Adult epithelioid sarcoma is a rare soft tissue cancer that often starts as a firm lump under the skin. It tends to appear in young to middle-aged adults and can show up in the limbs or trunk. People with adult epithelioid sarcoma may notice a slow-growing mass, pain, or an ulcer that does not heal. The condition can come back after treatment and can spread to lymph nodes or lungs, so long-term follow-up is important. Treatment often includes surgery, and may also involve radiation, chemotherapy, or targeted therapy, and outcomes vary by stage and response.
Overview
Adult epithelioid sarcomaSymptoms
Adult epithelioid sarcoma often starts as a firm, painless lump under the skin—commonly on an arm, hand, or leg—that slowly enlarges. As it grows, pain, skin ulceration, numbness, reduced movement, or swollen nearby lymph nodes can develop.
Outlook and prognosis
Adult epithelioid sarcoma tends to grow slowly but can come back and spread, even years later. With expert care—surgery when possible, plus targeted treatments—many people achieve meaningful control. Lifelong follow-up scans help catch recurrences early and guide next steps.
Causes and risk factors
Adult epithelioid sarcoma likely stems from acquired genetic changes in tumor cells—most often loss of the SMARCB1 (INI1) gene—and is usually not inherited. Few established environmental risks exist. Reported patterns include male predominance and onset in young-to-middle adulthood.
Genetic influences
Genetics play a modest role in adult epithelioid sarcoma. It isn’t usually inherited, but tumor cells often show changes like SMARCB1/INI1 loss that drive growth. Family genetic testing is rarely needed unless there’s a strong cancer history.
Diagnosis
Doctors suspect adult epithelioid sarcoma based on a lump and exam, then use MRI or CT to map it. A core-needle biopsy confirms the diagnosis with pathology and immunostains; genetic tests for SMARCB1/INI1 loss may help. Chest imaging stages spread.
Treatment and drugs
Treatment for adult epithelioid sarcoma is tailored by a sarcoma team and often combines surgery with careful margins, radiation, and systemic therapy. Options can include traditional chemotherapy and targeted drugs like tazemetostat for tumors with INI1 loss. Clinical trials may offer additional, promising approaches.
Symptoms
A small, firm lump under the skin is often the first sign, and it may not hurt at all, so it’s easy to dismiss. Early symptoms of adult epithelioid sarcoma are often subtle, and the mass can sit for months before drawing attention. Symptoms vary from person to person and can change over time. As it grows, the lump can affect nearby skin, nerves, or joints, leading to changes you feel in daily tasks like gripping, walking, or wearing shoes.
A firm, slow-growing bump under the skin may appear on an arm, leg, hand, foot, or trunk. It often doesn’t hurt at first. It can feel movable or slightly fixed when pressed.
The area around the lump can look puffy or feel thicker than the other side. Belts, sleeves, or shoes may feel tight over the spot.
The skin over the mass can look reddish or bruised. It may thin, break down, or form a sore that doesn’t heal.
Aching or sharp pain may develop as the mass grows or after a bump or strain. Pain can worsen with activity or at night.
How people usually first notice Adult epithelioid sarcoma?
Many people first notice adult epithelioid sarcoma as a small, firm lump under the skin of the hand, forearm, or other limb that doesn’t hurt and seems harmless at first but slowly grows or returns after removal. Over time, the area may ulcerate or look like a nonhealing sore, and nearby stiffness, reduced range of motion, or new numbness can draw attention. Doctors are often alerted when a “cyst” or “wart-like” spot keeps coming back or doesn’t heal, leading to imaging and a biopsy to confirm the first signs of adult epithelioid sarcoma.
Types of Adult epithelioid sarcoma
Adult epithelioid sarcoma can show up in more than one form, and those forms can feel different in day-to-day life. Some people notice a slow-growing, painless lump that’s easy to overlook at first, while others face a firmer mass that spreads sooner and causes stiffness or numbness nearby. Clinicians often describe them in these categories: classic/distal type and proximal type, with rare rhabdoid-like features reported in some tumors. Knowing the types of Adult epithelioid sarcoma can help you understand why early symptoms of Adult epithelioid sarcoma vary from a small nodule in a limb to a deeper, more aggressive growth closer to the trunk.
