Tumors of Soft Tissue : Wheeless' Textbook of Orthopaedics

- Bone Tumors
- Biopsy
- European Cancer Institute - Soft Tissue Sarcomas
- Metastatic Tumors
- MRI
- Stage Classification

Tissue type:

- Osseous
     - Myositis ossificans
     - Extraosseous osteosarcoma
- Carilaginous:
     - Chondroma
     - Extraosseous chondrosarcoma
- Synovial Chondromatosis
- Fibrous:
     - Fibroma
     - Fibrosarcoma
     - Desmoplastic Fibroma
     - Fibromatosis
     - Malignant fibrous histiocytoma
- Synovial
     - PVS
     - Synovial sarcoma
- Vascular:
     - Hemangioma
     - Angiosarcoma
- Fatty
     - Lipoma
     - Liposarcoma
- Neural
     - Neurolemmoma
     - Neurosarcoma
     - Neurofibroma
     - Neurofibrosarcoma
- Neuroblastoma
- Muscular:
     - Leiomyoma
     - Leiomyosarcoma
     - Rhabdomyoma
     - Rhabdomyosarcoma
- Skin/Dermis
- Malignant Melanoma
- Squamous Cell Carcinoma
- Unknown
     - GCT of Tendon Sheath
     - Epithelioid Sarcoma
- Mesenchymoma
     - Clear Cell Carcoma

- Discussion:
    - primary goal is to determine whether the mass is benign or malignant;
- prior to biopsy the physician should determine:
- whether the mass is above or below the fascia (deep lesions are more often malignant);
         - exceptions are MFH and leiomyosarcoma which can occur in the subcuanteous tissues;
- anecdotally malignant superficial lesions will not appear as a discrete circular mass, but there are always exceptions;
- size of mass:- if mass is > five cm, esp if it is deep and in thigh, it is likely to be a sarcoma;
- whether there are visible changes on x-ray (such as soft tissue calcification which can be seen in synovial sarcoma);
- it has been recommended by Springfield DS (1996) that superfical masses feel like fat (lipoma), which do not cause pain and which have not changed in size can be followed clinically;
                    - Biopsy: complicated and risky.
         - masses which are painful, have changed in size, or show suspicious x-ray findings, will require MRI and biopsy (either incisional biopsy or by needle)