An Undifferentiated High-Grade Pleomorphic Sarcoma of Spleen Presenting as a Splenic Abscess

Primary sarcomas are the rarest among primary malignant splenic neoplasms. Undifferentiated pleomorphic sarcoma (UPS), described in the past as malignant fibrous histiocytoma (MFH) of spleen is an extremely rare soft tissue malignant neoplasm. Due to non-specific symptoms, delayed presentation and aggressive nature of the tumour, overall prognosis is poor. We report the management experience of a case of splenic UPS of a 52-year-old Sri Lankan female who presented with epigastric fullness and discomfort. Initial clinical and ultrasonographic impression was of a large complex cystic lesion probably arising from the spleen or distal pancreas. Computed tomography confirmed the lesion to origin from the spleen. Due to spiking temperature and rising inflammatory markers, clinical suspicion was made of a splenic abscess related to the complicated cyst. At the laparotomy, a large predominantly cystic mass with concealed leaks arising from the spleen was noted containing inflammatory material within cyst cavities. The mass was adherent to the stomach and diaphragm. The patient underwent splenectomy with an uncomplicated post-operative period. Histology confirmed the lesion to be a UPS of the spleen and the patient was scheduled for a staging whole-body computed tomography. Unfortunately, she defaulted follow-up after 4 weeks from surgery and got readmitted as an emergency after 3 months with abdominal pain, distention and constitutional symptoms complicated with acute kidney injury. Ultrasonography proved her to have massive early local tumour recurrence and she succumbed due to the illness. This is the first reported case of UPS of the spleen in Sri Lanka.