10 new words at the very least

Date

31 July 2012

Diagnosis

High grade fibrosarcoma.

Histology

Mass between the shoulder blades.

One section from a single biopsy is examined. The mass is a portion of subcutaneous tissue with an irregular neoplastic proliferative growth characterised by poorly to moderate cellular, long interlacing fascicles of fusiform cells within a background of compacted stroma. There are clusters of lymphocytes infiltrating at the periphery.

The cells have bipolar eosinophilic cytoplasm, and oval nucleus with stippled chromatin and several nucleoli. There is moderate anisokaryosis with occasional karyomegaly. Atypical mitoses are present within the growth. Small satellite growths are present nearby. The mass is extending to the edges of the biopsy.

Comments

This neoplastic proliferation has features of high grade malignancy. Based on the morphology and the location this is compatible with an injection site sarcoma. They tend to have aggressive behaviour extending deep into multiple fascial planes. In this case given the extension to the edges I cannot verify complete excision of the process. There is still risk of recurrence. The prognosis remains very cautious.

The patient (in more adventurous times)

The patient’s reaction

Much of this went over his head, to be honest.

My prognosis

Initially I thought: Zapp’s a fighter – he’ll pull through.

But that’s not quite right: it’s Zapp’s zest for life that’ll win the day.

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