Nerve sheath tumor - malignant - sacrum
Right leg swelling and saddle anesthesia.
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CT demonstrates a large destructive mass involving the right side of the sacrum and pelvis and extending into the psoas muscle anteriorly. It also extends through the iliac blade anteriorly and into the gluteal muscles. The right common and external iliac veins are thrombosed with thrombus extending to the inferior aspect of the IVC.
The patient went on to have CT guided core biopsies of the lesion
Microscopic Description: Sections show several core biopsies involved by malignant spindle cell neoplasm. The tumor cells are arranged in vaguely fascicular pattern. Mitotic figures are easily identified. A subendothelial infiltrative arrangement of tumor cells is evident in some areas.
Final Diagnosis: Sacral mass, core biopsies: malignant peripheral nerve sheath tumor, high grade.