Skeletal Radiology

, Volume 42, Issue 6, pp 853–858 | Cite as

Epithelioid sarcoma presenting as radial mononeuropathy: anatomical, magnetic resonance neurography and diffusion tensor imaging appearances

  • Vibhor Wadhwa
  • Safia N. Salaria
  • Rashmi S. Thakkar
  • Avneesh Chhabra
Case Report


The authors report an unusual case of radial mononeuropathy caused by epithelioid sarcoma and describe the anatomical 3-Tesla MR neurography and the functional diffusion tensor imaging findings of the case, which were subsequently confirmed on surgical excision and histopathology.


MR neurography DTI ADC Epithelioid sarcoma Radial nerve 


Conflicts of interest

Vibhor Wadhwa: The author reports no conflicts of interest.

Safia N. Salaria: The author reports no conflicts of interest.

Rashmi S. Thakkar: The author reports no conflicts of interest.

Dr. Chhabra has received patient research grants from Siemens, Interga Life Sciences and GE-AUR. He also serves as MSK CAD consultant with Siemens.


  1. 1.
    Wang LH, Weiss MD. Anatomical, clinical, and electrodiagnostic features of radial neuropathies. Phys Med Rehabil Clin N Am. 2013;24(1):33–47.PubMedCrossRefGoogle Scholar
  2. 2.
    Rozen WM, Galloway S, Salinas C, Allen P, Schlicht S, Mann GB. Fasciitis ossificans with a radial neuropathy: a benign differential diagnosis for soft tissue sarcoma. J Clin Neurosci. 2007;14(4):391–4.PubMedCrossRefGoogle Scholar
  3. 3.
    Enzinger FM. Epithelioid sarcoma. A sarcoma simulating a granuloma or a carcinoma. Cancer. 1970;26(5):1029–41.PubMedCrossRefGoogle Scholar
  4. 4.
    Bos GD, Pritchard DJ, Reiman HM, Dobyns JH, Ilstrup DM, Landon GC. Epithelioid sarcoma. An analysis of fifty-one cases. J Bone Joint Surg Am. 1988;70(6):862–70.PubMedGoogle Scholar
  5. 5.
    Prat J, Woodruff JM, Marcove RC. Epithelioid sarcoma: an analysis of 22 cases indicating the prognostic significance of vascular invasion and regional lymph node metastasis. Cancer. 1978;41(4):1472–87.PubMedCrossRefGoogle Scholar
  6. 6.
    Agarwal M, Shatma MC, Deol P, Mehta VS, Sarkar C. Epithelioid sarcoma of the sciatic nerve perineural sheath: a mimic of nerve sheath tumor. Pathol Oncol Res. 2002;8(2):148–50.PubMedCrossRefGoogle Scholar
  7. 7.
    Harish S, Saifuddin A, Fajinmi M. Epithelioid sarcoma of the median nerve mimicking a peripheral nerve sheath tumour. Australas Radiol. 2007;51(1):71–4.PubMedCrossRefGoogle Scholar
  8. 8.
    Faridian-Aragh N, Chalian M, Soldatos T, Thawait GK, Deune EG, Belzberg AJ, et al. High-resolution 3 T MR neurography of radial neuropathy. J Neuroradiol. 2011;38(5):265–74.PubMedCrossRefGoogle Scholar
  9. 9.
    Halling AC, Wollan PC, Pritchard DJ, Vlasak R, Nascimento AG. Epithelioid sarcoma: a clinicopathologic review of 55 cases. Mayo Clin Proc. 1996;71(7):636–42.PubMedCrossRefGoogle Scholar
  10. 10.
    Chase DR, Enzinger FM. Epithelioid sarcoma. Diagnosis, prognostic indicators, and treatment. Am J Surg Pathol. 1985;9(4):241–63.PubMedCrossRefGoogle Scholar
  11. 11.
    Hornick JL, Dal Cin P, Fletcher CD. Loss of INI1 expression is characteristic of both conventional and proximal-type epithelioid sarcoma. Am J Surg Pathol. 2009;33(4):542–50.PubMedCrossRefGoogle Scholar
  12. 12.
    Hanna SL, Kaste S, Jenkins JJ, Hewan-Lowe K, Spence JV, Gupta M, et al. Epithelioid sarcoma: clinical, MR imaging and pathologic findings. Skeletal Radiol. 2002;31(7):400–12.PubMedCrossRefGoogle Scholar
  13. 13.
    Chhabra A, Williams EH, Wang KC, Dellon AL, Carrino JA. MR neurography of neuromas related to nerve injury and entrapment with surgical correlation. AJNR Am J Neuroradiol. 2010;31(8):1363–8.PubMedCrossRefGoogle Scholar
  14. 14.
    Chhabra A, Thakkar RS, Andreisek G, Chalian M, Belzberg AJ, Blakeley J, et al. Anatomic MR imaging and functional diffusion tensor imaging of peripheral nerve tumors and tumorlike conditions. AJNR Am J Neuroradiol. 2012. doi: 10.3174/ajnr.A3316 Google Scholar
  15. 15.
    Scheithauer BW, Amrami KK, Folpe AL, Silva AI, Edgar MA, Woodruff JM, et al. Synovial sarcoma of nerve. Hum Pathol. 2011;42(4):568–77.PubMedCrossRefGoogle Scholar
  16. 16.
    Thawait SK, Chaudhry V, Thawait GK, Wang KC, Belzberg A, Carrino JA, et al. High-resolution MR neurography of diffuse peripheral nerve lesions. AJNR Am J Neuroradiol. 2011;32(8):1365–72.PubMedCrossRefGoogle Scholar
  17. 17.
    Randall RL, Dailey A, Albritton KH, Olson PR, Coffin CM. Case reports: fibrosarcoma metastatic to the sciatic nerve. Clin Orthop Relat Res. 2005;(437):242–6.Google Scholar
  18. 18.
    Guggenberger R, Markovic D, Eppenberger P, Chhabra A, Schiller A, Nanz D, et al. Assessment of median nerve with MR neurography by using diffusion-tensor imaging: normative and pathologic diffusion values. Radiology. 2012;265(1):194–203.PubMedCrossRefGoogle Scholar
  19. 19.
    Tagliafico A, Calabrese M, Puntoni M, Pace D, Baio G, Neumaier CE, et al. Brachial plexus MR imaging: accuracy and reproducibility of DTI-derived measurements and fibre tractography at 3.0-T. Eur Radiol. 2011;21(8):1764–71.PubMedCrossRefGoogle Scholar
  20. 20.
    Vargas MI, Viallon M, Nguyen D, Delavelle J, Becker M. Diffusion tensor imaging (DTI) and tractography of the brachial plexus: feasibility and initial experience in neoplastic conditions. Neuroradiology. 2010;52(3):237–245.PubMedCrossRefGoogle Scholar
  21. 21.
    Hodaie M, Chen DQ, Quan J, Laperriere N. Tractography delineates microstructural changes in the trigeminal nerve after focal radiosurgery for trigeminal neuralgia. PLoS One. 2012;7(3):e32745.PubMedCrossRefGoogle Scholar

Copyright information

© ISS 2013

Authors and Affiliations

  • Vibhor Wadhwa
    • 1
  • Safia N. Salaria
    • 2
  • Rashmi S. Thakkar
    • 1
  • Avneesh Chhabra
    • 1
  1. 1.The Russell H. Morgan Department of Radiology and Radiological ScienceJohns Hopkins University School of MedicineBaltimoreUSA
  2. 2.Department of PathologyJohns Hopkins University School of MedicineBaltimoreUSA

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