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Brain
3%
21/643
Bone
6%
36/643
Lung
38%
243/643
Lymph nodes
51%
329/643
Thyroid
1%
7/643
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Figure A reveals a small, nodular, slow-growing mass on the hand characteristic of epithelioid sarcoma. The histology depicted in Figure B confirms the diagnosis of epithelioid sarcoma given the epithelial appearance and nodular pattern with central necrosis. Epithelioid sarcoma is the most common soft tissue sarcoma of the hand and frequently metastasizes to regional lymph nodes. Epithelioid sarcoma is one of five high-grade, histologic sarcoma subtypes with a propensity for regional lymph node metastatic spread. The other subtypes include rhabdomyosarcoma, clear cell sarcoma, synovial sarcoma, and vascular sarcomas. Sentinel lymph node biopsy may be indicated for disease staging and in determining prognosis. Andreou and Tunn, in their review of soft tissue sarcomas, present data on the application of sentinel node biopsy in patients with histologic sarcoma subtypes associated with a higher propensity for regional lymph node metastasis. Currently, there is no validated, noninvasive method to assess regional lymph node status. The authors suggest that lymphatic mapping with sentinel lymph node biopsy may prove to be a useful adjunct in the staging of soft tissue sarcomas. Blazer et al., in a review on the management of sarcoma, present an argument for the selective use of sentinel node biopsy in the management of sarcomas with a propensity for regional lymph node metastasis. They suggest that the evaluation of the regional lymph node basin by lymphatic mapping and sentinel node biopsy may be an excellent strategy for selecting patients who might benefit from lymphadenectomy or early systemic therapy. Maduekwe et al. performed a retrospective review of 29 patients with surgically resectable synovial, epithelioid, or clear cell sarcomas who underwent sentinel lymph node biopsy to identify occult lymph node metastasis. They found that only one patient had a positive sentinel node with micrometastatic disease at the time of the initial pathological examination. This finding suggests that the incidence of positive sentinel lymph node biopsy after complete radiological evaluation is lower than previously reported. They recommend that sentinel nodes should be subjected to more intense methods of analysis including serial step-sectioning and H&E and immunohistochemical staining to increase detection rates for micrometastases. Incorrect Answers: Answers 1, 2, 3, and 5: These locations are not common sites for epithelioid sarcoma metastasis.
3.3
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