Early distant metastases from epithelioid sarcoma of the hand

The authors describe a patient with epithelioid sarcoma in whom the presenting lesion was cervical lymph node metastasis. This proved to be a difficult diagnostic problem, until the occult primary tumor was discovered in the ipsilateral hand. A cerebral metastasis became evident early in the course of the disease. The authors believe this to be the first case reported in whom the presenting lesion was a nonregional metastasis. The rapid clinical progression of this patient's malignancy is of interest and illustrates the need for early intervention in patients with an epithelioid sarcoma, since the clinical course is not always indolent.