Epithelioid Sarcoma of Hand Masquerading as Radial Styloid Osteomyelitis: A Case Report

Epithelioid Sarcoma of the hand is a rare, high grade soft tissue sarcoma. It accounts for less than 1% of soft tissue sarcoma. It is often misdiagnosed and is a great mimicker of multiple diseases due to its deceptively harmless appearances during the initial stages of the disease.

We are presenting a case of a 24-year-old gentleman presented to our centre with history of nodular swelling and pus discharge over radial side of left wrist for 3 months. He was diagnosed with osteomyelitis of left radial styloid and treated with 6 weeks of antibiotic after wound debridement. He presented to us 2 months later with worsening wound over surgical site for which he underwent wound debridement and another 6 weeks course of antibiotics. Patient presented to us 2 weeks later with complaint of swelling and bleeding from operative site. On examination we noted a wound measuring 3x3 cm with friable granulation tissues over radial aspect of left wrist and multiple nodular lesions over left palm with haemoserous discharges. X ray of left wrist showed juxta-articular osteopenia with focal bone lysis. Patient underwent wound debridement and intraoperative histopathological sample sent came back as Grade 3 epithelioid sarcoma. Patient underwent above elbow amputation with postoperative radiotherapy after 3 months being treated for osteomyelitis of radial styloid.

This case should alert treating surgeons to include soft tissue sarcoma as differential diagnosis of harmless looking, occasional painful firm nodules localised on the hand and wrist region of young adults especially when there are osteolytic changes in x-rays.