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Chest wall tumor (395584)
Chest wall tumornew
Subtitle: Sarcoma
Type:
Biopsy
Sender:
jakob
2011-12-05 05:56
INCTR - Pathology Anglophone Africa
11.5879
 
M   13
 
Clinic: right  chest  wall:  Hard, fixed  mass,  fungating,  exulcerated,    5  x  4  cm. Duration   6 years.
 
FNA: Low-grade  sarcoma.
 
Received:      5  tiny  fragments.
 

 
Problem:  Most  of  the   fragments:   mononuclear inflammatory  infiltrate (plasma  cells > lymphocytes,   as  image  4728), but in  addition  there  are  slighlty  larger  cells  with    clear  cytoplasm and  distinct  cell   borders. The pattern of infiltration is  suggestive  of  a  sarcoma (as FNA   says). What is  the   subtype ?  Thanks !
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kunze
2011-12-05 21:53
I support your conception of a low grade sarcoma and favor a sclerosing epithelioid fibrosarcoma with a low grade leiomyosarcoma or myofibrosarcoma as diff. diagnosis.
baumhoer
2011-12-09 10:40
For proper interpretation an XRay or at least the precise anatomical location would be mandatory. Where is the main part of the tumor located? Is it projecting into the pleural cavity? Although the morphology is not very typical, solitary fibrous tumors can look weird and quite often occur in this location. Also synovial sarcoma should be ruled out (basic immunohistochemistry against cytokeratin). I agree that sclerosing epitheloid fibrosarcoma is a differential diagnosis (very rare), leiomyosarcoma and myofibrosarcoma are (in my opinion) rather unlikely. In any case, treatment should focus on complete resection of the tumor with clear margins.
Last modified: 2011-12-05 05:58:06