PMC2668915_01
(a) Coronal T1-weighted, (b) T2-weighted, and (c)
Gd enhanced magnetic resonance imaging shows a tumor 
measured approximately 8 x 4 x 3 cm. (d) Tumor encircles by the flexor
carpi radialis (FCR), flexor digitorum
superficialis (FDS), flexor digitorum
profundus (FDP), and flexor pollicis
longus (FPL), and pushes aside median 
nerve (arrow).
SRCM2009-595391.001.jpg
PMC2668915_01_SRCM2009-595391.001.jpg
fig1
Magnetic resonance imaging evaluation has been performed at that time, showing a tumor measured approximately 8 x 4 x 3 cm, encircled by the flexor carpi radialis (FCR), flexor digitorum superficialis (FDS), flexor digitorum profundus (FDP), and flexor pollicis longus (FPL)  (see Figure 1).  Open biopsy was subsequently performed, and histological appearance showed that tumor was consisted with malignant spindle cells with epithelioid features (see Figure 2), then he was referred to our institution afterward.
Histological appearance of open biopsy showing
that tumor is consisted with malignant (a) spindle and (b) rounded cells with
epithelioid features.
SRCM2009-595391.002.jpg
PMC2668915_01_SRCM2009-595391.002.jpg
fig2
Magnetic resonance imaging evaluation has been performed at that time, showing a tumor measured approximately 8 x 4 x 3 cm, encircled by the flexor carpi radialis (FCR), flexor digitorum superficialis (FDS), flexor digitorum profundus (FDP), and flexor pollicis longus (FPL)  (see Figure 1).  Open biopsy was subsequently performed, and histological appearance showed that tumor was consisted with malignant spindle cells with epithelioid features (see Figure 2), then he was referred to our institution afterward.
(a) Histological appearance of postoperative
section showing that no tumor cell is infiltrated into the nerve, but (b) the
pseudocapsule of the tumor is transitioning to the perineural sheath of the
median nerve.
SRCM2009-595391.003.jpg
PMC2668915_01_SRCM2009-595391.003.jpg
fig3
The macroscopic appearance of the resected tumor showed that the median nerve was directly involved in the tumor.  Microscopically, no tumor cell was infiltrated into the nerve, but the pseudocapsule of the tumor was transitioning to the perineural sheath of the median nerve (see Figure 3), suggesting that epithelioid sarcoma could arise from nerve sheath as well as deep fascia or tendon sheath.
Photograph of right
forearm on 2 years after operation. Grasp power of the affected hand has gained
up to 50%, and the sensory of the median nerve area has also been recovered up
to 50% of the unaffected side.
SRCM2009-595391.004.jpg
PMC2668915_01_SRCM2009-595391.004.jpg
fig4
The function of the affected hand showed DASH score of disability/symptom score of 22.5 and optional component score (sports/music or work optional module) of 50  (see Figure 4).