肢體軟組織肉瘤以創傷後肌肉內血腫來呈現：罕見案例報告和文獻探討

Extremity Soft Tissue Sarcoma Mimicking Traumatic Intramuscular Hematoma: A Case Report and Review of the Literature

背景：在極少數的病人，軟組織肉瘤會以肌肉內血腫來表現。此一個案為初始臨床診斷為創傷後肌肉內血腫，但後續追蹤治療卻發現是橫紋肌肉瘤。

病例報告：一位60 歲的女性騎機車發生車禍，造成右下肢受傷。一開始的理學檢查 和影像學檢查沒有骨折的情形，但有明顯的肌肉內血腫，因此給予保守性治療。幾個月後，病人腫脹的範圍變大（16x4 公分）且疼痛加劇，於是來門診 求助。我們安排了一系列的檢查及治療，包含：核磁共振、組織切片及最終的手術腫塊切除。最後的病理報告顯示為多形性橫紋肌肉瘤。

討論：肢體軟組織肉瘤以創傷後肌肉內血腫來表現，甚少於文獻中被報告。在軟組織 中的慢性擴展性血腫有時難以和惡性肉瘤區分，因此要做出正確的診斷對臨床醫師來說是一個極大的挑戰。肢體受傷後肌肉內血腫是常見的，但一旦血腫呈 現的方式和進展與臨床的預期不一致時，就要更仔細的去評估受傷的病史、安排一系列影像學檢查、甚至組織切片來做進一步診斷。核磁共振是一個重要的 診斷工具，但不是百分百的準確。如果有任何診斷上的疑慮，可以安排系列的核磁共振看腫塊的惡性變化或是切片檢查，以減少錯誤的診斷。

結論：因為臨床表現和影像學的相似性，要確切的診斷是創傷後肌肉內血腫或是軟組 織肉瘤是不容易的，因此配合仔細的病史詢問、系列性影像檢查及組織切片可以用來增加診斷率。

 

Background: Soft tissue sarcoma can mimic intramuscular hematoma in rare cases. We report one patient with rhabdomyosarcoma mimicking traumatic intramuscular hematoma.

Case report: A 60-year-old patient had an episode of minor trauma to the lower limb. Initial clinical and image findings interpreted the swollen lump as an intramuscular hematoma. A few months later, the lesion had grown (16x4cm) and the pain worsened. After serial MRI exams, needle biopsy, and surgical resection, the final result showed pleomorphic rhabdomyosarcoma.

Discussion: Soft tissue sarcoma mimicking traumatic intramuscular hematomas in the extremity has rarely been reported in the literature. Chronic expanding hematoma over soft tissue can manifest as a space-occupying lesion which mimics a sarcoma. Accurately diagnosing this condition is challenging for the clinician. It is important to evaluate prior trauma history, perform serial images and even a biopsy with an unusual presentation of traumatic hematoma in the extremities. MRI is an important diagnostic tool, but if there is any doubt, a serial MRI and biopsy can help avoid the tragic consequences of a missed soft tissue sarcoma.

Conclusion: It may be difficult to differentiate soft tissue sarcoma from traumatic intramuscular hematoma due to similarities in clinical presentation and image characteristic. Careful history taking, serial MRI, and biopsy can assist in a more accurate diagnosis.