ABSTRACT
BACKGROUND: Deep venous thrombosis (DVT) or pulmonary embolism (PE) is a rare, but not exceptional presentation of soft tissue sarcomas (STSs). Due to the remarkable difference in the incidence between DVT or PE and STSs, this type of STS presentation is usually associated with a considerable delay in tumor diagnosis and treatment. CASE PRESENTATION: We describe two cases of STS who presented with DVT and PE. Physical and radiographic examination only showed the presence of DVT. Both patients were treated for DVT or PE for several months. Due to the persistence of symptoms and the inefficacy of anticoagulant therapy, magnetic resonance imaging (MRI) was performed, which revealed the presence of a lower limb mass in both cases. The definite diagnosis was reached via excisional biopsy and histological examination.In one case, MRI showed a large tumor in the anterior muscle compartment of the right thigh, with thrombosis of the right common femoral vein and involvement of the ipsilateral common iliac vein and inferior vena cava until the confluence of the renal veins. In the other case, MRI showed a large tumor in the middle third of the right thigh. The lesion was in close proximity to the superficial femoral vein that appeared compressed and showed signs of thrombosis. In both cases, histological examination revealed a high-grade leiomyosarcoma. CONCLUSION: STSs of the lower extremities can rarely present with DVT or PE. This possibility should be considered in the differential diagnosis of painful leg swelling, especially in patients with recurrent or refractory venous thrombosis. When a STS is suspected, MRI should be obtained followed by excisional biopsy of the eventual mass. A delay in diagnosis and treatment of STSs often results in very poor prognosis.Level of evidence. IV.
Subject(s)
Diagnostic Errors , Leiomyosarcoma/diagnosis , Lower Extremity/blood supply , Pulmonary Embolism/diagnosis , Soft Tissue Neoplasms/diagnosis , Venous Thrombosis/diagnosis , Adult , Anticoagulants/therapeutic use , Biopsy , Female , Humans , Leiomyosarcoma/complications , Leiomyosarcoma/therapy , Magnetic Resonance Imaging , Male , Middle Aged , Predictive Value of Tests , Pulmonary Embolism/drug therapy , Pulmonary Embolism/etiology , Soft Tissue Neoplasms/complications , Soft Tissue Neoplasms/therapy , Time Factors , Treatment Failure , Ultrasonography, Doppler, Color , Venous Thrombosis/drug therapy , Venous Thrombosis/etiologyABSTRACT
Tumoral calcinosis is an extremely rare benign condition that is characterised by deposits of calcium hydroxyapatite crystals in periarticular soft tissues. Although it is mainly located around large joints such as the hips, shoulders and elbows, it may also involve the small joints of hand and wrist. There are multiple types of tumoral calcinosis with divergent clinical characteristics but the exact cause is still unknown. We present a literature review to evaluate the location, clinical features, treatment options and results of surgical excision in this condition. Wide resection appears to lead to a good clinical outcome and a low incidence of local relapse.
