Amira Niazi, Anwarul Haque.
Metatastatic alveolar soft part sarcoma ---A case report.
Int J Pathol Jan ;3(1):40-2.

A 33 year old female presented with complaints of left sided hemiplegia, headache off and on, vomiting, loss of vision in left eye, reduced vision in the right eye and history of weight loss for the past three months. A swelling on right upper leg, inner aspect was operated some ten years back. On examination, the right eye was deviated to the left and pupils of both the eyes were fixed and non reactive to light. There was 6th nerve palsy. On examination of the motor system the positive finding was that, the power in the left upper limb was reduced to 2 /5. Tone and reflexes were reduced in the same limb. Plantars were bilaterally down going. Rest of the systemic examination was unremarkable. There was a swelling on the inner aspect of right upper leg measuring 7x 4 cm. CT scan of the brain with and without contrast revealed a mixed density SOL at the parietal region. On the basis of history, examination and investigations a differential diagnosis of high grade glioma, tuberculoma & metastatic lesion were considered. Craniotomy was done and peroperatively the tumour was found to be vascular, soft to firm, well circumscribed, and suckable. It was removed piecemeal and sent for histopathological examination. Pathological Findings: Grossly the tissue consisted of multiple soft tissue fragments grayish brown in colour weighing 13 Gms. Representative sections were submitted. Microscopically section revealed neural tissue infiltrated by a malignant neoplasm composed of round to oval cells with abundant eosinophilic cytoplasm, arranged along highly vascular septae containing dilated blood vessels, forming alveolar pattern. A few of these cells were also lying in the alveolar lumen. These cells exhibited minimum pleomorphism and mitotic count. The features were those of a metastatic neoplasm and a differential diagnosis of metastases from an alveolar rhabdomyosarcoma, renal cell carcinoma, alveolar soft part sarcoma, adrenal gland carcinoma and malignant melanoma was made. Microscopic examination of biopsy sample from leg and PAS stained section revealed PAS Positive diastase resistant material in the cytoplasm of the neoplastic cells. On the basis of these findings, a diagnosis of alveolar soft part sarcoma metastasizing to the brain was made.

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