A 62-year-old Caucasian woman presented to her primary care provider with a recent notation of a lump in her right calf. She denies tenderness, but it bothers her. She has an 80–pack year history of smoking. She has COPD but is otherwise in average health. On initial examination, the lump was palpable, smooth, firm, and fixed. There were no abnormalities in the surrounding area of her lower extremity. She was scheduled for Doppler imaging, which revealed a solid mass with suggestion of increased vascularity. She was then sent for an MRI and subsequent consultation by both orthopedics and medical oncology. Surgical excisional pathology revealed a poorly differentiated leiomyosarcoma (LMS). Otherwise known as “soft tissue sarcoma,” LMS originates in the smooth or involuntary muscle. LMS is considered “treatable” when caught early.
LMS is rare but highly aggressive. This patient began radiation therapy but ultimately removed herself from treatment. She died within one year of her first presentation. (219-5)
These are letters from practitioners around the country who want to share their clinical problems and successes, observations and pearls with their colleagues. We invite you to participate. If you have a clinical pearl, submit it here.