Soft-Tissue Sarcoma Masquerading as a Haematoma

Abstract

Sarcomas commonly occur in the buttock and thigh, although the clinical presentation varies with no specific symptoms other than a painless lump. This case study reports on a soft-tissue sarcoma that was initially thought to be a haematoma on ultrasound, despite being rescanned 6 weeks later. The patient presented back to their general practitioner 8 months later with the subsequent ultrasound showing an irregular and hypervascular soft-tissue mass. Further imaging and ultrasound-guided biopsy led to a surgical excision of a myxofibrosarcoma. This case demonstrates the difficulty of differentiating between a haematoma and sarcoma, especially in patients presenting with a history of trauma.

Ultrasound of myxofibrosarcoma

“…Myxofibrosarcomas may also appear plate-like and hypoechoic (Fig. 7) [6] or may lose the nodular appearance and become more infiltrative over time [1], presenting as a completely infiltrative lesion extending along fascial planes [3,7]. The infiltrative nature of myxofibrosarcoma has been well-described in the literature, with a particular propensity for local spread, especially in low-grade tumors [1,3].…”

“…There are variable degrees of intrinsic echogenic septations, which vary in thickness, as well as variable degrees of cystic changes and vascularity (Figs. 6,7,8). The cystic changes correspond to areas of myxoid matrix accumulation, necrosis, or bleeding which frequently occur in these tumors [1].…”

“…The variability in appearance and size of myxofibrosarcomas [1,6,11] poses a diagnostic challenge on initial evaluation as well as on follow-up imaging with US. Myxofibrosarcomas may present with a plate-like morphology mimicking a hematoma which could result in a diagnostic delay and disease progression (Fig.…”

“…Myxofibrosarcomas may present with a plate-like morphology mimicking a hematoma which could result in a diagnostic delay and disease progression (Fig. 14) [6]. Early myxofibrosarcoma recurrence may be irregular/infiltrative (Fig.…”

“…In such cases, further evaluation with MRI is recommended. A diagnosis of hematoma on ultrasound should be made with caution, especially involving the extremities in the older age population given the overlap in ultrasound appearance between myxofibrosarcoma and hematoma [6,19] and MRI should be strongly considered. masses and contrast administration should be considered in US evaluation of palpable masses [24].…”