Now referred to as undifferentiated pleomorphic sarcoma
The following case study is inspired by patient data taken directly from the Soft-tissue-Sarcoma Collection within The Cancer Imaging Archive (TCIA), a service that hosts an archive of publicly accessible de-identified cancer medical images.
- Name: Bernie Saxophone
- Gender: M
- Age: 49
- Cancer: Sarcoma
- Type: Soft tissue sarcoma (STS)
- Histology: Malignant fibrous histiocytoma
- Grade: High
- Site of primary STS: Right thigh
- Treatment: Surgery + radiotherapy + chemotherapy
- Outcome: Metastasis to lung
Bernie is a 49 year old man who noticed as he was walking up the stairs a dull aching pain in his right thigh. When he reached the top of the stairs, he saw that part of his right thigh was swollen and recalled that he had in fact bumped his right leg into the kitchen table a few days ago. He read some advice columns online that for muscle strain-like pain, icing the affected area would help. He did this for a couple days, but the tenderness did not go away. After five weeks, his wife brought to Bernie’s attention that not only was the mass still there, but had enlarged noticeably. After some persistent nagging from the wife, he finally made a trip to the doctor’s office.
At the doctor’s office, Bernie insisted that the enlarging lump was due to his injury over the kitchen table, and that over time the affected area would naturally heal on its own. The physician was not convinced after observing the rather large mass in his right thigh, and asked Bernie a few standard questions based on his complaints:
Physician: When did the pain start?
Bernie: About five weeks ago after bumping into the corner of the kitchen table.
Physician: Whendid you first notice this mass?
Bernie: While climbing a set of stairs, maybe a few days afterbumping into the kitchen table.
Physician: Has the mass been increasing in size?
Bernie: Yes, it does seem bigger than before.
Physician: Is the pain getting worse?
Bernie: Yes, but it’s probably part of the healing process. I’m not concerned.
Physician: Have you taken any medication for this?
Bernie: Occasionally a pain reliever here and there. I made sure to ice the area like articles on the Internet instructed.
With these answers and information gathered from the patient history, Bernie’s physician ordered a set of imaging tests including an X-ray, magnetic resonance (MR), computed tomography (CT) and positron emission tomography (PET) scans for better visualization of the right thigh. A biopsy was also arranged to extract tissue from the enlarged area on the thigh to evaluate whether there was cancerous activity, and if so, the aggressiveness of the tumor, i.e., pace of spread or tendency to recur.
The pathology report returned with a histology finding of high grade malignant fibrous histiocytoma, now referred to as undifferentiated pleomorphic sarcoma, on the right thigh. Taking into account all information collected, the physician concluded that the mass in Bernie’s right thigh was not swollen due to injury, but soft tissue sarcoma.
It is not uncommon for patients with this particular type of soft tissue sarcoma, particularly malignant fibrous histiocytoma, to assume that a newly formed lump was caused by a physical accident such as bumping into a table or a sharp corner. However, trauma is not known to cause malignant fibrous histiocytoma.1 Some patients with malignant fibrous histiocytoma also incorrectly assume that a swollen mass on the body, such as on the leg, is caused by muscle strain. The physician explained that the tenderness in Bernie’s leg following the kitchen table injury was coincidental with progression of his soft tissue sarcoma, and along those lines, icing the affected area would not have helped.