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Orthogate  Cases Tumor Left Thigh Mass
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Click on images to view larger radiographs and clinical pictures.
Introduction
This 43 year old man noticed a right sided
mass on the posterior part of his thigh. It had been
enlarging over the course of three months. He reported
pain on activities which had progressed to the point where
climbing stairs would cause pain overlying the mass. There
was no radiation, and he took Acetaminophen to relieve the pain.
However, he had stopped playing golf because the pain would be
uncontrolled by over-the-counter analgesics.
Physical examination revealed a tender
rubbery mass on the posterolateral aspect of the right mid
thigh. The 5cm x 7cm egg-shaped mass was mobile with
respect to the overlying skin, but fixed to the underlying
tissue. There was no local or regional lymphadenopathy,
and no evidence of infection.
What is the Differential Diagnosis ?
What other questions are important to ask
on the history ?
This man had no anorexia, weight change,
fevers, chills, or night sweats. There was no history of
local trauma or surgery, and no congenital
abnormality.Past medical history revealed that this man was a 50
pack year smoker but had quit three years prior. One
year prior he complained of a "lump in the neck" and
was referred to a dermatologist by his family physician.
He then saw a general surgeon for an excisional biopsy.
What preliminary investigations would you
order ?
- AST / ALT / ALP / Bilirubin: Normal
- CBC: Normal
- Calcium: Slightly Elevated
- ESR: Elevated
- Radiographs: Normal except for small soft
tissue mass
What further investigations would you
order ?
Bone Scan:
MRI:
- Axial Images
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- Coronal Images
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- How would you now manage this issue ?
- Management
The mass appeared to be contained in
the substance of semitendinosus muscle on the left
side. Since there was no other laboratory or
radiographic evidence of local, regional, or distant
metastasis, an excisional biopsy was thought to be the best
management.
Under general anaesthesia, and
following tumour principles, an excisional biopsy of
Semitendinosus was carried out, taking great care to
identify and spare the Sciatic Nerve. Gross pathology
is shown below with the indentation of the Sciatic Nerve
evident (also see T2 weighted MRIs on the previous page).
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- Histology confirmed the diagnosis of
Squamous Cell Carcinoma with negative margins. The
previous diagnosis of this patient's neck mass was also SCC.
Four months later, investigations including blood analyses
outlined previously, and a bone scan were repeated and found
to be negative for recurrence.
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