Abstract
Purpose: Case to highlight the difficulties and delays in diagnosing pelvic soft tissue tumours.
Introduction: A 32 year old female presented with long standing lower back pain. She had a history of a road traffic accident four years prior which lead to a splenectomy. Over the next few years she had intermittent episodes of increasing pain in the lower back, groin and right leg. These symptoms were attributed to the RTA and she was given a course of physiotherapy.
There were no focal neurological signs and lumbar spine movements were normal. However, she did have some pain inhibition in her proximal muscles and difficulty weight bearing in her leg.
Lumbar spine x-rays showed grade II spondylolytic spondylolisthesis at L5/S1. MR scan of the lumbar spine confirmed this with some facet joint degeneration. She was sent back for more physiotherapy.
Six months later she presented with increasing pain in the right hip and a lump in the right groin. Subsequent MR scan showed a large 20cm x 15cm x 10cm lobulated soft tissue mass within the right obturator space extending through the foramen to lie in the adductor space with infiltration into right hip joint. She had a radical resection but later developed lung metastases.
Conclusion: This case highlights the difficulties in diagnosing pelvic soft tissue tumours especially with lower back pain. We should have a high index of suspicion in all young patients who present with intermittent flare up of groin/pelvic pain and no sign of inflammatory pathology. Once cutaneous signs appear it is often too late.
Correspondence should be addressed to BOOS at the Royal College of Surgeons, 35 - 43 Lincoln’s Inn Fields, London WC2A 3PN