Classic/distal type
Usually arises in the hands, forearms, feet, or lower legs. Often starts as a small, firm, painless lump that may ulcerate over time. Numbness or limited motion can develop if nearby nerves or tendons are involved.
Proximal type
Tends to occur in the pelvis, groin, armpit, or trunk and behaves more aggressively. Masses are often larger, deeper, and more likely to cause pain or rapid growth. Skin changes or swelling can appear if the tumor invades nearby tissues.
Rhabdoid-like variant
Some tumors show rhabdoid features under the microscope and may act more aggressively. People may notice faster growth and earlier spread compared with the classic form. Treatment plans often escalate more quickly to match the higher risk.
What genetics can tell you about symptoms
Some people with INI1/SMARCB1 gene loss develop slow-growing, firm lumps in the limbs or groin that can ulcerate, ache, or go numb as nearby nerves and vessels are pressed. When the same genetic loss appears in widespread tumor cells, it’s linked to earlier spread.
Causes and risk factors
Adult epithelioid sarcoma often starts when a growth-control gene in tumor cells, SMARCB1 (also called INI1), is lost. Many people ask about early symptoms of adult epithelioid sarcoma, but the cause is usually a gene change in the tumor, not anything you did. Having risk factors doesn’t mean you’ll definitely develop the condition. Risk patterns include being a young to middle-aged adult, being male, and prior radiation to the area. Lifestyle links are unclear, and rare inherited gene changes, such as SMARCB1 or Li-Fraumeni syndrome, can raise sarcoma risk.
Environmental and biological risk factors
Adult epithelioid sarcoma is rare, and most people won’t have a clear cause. Doctors often group risks into internal (biological) and external (environmental). Understanding these can help you decide when to check in with your doctor if early symptoms of Adult epithelioid sarcoma appear. Below are the main environmental and biological factors linked to this cancer.
Many cases are found in people in their 20s to 40s. It can occur at other ages, just less often. Age itself doesn’t cause the tumor; it reflects when it most commonly appears.
Adult epithelioid sarcoma occurs slightly more often in males than females. The reason for this difference is unclear. It can affect any sex.
High-dose radiation to a body area can raise the chance of a soft-tissue sarcoma forming there years later. This link is uncommon but well documented. Risk relates to the dose received and time since exposure.
Most people diagnosed with Adult epithelioid sarcoma have no identifiable environmental exposure. Not having a known risk factor does not remove the need to check new or changing lumps.
Genetic risk factors
In most people, the key genetic issue in Adult epithelioid sarcoma is loss of function in a tumor suppressor gene called SMARCB1 (also known as INI1). This change almost always occurs only in the tumor cells after birth rather than being inherited. Carrying a genetic change doesn’t guarantee the condition will appear. Very rarely, a SMARCB1 change present from birth can increase susceptibility and contribute to the inherited risk of Adult epithelioid sarcoma.
SMARCB1 gene loss: Loss of the SMARCB1 gene (also called INI1) inside the tumor is the hallmark genetic change in Adult epithelioid sarcoma. It removes a natural brake on cell growth.
Chromosome 22 deletion: Many tumors show missing pieces on chromosome 22 where SMARCB1 sits. This deletion usually arises only in the cancer cells, not as a change passed down in families.
SWI/SNF disruption: Losing SMARCB1 disrupts the SWI/SNF complex that normally helps switch genes on and off in a balanced way. This imbalance can push cells toward forming Adult epithelioid sarcoma.
Rare inherited SMARCB1: A small number of people carry an SMARCB1 change from birth, which can raise the chance of related tumors and, very rarely, Adult epithelioid sarcoma. When suspected, a genetics team may discuss testing and family counseling.
Not typically familial: Most Adult epithelioid sarcoma cases happen by chance with no pattern in families. Family history usually does not change personal genetic risk for this cancer.
Few other drivers: Aside from SMARCB1 loss, there are few consistent, repeated gene changes across Adult epithelioid sarcoma tumors. Other mutations may occur, but none are proven inherited risk factors.
Lifestyle risk factors
Evidence directly linking lifestyle to Adult epithelioid sarcoma is limited, but patterns known to influence cancer biology, treatment tolerance, and recovery likely matter. In practice, lifestyle choices can shape inflammation, immune function, wound healing, and fitness, which affect surgery, radiation, and systemic therapy outcomes. Below are lifestyle risk factors for Adult epithelioid sarcoma as understood from soft-tissue sarcoma and broader oncology data. These illustrate how lifestyle affects Adult epithelioid sarcoma care and survivorship.
