Undifferentiated round cell sarcoma - ankle

Case contributed by Anshuman Nagpaul
Diagnosis certain

Presentation

Left ankle swelling and pain.

Patient Data

Age: 35 years
Gender: Female

 There is an ill-defined lesion with T1 intermediate SI and T2 intermediate SI with few hyper SI areas. It is an expansile soft tissue lesion involving the postero-lateral aspect of ankle joint with underlying lateral malleolus and medial malleolus, distal fibula, calcaneal and talar involvement.

It is also displacing and encasing various tendons laterally, encasing and splaying peroneal brevis and longus, displacing extensor digitorum, tibialis anterior anteriorly, displacing flexor digitoum, hallucis and tibialis posterior medially.

Histology report:

Tumor was resected, section show features of malignant round cell tumor in myxoid stroma. Mitosis and areas of necrosis seen.

On IHC, tumor cells are positive for TLE1(HETROGENEOUS) and negative for CK, CD38, SATB2, LCA, NKx2.2, S100, BCOR, DESMIN, CCNB3, TLE1, H3-3G3HW, CD79A, MUC4, CD163, Myogenin, SOX10, ERG1, CD56 & CD138

Final opinion: undifferentiated round cell sarcoma.

Case Discussion

This is a case of histologically proven undifferentiated round cell sarcoma of soft tissue. On PET scan (not shown), it is seen as a metabolically active lesion involving the distal tibia, fibula and tibiotalar joint.

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