

CASE PRESENTATION
 CHIEF COMPLAINTS

 A 43 years gentleman, belonging to high socio

economic class, with an office job came with
 c/o a swelling over the left arm posterior aspect for
the past 2 months
HISTORY OF PRESENTING ILLNESS
 He was apparently normal before 2 months following which he
noticed a swelling on the left upper arm over the posterior
aspect , almost the size of his fist.
 Insidious in onset

 No significant change in the size or consistency of the swelling

from the time he noticed it.
 No h/o pain

 No h/o fever

 No h/o any discharge from the swelling

 No history s/o any secondary changes over the swelling.

 No h/o any functional impairment of the left upper limb or
shoulder.
 No h/o edema , numbness , loss of sensation, weakness or
gangrenous changes of the left upper limb.
 No h/o any swelling elsewhere.

 No h/o trauma.

 h/o loss of appetite and loss of weight was present.

 No h/o any bony pain or breathlessness.

 No h/o abdominal pain, jaundice , altered bowel habits.

 No h/o seizures , visual disturbances or skin pigmentations.

 PAST HISTORY

 No h/o any incidence of similar swellings in the past.

 No h/o any previous surgeries.

 No h/o radiation.

 No h/o exposure to harmful chemicals.

 No h/s/o lymphedema/ filariasis.

 No h/o DM, SHTN, asthma, CAD, CVA, TB, thyroid

abnormalities.
 No h/o any drug allergies.
 PERSONAL HISTORY

 Non vegetarian.

 No h/o smoking or alcoholism.

 Normal bowel and bladder habits.

 Married , 2 children.
 FAMILY HISTORY

 Nil significant.
 SUMMARY

 A 43 years gentleman with c/o a painless

swelling ,not progressive in size for the past
2months , over the posterior aspect of left upper
arm, with no functional impairment of the arm,
with loss of weight and appetite.
 GENERAL EXAMINATION
 ECOG Score-0

 Moderately nourished and built

 Patient was sitting comfortably with arms by the side,flexed at

shoulder ,extended at elbow.
 No pallor, Not icteric, no clubbing, no cyanosis, no pedal or limb edema, no
generalized lymphadenopathy .
 No swellings elsewhere.

 Vitals :PR- 86/ min

BP – 110/80 mm hg measured in right upper limb in sitting position.
RR – 12/ min
Temp – 98.7o F
 SYSTEMIC EXAMINATION

 CVS- s1s2 heard , no added sounds

 RS – B/L NVBS, no added sounds

 P/A – soft, BS +,no mass palpable

 CNS- no focal neurological deficit.

 Ocular examination- NAD

 EXAMINATION OF LEFT UPPER LIMB
After obtaining proper consent
patient was exposed from waist up
and examined in sitting position
with adequate privacy.
INSPECTION

 With arms by the side

 A single swelling of size
approx. 7*7
cm ,hemispherical in shape
was present over the postero
lateral region of left arm.
 Surface looks smooth , with ill
defined margins.
 Extend
• Superior : Approx. 10cm from acromion process
• Inferior : Approx. 15 cm from the olecranon process.
• Involves approx. 30 % of the circumference.
 No visible pulsations
 Skin over the swelling: multiple ecchymosis seen around the swelling inferiorly, no
dilated veins, no scars.
 Left UL : no edema , no wasting of muscles, no gangrenous changes .
 Right UL : appears normal.
 PALPATION
 No local rise in temperature over the swelling
 Not tender
 Swelling is approx. 8*8 cm in size , hemispherical extending approx.
10 cm from acromion process superiorly , 15 cm from the olecranon
process inferiorly and involving up to 35 % of the arm
circumference.
 Surface is smooth, margins are ill defined
 Firm in consistency, uniform throughout, not pitting,no signs of
moulding.
 Not compressible.
  Skin moves over the swelling and is pinchable.
 Able to move the swelling perpendicular and not along the axis of
the muscle.
 On contracting the triceps muscle, swelling becomes less prominent ,
not mobile in both parallel and perpendicular axis.
 Not fixed to the underlying bone.
 Swelling is not pulsatile

 Movements at the shoulder joint, elbow , wrist and fingers are not
restricted.
 Power : 5/5 in all muscle groups of both UL , no wasting of muscles
distal to the swelling.
 Radial , ulnar , brachial , axillary artery felt equally on both sides.
 No limb edema.
 Percussion
 Dull note over the swelling.

 Auscultation
 no bruit

 Left axillary region: a single node of size 1*1 cm , hard in

consistency, fixed.
 Right upper limb and axilla : normal.
 SUMMARY
 A 43 years gentleman with a single firm swelling of size
approx. 8* 8 cm over the postero lateral region of left arm,
probably arising from the muscle with no restriction of
movements and neurovascular deficit.
 PROVISIONAL DIAGNOSIS
 Soft tissue sarcoma left arm

 T2 N1 M0, Stage- IV( TNM STAGING a/t AJCC 8th edition)

 DIFFERENTIAL DIAGNOSIS

 Hematoma.

 Lipoma.