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Possible soft-tissue sarcoma presenting as an enlarging groin mass — MSRA MCQ

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HardHip and GroinPossible soft-tissue sarcoma presenting as an enlarging groin massMSRA

A 56-year-old woman presents with a 7-week history of a painless lump in the left groin. It was initially approximately 3 cm in diameter but she feels it has enlarged steadily. She has no weight loss, fever, night sweats, leg swelling or altered bowel habit. She has not noticed any variation in size with coughing, standing or lying down. Examination shows a firm, deep, poorly mobile 5 cm mass in the proximal medial thigh, just inferior to the inguinal ligament. It is non-tender, has no cough impulse and is not reducible. The overlying skin is normal. There is no clinically apparent inguinal lymphadenopathy and abdominal examination is unremarkable. What is the most appropriate next step in general practice?

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Correct answer: E — Arrange an urgent direct-access ultrasound scan to assess for soft-tissue sarcoma

The correct next step is urgent direct-access ultrasound. This is an unexplained soft-tissue mass in an adult that is enlarging, deep and poorly mobile. The absence of a cough impulse, reducibility or positional variation makes a hernia less likely, while the progressive increase in size means observation is inappropriate. NICE recommends urgent direct-access ultrasound for adults with an unexplained lump that is increasing in size to assess for soft-tissue sarcoma. A femoral hernia is an important differential diagnosis for a groin mass, particularly in women, but would more often have a cough impulse, be reducible or vary with position unless incarcerated; this lesion is painless and has none of these features. Direct suspected cancer pathway referral is premature: NICE specifies ultrasound first for an enlarging unexplained soft-tissue lump, with referral if ultrasound is suspicious or uncertain and concern persists. CT is not the recommended first-line primary-care investigation in this pathway and should not replace ultrasound. Delayed review risks postponing assessment of a potentially malignant soft-tissue mass.

Reference: Suspected cancer: recognition and referral (NG12) — Recommendations organised by site of cancer (2015; checked August 2026) — https://www.nice.org.uk/guidance/ng12/chapter/Recommendations-organised-by-site-of-cancer