Image Quiz
Thigh Mass in a Fifty-five-Year-Old Woman1
Amanda L. Tencza, MD, Rachel L. Slotcavage, MD, and Richard D. Lackman, MD*,
Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, Ohio (A.L.T.), and Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania (R.L.S. and R.D.L.). E-mail address for R.D. Lackman: rilack@pahosp.com
A fifty-five-year-old woman presented to our center with a mass in the left thigh that she had discovered several weeks earlier. The patient had experienced no trauma to the area, and she had no pain associated with the mass.
An atypical lipoma had been excised from the left side of the pelvis fifteen years earlier. There were two recurrences of this lesion, nine and seven years prior to the current presentation, for which the histologic diagnosis had been high-grade dedifferentiated liposarcoma. Both recurrent lesions had been treated with limb-sparing surgery. In addition, neoadjuvant radiation therapy had been administered prior to surgical excision of the lesion at the time of the first recurrence, and neoadjuvant chemotherapy had been administered at the time of the second recurrence. Metastatic lesions to the lung were found six years after the onset of dedifferentiation and again three years prior to the current presentation, and the patient had been managed with metastasectomy and additional chemotherapy at that time. An additional dedifferentiated liposarcoma of the right thigh had developed two years prior to the current presentation, and that lesion had been treated with local radiation and wide excision. Fifteen months prior to the current presentation, a new mass had been discovered in the left thigh and had been resected; the histologic examination of the resected specimen showed negative surgical margins and the tumor was diagnosed as an atypical lipoma.
At the time of the current presentation, physical examination revealed a new nontender mass, palpable on the lateral aspect of the left thigh. The mass was not associated with any warmth, erythema, or skin changes. Muscle strength and sensation were fully intact throughout the limb. No edema was noted, and a full painless range of motion was present at the hip and knee joints. Magnetic resonance images were acquired (Figs. 1 and 2).
Fig. 1 |
Fig. 2 |
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