Smoking impairs blood flow and oxygen delivery, raising wound and surgical complications after sarcoma procedures. It also undermines immunity and may worsen treatment tolerance and recovery.
High intake strains the liver, which is crucial for processing chemotherapy and other drugs. It can worsen nutrition and immunity, increasing infection and complication risks during treatment.
Obesity is linked to higher inflammation and perioperative risk, which can complicate sarcoma surgery and wound healing. Higher adiposity has been associated with poorer outcomes in some soft-tissue sarcoma cohorts.
Low fitness reduces reserve for surgery, radiation, or systemic therapy, increasing fatigue and deconditioning. Regular activity can improve strength, function, and symptom control during sarcoma care.
Risk prevention
There’s no proven way to prevent adult epithelioid sarcoma, but you can lower risks from delays and complications. Acting early on new or changing lumps and getting care at a sarcoma-experienced center make the biggest difference. For people previously treated, regular follow-up can catch return or spread early. Prevention is about lowering risk, not eliminating it completely.
Pay attention to a new, firm lump under the skin that doesn’t go away, grows over weeks, or causes skin breakdown. Early symptoms of adult epithelioid sarcoma can be subtle, so changes on the hands, forearms, feet, or groin deserve a check.
See a clinician if a lump lasts more than 4 weeks, is getting bigger, or is larger than about 5 cm (2 inches). Early assessment helps rule out benign causes and speeds diagnosis if adult epithelioid sarcoma is present.
Ask for referral to a sarcoma center before any biopsy or surgery. Expert teams use imaging and core needle biopsy to plan treatment and avoid procedures that can complicate care for adult epithelioid sarcoma.
If you’ve had adult epithelioid sarcoma, keep scheduled check-ups and scans. Regular skin, lymph node, and lung monitoring can catch recurrence or spread earlier, when options are broader.
Transmission
Adult epithelioid sarcoma is not contagious—you cannot catch it through touch, coughing, sex, or shared items. Within the body, however, the cancer can grow into nearby tissues and sometimes travel to lymph nodes or distant organs.
Most cases are not inherited; they arise from random changes in the tumor cells over time. In most families there is no genetic transmission of Adult epithelioid sarcoma, though rarely it can be linked to an inherited cancer syndrome. If several close relatives had related tumors at young ages, a genetics professional can advise on how Adult epithelioid sarcoma is inherited and whether testing makes sense.
When to test your genes
Consider genetic testing at diagnosis or recurrence to guide therapy choices, especially for SMARCB1/INI1 loss and to identify trial-matched targets. Test if the tumor appears unusually early, is multifocal, or if there’s a family history of related cancers, as inherited SMARCB1 alterations are rare but relevant. Re-test at progression to capture new, actionable changes.
Diagnosis
You might notice a firm, painless lump that slowly grows, or stiffness in a hand or forearm that starts getting in the way at work. Early and accurate diagnosis can help you plan ahead with confidence. Doctors use imaging and a biopsy to confirm the tumor type. Understanding how adult epithelioid sarcoma is diagnosed can make the steps feel more predictable.
Your provider checks the lump’s size, depth, mobility, and nearby skin and lymph nodes. They also ask how quickly it has changed and whether there were injuries or surgeries in that area.
MRI shows the tumor’s exact size and edges and how it relates to muscles, tendons, and nerves. It helps plan the safest biopsy route and later treatment.
Ultrasound can help assess superficial lumps and guide needle placement for biopsy. It is often used when the mass is close to the skin.
A core needle biopsy removes small cylinders of tissue for lab analysis. It typically provides enough material while lowering the chance of complications compared with open biopsy.
Stages of Adult epithelioid sarcoma
Staging describes how far Adult epithelioid sarcoma has grown or spread and helps guide treatment choices. Doctors consider tumor size (often using a 5 cm [about 2 inches] cutoff), depth, grade, and whether it has reached lymph nodes or distant organs. Different tests may be suggested to help map out the tumor and check for spread, including imaging and a biopsy. Because early symptoms of Adult epithelioid sarcoma can be subtle, staging relies more on scans and tissue testing than on how you feel day to day.
