Reticular perineurioma: a distinctive variant of soft tissue perineurioma

Soft tissue perineurioma is a relatively recently characterized, uncommon tumor composed of perineurial cells exhibiting immunoreactivity for epithelial membrane antigen (EMA). These lesions occur preferentially in adults and may arise in a wide variety of anatomic sites. We report the clinicopathologic, immunohistochemical, and ultrastructural features of six cases of a poorly recognized morphologic variant of soft tissue perineurioma, characterized by a highly distinctive reticular growth pattern. Four of the patients were women, two were men (age range, 34-61 yrs; median, 43 yrs). Four of the cases arose in the subcutis of the upper extremity; three were located distally (thumb, finger, palm), whereas one was situated more proximally near the elbow region. One case each was located in the gingiva and subcutaneous tissue of the inguinal region, respectively. In those cases in which clinical information was available (n = 5), the lesions were asymptomatic and had been present from 4 months to 10 years before resection. Tumor size ranged from 1.5 cm to 10 cm (median size, 4.25 cm). Microscopically the lesions demonstrated a predominantly lace-like or reticular growth pattern composed of anastomosing cords of fusiform cells with bipolar cytoplasmic processes and palely eosinophilic cytoplasm. Nuclei were centrally placed, ovoid to fusiform in shape, and no mitoses were seen. Transition to more cellular areas was focally present in all cases. The stroma was variably collagenous to myxoid. Immunohistochemically all six cases stained positively for EMA but not for S-100 protein. Two cases demonstrated focal positive cytoplasmic staining for cytokeratin, whereas one case was focally desmin positive. Ultrastructural examination of two tumors showed typical features of perineurial cells. Follow up (available in only two cases) showed no evidence of recurrence. Reticular perineurioma of soft tissue represents an unusual morphologic variant within the perineurioma group, which should be distinguished from myoepithelial tumors, extraskeletal myxoid chondrosarcoma, and myxoid synovial sarcoma.     

Epithelioid angiosarcoma of deep soft tissue: a distinctive tumor readily mistaken for an epithelial neoplasm.

We report eight cases of epithelioid angiosarcoma arising in deep, usually intramuscular soft tissue. All the patients were men (mean age, 58). All the lesions arose in a limb or limb girdle. Cardinal morphologic features were the diffuse, sheetlike growth pattern, with only focally apparent vascular differentiation, and epithelioid tumor cells with a degree of intracytoplasmic vacuolation/lumen formation. Immunohistochemically, all eight cases coexpressed keratin as well as endothelial markers. In three cases, endothelial differentiation was confirmed ultrastructurally. Clinically, deep-seated epithelioid angiosarcomas are high-grade neoplasms that rapidly develop metastases. These findings expand the range of recognized epithelioid endothelial tumors and provide further evidence of keratin expression by such lesions. The presence of intracytoplasmic lumina/vacuoles (sometimes containing red blood cells) combined with the characteristic reticulin pattern and striking positivity for Factor VIII-RAg provide the clearest means of distinction from an epithelial metastasis.     

Angiofibroma of soft tissue: clinicopathologic characterization of a distinctive benign fibrovascular neoplasm in a series of 37 cases

Thirty-seven cases of a distinctive benign fibrovascular soft tissue tumor that may be mistaken for a low-grade sarcoma are described. There were 25 female and 12 male patients, ranging in age from 6 to 86 years (median, 49 y). The tumors presented most commonly as a slowly growing painless mass located in the soft tissues of the extremities, mainly the lower extremity, often in relationship to joints or fibrotendinous structures. Most lesions (29 cases) were well circumscribed, ranging in size from 1.2 to 12 cm (median, 3.5 cm). The microscopic appearance was remarkably consistent and was characterized by 2 components: a relatively uniform proliferation of bland, spindle-shaped cells with inconspicuous cytoplasm and ovoid-to-tapering nuclei set in a variably collagenous or myxoid stroma and a prominent vascular network composed of numerous small, branching, thin-walled blood vessels, often accompanied by medium-sized round or irregular and ectatic vessels. Mitoses (1-4/10 hpf) were occasionally observed (9 cases). Mild degenerative nuclear atypia was uncommon (5 cases). Tumor cells expressed epithelial membrane antigen at least focally in 16 of 36 cases (44%), CD34 and smooth muscle actin in 5 cases (14%), and desmin in 4 cases (11%); none expressed S100 protein. Five out of 6 cases analyzed cytogenetically showed a simple karyotype with a balanced t(5;8) chromosomal translocation. Treatment consisted of surgical resection: either simple excision (29 cases), wide excision (6 cases), or amputation (1 case). Follow-up information was available for 28 patients (range, 6 to 144 mo; mean, 51.9 mo). Most patients were alive with no evidence of disease, regardless of the status of surgical resection margins. Four patients developed local recurrence 9, 13, 36, and 120 months after the primary tumor was removed; only in 1 case was there an association with extensively positive surgical resection margins. One of these patients developed a second recurrence 2 months after the first one. None of the patients developed metastasis. The designation "angiofibroma of soft tissue" is proposed to reflect both the likely fibroblastic nature of the proliferating cells and the prominent vascularization of this benign soft tissue neoplasm.     

