This document summarizes the findings of a tumor board discussion for a 55-year-old male patient with a soft tissue swelling in his right thigh. The initial biopsy showed a poorly differentiated malignant tumor possibly melanoma or sarcoma. A later wide local excision found a high grade malignant melanoma (nodular variant) infiltrating the deep resection margin with lymphovascular invasion. Given the patient's history of a previous tumor resection and recurrence, an accurate staging could not be determined.

1. Tumor Board
28/08/2018

2. Patient details
• Age/Sex : 55/M
• Hospital OP/ IP No: A18037692
• Biopsy No: 1666/18
• Date of Receiving Specimen : 5/7/2018
• Date of Report : 7/7/2018
• Clinical Diagnosis : Soft tissue sarcoma
• Nature of Specimen : Trucut biopsy from right thigh
swelling
.

3. Gross Examination
Biopsy no: 1666/18
Container labelled trucut biopsy right thigh:
Received multiple (nine) grey white to grey brown soft
tissue bits,
largest linear bit measuring 1 cm in length
smallest linear bit measuring 0.3cm in length.
All embedded in one block.

4. Microscopy
Section studied shows tumor tissue fragments with sheets of highly pleomorphic cells
with moderate cytoplasm with intracytoplasmic vacuoles and hyperchromatic irregular
nucleus.
10x 40x

5. Microscopy
Round to spindle shaped pleomorphic tumor cells containing pigments
40x10x

6. Microscopy
Another bit shows dense extracellular pigment deposition.
40x
10x

7. Microscopy
Occasional tumor giant cells are seen.
40x 40x

8. Impression
Trucut biopsy from thigh shows
•Features suggestive of poorly differentiated
malignant tumor.
•Possibility of poorly differentiated
melanoma/sarcoma has to be ruled out.
•Advised immunohistochemical markers for
further evaluation.

9. Patient details
• Age/Sex : 55/M
• Hospital OP/ IP No: A18037692
• Biopsy No: 1715/18
• Date of Receiving Specimen : 10/7/2018
• Date of Report : 16/7/2018
• Clinical Diagnosis : Soft tissue sarcoma
• Nature of Specimen : Wide local excision of right
thigh swelling

10. Gross Examination
Biopsy no: 1715/18
Container labelled soft
tissue sarcoma
• Received skin covered
elliptical soft tissue mass
measuring 19 x 10 cm.
• Attached skin measures
15 cm in length.
• External surface shows two nodular areas.

11. Gross Examination
Biopsy no: 1715/18
Cut section shows
• Two gray brown to
gray black soft tissue
masses largest
measuring 7x5cm,
smallest measuring
3x3cm with areas of
necrosis and
hemorrhage.
• A satellite nodule lies in close proximity to the smallest.
nodule, measures 0.5x0.5cm.

12. Gross Examination
Biopsy no: 1715/18
Cut section shows
• Tumour appears to be
arising close to the
skin.
• Tumour is
 2cm away from
inferior margin.
 1.5cm away from
superior margin.
 1cm away from deep resected margin.
 0.8cm away from lateral margin.

13. Microscopy
Tissue with underlying tumor composed of nests, lobules, trabeculae with diffuse
sheets of tumour cells.
4x4x

14. Microscopy
Individual tumor cells are polygonal to spindle shaped cells with moderate
eosinophilic cytoplasm, intracytoplasmic melanin pigmentation and dense
extracellular pigments with irregular pleomorphic nucleus and prominent
nucleoli.
40x40x

15. Microscopy
Many tumor giant cells and increased atypical mitosis seen.
40x40x

16. Microscopy
Section shows areas of necrosis and focal areas of lobules separated by
fibrous septa with dense lymphoplasmacytic infiltration

17. Microscopy
Section shows lymphovascular invasion by tumor
40x10x

18. Microscopy
Section shows lymphovascular invasion by tumor
40x10x

19. Microscopy
Section shows deep resected margin infiltrated by tumor cells
40x 40x
10x

20. Microscopy
Section shows tumor cells showing diffuse positivity for S100
40x10x

21. Final Impression
Biopsy nos: 1715/18
• Specimen : Wide local excision of right thigh swelling.
• Histologic Type : Malignant melanoma (Nodular variant).
• Histologic Grade : High grade.
• Extranodal Extension : Cannot be determined.
• Margins : Deep resected margin is infiltrated by tumor.
• Lymphovascular Invasion : Identified/present, not brisk.
• Perineural Invasion : Nil.
• Regional Lymph Nodes : No lymph nodes identified/sent.
• Pathologic Stage Classification :Considering previous
history of tumor resected
outside and recurrence,
staging could not be given.