Benign and Malignant Soft Tissue Tumors 

  • Author: Vinod B Shidham, MD, FRCPath; Chief Editor: Harris Gellman, MD   more...
 
Updated: Feb 6, 2012
 

History of the Procedure

Present achievements in the field of soft tissue tumors are the result of advances in molecular biology, oncogenetics, imaging techniques, immunochemistry, diagnosis by fine-needle aspiration, surgical reconstruction, radiation therapy, and tissue banking. Benign soft tissue tumors are fairly common and are treated with surgery alone. Prior to the 1970s, surgery was the primary therapy for malignant soft tissue tumors, and most patients with high-grade tumors had a poor prognosis and a significant mortality rate. Since the mid-1970s, radiation therapy, chemotherapy, and advanced surgical techniques have helped increase long-term survival and decrease the need for ablative surgery.[1] Future advances in molecular oncology may further improve diagnostic, prognostic, and treatment protocols for patients with soft tissue sarcomas.[2, 3]

Next

Problem

Soft tissue is defined as the supportive tissue of various organs and the nonepithelial, extraskeletal structures exclusive of lymphohematopoietic tissues. It includes fibrous connective tissue, adipose tissue, skeletal muscle, blood/lymph vessels, and the peripheral nervous system. Embryologically, most of it is derived from mesoderm, with a neuroectodermal contribution in the case of peripheral nerves. See the images below.

A computed-tomography (CT)–guided needle biopsy ofA computed-tomography (CT)–guided needle biopsy of a high-grade soft tissue sarcoma arising in the left hemipelvis. The CT artifact from the needle can be seen in the upper right corner of the image as the needle enters the lesion just anterior and medial to the dome of the left hip joint. Courtesy of Howard A. Chansky, MD Magnetic resonance imaging (MRI) is used to demonsMagnetic resonance imaging (MRI) is used to demonstrate involvement of critical structures by tumor. This recurrent, high-grade soft tissue sarcoma in the posterior calf abuts the tibial nerve and posterior tibial vessels. An extensive reactive zone surrounds the structures. This patient was treated with below-knee amputation. Courtesy of Howard A. Chansky, MD

Soft tissue tumors are a large and heterogeneous group of neoplasms. Traditionally, tumors have been classified according to histogenetic features. (Fibrosarcoma, for example, is categorized as a tumor arising from fibroblasts.) However, histomorphologic, immunohistochemical, and experimental data suggest that most, if not all, sarcomas arise from primitive, multipotential mesenchymal cells, which in the course of neoplastic transformation differentiate along one or more lines. A liposarcoma appears to arise from a lipoblast but may actually develop through lipoblastic differentiation of a precursor multipotent mesenchymal cell. At the clinical level, soft tissue tumors are classified according to various parameters, including location, growth pattern, likelihood of recurrence, presence and distribution of metastases, patient age, and prognosis.

Although most soft tissue tumors of various histogenetic types are classified as either benign or malignant, many are of an intermediate nature, which typically implies aggressive local behavior with a low to moderate propensity to metastasize.

Previous
Next

Epidemiology

Frequency

In general, benign soft tissue tumors occur at least 10 times more frequently than malignant ones, although the true incidence of soft tissue tumors is not well documented.

However, some insight regarding the incidence of soft tissue sarcomas can be derived from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program, which, between 1973 and 1983, accumulated data on 6883 such tumors.

  • Overall, age-adjusted annual incidence of soft tissue sarcomas ranges from 15-35 per 1 million population. The rate increases steadily with age and is slightly higher in men than in women.
  • Malignant soft tissue tumors occur twice as often as primary bone sarcomas.
  • Approximately 45% of sarcomas occur in the lower extremities, 15% in the upper extremities, 10% in the head-and-neck region, 15% in the retroperitoneum, and the remaining 15% in the abdominal and chest wall. Visceral sarcomas, arising from the connective tissue stroma in parenchymal organs, are not common.
  • The different types of soft tissue tumors have distinct age distributions.
    • Rhabdomyosarcoma is seen more frequently in children and young adults.
    • Synovial sarcoma arises in young adults.
    • Malignant fibrous histiocytoma and liposarcoma generally occur in older adults.
  • Benign deep masses in adults usually are due to intramuscular lipoma.
  • In general, the prognosis in older patients with a diagnosis of high-grade sarcoma is poor.
  • The incidence of soft tissue tumors is slightly higher in males than in females.
Previous
Next