Sustentaculoma: report of a case of a distinctive neoplasm of the adrenal medulla

A case of a morphologically distinctive tumor of the adrenal medulla occurring in a 54-year-old woman is described. On microscopic examination, the tumor was well circumscribed and characterized by the presence of ill-defined, irregular nests of spindle cells with oval to elongated nuclei, tiny nucleoli, and abundant eosinophilic cytoplasm. The tumor was associated with a moderate infiltrate of lymphocytes and plasma cells with occasional lymphoid follicles. Necrosis, marked cellular atypia, and mitoses were absent. Immunohistochemical studies demonstrated the tumor cells to be strongly reactive for vimentin, S-100 protein, and CD56, and nonreactive for glial fibrillary acidic protein, chromogranin, synaptophysin, melanoma-associated antigens, and dendritic cell markers. Ultrastructural examination showed elongated cells with interdigitating cytoplasmic processes devoid of a basal lamina. No secretory granules were noted. The morphology, immunophenotype, and ultrastructure of this unique neoplasm suggest derivation from sustentacular cells of the adrenal medulla. We propose the designation "sustentaculoma" for this hitherto undescribed neoplasm of the adrenal gland.     

Sciatica in a patient with unusual peripheral nerve sheath tumors

BACKGROUND: Other causes such as peripheral schwannomas can mimic lumbar disk disease. CASE DESCRIPTION: We present an unusual case of multiple nerve sheath tumors in a patient with left radicular leg pain accompanied by a Tinel sign. Initial lumbar MR imaging revealed a mass in the right lumbar plexus, side opposite the patient's symptoms. Magnetic resonance neurography subsequently revealed a compressive mass of the sciatic nerve proximal to the popliteal fossa, histologically identified as a schwannoma. CONCLUSION: This case emphasizes the importance of continued investigation when the radiographic findings do not correlate with the patient's history in the presence of localizing signs on physical examination.     

Benign epithelioid peripheral nerve sheath tumors of the soft tissues: clinicopathologic spectrum of 33 cases

Benign epithelioid peripheral nerve sheath tumors (BEPNSTs) have not been fully characterized, and their relationship to conventional schwannoma and neurofibroma has not been satisfactorily established. Herein, we detail the clinicopathologic features of 33 examples of BEPNST. The study included 22 females and 11 males ranging in age from 2 to 68 years (median, 31.5 years). Only one patient probably has neurofibromatosis type 1. The tumors were predominantly dermal/subcutaneous in location (85%) and involved the lower limb (n=15), upper limb (n=11), trunk (n=4), and head/neck (n=3). The lesions ranged in size from 0.3 to 6.8 cm (median, 1.1 cm). Microscopically, the tumors were generally well-circumscribed, uninodular, or multinodular masses. Twenty-six lesions were encapsulated. Tumors consisted of trabeculae, loosely arranged nodules, and cohesive nests of epithelioid tumor cells immersed in collagenous, myxohyaline, or chiefly myxoid stroma. A bland spindled cell component comprising 5% to 40% of the tumor was noted in 15 cases. Mitotic activity ranged from 0 to 6 mitoses/50 high power fields (mean, 1.5 mitoses/50 high power fields) with no abnormal division figures identified. Five lesions were considered atypical based on presence of focal nuclear/nucleolar enlargement and hyperchromasia. Immunohistochemical reactivity for Schwann cell-related markers in tumor cells included S-100 protein (20 of 20 cases), collagen type IV (10 of 10), laminin (8 of 8), nerve growth factor receptor, p75(7 of 8), CD57 (6 of 9), and glial fibrillary acidic protein (8 of 15). CD34-positive fibroblast-like cells were identified in all 12 neoplasms tested. Anti-epithelial membrane antigen highlighted perineurial cells in 9 of the 11 encapsulated tumors. Anti-neurofilament protein did not identify intralesional neuraxons in the 10 tumors evaluated. Eighteen tumors were subtyped as epithelioid neurofibromas. The remaining 15 cases showed some histologic features suggestive of schwannoma, but their uniform cellularity, absence of nuclear palisading, and presence of a significant CD34-positive spindled cell population in 5 cases led to their classification as "BEPNST of indeterminate histogenesis." Evaluation for loss of heterozygosity in 2 cases demonstrated deletion of genetic material on chromosome 22q and 17q involving NF2 and NF1 loci. However, sequencing of NF2 coding sequences revealed no mutations. Follow-up for 18 patients (median interval, 13.5 years), including 4 patients with tumors exhibiting cytologic atypia, revealed a nondestructive recurrence or persistent disease in 3 patients whose tumors lacked atypia, but no evidence of metastatic spread or tumor-related death. BEPNSTs are usually small neoplasms located in superficial soft tissue and have an excellent prognosis after complete local excision. Accurate subclassification of some of these lesions is difficult based on currently available techniques.     

