Highlights the diagnostic challenge of the spindle cell variant of epithelioid sarcoma, emphasizing the importance of clinical presentation and subcutaneous nodule histology for accurate diagnosis.
Heightened diagnostic vigilance for spindle cell epithelioid sarcoma is warranted; this case leaves open systematic validation of variant prevalence and criteria.
Epithelioid sarcoma is a histologically distinct soft tissue sarcoma of high grade malignancy. We report a case of epithelioid sarcoma in a young man who presented with multiple nodules over the left forearm, with bony invasion and pulmonary metastases. The histological features of the dermal tumour were those of a malignant spindle cell tumour with positive cytokeratin and vimentin staining and differed from the classical epithelioid sarcoma in its absence of typical necrobiotic nodular epithelioid pattern. It was the clinical presentation and the histology of the subcutaneous nodules that led to the final diagnosis of epithelioid sarcoma. This case illustrates a predominance of spindle cell pattern in the dermal tumour of epithelioid sarcoma, which has previously been reported as fibroma-like variant of epithelioid sarcoma.
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Tan et al. (2001) studied this question.
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