Soft Tissue Tumour Management Overview

Soft Tissue Tumours Introduction

• Soft tissue tumours have a mesenchymal origin, categorized by their tissue type and characteristics: benign, aggressive, or malignant.
• Common types include:
  • Benign: Fibroma, Dermatofibroma, Lipoma, Leiomyoma, Lymphangioma, Neurofibromas, Schwannomas.
  • Aggressive: Fibromatosis, Atypical lipoma, Dermatofibrosarcoma protuberans.
  • Malignant: Fibrosarcoma, Malignant fibrous histiocytoma, Liposarcoma, Leiomyosarcoma.

Management of Benign Soft Tissue Tumours

• Excision is recommended for cosmetic concerns, growth, functional impairment, or pain.
• Lipomas are the most frequently excised benign soft tissue tumours, typically managed as day surgical procedures.
• Neurofibromas may require local excision, particularly if cutaneous, while deeper tumours necessitate caution for potential malignancy.
• Hemangiomas usually resolve spontaneously but can be treated with beta blockers or corticosteroids if they affect crucial structures.
• Schwannomas are benign, with resection prioritized in superficial cases, ensuring nerve preservation in significant nerves.

Management of Fibromatosis

• Superficial fibromatosis (e.g., Palmar, Plantar, Peyronie's disease) treats with surgical excision, ultrasound ablation, or medication (steroids, collagenases).
• Deep fibromatosis (desmoids) can be managed through:
  • Surgery aiming for clear margins (30-50% local recurrence rate).
  • Watchful waiting due to spontaneous regression (30-50%).
  • Chemotherapy options include tyrosine kinase inhibitors.
  • Thermo/cryotherapy and endocrine therapy (e.g., Tamoxifen) yield around 60% response.

Management of Dermatofibrosarcoma Protuberans (DFSP)

• Diagnosis confirmed via biopsy; imaging is essential for margin assessment.
• Treatment involves wide local excision; flap closure or skin grafting may be necessary.
• Re-excision is required if margins remain positive post-resection, with radiotherapy as an option for resected positive margins.

Sarcomas Overview

• Sarcomas account for around 1% of new cancer cases; there is a significant disparity of benign STT to sarcomas (100:1).
• Common signs: painful lesions, deep location, size over 4 cm, rapid growth.
• More than 100 subtypes exist, with liposarcoma being the most common. Diagnosis is confirmed via biopsy and staging using CT or MRI.

Sarcoma Management

• A multidisciplinary team (MDT) is critical for managing sarcomas, with surgical intervention being preferred when metastasis is absent.
• Adjuvant options include radiotherapy and chemotherapy, though the latter has modest effectiveness.

Surgical Approaches

• Surgery types include biopsy, marginal, wide (includes pseudocapsule), and radical resection.
• Surgical planning is vital, with a local recurrence rate (LRR) of 3% for planned margins and 30% for unplanned margins.
• Limb-sparing techniques are often considered similar in survival prospects to amputation, though recurrence rates may be higher.

Radiotherapy Considerations

• Radiotherapy can be utilized alone or in conjunction with other modalities to enhance local control in sarcoma treatment.
• Approximately 50% of sarcomas receive radiotherapy, serving both curative and palliative purposes.
• Pre-surgery, it may help shrink tumours for better surgical outcomes, but risks include less toxicity and limitations due to critical structures.

Conclusion

• Soft tissue tumours are prevalent, with benign cases typically addressed through excision.
• Aggressive lesions and sarcomas require comprehensive MDT involvement with multiple treatment avenues.
• Surgical options are central for the management of desmoids and sarcomas, especially in non-metastatic instances.

This quiz covers the management of soft tissue tumors, focusing on their classification based on tissue origin and characteristics such as benign, aggressive, or malignant forms. It is suitable for those studying medicine and health sciences, particularly in oncology and pathology.