They comprise less than 1% of all adult malignancies but are relatively common in the pediatric population, with an estimated incidence of 4 per 100,000 cases per year . Sarcomas are a very rare and heterogenous group of human malignant tumors of mesenchymal cells. Immunohistochemical stain (IHC) results were as follows: The histopathology results showed malignant spindle and epithelioid neoplasm with necrosis consistent with high-grade sarcoma. The differentials of the pelvic mass included lymphoma and STSs, and core needle biopsy was performed. To better identify the mass and its extent for possible surgical debulking, magnetic resonance imaging (MRI) of the abdomen and pelvis with contrast was also performed, which was remarkable for large pelvic mass fistulizing with the rectum (Figures 2, 3). A urinary catheter was placed, and broad-spectrum antibiotics including ciprofloxacin and metronidazole for bloody diarrhea was initiated, and he was admitted for further medical optimization. Stool cytology revealed numerous malignant spindle cells. Computed tomography (CT) of the abdomen and pelvis with contrast performed in the emergency department was remarkable for a 14.0 x 9.1 cm heterogenous solid mass fistulizing into the rectum (Figure 1), distension of the small bowel, and bilateral moderate hydronephrosis with possible hydroureter. Stool studies were unremarkable, and urine culture did not grow any microorganism. Initial laboratory workup including blood urea nitrogen, serum creatinine, electrolytes, hemoglobin, white blood cell count, platelet count, and lactic acid were all within normal limits. Subsequently, straight urinary catheterization was performed, which retrieved 900 mL of urine, with remarkable improvement in his symptoms. Emergent bladder scan showed that approximately 800 mL of urine was retained in the bladder. In the subsequent days, his symptoms worsened and he presented to the emergency department with severe lower abdominal pain, inability to void, and bloody diarrhea. His symptoms were attributed to enlarged prostate gland, and he was sent home on tamsulosin. His past medical history was significant for hypertension only. This is a very rare presentation of STS, and, to the best of our knowledge, only few similar cases have been reported thus far.Ī 68-year-old male presented to the primary care physician with difficulty in passing urine for two days. Core needle biopsy of the mass was performed, which showed malignant spindle and epithelioid neoplasm with necrosis consistent with high-grade sarcoma. To better identify the extent of disease, magnetic resonance imaging (MRI) with contrast was performed, which also revealed a similar large pelvic mass fistulizing into the rectum. All laboratory workup including complete blood count, complete metabolic panel, and urinalysis were within normal limits, but computed tomography (CT) of the abdomen and pelvis with contrast was remarkable for bilateral moderate hydronephrosis and a large 14 x 9.1 cm pelvic mass fistulizing into the rectum. Straight urinary catheterization retrieved 900 mL of urine, and a Foley catheter was placed. A 68-year-old male presented to the emergency department with abdominal pain, inability to void urine, and bloody diarrhea. We present a very interesting case of high-grade spindle cell sarcoma of the pelvis manifested as urinary retention and bloody diarrhea. Extremities are the most commonly affected anatomical sites, and majority of them present as a painless mass. Soft tissue sarcomas (STSs) are rare malignant tumors originating from mesenchymal cells.
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