Stage I
Small and lower grade. The tumor is limited to where it started and usually measures 5 cm (about 2 inches) or less. No spread to lymph nodes or distant organs is found.
Stage II
Larger or higher grade. The tumor is still in the original area but is bigger than 5 cm (about 2 inches) and/or looks more aggressive under the microscope. Nearby structures may be pressed or irritated, but there is no confirmed spread.
Stage III
Advanced local disease. The tumor is high grade and sizable, sometimes involving nearby tissues or multiple areas within the same region. There is still no distant spread.
Stage IV
Metastatic spread. Cancer cells have reached distant sites such as the lungs or other organs, and sometimes lymph nodes. Treatment aims to control disease, ease symptoms, and extend quality life.
Outlook and prognosis
Looking ahead can feel daunting, but most people want a clear sense of what comes next with adult epithelioid sarcoma. This cancer tends to grow slowly at first but has a real tendency to come back in the same area or spread to nearby lymph nodes and, later, to the lungs. Doctors call this the prognosis—a straightforward way to talk about likely outcomes based on the tumor’s size, location, and how far it has traveled. When it starts in an arm or leg and is found early, surgery plus radiation can control it for many people, though close follow-up scans are key because recurrences are common in the first few years.
When the tumor begins in the trunk, pelvis, or deep tissues, adult epithelioid sarcoma is harder to remove completely and the risk of spread is higher. Some people experience early symptoms of adult epithelioid sarcoma like a firm, painless lump that slowly enlarges, while others notice changes only after it affects movement or comfort. If the cancer has already spread at diagnosis, treatment focuses on control and quality of life, using targeted drugs or chemotherapy to slow growth. Mortality varies: localized disease has a better outlook, while metastatic disease can shorten life expectancy, though newer treatments are helping some people live longer with fewer symptoms.
Understanding the prognosis can guide planning and day-to-day decisions. Regular follow-up—typically every few months at first—helps catch recurrence early, when options are broader. Talk with your doctor about what your personal outlook might look like, including your tumor’s features, treatment response, and the plan if it returns. With ongoing care, many people maintain work, family routines, and meaningful activities even during treatment.
Long-term effects
Adult epithelioid sarcoma can have lasting effects because it tends to come back locally and can spread to lymph nodes or lungs over time. Long-term effects vary widely, depending on the tumor’s location, stage at diagnosis, and treatments used. Many live for years with careful follow-up, additional treatments as needed, and support for day-to-day function. Thinking about the long-term effects helps explain why early symptoms of Adult epithelioid sarcoma—such as a firm lump that doesn’t go away—should be checked promptly.
The tumor may return in the same area months or years after surgery. Repeat operations or radiation can be needed to keep it controlled.
This cancer has a higher chance than many sarcomas to involve nearby lymph nodes. Swelling, discomfort, or lymphedema can develop if nodes are affected or removed.
Tumor cells can travel to the lungs over time. This can lead to cough, shortness of breath, or chest discomfort and may need systemic therapy.
Surgery and radiation near joints, tendons, or nerves can reduce range of motion and strength. Daily tasks like climbing stairs or lifting groceries may feel harder over time.
How is it to live with Adult epithelioid sarcoma?
Living with adult epithelioid sarcoma often means juggling treatment, recovery, and uncertainty while trying to keep daily routines intact. People may face pain, stiffness, or weakness near the tumor or surgery site, frequent appointments, and the practical challenges of wound care or prosthetics if a limb-sparing surgery or amputation was needed. Work, caregiving, and social plans can be hard to predict, and those close to you may feel worry and fatigue of their own, even as they offer support. Many find that honest communication, reliable pain control, physical therapy, and a small circle of steady helpers make the path more manageable day to day.
Treatment and drugs
Treatment for adult epithelioid sarcoma focuses on removing or controlling the tumor, easing symptoms, and preventing spread. When possible, surgeons aim to remove the mass with a clear margin of healthy tissue; nearby lymph nodes may also be evaluated or removed if involved. Radiation therapy is often used before or after surgery to shrink the tumor or lower the risk of it coming back, and systemic treatments such as doxorubicin- or ifosfamide-based chemotherapy, targeted therapy like tazemetostat (for tumors with loss of INI1/SMARCB1), or immunotherapy may be considered, especially for unresectable or metastatic disease. Treatment plans often combine several approaches, and choices depend on tumor location, size, spread, prior treatments, and your overall health. If first-line treatments don’t help, specialists may try second-line options, and clinical trials can offer access to newer therapies.
