidism, intra-abdominal location, massive tumor burden, and aggressive mixed histology (seminoma/choriocarcinoma) exemplifies the complexities encountered in managing such rare TGCT cases. Surgical extirpation via laparotomy remains indispensable for bulky intra-abdominal disease, providing both diagnostic confirmation and cytoreduction. Optimal patient outcomes mandate a meticulously planned, multidisciplinary approach integrating surgery with risk-stratified systemic chemotherapy, guided by precise histopathological analysis and serial tumor marker assessment.
Comparative Analysis of Anesthesia Techniques and Circumcision Methods on Pain Outcomes in Pediatric Mass Circumcision: An Observational Study Alifan Haqi; Ridwansyah; Catur Kurniawan; Ramdhan Nur Hidayat; Reza Armasyah Soenendar
Open Access Indonesian Journal of Medical Reviews Vol. 5 No. 2 (2025): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v5i2.738

Abstract

Circumcision is a common procedure in Indonesia, often performed in mass settings. The associated pain can lead to significant psychological distress in children. Effective pain management is crucial but often challenging in mass circumcision events. This study aimed to identify determinants of pain intensity, specifically comparing anesthesia techniques and circumcision methods, during pediatric mass circumcision. An observational study was conducted in February 2023 involving 56 male children aged 0-10 years undergoing mass circumcision in Bandung and Cirebon, Indonesia. Data collected included anesthesia technique (needle-free injection [NFI], injection, topical + NFI), anesthetic agent (lidocaine vs. lidocaine/pehacain mix), circumcision method (guillotine with thermocautery vs. modified dorsal slit clamp with electrosurgery), presence of phimosis, and event location. Pain was assessed intraoperatively using age-appropriate scales: Neonatal/Infant Pain Scale (NIPS) for 0-<2 years, Face Legs Activity Cry Consolability (FLACC) scale for 2-7 years, and Visual Analogue Scale (VAS) for >7 years. Bivariate and multivariate linear regression analyses were performed using SPSS 20.0 to identify factors significantly correlated with pain scores. The mean age was 4.07 years (SD ± 2.75), and 78.6% had a history of phimosis. The mean pain score was 2.66 (SD ± 2.5) on relevant scales. Multivariate analysis revealed that both anesthesia technique (p=0.010) and circumcision method (p=0.000) were significantly correlated with pain scores, with a moderate overall correlation (R=0.500). Specifically, the modified clamp method was associated with significantly higher pain scores compared to the guillotine method (B=2.719). Combined topical and NFI anesthesia was associated with lower pain scores compared to other techniques (B=-1.059). In conclusion, anesthesia technique and circumcision method are significant determinants of intraoperative pain during pediatric mass circumcision. Less invasive anesthesia approaches (topical + NFI) combined with methods involving less tissue manipulation and shorter duration (guillotine with thermocautery) were associated with lower pain scores. These findings suggest that careful selection of techniques can significantly improve the pediatric experience in mass circumcision settings.
Intravitreal Anti-VEGF Injection Monotherapy for Wet Age-Related Macular Degeneration: A Case Report Demonstrating Successful Visual and Anatomical Outcomes Ramzi Amin; Linda Tri Wulandari
Open Access Indonesian Journal of Medical Reviews Vol. 4 No. 4 (2024): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v4i4.735

Abstract

Neovascular (wet) age-related macular degeneration (nAMD) is a leading cause of severe vision loss in the elderly, characterized by choroidal neovascularization (CNV). Intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy has revolutionized nAMD management. This report details a case of nAMD successfully managed with anti-VEGF monotherapy. A 61-year-old male smoker with a history of hypertension presented with a two-year history of progressive blurred vision in his right eye (OD). Best-corrected visual acuity (BCVA) was 1/300 OD and 6/60 (pinhole 6/30) OS. Fundus examination OD revealed drusen, hard exudates, and reduced foveal reflex. Optical Coherence Tomography (OCT) OD confirmed intraretinal and sub-RPE fluid, pigment epithelial detachment (PED), and features suggestive of Type II CNV. The patient was diagnosed with nAMD OD and immature senile cataract bilaterally. He received intravitreal anti-VEGF injection OD. Seven days post-injection, BCVA OD improved to <1/60, with subjective improvement in vision. In conclusion, this case demonstrates the efficacy of intravitreal anti-VEGF monotherapy in improving visual and anatomical outcomes in a patient with nAMD. Despite known risk factors, timely intervention led to a favorable short-term response. Long-term management and monitoring remain crucial.
Stargardt Disease Unmasked During Primigravida Pregnancy: A Case Report on Diagnosis and Low Vision Management Ramzi Amin; Ginda Chitra
Open Access Indonesian Journal of Medical Reviews Vol. 4 No. 3 (2024): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v4i3.739