Etiology

Genetic conditions

Good evidence exists suggesting that certain genetic disorders and gene mutations are predisposing factors for some benign and malignant soft tissue tumors. The NF1 gene in neurofibromatosis is a classic example, predisposing patients to multiple neurofibromas with a proclivity for malignant transformation. Many tumor suppressor genes, oncogenes, and cytogenetic defects are now associated with various soft tissue sarcomas. Other clinical risk factors account for a small proportion of soft tissue malignancies.

A partial list of reported cytogenetic abnormalities is shown in Table 1. They have a significant role in diagnosis, and, in the future, some of these abnormalities may become therapeutically significant. Specific translocations involving selected genes have been observed. One of these, the t(X;18) translocation in synovial sarcoma, results in fusion of the SYT gene from chromosome 18 to either of 2 highly homologous genes at Xp11, SSX1 or SSX2.SYT-SSX fusion transcript may be detected by reverse transcriptase-polymerase chain reaction assay, using a cytologic specimen from fine-needle aspiration biopsy (FNAB), histologic material from paraffin block, or frozen material.

Radiation

Similar to postirradiation bone tumors, postirradiation fibrosarcomas have been described. The pathogenetic mechanism is the emergence of radiation-induced genetic mutations that encourage neoplastic transformation.

Chronic lymphedema

As observed in patients with late-stage breast carcinoma, chronic lymphedema may predispose individuals to the development of lymphangiosarcoma.

Environmental carcinogens

An association between exposure to various carcinogens and an increased incidence of soft tissue tumors has been reported. The occurrence of hepatic angiosarcoma, for example, has been linked to arsenic, thorium dioxide, and vinyl chloride exposure.

Infection

A classic example of an infection-induced soft tissue tumor is Kaposi sarcoma resulting from human herpesvirus type 8 in patients with human immunodeficiency virus (HIV). Infection with Epstein-Barr virus in an immunocompromised host also increases the likelihood of soft tissue tumor development.

Trauma

The relationship between trauma and soft tissue tumors appears to be coincidental. Trauma probably draws medical attention to a pre-existing lesion.

Previous
Next

Pathophysiology

Generally, soft tissue tumors grow centripetally, although some benign tumors, such as fibrous lesions, may grow longitudinally along tissue planes. Most soft tissue tumors respect fascial boundaries, remaining confined to the compartment of origin until the later stages of development. Once the tumor reaches the anatomic limits of the compartment, the tumor is more likely to breach compartmental boundaries. Major neurovascular structures usually are displaced as opposed to being enveloped or invaded by tumor. Tumors arising in extracompartmental locations, such as the popliteal fossa, may expand more quickly because of a lack of fascial boundaries; they are also more likely to involve neurovascular structures.

The peripheral portion of the tumor compresses surrounding, normal soft tissue because of centripetal expansile growth. This results in the formation of a relatively well-defined zone of compressed fibrous tissue potentially containing scattered tumor cells. This zone may also consist of inflammatory cells and demonstrate neovascularity. A thin layer of tissue called the reactive zone surrounds the compression zone, especially in higher-grade tumors. Together, the compression and reactive zones form a pseudocapsule that encloses the tumor and is useful in defining the extent of surgical resection.

Some extremely aggressive lesions with infiltrative growth patterns, such as childhood rhabdomyosarcoma, may not respect anatomic compartmental boundaries and frequently will invade fascial planes.

Local recurrence

Soft tissue sarcomas have the propensity to recur locally. Because recurrences are more difficult to treat than the primary lesion is, complete resection and appropriate use of radiation therapy are critical during the initial treatment. The pseudocapsule provides surgeons with a more or less obvious plane of dissection; however, such an excision can leave behind microscopic or occasionally gross tumor. This may lead to local recurrences in up to 80% of patients.[4] The addition of postoperative radiation therapy decreases the risk of recurrence associated with a marginal resection.

