Extraskeletal myxoid chondrosarcoma (EMC) is an uncommon form of sarcoma that typically localizes to the limbs. It is considered a neoplasm of uncertain differentiation, and accounts for fewer than 3% of all sarcomas. EMC is twice as common in males as it is in females, and most commonly occurs around the age of 50. Since EMC does not have specifically characteristic findings in terms of clinical presentation, pathology, or imaging, differentiation from other neoplasms can be challenging. However, immunohistochemistry studies and molecular analysis aid in its definitive diagnosis. Current treatment guidelines of EMC include total resection of the primary tumor with a wide safe surgical margin. Post-operatively the patient should be closely followed-up due to the high possibility of metastasis and recurrence. Here we report a case of this challenging tumor and include a brief review of the literature.

The case presents a dual diagnostic challenge in a 40-year-old diabetic patient with a history of type 2 diabetes, smoking, and mood disorder. Initially presenting with abdominal pain and vomiting, appendicitis was suspected. However, her diagnosis changes upon performing an Electrocardiogram (ECG). During directed questioning, the patient reported chest pain and the diagnosis of acute myocardial infarction is confirmed. Coronary angiography is performed, achieving reperfusion of the culprit vessel in 120 minutes. Subsequently, an Abdomen and Pelvis CT Angiography revealed colonic perforation due to Intrauterine Device (IUD) migration, associated with a positive blood culture for multidrug-sensitive Escherichia coli. The importance of thorough medical history to identify atypical presentations of serious diseases, such as Acute Myocardial Infarction (AMI) in women, is highlighted. Additionally, the need for regular gynecological follow-up to detect and prevent complications associated with intrauterine devices is emphasized. This case underscores the importance of multidisciplinary management in complex clinical situations and underlines the relevance of maintaining a high index of diagnostic suspicion to adequately address the multiple facets of the disease in patients with comorbidities and atypical presentations.

A 47-year-old woman presented with recurrent abdominal distension for more than 2 years. The patient developed a feeling of fullness in the upper and middle abdomen after eating food 2 years ago. There was no nausea, vomiting, abdominal pain, diarrhea, acid regurgitation or heartburn.