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Pathological Case of the Month

James Devitt, MD; Douglas M. England, MD; Enid Gilbert-Barness, MD
Am J Dis Child. 1992;146(7):837-838. doi:10.1001/archpedi.1992.02160190069023.
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An 18-year-old man sought medical attention for a slightly tender lump in his left calf of 2½ months' duration. He had an unrelated medical history of childhood asthma and Haemophilus influenzae meningitis at a young age. Results of physical examination revealed a tender, 3.0×2.0-cm, firm, immobile mass of the left lower gastrocnemius muscle. An excisional biopsy was performed. Results of gross pathologic examination revealed a 2.0×2.0× 1.0-cm, somewhat circumscribed, pale mass showing central necrosis. A frozen section of the mass was obtained for intraoperative diagnosis; however, results of examination of the section were inconclusive. Final histologic findings showed a tumor with an organoid appearance and an alveolar pattern, which was subdivided by delicate vascular septa (Fig 1). There was no true encapsulation, and focally vascular invasion was seen. Cytologically, the cells were large and polyhedral, with ample granular eosinophilic cytoplasm, and contained large, clear nuclei with prominent nucleoli. Stains using

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