PMC3715977_01
A large tumor mass in the right leg with skin involvement and ulceration (wound dressing done) (a) CT scan of the abdomen shows a large adrenal lesion (b) with infiltration of the liver (c) inferior Vena Caval thrombus (c, arrowhead), and lung metastasis (c, arrow)
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F1
At presentation, he had a soft tissue tumor involving the entire right leg with skin infiltration and ulceration [Figure 1a]. Abdominal computerized tomography (CT) scan showed a right suprarenal lesion with mass effect on the kidney and liver infiltration [Figure 1b]; additionally inferior vena cava thrombosis was also noted [Figure 1c]. Bone scan showed lesions only in the right tibia and fibula; chest CT scan showed lung metastases [Figure 1c].
Histology of amputated specimen shows sarcoma with storiform pattern and mitotic figures (arrows) (H and E, x200) (a) highly pleomorphic tumor cells and atypical mitosis (H and E, x400) (b) and immunohistochemical positivity for CD68 (Immunoperoxidase, x200) (c) biopsy from adrenal lesion showing necrosis and metastatic sarcoma with similar morphology (H and E, x400) (d)
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F2
Histopathology of the resected specimen showed an MFH with storiform pattern of growth and 5-6 mitoses per high power field; the cells were highly pleomorphic with presence of tumor giant cells, areas of necrosis, and atypical mitosis; histiocytic nature of the tumor was confirmed by CD68 positivity [Figure 2a-d].