A 12 year-old girl presented with an enlarging hand mass over a few months duration.
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A large soft tissue mass with bulk dimensions of 7.8X6.7X8.6 cm is seen occupying the palm of the hand along its volar and dorsal aspect being more sizable at the volar side. The lesion elicits intermediate signal on T1, a high signal on T2 and STIR with marked heterogeneous enhancement in the post-gadolinium series. The mass is filling the inter-meta-carpo-phalangeal spaces and infiltrating the related muscles and encasing the flexor tendons of the hand and flexor pollicis tendons. The mass breaches dorsally surrounding the extensor tendons as well. The neoplastic mass is seen infiltrating the second to fifth metacarpal bones most evident at the fourth meta-carpal bone extending to involve a 3.7 cm segment with total erosion of the proximal portion. It is seen also eroding the distal row of carpal bones.
A large skeletal mass with a dominant soft tissue component and localized pressure effects on neurovascular structures and related bones infiltration. In the pediatric population, the first impression is of a soft tissue sarcoma with such as a rhabdomyosarcoma.
The mass was biopsied and pathologically proven as embryonal Rhabdomyosarcoma