Epithelioid sarcoma:radiologic and pathologic manifestations

Orthopaedic Case of the Month: A 51-year-old Man with a Painless Wrist Mass

“…Once referred to as a large-cell sarcoma of the tendon sheath, epithelioid sarcoma has a tendency to extend regionally along the tendon sheaths, and frequently recurs locally after excision [24]. On plain film, it presents as a soft tissue mass adjacent to a bony structure, occasionally producing periosteal new bone as it invades and elevates the periosteum [14]. Bone invasion, combined with a prominent hemorrhagic component on MRI [23], distinguishes epithelioid sarcoma from GCTTS.…”

“…Their series contained only one case of GCTTS that had amorphous periarticular mineralization. When encountered, a soft tissue mass that exhibits intralesional mineralization on plain radiographs should be evaluated further with MRI, which is the preferred modality to determine the composition of a lesion and its anatomic relationship to surrounding structures [14,21]. This relationship reportedly influences the risk of recurrence [27].…”

Epithelioid sarcoma presenting as the reflex sympathetic dystrophy syndrome

“…Presentation is that of a slow-growing, painless, firm nodule which often becomes ulcerated; pain or tenderness is seldom a prominent feature and has only been reported when the tumour encroaches on a nerve.' Radiological features have been described by Lo et al in 1977;7 There may be a soft tissue mass with associated erosion or thickening of adjacent bone. Occasionally destruction of bone occurs through direct invasion by the tumour.8'9 Histologically the tumour may be mistaken for an inflammatory process or granuloma, but on careful inspection, the tumour cells have a distinct nodular arrangement and a tendency to undergo central degeneration and necrosis; the cells are epithelioid in appearance and eosinophilic.…”

Imaging Spectrum in Soft Tissue Sarcomas

“…Other soft tissue sarcomas that may be seen with accompanying calcifications include alveolar soft part sarcoma and epitheloid sarcoma [5][6][7]. Plain radiography can also provide an excellent method for assessment of osseous involvement by a soft tissue tumor, such as remodeling, periosteal reaction or overt destruction.…”