Misdiagnosis of soft tissue sarcomas of the lower limb associated with deep venous thrombosis: report of two cases and review of the literature
OPEN BMC musculoskeletal disorders | 21 Feb 2013
C Perisano, N Maffulli, P Colelli, E Marzetti, AS Panni and G Maccauro
BACKGROUND: Deep venous thrombosis (DVT) or pulmonary embolism (PE) is a rare, but not exceptional presentation of soft tissue sarcomas (STSs). Due to the remarkable difference in the incidence of the two conditions, this type of STS presentation is usually associated with a considerable delay in the diagnosis and treatment of the tumor.Case Presentation: We describe two cases of STS who presented with DVT and PE. Physical examination and ultrasound only revealed the presence of DVT. Both patients were treated for DVT for several months. Due to the persistence of symptoms and the inefficacy of anticoagulant therapy, magnetic resonance imaging (MRI) was performed, which revealed the presence of a mass in both cases. The definite diagnosis was reached via excisional biopsy and histological examination.In one case, MRI showed a large tumor in the anterior muscle compartment of the right thigh, with thrombosis of the right common femoral vein and involvement of the ipsilateral common iliac vein and inferior vena cava until the confluence of the renal veins. In the other case, MRI showed a large tumor in the middle third of the right thigh. The lesion was in close proximity to the superficial femoral vein that appeared compressed and showed signs of thrombosis. In both cases, histological examination revealed a high-grade leiomyosarcoma. CONCLUSION: STSs of the lower extremities can rarely present with DVT or PE. This possibility should be considered in the differential diagnosis of painful leg swelling, especially in patients with recurrent or refractory venous thrombosis. When a STS is suspected, MRI should be obtained followed by excisional biopsy of the eventual mass. A delay in diagnosis and treatment of STSs often results in very poor prognosis.Level of evidence. IV.
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