SOFT-TISSUE TUMOURS
SOFT-TISSUE TUMOURS
Soft-tissue tumours have also historically been classified according to their morphological appearance and presumed cell of origin. The range of biological behaviour is wide and most morphological types have a benign and malignant coun terpart, for example lipoma ( Figure 42.25 ) and liposarcoma. Other more frequent types include undi ff erentiated pleomor phic sarcoma and synovial sarcoma. Patients with suspected or confirmed soft-tissue sarcomas should be assessed and managed in a specialist centre. Summary box 42.8 Warning signs – soft-tissue tumour /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF Monique Trojani , contemporary , described the histopathological grading system in 1984. - The Trojani system, based on tumour di ff erentiation, mitotic count and tumour necrosis, is the standard for grading malignant soft tissue tumours. The AJCC / UICC system is used to stage malignant soft tissue tumours. - -
Larger than 5 /uni00A0 cm Increasing in size Painful Deep to the fascia Recurrence after previous excision (b) Figure 42.25 (a) Coronal T1-weighted magnetic resonance imaging scan showing a benign lipoma deep to the quadriceps muscle (arrow). (b) Excised benign lipoma.
Soft-tissue tumours
The treatment of soft-tissue tumours should take account of tumour type and the response to other treatments including radiotherapy . Large low-grade or benign lipomatous tumours may be excised in a deliberately marginal or close but complete fashion. Soft-tissue sarcomas should however be excised with a margin of normal tissue around them, which includes the biopsy track, wherever possible ( Figure 42.27 ). Skin involve ment may require resection of the skin and reconstruction with a split-skin graft or skin flap. Following surgical excision of high-grade soft-tissue sarco mas, adjuvant radiotherapy should be considered. Preopera radiotherapy can also have good results, but there is a risk of wound-healing problems following surgery . Chemotherap a limited role in the treatment of soft-tissue sarcomas. British Orthopaedic Oncology Society and British Orthopaedic Association. Metastatic bone disease. A guide to good practice . Oxford: BOOS; London: BOA, 2015. Cool P , Grimer R. Pathological fractures of the extremities. Trauma 2000; 2 : 101–11. Cool P , Grimer R, Rees R. Surveillance in patients with sarcoma of the extremities. Eur J Surg Oncol 2005; 31 (9): 1020–4. Dangoor A, Seddon B, Gerrand C et al . UK guidelines for the management of soft tissue sarcomas. Clin Sarcoma Res 2016; 6 : 20. Enneking WF , Spanier SS, Goodman MA. A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop Relat Res 1980; 153 : 106–20. Gerrand C, Athanasou N, Brennan B et al . on behalf of the British Sarcoma Group. UK guidelines for the management of bone sarcomas. Clin Sarcoma Res 2016; 6 : 7. Mankin HJ, Lange TA, Spanier SS. The hazards of biopsy in patients with malignant primary bone and soft tissue tumors. J Bone Joint Surg 1982; 64-A : 1121–7. Mirels H. Metastatic disease in long bones. Clin Orthop 1989; 249 : 256–64. Wedin R, Bauer HC. Surgical treatment of skeletal metastatic lesions of the proximal femur: endoprosthesis or reconstruction nail? J Bone Joint Surg Br 2005; 87 (12): 1653–7. - World Health Organization, International Agency for Research on Cancer. WHO classification of tumours. V ol. 3. Soft tissue and bone tumours , 5th edn. Lyon: IARC Press, 2019. - Union for International Cancer Control. TNM classification of malignant tumours , 8th edn. Oxford/Hoboken, NJ: John Wiley & Sons, 2017. tive y has SOFT-TISSUE TUMOURS
Soft-tissue tumours have also historically been classified according to their morphological appearance and presumed cell of origin. The range of biological behaviour is wide and most morphological types have a benign and malignant coun terpart, for example lipoma ( Figure 42.25 ) and liposarcoma. Other more frequent types include undi ff erentiated pleomor phic sarcoma and synovial sarcoma. Patients with suspected or confirmed soft-tissue sarcomas should be assessed and managed in a specialist centre. Summary box 42.8 Warning signs – soft-tissue tumour /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF Monique Trojani , contemporary , described the histopathological grading system in 1984. - The Trojani system, based on tumour di ff erentiation, mitotic count and tumour necrosis, is the standard for grading malignant soft tissue tumours. The AJCC / UICC system is used to stage malignant soft tissue tumours. - -
Larger than 5 /uni00A0 cm Increasing in size Painful Deep to the fascia Recurrence after previous excision (b) Figure 42.25 (a) Coronal T1-weighted magnetic resonance imaging scan showing a benign lipoma deep to the quadriceps muscle (arrow). (b) Excised benign lipoma.