PTEN hamartoma of soft tissue: a distinctive lesion in PTEN syndromes

PTEN hamartoma tumor syndrome (PHTS) presents in a spectrum that encompasses the eponymous disorders Cowden and Bannayan-Riley-Ruvalcaba. Herein, we delineate the distinctive histopathology of a predominantly intramuscular lesion in PHTS, often called "arteriovenous malformation," because of certain imaging and histopathologic features. Cases were identified by review of lesions resected from patients with PHTS registered at our Vascular Anomalies Center and of unusual intramuscular vascular anomalies in our pathology database from 1985 to 2008. Thirty-four patients with this lesion were identified: 20 had a clinical diagnosis of, or were suspected to have, PHTS (genetically confirmed in 16). In 4 patients without clinical manifestations of PHTS, 2 had PTEN mutations, 1 did not, and in 1 the mutation was intronic. In the remaining 10, there was insufficient clinical information to fully assess whether they had manifestations of PHTS. Lesions manifested by 15 years of age, normally with pain and swelling, and were most often located in the lower extremity. The major mass was usually intramuscular, but often there were fascial and subcutaneous components and not infrequently a cutaneous vascular stain. Magnetic resonance imaging generally showed an infiltrative soft tissue lesion involving the muscle, fascia, and subcutis with frequently enlarged, serpiginous vessels, small arteriovenous fistulae with disproportionately dilated draining veins, and a prominent adipocytic component. Some lesions involved contiguous muscles, and 20% were multifocal. Resected specimens ranged in size from 1.2 to 25 cm; in 1 patient, amputation was necessary. Histopathologically, these unencapsulated masses, often with a nodular appearance at scanning magnification, consisted of: (1) a variable admixture of mature adipocytic and dense and/or myxoid fibrous tissues (50% to 90% of surface area); (2) a vascular component (10% to 50% of surface area) with: (a) clusters of venous channels, some with excessively and irregularly muscularized complex walls and lumens, and others with thin walls resembling pulmonary alveoli, (b) tortuous, thick-walled arteries with concentric muscular hyperplasia and relatively small lumens, (c) numerous small vessels (arteries, veins, and indeterminate channels), and (d) occasional arteriovenous communications; (3) lymphoid follicles (50%); (4) foci of bone (20%); and (5) hypertrophic nerves with "onion bulb" proliferation of periaxonal spindled cells (9%). We designate this disorganized overgrowth of essentially mesenchymal elements as PTEN hamartoma of soft tissue. It differs from other vascular and connective tissue lesions that occur in patients with PHTS. PTEN hamartoma of soft tissue is histopathologically distinctive, and its identification should prompt a thorough investigation for PHTS.     

