PMC3400351_01
Gross specimen showing a section of skin with an ulcerative lesion (left) with necrotic tissue (right) that detached during resection.
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His past medical history consisted of hypertension and a left upper extremity necrotic mass, 4.4 x 3 x 3 cm, that was resected 5 weeks ago (Figure 1).
Section of skin showing malignant cells infiltrating the epidermis and dermis but without subcutaneous invasion (H&E 5x).
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Pathology revealed high-grade soft tissue undifferentiated sarcoma/pleomorphic malignant fibrous histiocytoma with clear resection margins tumor cells restricted to the dermis (Figure 2) without evidence of lymphovascular invasion.
Slide showing giant malignant cells (arrow) in an inflammatory background (H&E) 40x.
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Giant malignant cells on an inflammatory background were identified on H&E stain (Figure 3.) Immunohistochemistry of the pathology specimen was positive for CD 68 and CD 99 (Figures 4 and 5) and negative for S-100, HMB-45, SMA, pan-keratin, factor 13-A, and desmin.
Malignant cells showing positive immunohistochemistry for CD 68 (20x).
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Giant malignant cells on an inflammatory background were identified on H&E stain (Figure 3.) Immunohistochemistry of the pathology specimen was positive for CD 68 and CD 99 (Figures 4 and 5) and negative for S-100, HMB-45, SMA, pan-keratin, factor 13-A, and desmin.
Malignant cells showing positive Immunohistochemistry for CD 99 (20x).
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Giant malignant cells on an inflammatory background were identified on H&E stain (Figure 3.) Immunohistochemistry of the pathology specimen was positive for CD 68 and CD 99 (Figures 4 and 5) and negative for S-100, HMB-45, SMA, pan-keratin, factor 13-A, and desmin.
Presurgical chest radiography negative for metastasis.
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At the time, a chest X-ray was negative for metastatic disease (Figure 6).
(a) Chest radiography showing multiple bilateral pulmonary nodules suggesting metastasis. (b) CT-scan of the chest revealing numerous pulmonary nodules suspicions for metastasis.
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A chest X-ray and CT scan of the thorax both revealed numerous bilateral pulmonary nodules (Figures 7(a) and 7(b)) suspicious for metastasis with left axillary and left superior diaphragmatic lymphadenopathy with splenomegaly and bilateral adrenal nodules.