Patient: Female, 62Final Diagnosis: Undifferentiated pleomorphic sarcomaSymptoms: Pain in the legMedication: —Clinical Procedure: Surgical excisionSpecialty: OncologyObjective:Rare diseaseBackground:Sarcomas account for less than 1% of all cancers. Undifferentiated Pleomorphic Sarcoma, formerly called Malignant Fibrous Histiocytoma, is a rare subtype identified by a lack specific immunohistochemical markers for a specific lineage of differentiation. These soft tissue tumors are aggressive and rapidly enlarge. Risk for metastasis increases almost linearly as the tumor increases in size, emphasizing the importance of early detection, treatment, and post-resection monitoring.Case Report:This article reports a case of a large undifferentiated pleomorphic sarcoma of the posterior thigh in a 62-year-old female. Given the patient’s history of thrombotic thrombocytopenic purpure, her initial mass was thought to be a hematoma following a hernia repair surgery. After diagnosis of undifferentiated pleomorphic sarcoma, she underwent radical excision revealing a 24×9.5×7cm lesion – one of the largest reported in the literature.Conclusions:Sarcomas are very rare soft tissue neoplasms, but they should not be excluded in a physician’s differentials when a patient presents with an enlarging soft tissue mass. Because sarcomas enlarge rapidly, delay in evaluation and management should be avoided and these patients should be quickly referred to a center specializing in sarcoma treatment. Magnetic Resonance Imaging (MRI) is the recommended initial imaging for all soft tissue masses of the extremities, trunk, and head and neck while Computed Tomography (CT) is the recommended imaging choice for retroperitoneal and visceral masses. After successful surgical excision with clean margins, patients should undergo serial monitoring by CT or MRI for surveillance of recurrence or late pulmonary metastases.

Patient: Male, 58 Final Diagnosis: Spindle cell sarcoma Symptoms: Chest wall tenderness • painful paraspinal mass • shortness of breath Medication: — Clinical Procedure: Surgical excision with chemotherapy and radiation Specialty: Oncology Objective: Rare disease Background: Sarcomas account for less than 1% of all cancers. Spindle cell sarcomas are a rare form of soft tissue sarcomas classified as undifferentiated/unclassified based on their histomorphology. These tumors have a propensity for local recurrence and distant metastases are frequently found in the lungs. The risk for metastases increases with higher-grade malignancy and the size of the primary tumor. The often-painless nature of these tumors results in a delay in diagnosis, and physicians frequently overlook sarcomas in their differentials due to their rarity, complicating the disease process. Case Report: This article reports a case of a spindle cell sarcoma in the left paraspinal musculature in a 58-year-old Caucasian male; the tumor was excised in large pieces. There was an initial benign course, during which time the patient was undergoing regular imaging studies to evaluate for recurrence. Eight years later, the tumor metastasized to the lungs with an initial presentation of shortness of breath and pleural effusion on imaging. Conclusions: Sarcomas are very rare soft tissue neoplasms, but they should not be overlooked in a physician’s differentials, especially when evaluating an enlarging mass. Recommended treatment of choice is complete surgical excision with adequate resection margins of at least 1 cm or greater to a fascial barrier. Recurrence and late pulmonary metastases are common and metastatectomy is the recommended treatment choice if metastases are present.