Lower Leg Mass with Uncharacterizable Malignancy

Shared by a Plastic & Reconstructive Surgeon in the US

 A doctor shares a patient case about a 40-year-old male patient, who presents with asymptomatic but slowly growing subcutaneous mass in left lower leg for a number of years. The patient is otherwise healthy and had no lymphadenopathy on exam. Behavior of the mass was consistent with a lipoma or cyst, but a low potential of sarcoma was discussed in the abstract.

He was taken to surgery for removal with the caveat that if this was a mass suggesting sarcoma a small biopsy would be taken rather than enucleation. At the time of surgery, the mass was found to be cystic with a thin capsule and contain thin serous fluid and was removed completely.

The pathologist thought it was malignant on final path due to its cellularity of the capsule, but was befuddled by what to call the lesion. It was sent to Emory University to one of the world pathology gurus in soft tissue tumors, who likewise after multiple sections and tests agreed it was likely a malignancy but had no idea on the nature of the tumor.

Do you feel strongly one way or the other on XRT versus just clinical follow-up?

Are you a physician? Log into Sermo to read more about this patient case and help this physician out.