Spindle Cell Sarcoma of the Paraspinal Musculature with Late Pulmonary Metastases

Patient: Male, 58 Final Diagnosis: Spindle cell sarcoma Symptoms: Chest wall tenderness • painful paraspinal mass • shortness of breath Medication: — Clinical Procedure: Surgical excision with chemotherapy and radiation Specialty: Oncology OBJECTIVE: Rare disease BACKGROUND: Sarcomas account for less than 1% of all cancers. Spindle cell sarcomas are a rare form of soft tissue sarcomas classified as undifferentiated/unclassified based on their histomorphology. These tumors have a propensity for local recurrence and distant metastases are frequently found in the lungs. The risk for metastases increases with higher-grade malignancy and the size of the primary tumor. The often-painless nature of these tumors results in a delay in diagnosis, and physicians frequently overlook sarcomas in their differentials due to their rarity, complicating the disease process. CASE REPORT: This article reports a case of a spindle cell sarcoma in the left paraspinal musculature in a 58-year-old Caucasian male; the tumor was excised in large pieces. There was an initial benign course, during which time the patient was undergoing regular imaging studies to evaluate for recurrence. Eight years later, the tumor metastasized to the lungs with an initial presentation of shortness of breath and pleural effusion on imaging. CONCLUSIONS: Sarcomas are very rare soft tissue neoplasms, but they should not be overlooked in a physician’s differentials, especially when evaluating an enlarging mass. Recommended treatment of choice is complete surgical excision with adequate resection margins of at least 1 cm or greater to a fascial barrier. Recurrence and late pulmonary metastases are common and metastatectomy is the recommended treatment choice if metastases are present.