Technical ease of resectability (and, thus, the likelihood of local control) may be affected by the location of a soft tissue sarcoma. For example, lesions of the head and neck are more likely to involve or abut vital structures; consequently, they often are more difficult to resect than are lesions of the extremities. Even in an extremity, the tumor site may have prognostic implications. For proximal tumors, local control is more difficult to achieve than in tumors located more distally. Retroperitoneal sarcomas, which typically have a poor prognosis, have a higher proclivity for local recurrence and for intra-abdominal dissemination.

The pattern of recurrence generally is predictable, and most tumors destined to recur do so within the first 2-3 years. Adjuvant radiation therapy clearly minimizes local recurrence, but its ability to increase overall chances of survival, although likely, is not certain. Adjuvant chemotherapy may decrease the risk of local recurrence of high-grade tumors, presumably because of a reduction in the size of the tumor and an increase in the reactive zone, but this notion is very controversial.

Distant metastasis

Regional lymph node involvement is rare in soft tissue sarcomas; fewer than 4% of cases have nodal metastases at presentation. Lymph node involvement is more frequent in epithelioid sarcoma, rhabdomyosarcoma, synovial sarcoma, and clear cell sarcoma. Carcinoma and melanoma should be included in the differential diagnosis for any mass presenting with lymph node metastases.

Many patients with high-grade soft tissue sarcomas, as well as a few with the low-grade type, progress to metastatic disease, even following adequate local control of the primary tumor. The lung is by far the most common site of metastasis, which occurs in up to 52% of patients with high-grade lesions.[5] Although, at the time of presentation, most patients do not have clinically evident metastases, they may have occult micrometastases that eventually manifest clinically. This would appear to be an impetus for the development of chemotherapeutic methods of systemic disease control. At present, however, this is a controversial area of investigation, and it is uncertain whether systemic chemotherapy can improve long-term survival rates for patients with high-grade sarcomas.

Previous
Next

Presentation

A mass is the most common sign of a soft tissue tumor. It usually is painless and does not cause limb dysfunction. However, depending on the anatomic location of the tumor, it may cause pain or neurologic symptoms by compressing or stretching nerves, by irritating overlying bursae, or by expanding sensitive structures. A rapid rate of increase in the size of a mass should arouse suspicion that the lesion is malignant.

Physical examination can be used to determine the location and size of a mass and to exclude other, more common causes of pain. Whether the mass is deep or subcutaneous, transilluminates (cysts), and adheres to underlying structures also can be gleaned from physical examination. Regional lymph nodes should be examined as well. Neurovascular examination is useful for the detection of either primary or secondary tumor involvement.

Extremity masses larger than 5-7 cm and deeper than subcutaneous tissue favor a diagnosis of a malignant soft tissue tumor. However, up to 30% of soft tissue sarcomas occur in subcutaneous tissue and exhibit relatively less aggressive behavior.[6]

Previous
Next

Indications

See Treatment, Surgical therapy.

Previous
Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Vinod B Shidham, MD, FRCPath  Professor, Vice-chair-AP, and Director of Cytopathology, Department of Pathology, Wayne State University School of Medicine, Karmanos Cancer Center & Detroit Medical Center; Co-Editor-in-Chief and Executive Editor, CytoJournal

Vinod B Shidham, MD, FRCPath is a member of the following medical societies: American Association for Cancer Research, American Society of Cytopathology, College of American Pathologists, International Academy of Cytology, Royal College of Pathologists, and United States and Canadian Academy of Pathology

Disclosure: Nothing to disclose.

Coauthor(s)

Scott M Acker, MD  Associate Professor, Director of Dermatopathology, Departments of Dermatology and Pathology, University of Alabama at Birmingham

Scott M Acker, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, American Society for Clinical Pathology, and Southern Medical Association

Disclosure: Nothing to disclose.

