Clear cell sarcoma of soft tissue arising in the supraclavicular region: A cytological diagnosis

Abstract

Clear cell sarcoma of soft tissue is a rare malignant neoplasm which constitutes about 1% of soft tissue tumors. It most commonly arises in the distal extremities of young adults. Peak incidence is in the third decade. More commonly seen in women than men. A 30 year old female presented with swelling in right supraclavicular region associated with pain since 3 months. CT scan findings revealed irregular and non-enhancing, hypodense lesion measuring 2.5x2x1cm in right supraclavicular region. Cytological features revealed abundant cellularity comprising of atypical cells mainly dispersed singly and arranged in loose cohesive groups. The cytoplasm was abundant, vacuolated at places, pleomorphic round to oval nucleus, placed centrally to eccentrically with prominent nucleoli. Diagnosis of malignant mesenchymal neoplasm was made on the basis of the cytomorphological details. Clear cell sarcoma was included in the differential diagnosis. Cytomorphological diagnosis was confirmed by histological and immunohistochemical diagnosis. When cytology of a soft tissue tumor shows high cellularity alongwith dispersion and loosely cohesiveness of cells, nuclear pleomorphism and conspicuous nucleoli, diagnosis of clear cell sarcoma may be considered.