Case 67

Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed

Clinical History:
The patient was a 3 week old male who was noted at birth to have a large tumor on his back in the region of the right scapula.

Clinical Physical Exam:
Large, firm, palpable mass near the right scapula.

Images 1 and 2

Clinical Labs:
Non-contributory

Clinical Differential Diagnosis:
Fibrosarcoma

Imaging Findings:
Computed tomography from the first week of life showed an inhomogeneous mass arising near the right scapula. A color Doppler ultrasound from the third week of life showed the mass had significant peripheral vascularity and central ulceration. Preoperative angiography from the same day as the ultrasound demonstrated the mass to be hypervascular with malignant appearing feeding vessels arising from the right subclavian artery and the aorta. All the angiographically demonstrated feeding vessels were embolized with a mixture of Ivalon and Avitene.

Images 3 and 4

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Imaging Differential Diagnosis:
Fibrosarcoma

Operative Findings:
The patient was taken to the operating room. The mass was excised en bloc with the overlying skin.

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Images 8 and 9

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Pathological Findings:
Examination of the surgical specimen demonstrated findings characteristic of infantile fibrosarcoma.

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Final Diagnosis:
Infantile Fibrosarcoma, Chest Wall

Follow-up and Prognosis:
Not all of the surgical margins were clean on pathologic examination of the surgical specimen. The patient was reoperated on 10 days later to re-excise any remaining tissue, rather than commit him to a course of chemotherapy.

Similar Cases:
Case 15, Case 18, Case 27, Case 46, Case 68, Case 69

References:
None

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