J Korean Soc Radiol.  2015 Jun;72(6):405-410. 10.3348/jksr.2015.72.6.405.

Classic-Type Epithelioid Sarcoma Mimicking Multiple Droplet-Like Abscesses in the Lower Leg

• Park EH
• Lee YH
• Hahn S
• Kim SK
• Suh JS

• KMID: 2098020
• DOI: http://doi.org/10.3348/jksr.2015.72.6.405

Abstract

Epithelioid sarcoma is an uncommon, slow-growing soft tissue tumor that usually arises in the distal part of an upper extremity, predominantly occurring in young adults. Classic-type epithelioid sarcomas appear to be less aggressive and have a better prognosis. In magnetic resonance imagng, epithelioid sarcoma usually appears as a subcutaneous mass or ulcer with cutaneous erosion. Here, we report a classic-type epithelioid sarcoma in a 68-year-old male without an apparent mass, presenting with only numerous small disseminated droplet-like ring-enhancing nodules mimicking abscesses, and multiple metastases.

MeSH Terms

Abscess*
Aged
Humans
Leg*
Male
Neoplasm Metastasis
Prognosis
Sarcoma*
Ulcer
Upper Extremity
Young Adult

Figure

• 

  Fig. 1 MRI of the left lower leg. A. Axial T2-weighted fat saturation (TR/TE = 2468/70 ms) image shows multiple droplet-like hyperintense signal nodular lesion, mainly at superficial and deep posterior compartment of lower leg (short arrow). Diffuse muscular signal change was combined with focal fluid collection posterior to tibialis posterior (long arrow). The muscular signal change and nodular lesion was also noted at anterior compartment of leg (arrowhead). The margins of nodules were thin and had relatively regular thickness. B. Majority of these nodular lesions in axial gadolinium-enhanced T1-weighted fat saturation image (TR/TE = 618/20 ms) at the same section shows only peripheral ring-like enhancement (arrows). C. On coronal T2-weighted fat saturation (TR/TE = 2158/70 ms) image, there are disseminated nodular lesions from the level of proximal tibia to the level of distal tibia. Only in few, but some of nodules show internal intermediate or low signal foci (arrows). D. Coronal gadolinium-enhanced T1-weighted fat saturation (TR/TE = 618/20 ms) image at the same section shows numerous peripheral ring-like enhancing disseminated nodular lesions (arrows). TE = echo time, TR = repetition time

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  Fig. 2 Photomicrographies of histologic specimen. A. There are round to polygonal shape epithelioid cells with abundant eosinophilic cytoplasm and atypical nuclei possessing vesicular chromatin and small nucleoli (hematoxylin and eosin, × 200). B. Diffuse expression of cytokeratin are noted in the sarcoma (× 200). C. Strong membranous immunoreactivity for CD34 are noted (× 200). D. Complete loss of INI1 (SMARCB 1) protein expression in the tumor cells are noted (× 200).

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  Fig. 3 On coronal fusion positron emission tomography/CT image, peripheral enhancing lesions of lower leg demonstrate markedly increased glucose metabolism (arrow). Ipsilateral popliteal and inguinal lymph nodes also show intense fluorodeoxyglucose uptake (maximum standardized uptake value, 6.85) (arrowheads).

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  Fig. 4 Chest CT scan shows numerous small nodules with random distribution in both lung parenchyme.

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