Donald A Hackbarth Jr, MD, FACS  Professor of Clinical Orthopedic Surgery, Division Chief, Musculoskeletal Oncology, Department of Orthopedic Surgery, Medical College of Wisconsin

Donald A Hackbarth Jr, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Tissue Banks, American College of Surgeons, Children's Oncology Group, Christian Medical & Dental Society, Clinical Orthopaedic Society, and Wisconsin Medical Society

Disclosure: Musculoskeletal Transplant Foundation Honoraria Board membership

David H Vesole, MD, PhD, FACP  Professor of Medicine, Director of BMT Program, Division of Hematology/Oncology, Loyola University Medical Center

David H Vesole, MD, PhD, FACP is a member of the following medical societies: American College of Physicians, American Society for Blood and Marrow Transplantation, American Society of Hematology, and Sigma Xi

Disclosure: Celgene Honoraria Speaking and teaching; Millennium Honoraria Speaking and teaching; OrthoBiotech Honoraria Speaking and teaching; Celgene Ownership interest Stock; Millennium Ownership interest Stock

Specialty Editor Board

Howard A Chansky, MD  Associate Professor, Department of Orthopedics and Sports Medicine, University of Washington Medical Center

Howard A Chansky, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Sean P Scully, MD, PhD  Professor, Department of Orthopedics, University of Miami

Sean P Scully, MD, PhD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, International Society on Thrombosis and Haemostasis, and Society of Surgical Oncology

Disclosure: Nothing to disclose.

Dinesh Patel, MD, FACS  Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital

Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Harris Gellman, MD  Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami, Leonard M Miller School of Medicine

Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, and Arkansas Medical Society

Disclosure: Nothing to disclose.

References

  1. Conrad EU, Bradford L, Chansky HA. Pediatric soft-tissue sarcomas. Orthop Clin North Am. Jul 1996;27(3):655-64. [Medline].

  2. Ludwig JA. Personalized therapy of sarcomas: integration of biomarkers for improved diagnosis, prognosis, and therapy selection. Curr Oncol Rep. Jul 2008;10(4):329-37. [Medline].

  3. Ordóñez JL, Martins AS, Osuna D, Madoz-Gúrpide J, de Alava E. Targeting sarcomas: therapeutic targets and their rational. Semin Diagn Pathol. Nov 2008;25(4):304-16. [Medline].

  4. Enneking WF. Staging of musculoskeletal neoplasms. In: Uhthoff HK, ed. Current Concepts of Diagnosis and Treatment of Bone and Soft Tissue Tumors. Heidelberg:. Springer-Verlag;1984.

  5. Potter DA, Glenn J, Kinsella T. Patterns of recurrence in patients with high-grade soft-tissue sarcomas. J Clin Oncol. Mar 1985;3(3):353-66. [Medline].

  6. Gustafson P. Soft tissue sarcoma. Epidemiology and prognosis in 508 patients. Acta Orthop Scand Suppl. Jun 1994;259:1-31. [Medline].

  7. Gay F, Pierucci F, Zimmerman V, Lecocq-Teixeira S, Teixeira P, Baumann C, et al. Contrast-enhanced ultrasonography of peripheral soft-tissue tumors: Feasibility study and preliminary results. Diagn Interv Imaging. Jan 2012;93(1):37-46. [Medline].

  8. Bland KI, McCoy DM, Kinard RE. Application of magnetic resonance imaging and computerized tomography as an adjunct to the surgical management of soft tissue sarcomas. Ann Surg. May 1987;205(5):473-81. [Medline].

  9. Chang AE, Matory YL, Dwyer AJ. Magnetic resonance imaging versus computed tomography in the evaluation of soft tissue tumors of the extremities. Ann Surg. Apr 1987;205(4):340-8. [Medline].

  10. Dal Cin P. Soft tissue tumors: an overview. Atlas Genet Cytogenet Oncol Haematol. January 2003;[Full Text].

  11. Costa MJ, Campman SC, Davis RL. Fine-needle aspiration cytology of sarcoma: retrospective review of diagnostic utility and specificity. Diagn Cytopathol. Jul 1996;15(1):23-32. [Medline].

  12. Ball AB, Fisher C, Pittam M. Diagnosis of soft tissue tumours by Tru-Cut biopsy. Br J Surg. Jul 1990;77(7):756-8. [Medline].

