Prepared by Julie Marie Borba, MPH, medical student, Elena Kret-Sudjian, MD, Assistant Professor, Department of Internal Medicine, University of California Davis School of Medicine, Sacramento

A 72-year-old woman presented with a nonpainful, 10 x 7 cm, fungating mass on her right thumb (Figure). Thirty years earlier, when the mass was significantly smaller, it was biopsied and diagnosed as benign. Current radiographs and magnetic resonance imaging showed the mass to involve most of the hand. Biopsy revealed epithelioid sarcoma, and the hand was amputated.

Diagnosis: Epithelioid sarcoma.

Points to remember: Epithelioid sarcoma of the hand is often misdiagnosed because of its benign appearance initially, and because it is often mistaken clinically and pathologically for a granulomatous lesion. Prognosis depends on the location, size, and duration of the tumor. In most cases, however, lymph node and lung metastases are present by the time the diagnosis is established. Treatment consists of radical surgical excision of the tumor and, if indicated, lymph node dissection.

Figure  Epithelioid sarcoma of the hand.