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Open Access Case report

Misdiagnosis of soft tissue sarcomas of the lower limb associated with deep venous thrombosis: report of two cases and review of the literature

Carlo Perisano1*, Nicola Maffulli2, Pamela Colelli3, Emanuele Marzetti1, Alfredo Schiavone Panni4 and Giulio Maccauro1

Author affiliations

1 Department of Geriatrics, Neurosciences and Orthopedics, University Hospital “Agostino Gemelli”, Catholic University of the Sacred Heart School of Medicine, L.go A. Gemelli 1, 00168, Rome, Italy

2 Centre for Sports and Exercise Medicine, Queen Mary, University of London Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Rd, London, E1 4DG, UK

3 Department of Radiology, Hospital ”A.Perrino”, S.S.7 – 72100, Brindisi, Italy

4 Department of Health Science, University of Molise, Campobasso, Italy

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Citation and License

BMC Musculoskeletal Disorders 2013, 14:64  doi:10.1186/1471-2474-14-64

Published: 19 February 2013

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

Keywords:
Leiomyosarcoma; Venous thromboembolism; Lower extremity sarcoma; Pulmonary embolism