Beware the sarcoma
Don’t assume a swelling is benign
Six weeks previously a 67 year old man had undergone an unplanned excision of a presumed benign lipoma. During the surgery a lesion the size of a cricket ball was located just below his right scapula and removed. The lump had been increasing in size over a period of 18 months and was painless. The lump was sent for routine histology (figure). A sarcoma was subsequently diagnosed.
The patient presents to you in the sarcoma clinic. On review, he has a 15 cm transverse scar inferior to his scapula that has healed well. No masses are palpable under the scar tissue and there is no regional lymphadenopathy. The patient is advised to undergo magnetic resonance imaging, and computed tomography staging studies of his chest. His magnetic resonance imaging scan does not exclude residual disease, and the computed tomogram of the chest does not show metastasis.
(1) What does the histology