Epithelioid sarcoma is a rare soft tissue tumor with unclear histogenesis that represents the most common soft tissue sarcoma of a hand. This tumor is often mistaken for a chronic inflammatory process or necrotizing granuloma due to its innocuous presentation as well as unusual both epithelial and mesenchymal differentiation (immunohistochemistry stains were positive for vimentin and cytokeratin 8). Epithelioid sarcoma has known propensity for pulmonary metastases, which can present as cystic lesions and be complicated by the development of pneumothorax and hemorrhage.