PMC4553198_01
Clinical photograph of showing scapular swelling before chemotherapy.
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On local examination, a swelling of size 15 x 12 cm was found over right scapular region which was hard, smooth, and fixed to scapula (Figure 1).
Photomicrograph of biopsy taken from scapular swelling showing ovoid shaped dark cells can be noticed which gives sarcomatous picture.
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However biopsy of the swelling revealed striated muscle bundles and fibrocollagenous stroma with lobules of round to ovoid dark cells with scanty cytoplasm suggestive of either alveolar rhabdomyosarcoma or poorly differentiated synovial sarcoma (Figure 2).
Contrast enhanced CT scan showing huge scapular swelling.
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Computed tomography of thorax showed an enhancing mass over right scapular region of size 17.1 x 12.5 cm invading suprascapularis, infrascapularis, subscapularis, and deltoid muscle with necrotic component and lytic lesion in scapula (Figure 3).
Clinical photograph showing reduced swelling after 3 cycles of chemotherapy.
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He had complete response of the scapular lesion (Figure 4) and markers beta-hCG, alpha-fetoprotein, and LDH were normal after completion of chemotherapy.