  13. Geer RJ, Woodruff J, Casper ES. Management of small soft-tissue sarcoma of the extremity in adults. Arch Surg. Nov 1992;127(11):1285-9. [Medline].

  14. Shidham V, Gupta D, Galindo LM. Intraoperative scrape cytology: comparison with frozen sections, using receiver operating characteristic (ROC) curve. Diagn Cytopathol. Aug 2000;23(2):134-9. [Medline].

  15. Shidham VB, Dravid NV, Grover S. Role of scrape cytology in rapid intraoperative diagnosis. Value and limitations. Acta Cytol. Jul-Aug 1984;28(4):477-82. [Medline].

  16. Coindre JM, Nguyen BB, Bonichon F. Histopathologic grading in spindle cell soft tissue sarcomas. Cancer. Jun 1 1988;61(11):2305-9. [Medline].

  17. Costa J, Wesley RA, Glatstein E. The grading of soft tissue sarcomas. Results of a clinicohistopathologic correlation in a series of 163 cases. Cancer. Feb 1 1984;53(3):530-41. [Medline].

  18. Myhre-Jensen O, Kaae S, Madsen EH. Histopathological grading in soft-tissue tumours. Relation to survival in 261 surgically treated patients. Acta Pathol Microbiol Immunol Scand [A]. Mar 1983;91(2):145-50. [Medline].

  19. Wunder JS, Healey JH, Davis AM. A comparison of staging systems for localized extremity soft tissue sarcoma. Cancer. Jun 15 2000;88(12):2721-30. [Medline].

  20. Suit HD, Mankin HJ, Wood WC. Treatment of the patient with stage M0 soft tissue sarcoma. J Clin Oncol. May 1988;6(5):854-62. [Medline].

  21. Casper ES, Gaynor JJ, Harrison LB. Preoperative and postoperative adjuvant combination chemotherapy for adults with high grade soft tissue sarcoma. Cancer. Mar 15 1994;73(6):1644-51. [Medline].

  22. Elias AD, Antman KH. Adjuvant chemotherapy for soft-tissue sarcoma: a critical appraisal. Semin Surg Oncol. 1988;4(1):59-65. [Medline].

  23. Wardelmann E, Chemnitz JM, Wendtner CM. Targeted therapy of soft tissue sarcomas. Onkologie. 2012;35 Suppl 1:21-7. [Medline].

  24. Rosenberg SA, Tepper J, Glatstein E. The treatment of soft-tissue sarcomas of the extremities: prospective randomized evaluations of (1) limb-sparing surgery plus radiation therapy compared with amputation and (2) the role of adjuvant chemotherapy. Ann Surg. Sep 1982;196(3):305-15. [Medline].

  25. Alektiar KM, Brennan MF, Singer S. Local control comparison of adjuvant brachytherapy to intensity-modulated radiotherapy in primary high-grade sarcoma of the extremity. Cancer. Jan 24 2011;[Medline].

  26. Rosenberg SA, Tepper J, Glatstein E. Prospective randomized evaluation of adjuvant chemotherapy in adults with soft tissue sarcomas of the extremities. Cancer. Aug 1 1983;52(3):424-34. [Medline].

  27. Chang AE, Kinsella T, Glatstein E. Adjuvant chemotherapy for patients with high-grade soft-tissue sarcomas of the extremity. J Clin Oncol. Sep 1988;6(9):1491-500. [Medline].

  28. Huth JF, Eilber FR. Patterns of metastatic spread following resection of extremity soft- tissue sarcomas and strategies for treatment. Semin Surg Oncol. 1988;4(1):20-6. [Medline].

  29. Fong Y, Coit DG, Woodruff JM. Lymph node metastasis from soft tissue sarcoma in adults. Analysis of data from a prospective database of 1772 sarcoma patients. Ann Surg. Jan 1993;217(1):72-7. [Medline].

  30. Kushner BH, Meyers PA. How effective is dose-intensive/myeloablative therapy against Ewing's sarcoma/primitive neuroectodermal tumor metastatic to bone or bone marrow? The Memorial Sloan-Kettering experience and a literature review. J Clin Oncol. Feb 1 2001;19(3):870-80. [Medline].

