Multifocal Superficial Rapidly Growing Postirradiation Sarcoma Mimicking Metastatic Carcinoma

Radiation induced sarcomas (RIS) on cytology is rare however need to be reported as they are histologically distinct from the primary tumor and arise years after completion of the radiotherapy. Fine needle aspiration cytology is mostly indicated in cancer patients suspected of recurrence/metastasis and rarely in secondary tumors post therapy or irradiation. Depending on the morphology and site of occurrence of RIS they can cause diagnostic difficulty with the primary carcinoma or sarcoma that was irradiated. Here we discuss a 49 yr old lady, known and treated case of carcinoma cervix who presented with multiple nodular swellings in the lower back and gluteal region and had clinical impression of metastatic carcinoma. The fine needle aspiration cytology smears revealed pleomorphic spindle shaped cells with abundant mitotic figures. Extensive immunocytochemical work up was done on the smear and cell block which helped to make a final conclusion of radiation induced pleomorphic sarcoma. The diagnosis of a tumor in a proven case of previous malignancy needs consideration of tumors secondary to therapy as well, along with the diagnostic differentials of metastasis or recurrence.