Radiation-induced sarcoma presenting as a gluteal abscess: a diagnostic and therapeutic challenge

BMJ Case Rep. 2020 Dec 13;13(12):e236601. doi: 10.1136/bcr-2020-236601.

Abstract

Sarcomas are a rare and fatal treatment complication following radiotherapy. Radiation-induced sarcomas (RISs) presenting as a gluteal abscess is a rarity, accounting for its varied presentation. We present a case of a middle-aged woman, post-chemo-radiation for carcinoma cervix 5 years ago, who presented with gluteal abscess. Achieving haemostasis post incision and drainage under anaesthesia was a challenge. On further evaluation, she was diagnosed with radiation-induced gluteal soft tissue sarcoma. Haemostasis was achieved after radiation following failed attempts of surgical and radiological interventions. She is currently planned for chemotherapy. Cancer survivors have an increased risk of developing a second malignancy following radiation treatment. RISs are highly aggressive, exhibit a varied clinical presentation and pose a challenge in early diagnosis; thus, have a poor outcome. RISs pose a diagnostic challenge; any dubious lesion in the previously irradiated field should raise suspicion and prompt aggressive management.

Keywords: cervical cancer; interventional radiology; pain (palliative care); pathology; radiotherapy.

Publication types

  • Case Reports

MeSH terms

  • Abscess / diagnosis
  • Angiography, Digital Subtraction
  • Anus Diseases / diagnosis
  • Biopsy
  • Buttocks* / diagnostic imaging
  • Buttocks* / pathology
  • Carcinoma, Squamous Cell / radiotherapy
  • Computed Tomography Angiography
  • Diagnosis, Differential
  • Female
  • Hemorrhage / etiology
  • Hemorrhage / therapy
  • Hemostatic Techniques
  • Humans
  • Middle Aged
  • Neoplasms, Radiation-Induced / complications
  • Neoplasms, Radiation-Induced / diagnosis*
  • Neoplasms, Radiation-Induced / pathology
  • Neoplasms, Second Primary / complications
  • Neoplasms, Second Primary / diagnosis*
  • Neoplasms, Second Primary / pathology
  • Sarcoma / complications
  • Sarcoma / diagnosis*
  • Sarcoma / diagnostic imaging
  • Sarcoma / pathology
  • Tomography, X-Ray Computed
  • Uterine Cervical Neoplasms / radiotherapy