Objectives: To discuss the differential diagnosis of a case with leg swelling and pain with special emphasis on soft-tissue malignancy.
Methods: Symptomatic deep vein thrombosis (DVT) of lower limb was treated with standard anticoagulants. In view of persistent symptoms for three months, repeat duplex venography, magnetic resonance imaging (MRI) and biopsy were undertaken to uncover the underlying pathology.
Results: Imaging and biopsy revealed a 5 x 11 cm myxoid liposarcoma, adherent to the vein, that was the cause of her persistent symptoms despite anticoagulation, possibly by its local mass effect and also by its potential to create a thrombogenic milieu. Excision of the tumour led to symptom relief. A Medline search of English language papers was undertaken to review related literature.
Conclusion: The report highlights the importance of considering neo-plastic masses as differential in painful leg swelling. Diagnosis is made by a high index of suspicion in atypical cases and confirmed by follow-up duplex or MRI. Treatment involves surgical excision that provides symptom relief as well as avoids potential tumour extension.