Thursday, 5 February 2015

Soft Tissue Sarcoma

• Rare unusual neoplasm of soft tissues
• MC site: ExtremityQ (lower >upper) > Trunk >Retroperitoneum >Head & Neck
• MC type: Malignant fibrous histiocytomaQ
>Liposarcoma >Leiomyosarcoma >Synovial sarcoma >Malignant peripheral nerve sheath tumor
• MC pediatric soft tissue sarcoma:
Rhabdomyosarcoma Histopathological Type of STS is Site Dependent
Extremity • Malignant fibrous histiocytoma
>Liposarcoma
Retroperitoneum • Liposarcoma
Viscera • GIST Pathology:
• STS tends to grow along fascial planes, with the surrounding soft tissue compressed to form a pseudocapsule.
• Clinical behavior of STS is determined by:
Anatomic location (depth), grade & size • MC route of spread in soft tissue sarcoma:
Hematogenous
• MC site of metastasis: Lung; Lymphatic
metastasis is rare
Clinical Features:
• MC symptom of STS: Painless mass • Size at presentation is dependent on the location
of tumor. • Smaller tumors are located in distal extremities
• Larger tumors are detected in proximal extremity
& retroperitoneum.
• Retroperitoneal STS almost always present as
large asymptomatic mass Diagnosis of Soft Tissue Sarcoma
• Core-cut or true-cut biopsy (CT or USG guided) is diagnostic
• Incisional biopsy is done if core-cut biopsy is non-diagnostic
• FNAC: To confirm or rule out presence of metastatic focus or local recurrence • MRI: IOC for assessing extremity STSQ
• CECT: IOC for assessing retroperitoneal sarcoma
Treatment:
• Adequate excision + adjuvant radiotherapy with
or without adjuvant chemotherapy.
Prognosis: • Best prognostic factor of soft tissue sarcoma:
Grading
• Best prognosis is seen in: Extremity STS
• MC cause of death in STS: Metastasis; 5-year
survival rate for STS (all stages): 50-60%

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