Soft Tissue Sarcoma Masquerading as Chronic Hematoma: A Case Report and Literature Review

Area of Science:

• Oncology
• Radiology
• Pathology

Background:

• Soft tissue sarcomas can rarely present with symptoms mimicking intramuscular hematomas.
• Accurate differentiation is crucial for timely and appropriate patient management.

Observation:

• A 45-year-old male with a history of minor trauma developed a painful, swollen thigh mass initially diagnosed as a hematoma via MRI.
• Subsequent infection and imaging findings of gas in soft tissues led to suspicion of gas gangrene.
• Intraoperative frozen section revealed a spindle cell neoplasm, confirming sarcoma.

Findings:

• The patient was diagnosed with pleomorphic spindle cell sarcoma.
• Despite surgical intervention and treatment for secondary infection, the patient developed pulmonary metastases and succumbed to the disease.
• Bacterial infections (Acinetobacter baumannii, Enterobacter cloacae) contributed to gas formation in the soft tissues.

Implications:

• This case highlights the critical importance of considering malignancy in the differential diagnosis of post-traumatic soft tissue masses.
• Routine reliance on imaging alone can be misleading; histopathological examination is essential for definitive diagnosis.
• Heightened clinical suspicion and prompt biopsy are vital for distinguishing sarcomas from hematomas to prevent diagnostic delays and improve outcomes.