MEETING No. 30, APRIL 11th, FATEBENEFRATELLI HOSPITAL, MILAN

Case 1
Case 2
Case 3

Case 1

"MASS, THE ARM AND COMA"
C. GALLI - Niguarda Hospital - Milan
(pict. by dr. Crippa)

Clinical history: a 45y.o. man in the year 2000 had surgery for carpal tunnel syndrome in other hospital.
After the surgery a subcutaneous abscess appeared with no apparent relation to the previous operation.
This mass enlarged and was drained two times, after which the patient was sent home. Then the patient presents at the emergency room of the Niguarda Hospital in a coma and is admitted in the Intensive Care Dept.
Some of the necrotic material from the lesion, the arm is sent to the Anatomical Pathology dept. for examination; following a suggestive but non-diagnostic report, the lesion, it is decided to perform a larger biopsy of the lesion.
Microscopic description of the biopsy: the lesion consists of epithelioid cells in a loose arrangement and admixed to inflammatory cells (pict. 1) - (pict. 2) - (pict. 3) - (pict. 4) - (pict. 5) - (pict. 6).
The lesion does not involve the epidermal surface. These epithelioid cells are strongly positive for Vimentin (pict. 7) and pool Cytokeratin (pict. 8).
A diagnosis of poorly differentiated carcinoma is suggested. The lesion, meanwhile, is still growing and the patient has a total body CT scan, which doesn't provide more useful information. The lesion is removed and the histological picture is the same of the previous biopsy. There are more areas with sarcomatoid features. The neoplastic cells are also positive for EMA and CD34.

Diagnosis

pict. 1	pict. 2
pict. 3	pict. 4
pict. 5	pict. 6
pict. 7	pict. 8

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