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Background <p>Intermediate and high-grade soft tissue sarcomas (STS) can initially be misdiagnosed as haematomas. These cases can present a diagnostic challenge to clinicians and despite them being recognised in the literature they continue to be reviewed in sarcoma units as delayed presentations.</p> Methods <p>A retrospective analysis was performed over seven years (2014 to 2021) in one regional Sarcoma Unit at the North Bristol Trust in the United Kingdom. The inclusion criteria involved patients with a definitive diagnosis of STS following initial diagnosis by referring clinicians or preliminary imaging. The entire diagnostic workup for each patient was included such as method of diagnosis, histological analysis, operative treatment, radiotherapy and long-term follow up morbidity.</p> Results <p>Seven patients were included with an age range of 21-79 years. Tumours were not confined to a single region but located in the upper extremity, gluteal region, flank and the lower extremities. Most patients had an ultrasound performed first with false negative reports indicating benign pathology which resulted in a delayed referral to the sarcoma team. MRI alone suggested an STS diagnosis in 57% (n=4) of patients. Histology confirmed two angiosarcomas, two leiomyosarcomas, a spindle cell sarcoma, a myxoid liposarcoma and a round cell sarcoma, all of which were intermediate or high grade. One patient had metastases at time of diagnosis. Six patients underwent radical resection and two required free flap reconstruction.</p> Conclusions <p>This case series highlights some of the diagnostic challenges with STS. MRI scans proved to be useful in most cases raising the possibility of sarcoma which were eventually diagnosed with image-guided tissue biopsies or aspirations. Therefore, the authors advocate a specific diagnostic pathway for patients with chronic expanding haematomas to mitigate critical morbidity and the risk of mortality associated with a delayed diagnosis of an underlying STS.</p> <p>Level of Evidence: Level IV, diagnostic study.</p>

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The importance of correct diagnostic workup of chronic expanding haematomas with underlying soft tissue sarcomas: a case series

  • 期刊论文

  • 发表日期：

    2025年5月29日

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  • Edward Muscat,
  • Robert Slade,
  • Rachel Clancy,
  • Giulia Colavitti,
  • Thomas Wright

摘要

Background

Intermediate and high-grade soft tissue sarcomas (STS) can initially be misdiagnosed as haematomas. These cases can present a diagnostic challenge to clinicians and despite them being recognised in the literature they continue to be reviewed in sarcoma units as delayed presentations.

Methods

A retrospective analysis was performed over seven years (2014 to 2021) in one regional Sarcoma Unit at the North Bristol Trust in the United Kingdom. The inclusion criteria involved patients with a definitive diagnosis of STS following initial diagnosis by referring clinicians or preliminary imaging. The entire diagnostic workup for each patient was included such as method of diagnosis, histological analysis, operative treatment, radiotherapy and long-term follow up morbidity.

Results

Seven patients were included with an age range of 21-79 years. Tumours were not confined to a single region but located in the upper extremity, gluteal region, flank and the lower extremities. Most patients had an ultrasound performed first with false negative reports indicating benign pathology which resulted in a delayed referral to the sarcoma team. MRI alone suggested an STS diagnosis in 57% (n=4) of patients. Histology confirmed two angiosarcomas, two leiomyosarcomas, a spindle cell sarcoma, a myxoid liposarcoma and a round cell sarcoma, all of which were intermediate or high grade. One patient had metastases at time of diagnosis. Six patients underwent radical resection and two required free flap reconstruction.

Conclusions

This case series highlights some of the diagnostic challenges with STS. MRI scans proved to be useful in most cases raising the possibility of sarcoma which were eventually diagnosed with image-guided tissue biopsies or aspirations. Therefore, the authors advocate a specific diagnostic pathway for patients with chronic expanding haematomas to mitigate critical morbidity and the risk of mortality associated with a delayed diagnosis of an underlying STS.

Level of Evidence: Level IV, diagnostic study.