What Is Soft Tissue Sarcoma?

Soft tissue sarcomas originate from fat, fascia, muscle, fiber, lymph, and blood vessels, and each has different histology, biological characteristics, and different local infiltration, hematology, and lymphatic metastasis tendencies. Pulmonary metastases are more common, and they are ranked according to the incidence of different parts of the body as lower limbs, trunk, head and neck, upper limbs, and liposarcomas and fibrosarcomas can also appear in the retroperitoneum. The incidence of this disease is high among the elderly and there is no gender difference. Soft tissue sarcomas can occur anywhere, with about 75% of lesions in the limbs (most common in the thigh). Soft tissue sarcomas are mostly malignant. Tumor types vary by age.

Basic Information

English name: soft tissue sarcoma
Visiting department: Oncology; Orthopedics
Multiple groups: Middle-aged and elderly

Common locations: Limbs
Common symptoms: Painless masses, well-differentiated sarcomas are often accompanied by dull pain, and the local temperature can be higher than the surrounding normal tissues

Causes of soft tissue sarcoma

The cause of soft tissue sarcoma is unknown.

Clinical manifestations of soft tissue sarcoma

Lump

Patients often see a painless mass, which can last for months or a year. Masses range in size from small to large. Malignant tumors grow faster and are larger, often larger than 5 cm in diameter. The boundaries of tumors in deep tissues are often unclear.

Pain

Well-differentiated sarcomas grow faster and are often accompanied by dull pain. If the tumor involves adjacent nerves, pain is the first symptom, and pain is a poor prognosis. Only 27% of cases with successful limb salvage experienced pain, while pain was as high as 50% during amputation.

3.hardness

Tumors with more fibers and smooth muscle components have a harder texture, while those with more blood vessels, lymphatic vessels, and fat have a softer texture.

4. Parts

Fibrous tumors are more common in the subcutaneous tissue; fatty tumors are more common in the buttocks, lower limbs, and posterior peritoneum; mesotheliomas are more common in the chest and abdominal cavity; smooth muscle-derived tumors are more common in the abdominal cavity and trunk; synovial sarcomas are more likely Near joints and fascia.

5. Activity

Benign or low-grade malignant tumors, often with superficial growth sites and greater mobility. Tumors with deeper growth sites or infiltrating surrounding tissues have less mobility. Retroperitoneal tumors are mostly fixed due to anatomical relationships.

6. Temperature

Soft tissue sarcoma has a rich blood supply, a strong metabolism, and local temperatures can be higher than surrounding normal tissues. The local temperature of benign tumors can be normal.

7. Regional lymph nodes

Soft tissue sarcomas can metastasize along the lymphatic tract. Synovial sarcoma and rhabdomyosarcoma often have regional lymphadenopathy and sometimes fuse into clusters.

Soft tissue sarcoma examination

1. X-ray inspection

It helps to understand the scope, transparency, and relationship of soft tissue tumors to adjacent bone. Clear borders often suggest benign tumors; clear borders and calcifications suggest malignant sarcomas, which are more common in synovial sarcomas and rhabdomyosarcoma.

2. Ultrasound

The volume range of the tumor, the envelope boundary, and the echo of the tumor tissue inside the tumor can be seen as benign or malignant. Malignant individuals have large bodies with unclear boundaries and blurred echoes, such as rhabdomyosarcoma, synovial myoma, and malignant fibrous histiocytoma. Ultrasound can also guide needle biopsy cytology of deep tumors.

3.CT inspection

It has the characteristics of density resolution and spatial resolution of soft tissue tumors, and is a commonly used method in recent years.

4.MRI examination

It can make up for the deficiency of X-ray and CT. It can show the levels of various tissues and the full range of tumors from the longitudinal section. The image of the extent of bone or bone marrow invasion is displayed more clearly.

5. Cytological examination

It is a simple, fast and accurate pathological examination method. Applicable to the following situations: Obtain the cells of the ruptured soft tissue tumor using the method of smear or scraping, and confirm the diagnosis by microscopy; Thoracic and abdominal fluid caused by soft tissue sarcoma; Deeper tumors intended for radiation or chemotherapy are also suitable for metastatic and recurrent lesions.

6. Immunohistochemistry

The tumors with similar morphology under the original light microscope can be correctly classified through the research of immunohistochemistry. There are many markers used for immunohistochemistry, such as general markers, endothelial cell markers, muscle cell markers, and so on.

Soft tissue sarcoma diagnosis

According to medical history, clinical manifestations, and laboratory tests, soft tissue sarcoma is not difficult to diagnose. The possibility of this disease should be highly suspected in the following cases: the patient found a painless, progressively enlarged mass within a few weeks or months, fever Systemic symptoms, such as weight loss, are rare; clinically rare, syndromes caused by tumors, such as hypoglycemia, are often associated with fibrosarcoma.

Soft Tissue Sarcoma Treatment

Surgical treatment

For a tumor that can be completely removed, it must be removed along with the surrounding normal tissue, including the biopsy site, the skin, and nearby muscles. For intramuscular tumors, the affected muscle should be completely removed head and tail. Lymph node dissection should be performed only when clinically shown that the lymph nodes are involved.

Soft tissue tumors that cannot be completely removed are treated with debulking surgery, followed by other treatments to improve the quality of life of the patient and prolong the patient's life. Huge liposarcoma, such as retroperitoneum, can be treated with volume reduction first, followed by radiation therapy.

Amputation surgery is suitable for those with large tumors with bleeding and ulcers that cannot stop bleeding; or with severe infections (such as sepsis, tetanus, etc.); or rapid growth of tumors causing severe pain, which is difficult to control with drugs; Those with pathological fractures and incapacity.

2. Radiation therapy

When radical radical surgery can cause dysfunction, a combination of surgery and radiation can be selected. The disadvantage is that the wound is not easy to heal after surgery.

3. Chemotherapy

There are many effective drugs for soft tissue sarcoma, mainly ADM, DTIC, CTX, IFO, KSM and so on. It is generally considered that the better effect is the CYVADIC combination regimen, with 3 to 4 weeks as a course of treatment. But most soft tissue sarcomas are not sensitive to chemotherapy and can only be used as clinical adjuvant therapy.