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Recurrent metastases in malignant tumor of left forearm

4-year-old boy presented with a lesion on his left forearm was diagnosed with small cell malignant neoplasm. It was thought that he had a malignant myoepithelioma but other reports suggested a primitive poorly differentiated neoplasia of neuro-ectodermal origin. He underwent surgery and chemotherapy but subsequently developed pulmonary metastases. The treating doctors recommended a second line chemo approach.