Chronic Cavitary Pulmonary Metastases Mimicking Infection in Epithelioid Sarcoma: A Case Report

Introduction: Epithelioid sarcoma is a rare soft tissue malignancy with a high propensity for local recurrence and distant metastasis, usually to the lungs. Pulmonary metastases typically appear as solid nodules, whereas cavitary pulmonary metastases are exceptionally rare and may closely mimic infectious lung disease. Case Presentation: Herein, we report the case of a woman diagnosed with epithelioid sarcoma of the foot at 26 years of age. She developed slowly progressive cavitary pulmonary lesions more than a decade after initial treatment. During long-term follow-up without adjuvant therapy, small pulmonary nodules gradually evolved into cavitary lesions, raising strong suspicion for tuberculosis or fungal infection rather than metastatic disease. Video-assisted thoracic surgery was performed for definitive diagnosis and treatment, and histopathological examination confirmed metastatic epithelioid sarcoma. Conclusion: This case underscores the fact that epithelioid sarcoma can present as a chronic cavitary pulmonary disease that mimics infection. Clinicians should consider metastatic disease in the differential diagnoses of cavitary lung lesions in patients with a history of this malignancy.