Beware the Red Herring: Sarcomas Disguised as Hematomas

Orthopedic Oncologist and Sarcoma Surgeon, Dr. James C. Wittig, discusses the case of a patient with an interesting presentation and diagnosis!

In this case, a patient had a minor injury and began to develop a painless mass a month after the injury. The mass was growing rapidly. An MRI was performed that showed a mass filled with blood and other products. Because of the remote history of an injury and the presence of extensive bleeding into the mass, it was thought initially to be a hematoma which is a benign collection of blood often stemming from a muscle tear. The mass continued to grow and was ultimately biopsied. It turned out to be a high grade soft tissue sarcoma. Sarcomas can grow rapidly and cut off their blood supply causing necrosis and bleeding within the mass. Soft tissue sarcomas are usually painless and enlarge. Almost everybody with a soft tissue sarcomas gives a remote history of an injury which is insignificant and can distract a doctor or other healthcare provider from rendering the correct diagnosis. A hematoma enlarges immediately and reaches its maximum size within one day and is painful. Slowly a hematoma shrinks in size and the pain slowly goes away. One must have a high degree of suspicion for any mass that forms without a substantial trauma that is painless and enlarging. Don't let the history of an injury in the past cloud your differential diagnosis and how to approach the patient! Strongly consider biopsy.

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