Metastatic Disease

MicroRNAs — small noncoding RNAs that seem to be involved in epigenetic control of gene expression — have garnered increasing attention as potential biomarkers in the past few years, with interest focused on gastrointestinal malignancy, and now germ cell tumors.

A 14-year-old patient with no significant past medical history presented with a 2-year history of a left arm mass. On exam, the patient was neurovascularly intact with full strength and intact sensation throughout her left upper extremity. There was a firm, semi-mobile mass located over the dorsal ulnar left forearm. The mass had a negative Tinel’s sign, and she had no palpable lymph nodes. MRI showed a heterogeneous mass on the dorsal ulnar left forearm, with indeterminate features, that was closely associated with the radius (Figure 1). Biopsy was consistent with low-grade fibromyxoid sarcoma. CT of the chest was negative for metastatic disease. Wide resection was planned without radiotherapy secondary to the patient’s age. In anticipation of the need for soft tissue and potential bony reconstruction, a CT angiogram of the bilateral lower extremities was obtained (Figure 2). Despite the patient having palpable dorsalis pedis and posterior tibial pulses, the angiogram revealed absence of the bilateral posterior tibial arteries.