Abstract

Stargardt disease (STGD1), the most prevalent inherited macular dystrophy in juveniles and young adults, typically results from biallelic mutations in the ABCA4 gene. It leads to progressive central vision loss due to lipofuscin accumulation in the retinal pigment epithelium (RPE) and subsequent photoreceptor degeneration. While onset often occurs in the first two decades, presentation can vary. Managing STGD1 involves optimizing remaining vision through low vision rehabilitation and addressing the psychosocial impact, particularly crucial during significant life events like pregnancy. We report the case of a 23-year-old Indonesian female, primigravida at 35 weeks of gestation, referred from obstetrics for evaluation of a longstanding visual impairment before delivery planning. She reported progressive bilateral blurred vision since age 7, significantly worsening over the past three years, accompanied by photophobia and difficulty reading, requiring close proximity to text. Her younger sibling also had similar visual complaints. Best-corrected visual acuity was 1/60 OD and 2/60 OS, unamenable to refractive correction. Fundus examination revealed bilateral macular atrophy with a "beaten bronze" appearance, surrounding pisciform yellowish flecks extending towards the mid-periphery, and peripheral retinal dystrophy. Optical Coherence Tomography (OCT) confirmed foveal atrophy and RPE disruption. Fundus autofluorescence (FAF) showed hypoautofluorescence corresponding to atrophy, surrounded by areas of hyperautofluorescence (flecks). Amsler grid testing indicated bilateral central scotomas. Contrast sensitivity was severely reduced (1.25% Pelli-Robson bilaterally), and Ishihara testing revealed dyschromatopsia. Based on the clinical findings, family history, and characteristic imaging features, a diagnosis of Low Vision secondary to suspected Stargardt Disease was made. Obstetric examination was normal, and no contraindications for vaginal delivery were identified from an ophthalmic perspective. Low vision management included counseling, prescription of photochromic lenses, and demonstration of non-optical aids (typoscope, large print materials, handheld/stand magnifiers, glare control measures like hats/sunglasses, and a white cane for mobility). In conclusion, this case highlights the presentation of suspected Stargardt disease in a young primigravida woman, emphasizing the importance of thorough ophthalmic evaluation and multimodal imaging for diagnosis, even when symptoms have been present since childhood. Pregnancy provided the context for a formal diagnosis and initiation of low vision rehabilitation. Management focused on maximizing functional vision using appropriate aids, patient education regarding the condition's nature and inheritance, and addressing safety during mobility. Multidisciplinary care involving ophthalmology, obstetrics, and low vision services is crucial for optimal patient outcomes.
Successful Management of Rhegmatogenous Retinal Detachment with Concomitant Cataract Using Combined Phacoemulsification, Pars Plana Vitrectomy, and Scleral Buckling: A Case Report Ramzi Amin; Alfin Radhian
Open Access Indonesian Journal of Medical Reviews Vol. 4 No. 2 (2024): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v4i2.740

Abstract

Rhegmatogenous retinal detachment (RRD) coexisting with significant cataract presents a complex surgical challenge, often necessitating combined phacoemulsification, pars plana vitrectomy (PPV), and potentially scleral buckling (SB) for optimal anatomical and visual outcomes. This report details the successful management of such a case using a combined surgical approach. A 43-year-old female presented with a one-week history of a sudden-onset black shadow in the nasal visual field of her right eye (OD), preceded by photopsia for one month. Visual acuity was 1/60 OD and 1/60 OS, non-improving with pinhole. Ophthalmic examination revealed an RRD with a superior retinal tear between the 1-2 o'clock position in the OD, associated undulation, and retinal folds. Bilateral immature senile cataracts (Nuclear Opalescence Grade 2, Nuclear Color Grade 2) were also noted. The patient underwent combined phacoemulsification with intraocular lens (IOL) implantation, 360° SB, 23-gauge PPV, endolaser photocoagulation around the break, and silicone oil tamponade in the OD. Postoperatively, the retina remained attached under silicone oil. Visual acuity improved to 6/21 OD at the 8-day follow-up. Postoperative intraocular pressure (IOP) elevation (39.4 mmHg OD) was managed medically. In conclusion, combined phacoemulsification, PPV, and SB proved effective in achieving both retinal reattachment and significant visual improvement in this patient with RRD and concomitant cataract. Careful surgical planning and postoperative management, including IOP control, are crucial for successful outcomes in these complex cases.
Early Intervention in Neonatal Gastric Volvulus: A Case Report on Prompt Diagnosis and Surgical Success Purnama Parulian Siahaan; Thomas Aribowo Kristianto
Open Access Indonesian Journal of Medical Reviews Vol. 5 No. 4 (2025): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v5i4.750

