Epithelioid sarcoma with muscle metastasis detected by positron emission tomography

doi:10.1186/1477-7819-6-84

World Journal of Surgical Oncology

Volume 6

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Sakamoto A
Jono O
Hirahashi M
Oya M
Iwamoto Y
Arai K

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Jono O
Hirahashi M
Oya M
Iwamoto Y
Arai K
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Case report

Epithelioid sarcoma with muscle metastasis detected by positron emission tomography

Akio Sakamoto¹^,2 , Osamu Jono² , Minako Hirahashi³ , Masafumi Oya³ , Yukihide Iwamoto¹ and Ken Arai²

¹Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Fukuoka, 812-8582, Japan

²Department of Orthopaedic Surgery, 3-83 Yoshio, Iizuka, Iizuka Hospital, 820-8505, Fukuoka, Japan

³Department of Pathology, 3-83 Yoshio, Iizuka, Iizuka Hospital, 820-8505, Fukuoka, Japan

author email corresponding author email

World Journal of Surgical Oncology 2008, 6:84doi:10.1186/1477-7819-6-84


Published:	15 August 2008

Abstract

Background

Epithelioid sarcoma is an uncommon high-grade sarcoma, mostly involving the extremities.

Case presentation

A 33-year-old man was referred to our institute with a diagnosis of Volkmann's contracture with the symptom of flexion contracture of the fingers associated with swelling in his left forearm. Magnetic resonance imaging (MRI) showed abnormal signal intensity, comprising iso-signal intensity on T1- and high-signal intensity on T2-weighted images surrounding the flexor tendons in the forearm. Diagnosis of epithelioid sarcoma was made by open biopsy, and amputation at the upper arm was then undertaken. [¹⁸F]-2-fluoro-2-deoxy-D-glucose-positron emission tomography (FDG-PET) detected multiple lesions with an increased uptake in the right neck, the bilateral upper arms and the right thigh, as well as in the left axillary lymph nodes, with maximum standardized uptake value (SUVmax) ranging from 2.0 to 5.5 g/ml. Magnetic resonance imaging confirmed that there was a lesion within the right thigh muscle which was suggestive of metastasis, even though the lesion was occult clinically.

Conclusion

Increased uptake on FDG-PET might be representative of epithelioid sarcoma, and for this reason FDG-PET may be useful for detecting metastasis. Muscle metastasis is not well documented in epithelioid sarcoma. Accordingly, the frequency of muscle metastasis, including occult metastasis, needs to be further analyzed.