SOFT TISSUE SARCOMA PRESENTING AS A HEMATOMA: A REPORT OF THREE CASES

Quinn RH, Drenga JL (From the combined University of Connecticut/Hartford Hospital/Connecticut Children’s Medical Center Orthopedic Oncology Service, Hartford, CT, 06106)

Soft tissue sarcomas generally present as enlarging, painless masses with solid tissue characteristics on magnetic resonance imaging (MRI) and computerized tomography (CT). A soft tissue hematoma induced by trauma can occasionally be confused with the diagnosis of sarcoma. Less commonly, but potentially more ominous, a soft tissue sarcoma can present as an enlarging hematoma with delay in diagnosis and the possibility of mismanagement. We present three patients who presented with soft tissue masses consistent with hematomas on physical examination and diagnostic imaging, which later proved to be soft tissue sarcomas. All three patients were healthy individuals without a preceding history of trauma or a bleeding diathesis. Although the occasional soft tissue sarcoma presenting as a hematoma has been discussed often in oncologic circles, a review of the literature has revealed only a few such cases reported. Any patient presenting with an enlarging soft tissue mass, particularly in the absence of trauma, should be considered at risk for malignancy. Even if imaging studies support the diagnosis of a hematoma, failure to consider the possibility of sarcoma can lead to significant delay in diagnosis and inappropriate treatment can be limb or life threatening. When a suspicious hematoma is biopsied multiple samples should be obtained from within the hematoma cavity as the actual sarcomatous element can be quite small compared to the overall volume of the hematoma.