Date of Presentation:5/07/2021

Attending pathologist: Paul E. Wakely Jr., MD

Presented by: Ashley Patton, DO, PhD

Prepared by: Ashley Patton, DO, PhD

Organ:Bone and Soft Tissue

HISTORY:

45 year old female with a history of a left lateral thigh mass. Ultrasound reveal a large heterogeneous mixed echogenic solid cystic hypoechoic lesion anterior to the left hip joint likely represents a large complex collection/hematoma. Possibility of a neoplastic lesion cannot be entirely excluded.

Magnetic resonance imaging (MRI) demonstrated a large 9.8 x 12.1 x 14.3 cm complex collection in the left lateral thigh. Imaging characteristics were be consistent with a hematoma although underlying neoplastic process is difficult to completely exclude.

GROSS:

Gross: The specimen is designated as “left thigh mass” and consists of a 1,111 gram, 15.5 x 13.2 x 13.1 cm cystic mass with attached yellow-pink soft tissue. Cut section through the mass reveals extensively necrotic tissue, approximately 75% cystic and 25% solid.  Areas of necrosis appear to occupy approximately 90% of the mass.  The cystic component is filled with blood-tinged mucinous material.  The solid component of the mass is pink-white and gelatinous.  

Gross image of left thigh mass
Microscopic image possibly detecting cancerous areas in human tissue
Microscopic image possibly detecting cancerous areas in human tissue
Microscopic image possibly detecting cancerous areas in human tissue
Microscopic image possibly detecting cancerous areas in human tissue
Microscopic image possibly detecting cancerous areas in human tissue
Microscopic image possibly detecting cancerous areas in human tissue
Microscopic image possibly detecting cancerous areas in human tissue
Microscopic image possibly detecting cancerous areas in human tissue

What is the most likely diagnosis?

  1. Leiomyosarcoma
  2. Malignant peripheral nerve sheath tumor
  3. Spindle cell rhabdomyosarcoma
  4. Dedifferentiated liposarcoma
Malignant peripheral nerve sheath tumor