Sarkom der Haut

CASE REPORT While vacationing in Mexico, a 62-year-old woman experienced a dull, intermittent ache in the left upper part of her abdomen. Over the next two weeks, the ache became steady, accompanied by pain in her back and left shoulder. Because of her progressive discomfort, she sought help at a local hospital where physical examination uncovered a left-sided abdominal mass. Subsequent studies identified a mass in the left kidney together with lytic lesions in the lumbar spine, pelvis, both femurs, and left humerus. At nephrectomy, the mass proved to be a renal cell carcinoma. A month later, the patient returned to Houston for further care. On admission to our facility, she had severe, diffuse skeletal pain. Otherwise, the most conspicuous finding was a 2 × 3 × 4 cm painless, firm nodule on her forehead (Figure 1) and several smaller nodules of similar nature on her scalp. All of these lesions pulsated, but none had a murmur or thrill. The patient herself had noticed them pulsating and enlarging for about eight months before the onset of her abdominal symptoms. Radiographs of her skull showed striking lytic lesions in close proximity to the previously described nodules (Figure 2). Management consisted primarily of pain control and radiation therapy to the areas of advanced bony destruction. At discharge, her condition had improved, but she was lost to follow-up.

Pulsatile Metastases: What Every Medical Practitioner Should Know

There is a clinical overlap between hypervascularized sarcomas and arteriovenous malformations (AVM). MRI imaging should be interpreted with caution keeping in mind that some cancers could mimic AVM. A biopsy is mandatory in doubtful cases.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/ccr3.3222

V J Selmanowitz

Papers

Pulsatile cutaneous tumors.