Abstract

Neonatal gastric volvulus (NGV) is an uncommon but potentially life-threatening surgical emergency characterized by the abnormal rotation of the stomach around one of its axes. This condition can lead to gastric outlet obstruction, ischemia, necrosis, and perforation if not promptly diagnosed and managed. The clinical presentation is often nonspecific, posing significant diagnostic challenges. Early recognition and immediate surgical intervention are paramount for favorable outcomes. We report the case of a 7-day-old female neonate who presented with recurrent postprandial, non-bilious vomiting and significant orogastric tube residuals since the first few days of life. Antenatal and perinatal histories were largely unremarkable. Initial physical examination revealed a generally stable neonate with mild distress during vomiting episodes, but the abdomen was soft, non-distended, and without palpable masses or signs of peritonitis. Laboratory investigations were within normal neonatal limits. A plain abdominal radiograph was initially inconclusive but suggested some degree of gastric distension. Subsequent upper gastrointestinal (UGI) contrast study revealed features consistent with organoaxial gastric volvulus, demonstrating abnormal positioning of the greater curvature of the stomach and obstruction to contrast passage. Exploratory laparotomy confirmed organoaxial gastric volvulus secondary to marked laxity of the gastrocolic and gastrosplenic ligaments. Detorsion of the stomach and an anterior gastropexy were performed. Postoperatively, the patient had an uneventful recovery, with gradual introduction and tolerance of oral feeds. Follow-up at 6 months showed normal growth and no recurrence of symptoms. Neonatal gastric volvulus remains a diagnostic challenge due to its rarity and nonspecific symptoms. A high index of suspicion, particularly in neonates with persistent, non-bilious vomiting, is crucial. Prompt radiological evaluation, typically with an UGI series, can confirm the diagnosis. Early surgical intervention involving detorsion and gastropexy is the mainstay of treatment and is associated with excellent outcomes, preventing potentially lethal complications. This case underscores the importance of early diagnosis and timely surgical management in achieving successful outcomes in neonatal gastric volvulus.
Aggressive Multifocal Recurrent Fibrosarcoma in an Elderly Patient: A Case Report Nadhim Askar; Widyanti Soewoto
Open Access Indonesian Journal of Medical Reviews Vol. 5 No. 4 (2025): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v5i4.751

Abstract

Fibrosarcoma is an uncommon malignant mesenchymal neoplasm originating from fibroblasts, notorious for its aggressive clinical behavior, high local recurrence rates, and potential for distant metastatic spread. Managing fibrosarcoma in elderly patients presents unique challenges, particularly when characterized by multifocal and recurrent disease. This case report aims to describe an unusual and particularly challenging presentation of aggressive, multifocal recurrent fibrosarcoma in a 65-year-old female patient. A 65-year-old Indonesian female presented with a complex history of multiple recurrent fibrosarcomas. Her oncological journey began with an inguinal mass excised in 2022, diagnosed as Grade I fibrosarcoma, followed by chemotherapy. Despite these interventions, she experienced recurrence at the primary site and developed new masses in the abdomen, flank, gluteal regions, left breast, right supraclavicular area, right antebrachial region, and left femur over the ensuing year. Comprehensive imaging, including whole abdomen MSCT, revealed multiple widespread soft tissue masses with suspicious lymphadenopathy and equivocal liver lesions. Histopathological examination of subsequent biopsies and excised specimens, supported by immunohistochemistry (CD34 positive; S-100, CD-117, Desmin negative), consistently confirmed recurrent fibrosarcoma. The patient underwent multiple extensive wide excision surgeries for various tumor locations, including the left inguinal region, left breast, left flank, bilateral gluteal regions, left antebrachial, and left supraclavicular areas. In conclusion, this case underscores the exceptionally aggressive and relentless nature of multifocal recurrent fibrosarcoma in an elderly individual. Despite an initial low-grade diagnosis and adjuvant chemotherapy, the disease progressed rapidly with widespread recurrences. Aggressive surgical management with wide excision remains the cornerstone of treatment in an attempt to achieve local control. However, the propensity for new lesions highlights the limitations of current therapies for such extensive disease. Vigilant, long-term surveillance and a multidisciplinary approach are paramount. This case also emphasizes the need for further research into the molecular drivers of such aggressive behavior and the development of more effective systemic therapies.

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