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  • Soft Tissue Sarcomas

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    Herman Purnomo
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    Soft tissue sarcomas originate from mesenchymal tissues like fat, muscle, and connective tissue. They can be benign or malignant. Malignant soft tissue sarcomas are graded from I to IV based on their level of differentiation. While benign tumors are non-invasive, malignant sarcomas grow invasively and can metastasize hematogenously, mainly to the lungs. Treatment involves wide local excision with clear margins followed by radiation therapy or chemotherapy depending on tumor stage and grade. Prognosis depends on factors like tumor type, grade, size, and presence of metastases.

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    Soft tissue sarcomas originate from mesenchymal tissues like fat, muscle, and connective tissue. They can be benign or malignant. Malignant soft tissue sarcomas are graded from I to IV based on their level of differentiation. While benign tumors are non-invasive, malignant sarcomas grow invasively and can metastasize hematogenously, mainly to the lungs. Treatment involves wide local excision with clear margins followed by radiation therapy or chemotherapy depending on tumor stage and grade. Prognosis depends on factors like tumor type, grade, size, and presence of metastases.

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    195 views8 pages

    Soft Tissue Sarcomas

    Uploaded by

    Herman Purnomo
    Soft tissue sarcomas originate from mesenchymal tissues like fat, muscle, and connective tissue. They can be benign or malignant. Malignant soft tissue sarcomas are graded from I to IV based on their level of differentiation. While benign tumors are non-invasive, malignant sarcomas grow invasively and can metastasize hematogenously, mainly to the lungs. Treatment involves wide local excision with clear margins followed by radiation therapy or chemotherapy depending on tumor stage and grade. Prognosis depends on factors like tumor type, grade, size, and presence of metastases.

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    SOFT TISSUE SARCOMAS

    • AETIOLOGY : UNKNOWN
    • High-risk factor :
    - Neurofibromatosis ( Von
    Recklinghausen`s disease)
    - Previous radiation therapy
    - Long-lasting lymphoedema
    Pathological appearance
    • Originate from all mesenchymal tissues ( fat, muscular, connective
    tissue, vessels, peripheral nerves, tendon and synovial

    • Benign tumor(- omas), malignant tumor (- sarcomas)


    - Connective tissue : fibroma- fibrosarcoma
    - Fat tissue : lipoma – liposarcoma
    - Striated muscle : rhabdomyoma- rhabdomyosarcoma
    - Smooth muscle : leiomyoma- leiomyosarcoma
    - Blood vessel : haemangioma-haemangiosarcoma
    - Lymph vessel : lymphangioma-lymphangIosarcoma

    Grade of malignancy : grade I,II,III,IV ( well-moderate, poorly and


    undifferentiated)
    Biological behaviour
    • Benign soft tissue tumour grow non-invasive but
    expansive, do not metastases
    • Malignant soft tissue tumour grow expansive
    and invasive, frequently metastases
    • Expansive growth lead to compression
    surrounding tissue and make pseudocapsules
    • Sarcoma nearly always spread
    hematogeneously,mainly to the lung, only
    occasionally to lymphnode (synoviosarcoma,
    rhabdomyosarcoma, fibrosarcoma,
    angiosarcoma)
    Diagnostic approach
    Physical examination :
    • Inspection : compare the two side
    symmetry?, atrophic / contracture muscle,
    colour of the skin, functional disorder
    • Palpation : skin temperature, swelling
    sharply demarcated, ill-defined, size,
    fixation to surround tissue, painful,
    neurological disorder
    Microscopic diagnostics
    • Incisional biopsy : standard procedure to
    accurate diagnostic
    • FNAB : not establish and not standard,
    indication for tumour recurrent, tumour
    metastases
    • Immuno-histochemistry : golden standard
    to mention accurate diagnostic
    Staging tumour
    According to TNM-G system

    T 1 : tumour < 5 cm, T1a : superficial tum or


    T1b : deep tumor
    T 2 : tumour > 5 cm, T2a and T2b ( superficial and deep)

    No : no regional metastases
    N1 : positive regional lymphnode metastases

    M0 : No distant metastases
    M1 : Positive distant metastases

    G1,2,3,4 (well,moderate,poorly,undiffer)

    Stage 1A : G1-2, T1a or T1b ,N0,M0 ( low grade, small, superficial ,deep)
    Stage IB : G 1-2, T2a , No,MO (low grade, large,superficial,
    Stage IIA : G!-2, T2b, No,MO ( low grade,large,deep
    Stage IIB : G3-4, T1-b,NO,MO ( high grade,small superf, or deep)
    Stage IIC : G3-4, T2a, No,MO ( high grade, large, superficial tumor
    Stage III : G3-4, T2b, No,Mo ( high grade, large, deep tumor)
    Stage IV : any G,Any T,No,Ni,Mo,Mi (any meta lymphnode,distant metastases)
    Treatment of STS
    • Local treatment : standart therapy
    - Wide excision ( compartment procedure,
    amputation, safety margin 2 cm )
    -Radiotherapy
    • Systemic treatment : adjuvant therapy
    Chemotherapy adjuvant (cyclophosphamide,
    ifosphamid, adriamycin, dacarbacin,
    vincristin, taxane, Growth factor /VEGF
    Prognosis of STS

    • Prognostic factors :
    - Type of tumor
    - Grade of malignancy
    - Size of tumor
    - Location
    - Metastases
    - Age of patient
    - Recurrence

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