Soft-tissue tumours
The treatment of soft-tissue tumours should take account of tumour type and the response to other treatments including radiotherapy . Large low-grade or benign lipomatous tumours may be excised in a deliberately marginal or close but complete fashion. Soft-tissue sarcomas should however be excised with a margin of normal tissue around them, which includes the biopsy track, wherever possible ( Figure 42.27 ). Skin involve ment may require resection of the skin and reconstruction with a split-skin graft or skin flap. Following surgical excision of high-grade soft-tissue sarco mas, adjuvant radiotherapy should be considered. Preopera radiotherapy can also have good results, but there is a risk of wound-healing problems following surgery . Chemotherap a limited role in the treatment of soft-tissue sarcomas. British Orthopaedic Oncology Society and British Orthopaedic Association. Metastatic bone disease. A guide to good practice . Oxford: BOOS; London: BOA, 2015. Cool P , Grimer R. Pathological fractures of the extremities. Trauma 2000; 2 : 101–11. Cool P , Grimer R, Rees R. Surveillance in patients with sarcoma of the extremities. Eur J Surg Oncol 2005; 31 (9): 1020–4. Dangoor A, Seddon B, Gerrand C et al . UK guidelines for the management of soft tissue sarcomas. Clin Sarcoma Res 2016; 6 : 20. Enneking WF , Spanier SS, Goodman MA. A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop Relat Res 1980; 153 : 106–20. Gerrand C, Athanasou N, Brennan B et al . on behalf of the British Sarcoma Group. UK guidelines for the management of bone sarcomas. Clin Sarcoma Res 2016; 6 : 7. Mankin HJ, Lange TA, Spanier SS. The hazards of biopsy in patients with malignant primary bone and soft tissue tumors. J Bone Joint Surg 1982; 64-A : 1121–7. Mirels H. Metastatic disease in long bones. Clin Orthop 1989; 249 : 256–64. Wedin R, Bauer HC. Surgical treatment of skeletal metastatic lesions of the proximal femur: endoprosthesis or reconstruction nail? J Bone Joint Surg Br 2005; 87 (12): 1653–7. - World Health Organization, International Agency for Research on Cancer. WHO classification of tumours. V ol. 3. Soft tissue and bone tumours , 5th edn. Lyon: IARC Press, 2019. - Union for International Cancer Control. TNM classification of malignant tumours , 8th edn. Oxford/Hoboken, NJ: John Wiley & Sons, 2017. tive y has SOFT-TISSUE TUMOURS
Soft-tissue tumours have also historically been classified according to their morphological appearance and presumed cell of origin. The range of biological behaviour is wide and most morphological types have a benign and malignant coun terpart, for example lipoma ( Figure 42.25 ) and liposarcoma. Other more frequent types include undi ff erentiated pleomor phic sarcoma and synovial sarcoma. Patients with suspected or confirmed soft-tissue sarcomas should be assessed and managed in a specialist centre. Summary box 42.8 Warning signs – soft-tissue tumour /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF Monique Trojani , contemporary , described the histopathological grading system in 1984. - The Trojani system, based on tumour di ff erentiation, mitotic count and tumour necrosis, is the standard for grading malignant soft tissue tumours. The AJCC / UICC system is used to stage malignant soft tissue tumours. - -
Larger than 5 /uni00A0 cm Increasing in size Painful Deep to the fascia Recurrence after previous excision (b) Figure 42.25 (a) Coronal T1-weighted magnetic resonance imaging scan showing a benign lipoma deep to the quadriceps muscle (arrow). (b) Excised benign lipoma.
Soft-tissue tumours
The treatment of soft-tissue tumours should take account of tumour type and the response to other treatments including radiotherapy . Large low-grade or benign lipomatous tumours may be excised in a deliberately marginal or close but complete fashion. Soft-tissue sarcomas should however be excised with a margin of normal tissue around them, which includes the biopsy track, wherever possible ( Figure 42.27 ). Skin involve ment may require resection of the skin and reconstruction with a split-skin graft or skin flap. Following surgical excision of high-grade soft-tissue sarco mas, adjuvant radiotherapy should be considered. Preopera radiotherapy can also have good results, but there is a risk of wound-healing problems following surgery . Chemotherap a limited role in the treatment of soft-tissue sarcomas. British Orthopaedic Oncology Society and British Orthopaedic Association. Metastatic bone disease. A guide to good practice . Oxford: BOOS; London: BOA, 2015. Cool P , Grimer R. Pathological fractures of the extremities. Trauma 2000; 2 : 101–11. Cool P , Grimer R, Rees R. Surveillance in patients with sarcoma of the extremities. Eur J Surg Oncol 2005; 31 (9): 1020–4. Dangoor A, Seddon B, Gerrand C et al . UK guidelines for the management of soft tissue sarcomas. Clin Sarcoma Res 2016; 6 : 20. Enneking WF , Spanier SS, Goodman MA. A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop Relat Res 1980; 153 : 106–20. Gerrand C, Athanasou N, Brennan B et al . on behalf of the British Sarcoma Group. UK guidelines for the management of bone sarcomas. Clin Sarcoma Res 2016; 6 : 7. Mankin HJ, Lange TA, Spanier SS. The hazards of biopsy in patients with malignant primary bone and soft tissue tumors. J Bone Joint Surg 1982; 64-A : 1121–7. Mirels H. Metastatic disease in long bones. Clin Orthop 1989; 249 : 256–64. Wedin R, Bauer HC. Surgical treatment of skeletal metastatic lesions of the proximal femur: endoprosthesis or reconstruction nail? J Bone Joint Surg Br 2005; 87 (12): 1653–7. - World Health Organization, International Agency for Research on Cancer. WHO classification of tumours. V ol. 3. Soft tissue and bone tumours , 5th edn. Lyon: IARC Press, 2019. - Union for International Cancer Control. TNM classification of malignant tumours , 8th edn. Oxford/Hoboken, NJ: John Wiley & Sons, 2017. tive y has
No comments to display
No comments to display