Case 1092 - Patient with a Medial Thigh "Lump" Thought to Be a Hematoma

Contributed by Tanner Freeman MD, PhD, John M. Skaugen, MD


Female patient in her 60's presented to an outside hospital with a "lump" in her medial thigh. Outside providers thought the lesion to be a hematoma though the patient was not on anticoagulants or recalled any trauma to that area. The lesion did not resolve after some time. Upon excision, the "lump" was discovered to be a tumor. The patient was referred to our hospital system for radical re-excision of the lesion along with lymph node dissection. Pathologic evaluation demonstrated the tumor to be composed of sheets of pleomorphic epithelioid cells with abundant amphophilic cytoplasm and marked nuclear pleomorphism with frequent mitotic figures (see below). The lymph node was positive for metastatic tumor. Immunohistochemistry demonstrated the tumor cells to be negative for PANCK, CK5/6, p40, S100, SOX10, Melan-A, HMB45, SMA, desmin, CD34, and ERG with rare cells positive for p40. A preliminary diagnosis of undifferentiated pleomorphic sarcoma was rendered. However, since sarcomas usually do not metastasize through the lymphatic system the tumor was submitted for molecular testing.


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