Soft-Tissue Sarcoma Mimicking Large Haematoma: A Report of Two Cases and Review of the Literature

Abstract

We report on 2 patients with soft-tissue sarcomas mimicking large haematomas. Neither patient had a medical history of trauma or bleeding tendency. In a patient with a large leiomyosarcoma in the buttock, insufficient biopsy material from initial surgeries precluded a correct diagnosis. In the second patient with epithelioid sarcoma of the forearm, fasciotomy was repeatedly performed for compartment syndrome arising from the tumour. It is important to reconfirm prior trauma and investigate the clinical course and images of patients with an unusual history of haematoma in the extremities. The possibility of a malignant tumour should be suspected, and repeated biopsies should be performed if necessary.

Sarcoma the great “masquerader” hematoma/deep vein thrombosis manifestation

“…When a patient presents with an expanding, nontraumatic mass simulating a haematoma, several other differential diagnoses should be considered including aneurysm, bleeding tendency, chronic expanding haematoma and soft-tissue sarcoma [11].…”

Chronic Expanding Hematoma in the Dorsal Cervicothoracic Region as a Long-Term Complication of Retained Bullet Fragments: Case Report

“…The etiology of chronic expanding hematoma remains ambiguous; however, a number of theories have been presented within the literature [3, 8-9]. Displacement of subcutaneous tissue due to trauma or surgery may lead to the formation of a potential space, which fills with blood [9].…”

“…These substances are thought to impact the coagulation cascade and local vasculature and create a high osmotic pressure gradient, thus, causing further inflammation and bleeding [8]. As these lesions can mimic malignant tumors (in particular, soft tissue sarcoma), they present a diagnostic dilemma for clinicians [2-3]. …”

“…However, due to the non-specific nature of these lesions, it can be difficult to formulate a conclusive diagnosis [1]. Confusion can arise while assessing superficial masses clinically, particularly when distinguishing chronic expanding hematoma from malignant soft tissue sarcoma [2-3]. Furthermore, due to the rare occurrences of chronic expanding hematoma, which have variable anatomical and morphological characteristics, early and prompt diagnosis is rarely established [2, 4].…”

The Role of Ultrasound in the Diagnosis of Soft Tissue Tumors

“…Patient history may help, and hemorrhagic neoplasms are usually painless. Large hemorrhagic components were reported in many types of soft tissue sarcomas including angiosarcoma, synovial sarcoma, extraskeletal Ewing's sarcoma, liposarcoma, leiomyosarcoma, rhabdomyosarcoma, 59 epithelioid sarcomas, and malignant fibrous histiocytomas. 59,60 Reparative healing of muscle tears can also simulate soft tissue sarcomas 61 with its US appearances as irregular hyperechoic masses with marginal hyperemia and edema.…”