A ruthless sarcoma of the foot.

To cite: Agarwal S. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2014206287 DESCRIPTION A 45-year-old man presented with non-tender soft tissue swelling on the medial aspect of the right foot with pain during dorsiflexion and eversion of the foot. X-ray (figure 1) and MRI (figure 2) of the mass revealed a heterogeneous soft tissue mass arising out of the calcaneal bone. Figure 1 demonstrates the X-ray showing the soft tissue mass in the medial aspect of the right foot along with diffuse osteopenia of the calcaneal bone. Figure 2 demonstrates the MRI corroborating the findings of the X-ray showing a heterogeneous mass arising from the calcaneal bone on the medial aspect of the foot. Surgical biopsy of the mass was consistent with clear cell sarcoma involving the tendon sheaths. Fluorescence in situ hybridisation demonstrated the presence of an Ewing Sarcoma translocation [t(12,22)(q13,q12)], characteristic of clear cell sarcoma. The tumour at presentation was widely metastatic involving lungs (figure 3) as well as retroperitoneal and inguinal lymph nodes (figure 4). Figure 3 demonstrates CT of the chest (axial, panel A; coronal, panel B) showing prominent hilar lymphadenopathy (white arrows). Figure 4 demonstrates CT of the pelvis demonstrating significant right-sided inguinal lymphadenopathy (white arrow). Owing to this widespread metastasis, an amputation was not performed, as the disease was thought