case_images: PMC2668915_01
case_images: (a) Coronal T1-weighted, (b) T2-weighted, and (c)
  Gd enhanced magnetic resonance imaging shows a tumor 
  measured approximately 8 x 4 x 3 cm. (d) Tumor encircles by the flexor
  carpi radialis (FCR), flexor digitorum
  superficialis (FDS), flexor digitorum
  profundus (FDP), and flexor pollicis
  longus (FPL), and pushes aside median 
  nerve (arrow).
case_images: SRCM2009-595391.001.jpg
case_images: PMC2668915_01_SRCM2009-595391.001.jpg
case_images: fig1
case_images: Magnetic resonance imaging evaluation has been performed at that time, showing a tumor measured approximately 8 x 4 x 3 cm, encircled by the flexor carpi radialis (FCR), flexor digitorum superficialis (FDS), flexor digitorum profundus (FDP), and flexor pollicis longus (FPL)  (see Figure 1).  Open biopsy was subsequently performed, and histological appearance showed that tumor was consisted with malignant spindle cells with epithelioid features (see Figure 2), then he was referred to our institution afterward.
case_images: Histological appearance of open biopsy showing
  that tumor is consisted with malignant (a) spindle and (b) rounded cells with
  epithelioid features.
case_images: SRCM2009-595391.002.jpg
case_images: PMC2668915_01_SRCM2009-595391.002.jpg
case_images: fig2
case_images: Magnetic resonance imaging evaluation has been performed at that time, showing a tumor measured approximately 8 x 4 x 3 cm, encircled by the flexor carpi radialis (FCR), flexor digitorum superficialis (FDS), flexor digitorum profundus (FDP), and flexor pollicis longus (FPL)  (see Figure 1).  Open biopsy was subsequently performed, and histological appearance showed that tumor was consisted with malignant spindle cells with epithelioid features (see Figure 2), then he was referred to our institution afterward.
case_images: (a) Histological appearance of postoperative
  section showing that no tumor cell is infiltrated into the nerve, but (b) the
  pseudocapsule of the tumor is transitioning to the perineural sheath of the
  median nerve.
case_images: SRCM2009-595391.003.jpg
case_images: PMC2668915_01_SRCM2009-595391.003.jpg
case_images: fig3
case_images: The macroscopic appearance of the resected tumor showed that the median nerve was directly involved in the tumor.  Microscopically, no tumor cell was infiltrated into the nerve, but the pseudocapsule of the tumor was transitioning to the perineural sheath of the median nerve (see Figure 3), suggesting that epithelioid sarcoma could arise from nerve sheath as well as deep fascia or tendon sheath.
case_images: Photograph of right
  forearm on 2 years after operation. Grasp power of the affected hand has gained
  up to 50%, and the sensory of the median nerve area has also been recovered up
  to 50% of the unaffected side.
case_images: SRCM2009-595391.004.jpg
case_images: PMC2668915_01_SRCM2009-595391.004.jpg
case_images: fig4
case_images: The function of the affected hand showed DASH score of disability/symptom score of 22.5 and optional component score (sports/music or work optional module) of 50  (see Figure 4).