Metanephric stromal tumor: report of 31 cases of a distinctive pediatric renal neoplasm

We report 31 cases of a novel pediatric renal neoplasm, metanephric stromal tumor (MST). Mean patient age was 2 years, and the most common presentation was that of an abdominal mass. Gross examination typically revealed a fibrous lesion centered in the renal medulla containing smooth-walled cysts (mean tumor size, 5.5 cm). MST is histologically identical to the stromal component of metanephric adenofibroma (MAF, previously termed nephrogenic adenofibroma) and is an unencapsulated spindle cell lesion that entraps native kidney. Characteristic histologic features of MST include alternating cellularity that imparts a nodular low-power appearance, onion-skin cuffing around entrapped renal tubules, heterologous differentiation (glia or cartilage), and vascular alterations (angiodysplasia of entrapped arterioles, juxtaglomerular cell hyperplasia in entrapped glomeruli). Three tumors in which the vascular alterations were particularly florid were associated with extrarenal vasculopathy and attendant morbidity. A majority of cases stained for CD34, although the degree of staining was variable. Most patients were treated with surgical excision alone, and none experienced recurrence or metastasis. Recognition of this entity can spare a child potentially toxic adjuvant chemotherapy that might be used for lesions in its differential diagnosis, specifically clear cell sarcoma of the kidney.     

Malignant peripheral nerve sheath tumors: an update

Malignant peripheral nerve sheath tumors (MPNSTs) are highly malignant cancers that account for approximately 5-10% of all soft tissue sarcomas. They occur either sporadically, in association with neurofibromatosis type 1 (NF1), or subsequent to radiation therapy. Histologically, MPNSTs resemble fibrosarcomas in their basic organization. Immunohistochemistry, particularly S100, plays an important role in the diagnosis. At the molecular level, loss of the NF1 gene and high levels of Ras-activity are hallmarks. Magnetic resonance imaging (MRI) is the most helpful imaging technique to clearly identify tumoral extent and to suggest neurogenic origin. The presence of heterogeneity with evidence of necrosis and hemorrhage on MRI and increased uptake on positron emission tomography scan may prove helpful in detecting malignant changes. MPNSTs need to be approached by a multidisciplinary team, assuring the complete surgical removal of the lesion. Disease-free and overall survival statistics reinforce the aggressive nature of this unique soft tissue tumor.     

Malignant peripheral nerve sheath tumor with Horner's syndrome: a case report

We report on a 42-year-old woman with malignant peripheral nerve sheath tumor (MPNST) arising from the cervical sympathetic nerve. A collar incision and partial sternotomy were performed at the second intercostal space. The mass was spindle shaped and connected to the sympathetic trunk on the cranial and caudal sides, and it compressed the left carotid sheath on the median side. After the patient's uneventful recovery from surgery, adjuvant radiotherapy was administered to the area of resection. The patient remains well 5 years after surgery with no evidence of recurrence.     

Spindle cell thymic carcinoma: clinicopathologic and immunohistochemical study of a distinctive variant of primary thymic epithelial neoplasm.

We report 16 cases of a distinctive variant of primary thymic epithelial neoplasm characterized by prominent spindling of the tumor cells. The patients were seven women and nine men aged 23 to 82 years (mean, 54 years). The lesions presented as anterior mediastinal masses without clinical or radiographic evidence of tumor elsewhere. Most patients had chest pain, dyspnea, and cough; in five patients, the tumors were asymptomatic and were discovered on routine clinical examination. Grossly, the lesions were firm, well-circumscribed, and locally infiltrative, and had a firm cut surface with foci of hemorrhage, necrosis, and cystic changes. Most of the tumors were treated by complete surgical excision. Histologically, they were characterized by a spindle cell proliferation showing varying degrees of atypia and mitotic activity. In 12 cases, transitions could be seen with areas that showed the features of conventional spindle cell thymoma. In two cases, areas showing features of poorly differentiated (lymphoepitheliomalike) carcinoma and anaplastic carcinoma could also be observed. Immunohistochemical studies in 10 cases showed strong positivity of the spindle tumor cells for CAM5.2 cytokeratin, and negative staining for a panel of antibodies including epithelial membrane antigen, carcinoembryonic antigen, actin, desmin, vimentin, S-100 protein, HMB45, CD34, CD5, and CD99. Clinical follow-up of eight patients showed an aggressive biologic behavior with recurrence, metastasis, and death by tumor in five of them 2 to 5 years after diagnosis. Based on these findings, the present tumors are interpreted as an unusual spindle cell variant of thymic carcinoma. The close association of these cases with areas showing the features of spindle cell thymoma within the same tumor mass suggests that some of these lesions may arise as a result of malignant transformation in a preexisting spindle cell thymoma.     

