title: Epithelioid sarcoma with multiple lesions on the left arm: a case report.
abstract: BACKGROUND
  Epithelioid sarcoma is a rare, high-grade malignant tumor of the soft tissue. The incidence of local recurrence, regional lymph node involvement, and distant metastases is high. Epithelioid sarcoma is most often seen in adolescents and young adults. In the early stage before the development of full clinical features, epithelioid sarcoma is often misdiagnosed as a benign disease such as granuloma.
  
  
  METHODS
  We report a case of a 74-year-old Japanese woman whose epithelioid sarcoma was initially misdiagnosed as fungal infection. Rebiopsy revealed the proliferation of atypical polygonal or oval epithelioid cells in the dermis and lymphocyte infiltration through the dermis. Immunohistochemically, the tumor cells were positive for vimentin, cell adhesion molecule 5.2, epithelial membrane antigen, and E26-related gene. The nuclear expression of integrase interactor 1 was lost in the tumor cells.
  
  
  CONCLUSIONS
  We encountered a rare case of epithelioid sarcoma and had difficulty in making the correct diagnosis. We suggest that in patients whose lesions are resistant to conventional treatments, repeat biopsy and immunohistochemical studies should be considered to rule out rare epithelioid sarcoma.
authors: Department of Dermatology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan. rie-k@m2.kufm.kagoshima-u.ac.jp.
authors: Rie
authors: R
authors: Nishibaba
authors: Department of Dermatology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan.
authors: Yuko
authors: Y
authors: Higashi
authors: Department of Pathology, Field of Oncology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
authors: Yuko
authors: Y
authors: Goto
authors: Department of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, Kitakyusyu, Japan.
authors: Masanori
authors: M
authors: Hisaoka
authors: Department of Dermatology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan.
authors: Takuro
authors: T
authors: Kanekura
mesh_terms: D000368:Aged; D001132:Arm / Q000098:blood supply / Q000473:pathology*; D044466:Asian People; D001365:Axilla / Q000098:blood supply / Q000473:pathology*; D014408:Biomarkers, Tumor; D004188:Disarticulation; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D012509:Sarcoma / Q000473:pathology* / Q000601:surgery; D012782:Shoulder / Q000601:surgery*; D012983:Soft Tissue Neoplasms / Q000473:pathology* / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor
keywords: CA-125; E26-related gene; Epithelioid sarcoma; Integrase interactor 1; Malignant soft tissue tumor