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Epithelioid sarcoma (ES) has been described in many sites1 and classical and proximal variants of ES display characteristic loss of INI1 expression.2 We detail, for what is believed to be the first time, a primary ES of the base of skull for which, because of extensive local disease, specific origin from dura or bone3 could not be determined.
A 55-year-old Malay man presented with a 3-month history of epistaxis and visual disturbances. MRI scan revealed a large intracranial extra-axial lobulated mass measuring 7.0×6.1×7.3 cm with extension into the anterior cranial fossa, left posterior choana and left ethmoid sinus, suggesting a meningioma. The patient underwent tumour resection during which part of the skull base and small part of the left frontal lobe were removed. Intra-operatively, the lesion was extra-axial and remote from the normal appearing pituitary gland and suprasellar region. Postoperatively, a thorough physical examination, oesophago-gastro-duodenoscope and CT scan of the thorax, abdomen and pelvis failed to detect a primary tumour elsewhere. A repeat MRI of the brain and spine 1 month post surgery …