Malignant peripheral nerve sheath tumors in the setting of segmental neurofibromatosis. Case report

Approximately 100 cases of segmental neurofibromatosis (NF5) have been reported in the recent literature. Patients with NF5 present with café-au-lait macules, freckles, and/or neurofibromas limited to one or adjacent dermatomes. Neurofibromas arising in NF5 have been uniformly considered to be benign; patients were thought to have an excellent prognosis without the risk of developing malignant peripheral nerve sheath tumors (PNSTs), which are characteristic in patients with the generalized form of this disease, von Recklinghausen's NF. In this report the authors detail the first observations of malignant PNSTs in two patients with NF5. Indications for surgical removal of a neurofibroma in a patient with NF include pain. neurological impairment, compression of adjacent structures, cosmetic disfigurement, and rapid tumor growth suggestive of malignant degeneration. Surgical indications are similar for patients with NF5. All patients with neurofibromas should be considered at risk for malignant degeneration.     

Nerve sheath myxoma: a clinicopathologic and immunohistochemical analysis of 57 morphologically distinctive, S-100 protein- and GFAP-positive, myxoid peripheral nerve sheath tumors with a predilection for the extremities and a high local recurrence rate

This report describes the clinicopathologic findings in 57 cases of nerve sheath myxoma. Our study group included 34 males and 23 females, ranging from 8 to 72 years of age at the time of their first surgical procedure (mean, 36 years; median, 34 years). The patients typically presented with solitary, superficial, multinodular masses in the 0.5- to 2.5-cm size range. Eighty-six percent of cases occurred in the extremities, with the most common locations being the hand/fingers (n = 22), knee/pretibial region (n = 10), and ankle/foot (n = 7). Only 7 cases (12.3%) involved the trunk or head and neck region. The tumors were generally slow growing, and often, they were present for many years before surgical resection was sought. In the majority of instances, the lesions were painless. Histologically, the tumors involved the dermis and/or subcutis, and they formed distinct multinodular/multilobular masses with abundant myxoid matrix and a peripheral fibrous border. All cases had small epithelioid Schwann cells in corded, nested, and/or syncytial-like aggregates, a variable number of Schwann cells with a ring-like appearance, and scattered spindled and stellate-shaped Schwann cells. These cells often had cytoplasmic-nuclear invaginations, and they were immunoreactive for S-100 protein, glial fibrillary acidic protein, neuron specific enolase, and CD57. They were also bordered by collagen IV. Epithelial membrane antigen-positive perineurial cells were typically present in small numbers, primarily in the fibrous tissue directly adjacent to the myxoid nodules. CD34-positive intraneural fibroblasts were generally sparse. Mitotic figures were uncommon. All cases were initially managed by simple excision, and in almost all instances, tumor extended to the tissue edge. Follow-up information is available for 34 patients (follow-up range, 8 months to 28 years; median follow-up interval, 14 years 3 months). Sixteen patients (47%) had one (n = 11) or more (n = 5) local recurrence of their tumor, and 2 additional patients had findings suspicious for a recurrence. Nerve sheath myxomas are morphologically distinct peripheral nerve sheath tumors with a peak incidence in the fourth decade of life and a strong predilection for the extremities. These tumors have a relatively high local recurrence rate when managed by simple local excision. They appear to be unrelated to so-called cellular and mixed-type neurothekeomas.     

Carcinoma cuniculatum: a distinctive variant of penile squamous cell carcinoma: report of 7 cases

