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  Diagnostic Quizzes
A Painless Mass on the Upper Arm
A 92-year-old male patient presented with a 3-year history of an enlarging, painless mass on the right arm (Fig. 1). He did not have any history of trauma on the area. The patient reported no weight loss and had no other symptoms other than rapid enlarging of the tumor for the last 6 months. Physical examination showed an 8 x 5 cm flesh colored, firm, ill-defined mass on right arm (Fig. 1). No cervical or axillary lymphadenopathy was noted. The MRI showed a huge ill-defined soft tissue mass on the anterior aspect of lower right arm measuring 13 x 5.7 x 4.6 cm. T1-weighted images showed heterogeneous hypo and hyper-intense signal (fatty tissue) with increased enhancement in T2-weighted image. The initial clinical differential diagnoses included liposarcoma, lipoma, teratoma, lymphoma, and germ cell tumor (Fig. 2). An incisional biopsy was performed and the microscopic pictures are shown in (Fig. 3). After the diagnostic biopsy, a marginal excision was performed under general anesthesia and a partial thickness skin graft was used to cover the defect.


fig 1
Clinical picture


fig 2

fig 3
CT scan

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