A Misdiagnosed Spindle Cell Sarcoma

Abstract

In recent years, outsourcing of medical services has become increasingly popular due to financial reasons. We describe a case of a 35-year-old Chinese female who presented with a tender left perianal lump and worsening pain. She had a magnetic resonce imaging of the rectum performed and reported overseas but unfortunately a left ischiorectal fossa mass was missed in the initial report. Subsequently, the patient was managed on the working diagnosis of an abscess and underwent an “excisional” biopsy of her perianal lesion. The lesion was confirmed to be malignant based on histological findings and the patient underwent neoadjuvant therapies followed by wide resection of the tumour. The tumour was eventually diagnosed as unclassified malignant spindle cell neoplasm. The patient eventually developed metastases in the lungs and bilateral inguinal lymph nodes and passed away six months post-operatively. Spindle-cell sarcomas comprise a group of highly heterogeneous soft tissue sarcomas that is best managed by an experienced multi-disciplinary team at a tertiary centre. This case highlights the importance of an early diagnosis and multi-modal approach towards sarcomas. Although certain overseas institutes provide excellent healthcare at significantly lower cost, identifying such centres are a challenge, especially for the layperson. Therefore, the risks and benefits of seeking medical services abroad should be carefully weighted and second opinions should be sought when in doubt.