DP19 Epithelioid sarcoma of the hand in a young adult

Abstract Epithelioid sarcoma is a rare neoplasm that contributes to < 1% of all soft-tissue sarcomas. It is a slow-growing neoplasm mainly affecting adolescent and young populations. Although it is a slow-growing neoplasm, it has a strong predisposition for spreading to regional lymph nodes and local recurrence in the vicinity of the primary tumour, in contrast to other types of sarcoma. A 34-year-old man presented with a painless, slowly enlarging, nonhealing ulcer on the palmar aspect of the left hand for 4 years, with multiple recurrences after excision. Cutaneous examination revealed an ulcer on the left palm measuring 3 × 2 cm. It was irregular with undermined edges and granulation tissue forming the floor, with seropurulent discharge. The surrounding skin showed erythema with infiltration. Histopathological examination revealed that the epidermis was partially ulcerated. The dermis showed an ill-defined tumour arranged in single-file pattern and insinuating through the thick dermal collagen fibrils. The tumour cells had epithelioid morphology, exhibiting moderate nuclear pleomorphism, fine chromatin, inconspicuous nucleoli and a moderate amount of eosinophilic cytoplasm. There was no evidence of necrosis, and mitotic activity was 2–3 per 10 high-power fields. Immunohistochemical staining revealed tumour cells positive for both pan-cytokeratin and vimentin. CD163 and CD31 were negative. The overall features were suggestive of epithelioid sarcoma over a metastatic carcinoma. The patient was referred to oncology for further management. Epithelioid sarcoma carries a high risk of recurrence or metastasis. Long-term follow-up is essential due to the tumour’s propensity for recurrence and metastatic spread.