Negin Ceraolo, M.D., M.S.

Undifferentiated pleomorphic sarcoma is uncommonly seen and can be present in soft tissue as a slow-growing and painless mass. The usual presenting symptoms of these tumors are swelling, pain, and constitutional symptoms. However, an initial presentation of pleomorphic sarcoma as an embolic stroke is rarely seen. We report a patient who presented with cerebellar stroke and had widespread pulmonary nodules on chest X-ray. The Computed Tomography (CT)-guided biopsy of the pulmonary nodules revealed a diagnosis of undifferentiated pleomorphic sarcoma. These findings prompted a thorough physical examination in search of malignancy. Unfortunately, the patient was found to have left leg swelling, which was missed on the initial exam, delaying diagnosis and management. Additionally, the patient was found to have a patent foramen ovale (PFO) on transesophageal echocardiogram (TEE). However, no source of emboli was found.