Non-drug treatment
Adult epithelioid sarcoma often relies on non-drug treatments to remove or control tumors and protect function. Alongside medicines, non-drug therapies like surgery, radiation, and rehabilitation usually form the backbone of care. Recognizing early symptoms of adult epithelioid sarcoma can lead to earlier surgery and better chances to save strength and mobility. Care plans are tailored to tumor size, location, and your personal goals.
Surgeons aim to remove the tumor with a rim of healthy tissue to lower the risk of it coming back. When possible, they use limb-sparing approaches to preserve movement and strength.
If nearby lymph nodes are involved, removing them can help with local control. Your team may assess nodes during or after the main operation.
Targeted radiation before or after surgery can lower the chance of local recurrence. It may also be used if surgery isn’t an option to shrink or slow the tumor.
Skin, muscle, nerve, or tendon repairs can restore coverage and function after tumor removal. This can improve healing, reduce complications, and support daily use of the limb.
Your genes may have an impact on how drugs work for you
Some medicines for adult epithelioid sarcoma are processed differently depending on your genes, which can change how well they work and the risk of side effects. Genetic testing may guide dose choices or drug selection so treatment is safer and more effective.
Pharmacological treatments
Medicines for adult epithelioid sarcoma are usually used when surgery isn’t possible, the cancer has spread, or to shrink tumors before an operation. Options include targeted therapy, standard chemotherapy, and in select cases, immunotherapy—these systemic treatment options for adult epithelioid sarcoma are tailored to tumor features and prior treatments. Not everyone responds to the same medication in the same way. Your oncology team will also consider side effects, other health conditions, and goals of care when choosing a drug plan.
This targeted pill blocks a protein (EZH2) that tumors with SMARCB1/INI1 loss often rely on. It’s commonly used for unresectable or metastatic adult epithelioid sarcoma and may shrink or stabilize tumors.
These backbone chemotherapy drugs can shrink or slow soft-tissue sarcomas. They are often used first in fit adults when rapid tumor control is needed, sometimes before surgery.
This chemo pair is an alternative when other regimens aren’t suitable or have stopped working. It may help control disease and relieve symptoms in adult epithelioid sarcoma.
This once-daily tablet targets blood vessel signals tumors use to grow. It’s used for advanced soft-tissue sarcoma after prior chemotherapy to help keep disease from worsening.
Genetic influences
People often ask whether adult epithelioid sarcoma is hereditary; in most cases, it is not. In adult epithelioid sarcoma, the cancer cells commonly lose a tumor‑protecting gene called SMARCB1 (also called INI1), a change that occurs within the tumor rather than being passed down through a family. A change in a gene (mutation or variant) can sometimes affect health. In this condition, those acquired changes disrupt a cell’s growth controls and can make related growth drivers, such as EZH2, more active. Very rarely, an inherited SMARCB1 change tied to a broader tumor‑risk syndrome has been reported in families, and epithelioid sarcoma may be one of the cancers seen. Because most cases are not inherited, doctors usually focus on testing the tumor’s genetics to confirm SMARCB1 loss and to help guide treatment, including whether targeted therapy could be an option.
Is Adult epithelioid sarcoma genetic?
Genetics play a modest role in adult epithelioid sarcoma. It isn’t usually inherited, but tumor cells often show changes like SMARCB1/INI1 loss that drive growth. Family genetic testing is rarely needed unless there’s a strong cancer history.
Pharmacogenetics—how genetics influence drug effects
Genes inside the tumor and in your own body can shape which treatments work best and how you tolerate them. In Adult epithelioid sarcoma, many tumors lose a protein called INI1 (also called SMARCB1), which can make them more likely to respond to the targeted drug tazemetostat. Alongside your medical history and prior treatments, genetic testing for Adult epithelioid sarcoma can help doctors match you to targeted therapies or clinical trials when they fit your tumor’s biology. Your inherited genes also affect how your liver enzymes handle chemotherapy or targeted pills, which can change dose needs and the risk of side effects. For example, a small group of people with Gilbert syndrome may be more prone to temporary rises in bilirubin on certain medicines used in sarcoma care, so teams monitor blood tests and adjust as needed. Pharmacogenetic testing isn’t routine for every drug in sarcoma, but if you’ve had unexpected side effects or little benefit from a medicine, your team may discuss testing.
