title: Misdiagnosis of soft tissue sarcomas of the lower limb associated with deep venous thrombosis: report of two cases and review of the literature.
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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors: 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. carloperisano@hotmail.it
authors: Carlo
authors: C
authors: Perisano
authors: Nicola
authors: N
authors: Maffulli
authors: Pamela
authors: P
authors: Colelli
authors: Emanuele
authors: E
authors: Marzetti
authors: Alfredo Schiavone
authors: AS
authors: Panni
authors: Giulio
authors: G
authors: Maccauro
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D001706:Biopsy; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D007890:Leiomyosarcoma / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D035002:Lower Extremity / Q000098:blood supply*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D012983:Soft Tissue Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D013997:Time Factors; D017211:Treatment Failure; D018615:Ultrasonography, Doppler, Color; D020246:Venous Thrombosis / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology
chemical_list: D000925:Anticoagulants