Patient History

A 66 year-old female presented to another facility with a several-month history of painless mass in her left upper extremity, extant for several months.  She was otherwise asymptomatic.  Her medical history was significant for rheumatoid arthritis, diabetes mellitus, hiatal hernia, and hypertension. Her surgical history included an appendectomy and a total hysterectomy with bilateral salpingo-oophorectomy for intractable pelvic pain and dysfunctional bleeding.

Physical examination confirmed a painless, firm mass approximately 3cm in diameter in the medial aspect of  the left antecubital fossa.  No epitrochlear or axillary nodes were palpable. There was no sensory or motor dysfunction noted.

The patient underwent excisional biopsy of the lesion (microscopy, FIGURES 1-2), followed by wide excision.  The patient then underwent successful brachytherapy and radiation treatment, and was scheduled for a 3-month follow-up to include chest computed axial tomography (CT).  At this time, two nodules were identified in the right lung.  The first was 4-5mm in diameter, located in the peripheral right upper lobe.  The larger was 1.6 x 1.0 cm in diameter, seen in the peripheral right middle.

Video-assisted right thoracotomy was performed, with lung wedge biopsies of the nodular areas submitted for pathologic examination

Figure 1	Figure 2