ArticleJournal of orthopaedic case reports2026
Undifferentiated Pleomorphic Sarcoma with Dual Smooth-Muscle and Osteogenic Differentiation Mimicking Plasma Cell Dyscrasia: A Rare Diagnostic Pitfall.
Article in Journal of orthopaedic case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Pleomorphic sarcoma (PS) is a high-grade soft-tissue malignancy with marked morphologic variability. Divergent differentiation is recognized, but dual smooth-muscle and osteogenic lineage differentiation is exceedingly rare and may mimic other malignancies. Case Report: A 52-year-old male presented with progressive low-back pain, weight loss, and an enlarging iliac mass. Magnetic resonance imaging showed multiple lytic lesions suggestive of plasma-cell dyscrasia; however, serum electrophoresis was negative. Histopathology revealed high-grade PS, and immunohistochemistry demonstrated simultaneous positivity for smooth-muscle actin and osteocalcin, confirming dual smooth-muscle and osteosarcomatous differentiation. The patient was referred to oncology for multidisciplinary management. Conclusion: PS with dual divergent differentiation represents a rare diagnostic challenge. Clinical and imaging features may falsely suggest hematologic malignancy, underscoring the necessity of correlating radiology, histopathology, and immunohistochemistry.
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