1. Soft Tissue Tumors
Ali AlGhamdi

2. case scenario
38-year-old male presents with right knee pain that is progressively worsening over the past 5 months
The patient had an effusion that was drained by his primary care provider 2 months ago

6. out lines Definition Etiology Classifications
Clinical features and treatment
Summary

7. Defintion
Mesenchymal proliferations that occur in the extraskeletal, nonepithelial tissues of the body, excluding the viscera, coverings of the brain, and lymphoreticular system.

8. Etiology Unknown ! Radiation therapy chemical burns Trauma Heat Burns
Disease related (Ex neurofibromatosis)

9. Classification
Benign
Malignant

10. Histologic type Benign Malignant Adipose Tissue Lipoma Liposarcoma
Fibrous tissue
Fibromatosis
Nodular fasciitis
Fibrosarcoma
Fibrohistiocytic tumours
Fibrous histiocytoma
Dermatofibroma
Malignant Fibrous Histiocytoma?????
Skeletal Muscle
Rhabdomyoma
Rhabdomyosarcoma
Smooth Muscle
Leiomyoma
Leiomyosarcoma
Vascular
Haemangioma
Lymphangioma
Angiosarcoma
Peripheral nerve
Neurofibroma
Schwannoma
Malignant peripheral nerve sheath tumour
Uncertain histogenesis
Granular cell tumour
Synovial Sarcoma
Alveolar soft part sarcoma
Epithelioid sarcoma

11. Benign Soft Tissue Tumours
Lipoma
Hemangiomas
Fibroma
Myxoma
Schwannoma
PVNS

12. Lipoma Most common Soft tissue tutor Subcutaneous (common) VS Deep
Male = female
Slowly growing painless mass
Radiolucent
MRI , T1 High signal and T2 Intermediate signal

13. Treatment Benign and Do not metastasize
No Rule for Chemotherapy of Radiotherapy
Observation (small)
Marginal Excision (Large and Symptomatic)
Recurrence rate : rare (subcutanous) , up to 20% (deep)

17. Hemangiomas Benign proliferation of mature blood vessels
Skin, subcutaneous or intramuscular
male = female
Painful mass
X-rays appears as phleboliths (calcification)
MRI with gadolinium increase signal in T1 and T2

18. Treatment Observation
NSAID , Vascular stockings and activity modification
Sclerotherapy or embolization (painful and large)
Marginal Excision

21. Fibromas Fibrocytes, Fibroblast and myofibroblasts Female > male
shoulder (most common), upper arm, buttocks and trunk
painful or painless mass
Radiolucent
MRI ,T1 intermediate signal T2 High signal

22. Treatment Wide surgical excision (high recurrence rate )
Radiotherapy is controversial
Chemotherapy is controversial

26. Schwannoma arising from schwann cell of peripheral nerve
5% of benign soft tissue tumors
affects major peripheral nerves of upper and lower extremities
painful slowly growing mass (<5cm )
+ve Tinel's sign
Radiolucent
MRI T1 intermediate signal T2 High (Taget sign)

27. Treatment Marginal Excision (spare the nerve )
Recurrence rate low (<1%)

30. PVNS Monoarticular neoplastic synovial disease
exuberant proliferation of synovial villi
affect large joints (knee most common )
male = female
Painful swelling (Hx of trauma)
X-rays cystic erosion with sclerotic margins on both sides of the joint
MRI low signal in both T1 and T2

31. Treatment
Observation ( Mild )
Total Synovectomy
Radiation therapy

35. Malignant soft Tissue Tumors
MFH
Liposarcoma
Leiomyosarcoma
Fibrosarcoma
Epitheliod sarcoma

36. Sarcoma in General Presents in All ages painless mass
MRI ,T1 low signal T2 high signal
Metastasize to lung >bone> liver
Any part of Body (>5cm)
Biopsy is the gold standard in Dx

37. Malignant Fibrous Histocytosis
pleomorphic , High grade , anaplastic sarcoma
Most common sarcoma
70 % in extremities
painless mass
MRI low signal T1 and High signal in T2

38. Treatment Wide Surgical Excision PostOP radiation
Amputation (unresectable)
65% 5 year survival

42. Liposarcoma 2nd most common Sarcoma Adult tumor (40-70)
Extremeties (thigh)
painfull large mass (firm)
MRI high signal in T1 and T2

43. Treatment Wide Surgical Excision Does not metastasize ,
100 % 5 year survival
high recurrence rate (20%)

47. Synovial sarcoma 5-10 % of all soft tissue sarcoma
young adults and teenagers (15-35)
In proximity to large Joints
lower extremities > upper extremities
Male > Female
Painful slowly going mass

48. Radiology X -ray (calcification) CT (lobular mass close to joint)
X rays calcification
MRI T1 intermediate signal T2 hight signal

49. Treatment Wide surgical excision post Op radiation
Amputation (unresectable )
Metastasize to Lungs >LN>BM
65% 5 year survival

53. Leiomyosarcoma 9% of soft tissue sarcomas Retroperitoneum of Thigh
painless mass
MRI intermediate signal in T1 and T2

54. Treatment Wide surgical Resection Post OP radiation
metastasise to Lung >liver>bone
50% 5 year survival

59. Take Home message
soft tissue benign tumors outnumbered malignant tumors (100:1)
present with enlarging painless or painful mass
mass >5 cm growing,deep to the superficial facia is soft tissue sarcoma until proven otherwise
MRI is the best imaging modality for defining the anatomy and helping characratize the lesion

60. Take home message CT chest is required to evaluated for metastasis
Exicional biopsy shouldn't performed if the clinician does not know the origin of the tumor
most soft tissue sarcoma are sensitive to radiation

61. References www.tumorsurgery.org
paediatric soft tissue tumors, Karman aflatoon, 2011
Miller’s review of orthopaedics , 7th edition