Review Question - QID 1987

The clinical photograph and histologic section are consistent with epithelioid sarcoma.

Epithelioid sarcoma is the most common soft tissue sarcoma of the hand and frequently metastasizes to regional lymph nodes. The other sarcomas with nodal metastasis include rhabdomyosarcoma, clear cell sarcoma, synovial sarcoma, and vascular sarcomas. Sentinel lymph node biopsy may be indicated for disease staging and in determining prognosis.

Pradhan et al. describe the management of 63 patients treated for soft-tissue sarcoma of the hand. Clear cell sarcoma (17.4%), epitheloid sarcoma (17.4%), and synovial sarcoma (16%) were the most common types of tumors encountered. Radiotherapy use did not affect local recurrence rates in the setting of an inadequate surgical margin.

McPhee et al. describe the evaluation and treatment of 24 patients diagnosed with primary soft tissue sarcoma of the hand. Malignant fibrous histiocytoma (37.5%) and epithelioid sarcoma (25%) were the most common diagnoses and the authors found tumor grade and surgical margin most affected local recurrence and survival.

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.

Incorrect Answers:

Answer 1: Rheumatoid nodule - while the clinical finding (firm nodule) overlaps, this is a granulomatous lesion with inflammatory, non-atypical cells
Answer 2: Ganglion cyst - this should be adjacent to a joint and composed of mucinous fluid with thin, bland capsule
Answer 4: Squamous cell carcinoma - again, clinical appearance could overlap somewhat, although SCC should be a little less firm, but the classic appearance of is pavement-type epithelial cells with deposits of keratin ("pearls")
Answer 5: Chondrosarcoma - this is a bone tumor