Interactions with other conditions
When Adult epithelioid sarcoma occurs alongside other health issues, care can become more complex, especially around surgery, healing, and infection risk. Doctors call it a “comorbidity” when two conditions occur together. Because early symptoms of Adult epithelioid sarcoma can resemble a stubborn cyst or a slow-healing sore, diabetes, peripheral artery disease, or immune-suppressing illnesses can mask warning signs and make wound care harder. Heart, kidney, or liver problems may limit anesthesia choices and influence which chemotherapy or targeted medicines are safe, and some drugs used for seizures, infections, or acid reflux can interact with cancer treatments. Cancer itself raises the chance of blood clots, so a history of clots, recent surgery, or limited mobility adds to that risk and usually means closer monitoring and preventive measures. Chronic pain, depression, or anxiety can overlap with treatment side effects like fatigue and sleep changes, making it tougher to tell what’s driving day-to-day symptoms but guiding a more tailored plan. Interactions can look very different from person to person, so it’s worth reviewing all diagnoses and medications with your care team to align treatments and avoid conflicts.
How genes can cause diseases
Humans have more than 20,000 genes, each carrying out one or a few specific functions in the body. One gene instructs the body to digest lactose from milk, another tells the body how to build strong bones and another prevents the body's cells from beginning to multiply uncontrollably and developing into cancer. As all of these genes combined are the building instructions for our body, a defect in one of these genes can have severe health consequences.
Through decades of genetic research, we know the genetic code of any healthy/functional human gene. We have also identified that in certain positions on a gene, some individuals may have a different genetic letter from the one you have. We call these hotspots "Genetic Variations" or "Variants" in short. In many cases, studies have been able to show that having the genetic letter "G" in the position makes you healthy, but having the letter "A" in the same position disrupts the gene function and causes a disease. Genopedia allows you to view these variants in genes and summarizes all that we know from scientific research, which genetic letters (Genotype) have good or bad consequences on your health or on your traits.
History
Throughout history, people have described slow-growing lumps on the hand or forearm that seemed harmless at first, only to return after removal and spread later on. Families and communities once noticed patterns of a “stubborn” bump in young adults who worked with their hands, often mistaken for a cyst or wart. These everyday stories echo what modern doctors now recognize as adult epithelioid sarcoma.
First described in the medical literature as a distinctive soft-tissue tumor in the 1970s, it stood out because the growths often felt firm but not especially tender, and they tended to recur after surgery. Early reports focused on the way the tumor could mimic benign conditions, leading to delays in diagnosis. Over time, descriptions became more precise as pathologists noticed its characteristic appearance under the microscope and its habit of traveling to nearby lymph nodes, which is uncommon for many soft-tissue cancers.
With each decade, classification improved. What initially seemed like a single entity was later understood to include classic and proximal types, which differ in where they arise and how aggressive they can be. Once considered rare, now recognized as a form of soft-tissue sarcoma that may appear in the arms, hands, or legs of young to middle-aged adults, adult epithelioid sarcoma has gradually taken its place in cancer guidelines and specialist care pathways.
Advances in genetics added crucial detail. Researchers identified common molecular changes, including loss of a tumor-suppressor protein called INI1/SMARCB1, which helps confirm the diagnosis when the tumor looks like other conditions. From early theories to modern research, the story of adult epithelioid sarcoma shows how combining clinical observation, improved imaging, and molecular testing clarified a confusing picture.
In recent decades, awareness has grown, and earlier biopsy for suspicious, persistent lumps has become more routine. This shift reduced the years-long journeys many once faced between first noticing a nodule and finally receiving the right name for it. Not every early description was complete, yet together they built the foundation of today’s knowledge.
Treatment history reflects this progress. Surgery was the mainstay for many years, followed by more consistent use of radiation to reduce local recurrence. As understanding of the tumor’s behavior and genetics deepened, clinical trials explored targeted and immunotherapy options for advanced disease. While care continues to evolve, the historical arc—misunderstood lumps to a well-defined diagnosis—helps explain why a careful exam, imaging, and timely biopsy are now standard when evaluating potential early symptoms of adult epithelioid sarcoma.