A diagnostic dilemma—to operate or not to operate—a rare case report

TL;DR

A 41-year-old man with a complex flank swelling faces a difficult decision between surgery or nonsurgical treatment due to an uncertain diagnosis.

Contribution

This case report highlights diagnostic challenges in distinguishing sarcoma from lymphomatous malignancy and plasmacytic infiltrate.

Findings

Initial core biopsy suggested undifferentiated sarcoma, but further testing indicated lymphomatous origin.

Final diagnosis was plasmacytic infiltrate of uncertain clinical significance.

No definitive treatment plan could be decided due to diagnostic uncertainty.

Abstract

A 41-year-old male presented with a swelling in the right flank present since 2 years. Initially, it was small in size but increased in size for the past 6 months. Examination revealed a large swelling in the right flank that was soft in consistency and attached to the deeper muscle. CT scan revealed a heterogenous complex swelling with attachment to the underlying muscle. Core biopsy of the lesion was reported as undifferentiated sarcoma. After immunohistochemistry markers, the diagnosis was revised to a malignancy of a lymphomatous origin. Gene sequencing studies and extensive higher marker studies were done and a final diagnosis of plasmacytic infiltrate of uncertain clinical significance was reported. With no further diagnostic options available, the case still remains to be a diagnostic challenge as the choice of treatment between surgical resection and nonsurgical treatment with chemotherapy and/or radiation cannot be decided upon.

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