Sentinel lymph node biopsy may be indicated for disease staging and in determining prognosis. describe the management of 63 patients treated for soft-tissue sarcoma of the hand.
Clear cell sarcoma (17.4%), epitheloid sarcoma (17.4%), and synovial sarcoma (16%) were the most common types of tumors encountered.
Epithelioid sarcoma is one of five high-grade, histologic sarcoma subtypes with a propensity for regional lymph node metastatic spread.
They found that only one patient had a positive sentinel node with micrometastatic disease at the time of the initial pathological examination.
This finding suggests that the incidence of positive sentinel lymph node biopsy after complete radiological evaluation is lower than previously reported.
The clinical photograph and histologic section are consistent with epithelioid sarcoma.
The other sarcomas with nodal metastasis include rhabdomyosarcoma, clear cell sarcoma, synovial sarcoma, and vascular sarcomas.
A 25-year-old right hand dominant male presents for a second opinion with the painless mass seen in Figure A.
He denies recent fevers, chills, or any other systemic symptoms.
A biopsy of the mass is taken, and the histopathology is shown in Figures B and C. Figure A shows an erythematous, ill defined, multi-nodular firm mass with areas of ulceration.
Figures B and C shows the characteristic appearance of epitheliod sarcoma with a multi-nodular granulomatous pattern and areas of central necrosis.
The histology depicted in Figure B confirms the diagnosis of epithelioid sarcoma given the epithelial appearance and nodular pattern with central necrosis.
Epithelioid sarcoma is the most common soft tissue sarcoma of the hand and frequently metastasizes to regional lymph nodes.
Currently, there is no validated, noninvasive method to assess regional lymph node status.