We are reporting a peculiar variant of penile squamous cell carcinoma (SCC) characterized by its peculiar deeply penetrating and burrowing pattern of growth. This low grade, verruciform penile neoplasm is similar to the plantar epithelioma cuniculatum originally described by Ayrd in 1954. Clinical and pathologic features of 7 patients are presented. There were 7 partial penectomies and 4 bilateral inguinal node dissections. The mean patient's age was 77 years. Grossly, the tumors were white to gray, exo-endophytic, and papillomatous with a cobblestone or spiky appearance. All cases affected the glans and extended to coronal sulcus and foreskin (average size was 6.3 cm). The hallmark of the lesion was noted on cut surface where there were deep tumoral invaginations forming irregular, narrow, and elongated neoplastic sinus tracts connecting the surface of the neoplasm to deep anatomic structures. The neoplasm invaded through lamina propria and corpus spongiosum and grew along the loose connective tissue of Buck fascia to involve the tunica albuginea and corpora cavernosa (average depth was 32 mm). Deeply invasive keratin filled cysts or crypts, on serial sections, showed to be connected to the surface tumor. Fistulization to the skin was also noted. Microscopically, the lesions corresponded to well-differentiated carcinomas with bulbous front of invasion. There were focal areas of higher histologic grade and more infiltrative and jagged borders in 4 cases. Inguinal nodes were negative in 4 patients in which groin dissection was performed. Carcinoma cuniculatum is a variant of penile SCC with distinctive growth pattern and should be distinguished from other verruciform tumors such as the verrucous, papillary, and warty carcinomas. Unlike most subtypes of penile SCCs and despite the deep invasion, none of the tumors showed groin or systemic dissemination at time of diagnosis.     

磁共振氢质子波谱鉴别软组织肿瘤良恶性的价值

目的探讨1H-MRS在软组织肿瘤定性诊断中的应用价值。方法收集经手术及病理证实的12例良性和10例恶性软组织肿瘤患者,分析其1H-MRS各代谢物浓度比值（Cho/Cr、Cho/NAA、Cr/NAA）及其相关性。结果①恶性和良性软组织肿瘤Cho/Cr比值分别为3.72±2.76、0.88±0.53,差异有统计学意义（P〈0.05）,Cho/NAA和Cr/NAA差异均无统计学意义（P均〉0.05）。②良性软组织肿瘤Cr浓度与Cho及NAA浓度均呈正相关（r=0.884、0.822,P均〈0.01）,其余代谢物浓度间均无相关性（P均〉0.05）。③恶性软组织肿瘤Cr浓度与NAA浓度呈正相关（r=0.952,P〈0.001）,其余代谢物浓度间均无相关性（P均〉0.05）。结论 Cho/Cr比值可作为良、恶性软组织肿瘤鉴别诊断的重要依据。Cho/Cr比值升高提示软组织肿瘤为恶性可能性大;Cho/Cr比值降低提示软组织肿瘤为良性可能性大。     

Malignant peripheral nerve sheath tumour of median nerve - an unusual presentation: a case report

Malignant peripheral nerve sheath tumours (MPNST) are rare tumours, which usually occur in patients with multiple neurofibromatosis. They are common in the head and neck and trunk and only a few cases have been reported in the hand. Many of these occur in patients with von Recklinghausens disease and rarely as a malignant transformation of benign schwannomas. When they appear in the hand they often present with various symptoms. We encountered a patient who presented with a longstanding asymptomatic swelling of the palm. On excision the histopathology showed a high-grade malignant peripheral nerve sheath tumour, which led us to speculate that a malignant transformation had occurred in a pre-existing benign swelling. This is reported for its unusual presentation, which, to our knowledge, has never been described previously.     

Lung metastasis of malignant peripheral nerve sheath tumor: report of a case

A 37-year-old man with von Recklinghausen's disease admitted to our hospital because of chest abnormal shadow. He had underwent extended radical tumorectomy for malignant peripheral nerve sheath tumor (MPNST) in left lower limb 33 months before. Chest X-ray and computed tomography (CT) scan revealed solitary tumor on right S10. Tumor was resected under thoracoscopic surgery. Histological diagnosis was metastasis of MPNST. MPNST with lung metastasis showing very poor prognosis. The patient is doing well 2 years after pulmonary resection without recurrence. Careful follow up is important for MPNST.     

Postradiation neural sheath sarcoma of the brachial plexus: a case report.

Sarcoma arising in the brachial plexus is a rare complication following radiation therapy, with only 7 patients reported in the literature. The absolute number of patients is likely to increase with the growth of radiation therapy to treat breast cancer. Because of its rarity, early diagnosis requires a high degree of suspicion. We present a patient with neural sheath sarcoma of the brachial plexus arising 18 years after external beam radiation for breast cancer. The interval between presentation and definitive therapy was prolonged by workup and treatment of carpal tunnel syndrome and cervical nerve root compression. The English language literature regarding postradiation sarcoma is reviewed and the clinical, radiological, and electrophysiological workup of postradiation brachial plexopathy is discussed.