Highlights the importance of recognizing clinical features of undifferentiated pleomorphic sarcoma presenting as pathological fractures to avoid diagnostic delay and poor outcomes.
Alerts clinicians to sarcoma in atypical fractures; leaves open whether routine biopsy improves outcomes.
Bone sarcomas are a rare group of tumors arising mostly in the extremities, being the undifferentiated pleomorphic sarcoma (UPS), also known as malignant fibrous histiocytoma, the most common. UPS exhibits a wide spectrum of clinical behavior and a diagnosis challenge. We report a clinical case of a proximal humeral UPS that presented with a non-recognized pathological fracture, initially treated with open reduction and internal fixation. Suboptimal postoperative management of the patient, leading to a diagnosis delay, occurred related to its hematoid transformation, a variant of aggressive high-grade sarcoma associated with a worse prognosis. Pulmonary embolic complication, external axillary vein compression, rapidly tumor growth and diffuse metastization were some characteristics. Abrupt disease development makes important to recognize the clinical features of those tumors, so better outcomes can be obtained.
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Costa et al. (2018) studied this question.
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