Crystal-deficient alveolar soft part sarcoma

Classically, ultrastructural examination of alveolar soft part sarcoma reveals large, dramatic, rhomboid to needlelike crystals with a characteristic substructure. In this study of four cases of alveolar soft part sarcoma, only two exhibited large crystals, which were rare. All four cases, however, exhibited round, electron-dense granules, and in the two cases without large crystals these granules rarely exhibited elongation with the characteristic substructure of alveolar soft part sarcoma that permits definitive diagnosis. Two of these cases had been previously studied at other institutions, where crystals were not identified ultrastructurally and electron microscopy was considered noncontributory. Large crystals, then, may be rare or absent in alveolar soft part sarcoma. Careful search may be necessary to find granules with the characteristic periodic substructure.