  31. Chou YS, Liu CY, Chen WM, Chen TH, Chen PC, Wu HT, et al. Follow-up after primary treatment of soft tissue sarcoma of extremities: Impact of frequency of follow-up imaging on disease-specific survival. J Surg Oncol. Feb 1 2012;[Medline].

  32. Stotter AT, A'Hern RP, Fisher C. The influence of local recurrence of extremity soft tissue sarcoma on metastasis and survival. Cancer. Mar 1 1990;65(5):1119-29. [Medline].

  33. Jensen OM, Hogh J, Ostgaard SE. Histopathological grading of soft tissue tumours. Prognostic significance in a prospective study of 278 consecutive cases. J Pathol. Jan 1991;163(1):19-24. [Medline].

  34. Marcus SG, Merino MJ, Glatstein E. Long-term outcome in 87 patients with low-grade soft-tissue sarcoma. Arch Surg. Dec 1993;128(12):1336-43. [Medline].

  35. Bell RS, O'Sullivan B, Liu FF, et al. The surgical margin in soft-tissue sarcoma. J Bone Joint Surg Am. Mar 1989;71(3):370-5. [Medline].

  36. Herbert SH, Corn BW, Solin LJ. Limb-preserving treatment for soft tissue sarcomas of the extremities. The significance of surgical margins. Cancer. Aug 15 1993;72(4):1230-8. [Medline].

  37. Markhede G, Angervall L, Stener B. A multivariate analysis of the prognosis after surgical treatment of malignant soft-tissue tumors. Cancer. Apr 15 1982;49(8):1721-33. [Medline].

  38. Gustafson P, Rooser B, Rydholm A. Is local recurrence of minor importance for metastases in soft tissue sarcoma?. Cancer. Apr 15 1991;67(8):2083-6. [Medline].

  39. Agarwal V, Greenebaum E, Wersto R. DNA ploidy of spindle cell soft-tissue tumors and its relationship to histology and clinical outcome. Arch Pathol Lab Med. Jun 1991;115(6):558-62. [Medline].

  40. Swanson SA, Brooks JJ. Proliferation markers Ki-67 and p105 in soft-tissue lesions. Correlation with DNA flow cytometric characteristics. Am J Pathol. Dec 1990;137(6):1491-500. [Medline].

  41. Ueda T, Aozasa K, Tsujimoto M. Prognostic significance of Ki-67 reactivity in soft tissue sarcomas. Cancer. Apr 15 1989;63(8):1607-11. [Medline].

  42. Kroese MC, Rutgers DH, Wils IS. The relevance of the DNA index and proliferation rate in the grading of benign and malignant soft tissue tumors. Cancer. Apr 15 1990;65(8):1782-8. [Medline].

  43. Cance WG, Brennan MF, Dudas ME. Altered expression of the retinoblastoma gene product in human sarcomas. N Engl J Med. Nov 22 1990;323(21):1457-62. [Medline].

  44. Drobnjak M, Latres E, Pollack D. Prognostic implications of p53 nuclear overexpression and high proliferation index of Ki-67 in adult soft-tissue sarcomas. J Natl Cancer Inst. Apr 6 1994;86(7):549-54. [Medline].

  45. Kawai A, Noguchi M, Beppu Y. Nuclear immunoreaction of p53 protein in soft tissue sarcomas. A possible prognostic factor. Cancer. May 15 1994;73(10):2499-505. [Medline].

  46. Mankin HJ, Mankin CJ, Simon MA. The hazards of the biopsy, revisited. Members of the Musculoskeletal Tumor Society. J Bone Joint Surg Am. May 1996;78(5):656-63. [Medline].

  47. Association of Directors of Anatomic and Surgical Pathology. Recommendations for the reporting of soft tissue sarcomas. Mod Pathol. Dec 1998;11(12):1257-61. [Medline].

  48. Barth RJ, Merino MJ, Solomon D. A prospective study of the value of core needle biopsy and fine needle aspiration in the diagnosis of soft tissue masses. Surgery. Sep 1992;112(3):536-43. [Medline].

  49. Bennert KW, Abdul-Karim FW. Fine needle aspiration cytology vs. needle core biopsy of soft tissue tumors. A comparison. Acta Cytol. May-Jun 1994;38(3):381-4. [Medline].

