Case 689 -- An 86 year-old woman with a sacrococcygeal mass

Contributed by Milon Amin, MD and Sara Monaco, MD

An 86-year-old woman presented to an outpatient orthopedic clinic with lower back pain, exacerbated by sitting. She also noted the presence of a 'bump' in her lower back that was slowly growing over the past two years.

Physical examination revealed a firm, palpable area in the sacrococcygeal region. The skin overlying this mass was intact, with some erythema and bluish discoloration. A computed tomography scan showed a 10 x 9 x 8 cm soft tissue mass in the sacrococcygeal region.

A fine needle aspiration (FNA) of this mass was performed by the pathologist.

After reviewing the Romanowsky-type stained slides (Images 1, 2, 3 and 4), the clinician asks for an immediate impression.


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