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Sarcoma. 2009;2009:595391. doi: 10.1155/2009/595391. Epub 2009 Apr 14.

Epithelioid sarcoma of the forearm arising from perineural sheath of median nerve mimicking carpal tunnel syndrome.

Sarcoma

Hiromasa Fujii, Kanya Honoki, Hiroshi Yajima, Akira Kido, Yasunori Kobata, Daisuke Kaji, Yoshinori Takakura

Affiliations

  1. Department of Orthopedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8521, Japan.

PMID: 19381344 PMCID: PMC2668915 DOI: 10.1155/2009/595391

Abstract

We report here a case of epithelioid sarcoma in the forearm of a 33-year-old male presenting with symptoms and signs of carpal tunnel syndrome originating from the direct involvement of the median nerve. Due to the slow growing of the tumor, the patient noticed the presence of tumor mass in his forearm after several months from the initial onset of the symptoms. Magnetic resonance imaging showed an 8 x 4 cm mass involving the median nerve in the middle part of the forearm, and histological analysis of the biopsy specimen revealed the diagnosis of epithelioid sarcoma. Radical surgical resection was performed in conjunction with adjuvant chemotherapy. The function of the flexors were restored by the multiple tendon transfers (EIP --> FDS; ECRL --> FDP; BrR --> FPL; EDM --> opponens) with superficial cutaneous branch of radial nerve transfer to the resected median nerve. The function of the affected hand showed excellent with the DASH disability/symptom score of 22.5, and both the grasp power and sensory of the median nerve area has recovered up to 50% of the normal side. The patient returned to his original vocation and alive with continuous disease free at 3.5-year follow-up since initial treatment.

References

  1. Cancer. 1970 Nov;26(5):1029-41 - PubMed
  2. Hand Clin. 1988 May;4(2):289-96 - PubMed
  3. Australas Radiol. 2007 Feb;51(1):71-4 - PubMed
  4. Hum Pathol. 1999 Aug;30(8):934-42 - PubMed
  5. Pathol Oncol Res. 2002;8(2):148-50 - PubMed
  6. Mayo Clin Proc. 1996 Jul;71(7):636-42 - PubMed
  7. J Surg Oncol. 2006 Nov 1;94(6):490-503 - PubMed
  8. Am J Ind Med. 1996 Jun;29(6):602-8 - PubMed
  9. Am J Surg Pathol. 1985 Apr;9(4):241-63 - PubMed
  10. Eur J Surg Oncol. 1989 Aug;15(4):345-9 - PubMed
  11. Skeletal Radiol. 2002 Jul;31(7):400-12 - PubMed
  12. Microsurgery. 2008;28(1):71-5 - PubMed
  13. Arch Pathol Lab Med. 1977 Jan;101(1):14-8 - PubMed
  14. Eur Radiol. 2001;11(8):1470-82 - PubMed
  15. Surg Oncol Clin N Am. 1996 Oct;5(4):847-92 - PubMed
  16. J Bone Joint Surg Am. 1988 Jul;70(6):862-70 - PubMed
  17. Hand Clin. 1997 May;13(2):279-89 - PubMed
  18. J Orthop Sci. 2002;7(4):462-6 - PubMed

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