  50. Boddaert A, Trojani M, Contesso G, et al. Soft tissue sarcomas of adults: study of pathological variables and definition of a histopathological grading system. In: van Oosterom AT, van Unnik JAM, eds. Management of Soft Tissue and Bone Sarcomas. New York, NY: Raven Press;1986.

  51. Cantin J, McNeer GP, Chu FC. The problem of local recurrence after treatment of soft tissue sarcoma. Ann Surg. Jul 1968;168(1):47-53. [Medline].

  52. Enneking WF, Maale GE. The effect of inadvertent tumor contamination of wounds during the surgical resection of musculoskeletal neoplasms. Cancer. Oct 1 1988;62(7):1251-6. [Medline].

  53. Enneking WF, McAuliffe JA. Adjunctive preoperative radiation therapy in treatment of soft tissue sarcomas: a preliminary report. Cancer Treat Symp. 1985;3:37.

  54. Enzinger FM, Weiss SW. Soft Tissue Tumors. 3rd ed. St. Louis, Mo:. Mosby;1995.

  55. Epstein HD. Fine-needle aspiration of soft tissue lesions. Pathology (Phila). 1996;4(2):463-92. [Medline].

  56. Giuliano AE, Eilber FR. The rationale for planned reoperation after unplanned total excision of soft-tissue sarcomas. J Clin Oncol. Oct 1985;3(10):1344-8. [Medline].

  57. Greenberg DB. Psychological aspects of patient management. In: Simon MA, Springfield D, eds. Surgery for Bone and Soft-Tissue Tumors. Philadelphia, Pa:. Lippincott-Raven;1998:67-75.

  58. Hashimoto H, Daimaru Y, Takeshita S. Prognostic significance of histologic parameters of soft tissue sarcomas. Cancer. Dec 15 1992;70(12):2816-22. [Medline].

  59. Indelicato DJ, Meadows K, Gibbs CP Jr, Morris CG, Scarborough MT, Zlotecki RA. Effectiveness and Morbidity Associated with Reirradiation in Conservative Salvage Management of Recurrent Soft-Tissue Sarcoma. Int J Radiat Oncol Biol Phys. Aug 14 2008;[Medline].

  60. Lawrence W, Donegan WL, Natarajan N. Adult soft tissue sarcomas. A pattern of care survey of the American College of Surgeons. Ann Surg. Apr 1987;205(4):349-59. [Medline].

  61. Meyers PA, Heller G, Healey J. Chemotherapy for nonmetastatic osteogenic sarcoma: the Memorial Sloan-Kettering experience. J Clin Oncol. Jan 1992;10(1):5-15. [Medline].

  62. Montag A. Management of surgical specimen. In: Simon MA, Springfield D, eds. Surgery for Bone and Soft-Tissue Tumors. Philadelphia, Pa:. Lippincott-Raven;1998:67-75.

  63. Pacelli F, Tortorelli AP, Rosa F, Papa V, Bossola M, Sanchez AM, et al. Retroperitoneal soft tissue sarcoma: prognostic factors and therapeutic approaches. Tumori. Jul-Aug 2008;94(4):497-504. [Medline].

  64. Pezzi CM, Pollock RE, Evans HL. Preoperative chemotherapy for soft-tissue sarcomas of the extremities. Ann Surg. Apr 1990;211(4):476-81. [Medline].

  65. Pinkerton CR, Groot LJ, Barrett A. Rapid VAC high dose melphalan regimen, a novel chemotherapy approach in childhood soft tissue sarcomas. Br J Cancer. 1991;64:381-385. [Medline].

  66. Praemer A, Furner S, Rice DP. Neoplasms of bone and connective tissue. In: Musculoskeletal conditions in the United States. Park Ridge, Ill:. American Academy of Orthopaedic Surgeons;1992:55.

  67. Rooser B, Attewell R, Berg NO. Prognostication in soft tissue sarcoma. A model with four risk factors. Cancer. Feb 15 1988;61(4):817-23. [Medline].

