PMC2943094_01
Macroscopic findings of the tumor in the pre-treatment condition. The tumor involved multiple ulcers and necrotic tissues. Bar = 2 cm.
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Physical examination revealed the presence of a large irregular mass with multiple ulcers and necrotic tissues, measuring approximately 10 x 10 cm in the lateral side of the proximal thigh (Figure 1).
MR images of the tumor in the pre-treatment condition. (a) Axial T1-weighted image. (b) Axial T2-weighted image. (c) Coronal STIR sequence enhanced with Gd-DTPA. Bars = 2 cm. The heterogeneous mass was attached to the fascia lata and expanded across the skin layer.
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MR images demonstrated relatively a well defined and heterogeneous mass, which was attached to the fascia lata and expanded across the skin layer (Figures 2(a), 2(b)). T1-weighted images and inhomogeneous hyperintense on T2-weighted images. The mass was relatively well defined and enhanced with Gd-DTPA on STIR sequences (Figure 2(c)).
Thallium-201 scintigram of whole body in early phase. Abnormal accumulations accorded for the mass were detected (black arrows).
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Thallium-201 scintigrams showed a robust accumulation accorded for the mass in both of early and delayed phases (Figure 3).
Histological findings of the HE-stained biopsy sections. (a) Low power view (magnification: x6). Cellular nodules are scatters within fibrous stroma. (b) High power view (magnification: x36). The tumor cells have oval nuclei with scant cytoplasms. Mitotic figures are common.
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Histopathology of the permanent sections showed the nodular or sheets-like proliferation pattern of small round cells with a high nuclear/cytoplasmic ratio in the background of sparse extracellular collagen (Figure 4).
The tumor mass reduction induced by pre-operative RT. (a) Macroscopic findings of the tumor. (b) Coronal STIR sequence enhanced with Gd-DTPA. Bars = 2 cm. The size of the tumor reduced to approximate 40% of the pre-treatment condition.
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As a result of the total dose irradiation of 30 Gy in 15 fractions with sanazole (0.6 g/m2  x 10 days), the tumor volume was reduced to approximately 40% of the pre-treatment condition (Figure 5).
(a) Macroscopic findings of the resected tumor with adjacent soft tissues. Note that the specimen was longitudinally dissected across the tumor (white arrow). (b) Post-operative findings repaired with a musculocutaneous flap of rectus abdominis.
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Subsequently, we could perform the surgical resection with subtotal resection of the tensor fascia lata muscle, the gluteus maximus muscle, the gluteus medius muscle, and adjacent soft tissues to obtain wide surgical margins (Figure 6(a)). The huge surgical defect in the lateral thigh was repaired with a musculocutaneous flap of rectus abdominis (Figure 6(b)).
Histological findings of the HE-stained resected sections (magnification: x36). The tumor cells completely showed necrotic appearances.
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Because the tumor cells completely showed necrotic appearances and there were no viable tumor cells in the tumor specimen, we diagnosed the necrosis ratio as 100% (Figure 7).