Lymphoma presenting as a soft tissue mass - A soft tissue sarcoma simulator

Lymphoma presenting as a soft tissue mass is rare and thus may be confused with the more common soft tissue sarcoma, No previous analysis of the clini cal and radiologic features of lymphomas presenting as soft tissue masses i s available because most of the cases reviewed are from the pathology liter ature. Four patients with diagnoses of extranodal lymphomas of the soft tis sues were reviewed retrospectively with respect to their clinical features, primary tumor characteristics, stage, radiographic characteristics, treatm ent, and followup, Mean age was 72.5 years (range, 52-85 years). The soft t issue mass occurred in the thigh (three cases) and shoulder (one case). The median size of the soft tissue mass was 6.7 cm (range, 2-15 cm) in the lar gest dimension, as measured on magnetic resonance imaging. These patients e ach had evidence of lymphadenopathy at the time of diagnosis. Lactate dehyd rogenase was increased significantly in two cases and increased slightly in two other cases. One case was Stage II(E) at presentation, one was Stage I II(E), and two were Stage IV. All were B cell immunophenotype, All patients died between 2 and 24 months after diagnosis, despite the use of Cytoxan, vincristine, adriamycin, and prednisone chemotherapy in each case. Clinical and radiographic features that favor extranodal soft tissue lymphoma over sarcoma include pain and tenderness, lymphadenopathy (particularly when con fluent radiologically), ipsilateral extremity swelling, and elevated lactat e dehydrogenase.