Sarcoma or Carcinoma ?

Today's interesting pt:

Patient presented with abdominal swelling and hematuria, 

USG showed a mass lesion in left iliac fossa and lumbar region, with left sided HUN

CT Urography shows, 

  • An irregular heterogenous enhancing mass with epicentre in rectovesical pouch region/ presacral region with infiltration of left VUJ, with upstream left HUN. 
  • No calcifications within. 
  • Prostate appears separate from the lesion. 
  • Multiple pleural enhancing nodules with thickening and effusion noted in right hemithorax - metastatic lesions.
  • No mediastinal/ retroperitoneal/ pelvic lymphadenopathy. No focal lesion in liver/ adrenal/ bones. 
  • No obvious bowel origin, focal infiltration of sigmoid colon noted. 
  • Arterial supply from IMA. 
  • Closely abutting lower lumbar and upper sacral vertebrae.

Distal ureteric infiltration and right pleural deposits. 


Left CIA and EIA encasement by the lesion. 

Inferiorly infiltrating bladder along distal ureter/ UVjunction. 

Differential diagnosis:

  • Lesion appears infiltrative into adjacent structures, with pleural mets. no lymph node/ hematological mets. 
  • Possibly: Carcinoma > sarcoma. 
  • TCC, or any other epithelial carcinoma. 
  • Desmoplastic small round cell tumor,
  • GIST, 
  • Presacral malignant masses - MPNST.  
One another rare differential for a presacral mass - Extramedullary hematopoiesis.

P.S: Pt is yet to undergo biopsy/ will update once it is done and reported. 

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