  68. Roth JA Jr, Roth JA. Resection of sarcomatous pulmonary metastases. Surg Oncol Clin N Am. 1993;2:673.

  69. Rydholm A, Gustafson P, Rooser B. Limb-sparing surgery without radiotherapy based on anatomic location of soft tissue sarcoma. J Clin Oncol. Oct 1991;9(10):1757-65. [Medline].

  70. Scoggins CR, Pisters PW. Diagnosis and management of soft tissue sarcomas. Adv Surg. 2008;42:219-28. [Medline].

  71. Tanabe KK, Pollock RE, Ellis LM. Influence of surgical margins on outcome in patients with preoperatively irradiated extremity soft tissue sarcomas. Cancer. Mar 15 1994;73(6):1652-9. [Medline].

  72. Tepper JE, Suit HD. Radiation therapy of soft tissue sarcomas. Cancer. May 1 1985;55(9 Suppl):2273-7. [Medline].

  73. Trojani M, Contesso G, Coindre JM. Soft-tissue sarcomas of adults; study of pathological prognostic variables and definition of a histopathological grading system. Int J Cancer. Jan 15 1984;33(1):37-42. [Medline].

  74. Tsujimoto M, Aozasa K, Ueda T. Multivariate analysis for histologic prognostic factors in soft tissue sarcomas. Cancer. Sep 1 1988;62(5):994-8. [Medline].

  75. Willén H, Akerman M, Carlén B. Fine needle aspiration (FNA) in the diagnosis of soft tissue tumours; a review of 22 years experience. Cytopathology. Aug 1995;6(4):236-47. [Medline].

  76. Zalupski MM, Ryan JR, Hussein ME, et al. Systemic adjuvant chemotherapy for soft tissue sarcomas of the extremities. Surg Oncol Clin N Am. 1993;2:621.

 
Previous
Next
 
A computed-tomography (CT)–guided needle biopsy of a high-grade soft tissue sarcoma arising in the left hemipelvis. The CT artifact from the needle can be seen in the upper right corner of the image as the needle enters the lesion just anterior and medial to the dome of the left hip joint. Courtesy of Howard A. Chansky, MD
Magnetic resonance imaging (MRI) is used to demonstrate involvement of critical structures by tumor. This recurrent, high-grade soft tissue sarcoma in the posterior calf abuts the tibial nerve and posterior tibial vessels. An extensive reactive zone surrounds the structures. This patient was treated with below-knee amputation. Courtesy of Howard A. Chansky, MD
Table 1
Benign Soft Tissue TumorsCharacteristic



Cytogenetic Events



Frequency
Benign schwannomaMonosomy 2250%
Desmoid tumorTrisomy 825%
Deletion of 5q10%
LipoblastomaRearrangement of 8q>25%
Lipoma, solitaryRearrangement of bands 12q14-1575%
Rearrangement of 6p10%
Deletion of 13q10%
Uterine leiomyomat(12;14)(q15;q24)20%
Deletion of 7q15%
Trisomy 1210%
Malignant Soft Tissue TumorsCharacteristic



Cytogenetic Events



Frequency
Clear cell sarcomat(12;22)(q13;q12)>75%
Dermatofibrosarcoma protuberansRing chromosome 17>75%
Ewing sarcomat(11;22)(q24;q12)95%
Extraskeletal myxoid chondrosarcomat(9;22)(q31;q12)50%
Liposarcoma, myxoidt(12;16)(q13;p11)75%
Liposarcoma, well differentiatedRing chromosome 1280%
Alveolar rhabdomyosarcomat(2;13)(q35;q14)80%
Synovial sarcomat(X;18)95%
Table 2. AJCC GTNM Classification and Stage Grouping of Soft Tissue Sarcomas
Stage GroupingsTumor GradePrimary TumorRegional Lymph Node InvolvementDistant Metastasis
Stage IAG1T1N0M0
Stage IBG1T2N0M0
Stage II AG2T1N0M0
Stage IIBG2T2N0M0
Stage IIIAG3T1N0M0
Stage IIIBG3T2N0M0
Stage IVAAny GAny TN1M0
Stage IVBAny GAny TAny NM1
Previous
Next
 
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.