Soft tissue tumour Mx TBH - Copy.pdf

2024 Soft Tissue Tumour Management Dr S.R. Čačala Photo by Stefan Els Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe Soft Tissue T...

2024 Soft Tissue Tumour Management Dr S.R. Čačala Photo by Stefan Els Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe Soft Tissue Tumours Introduction Mesenchymal origin Categorize as tissue of origin Benign/ Aggressive/ Malignant Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe Soft Tissue Tumours Introduction Examples Benign Aggressive Malignant Fibrous Fibroma Fibromatosis Fibrosarcoma Desmoid tumour F.histiocytic Dermatofibroma Dermatofibro- Malignant fibrous sarcoma protruberans histiocytoma Adipose Lipoma Atypical lipoma Liposarcoma Angiolipoma Smooth muscle Leiomyoma Leiomyosarcoma Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe Soft Tissue Tumours Introduction Most of STT are benign Dermatofibroma * fibrous tissue in the skin Lipoma* adipose fat tissue Leiomyoma * smooth muscle tissue Lymphangioma * lymph vessels Neurofibromas * nerve sheath Schwannomas * Schwann cells Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe  Benign Soft Tissue Tumours Management Excision if cosmetic concern, growing, functional impairment, painful Most common STT excised are lipoma Day surgery procedure Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe  Benign Soft Tissue Tumours Management- neurofibromas Local excision if cutaneous May be painful Beware deeper tumours - ?malignant MPNS tumours Require core bx Neurosurgery for non cutaneous lesions Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe  Benign Soft Tissue Tumours Management- haemangioms Most spontaneously resolve Cosmetic or location concern, involving impt structures: Beta blocker Corticosteroid injection Lazer surgery Surgery for functional reasons depending on site, size Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe  Benign Soft Tissue Tumours Management- Schwannomas Benign tumours with Schwann cell differentiation Superficial cutaneous lesions: Resection with nerve preservation in larger impt nerves Excision with nerve in small nerves Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe  Fibromatosis Management- Superficial Palmar/ Plantar/ Peyronnies/ Nodular fasciitis Treatment- surgical excision of contracture band ultrasonic ablation steroids/ collagenases/ radiation- variable effect Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe  Fibromatosis Management- Deep Desmoids- abdominal or extra-abdominal Treatment choices Surgery- Clear margins LRR 30-50% Watch and wait – Spon regression 30-50% Chemotherapy- (adj or neo-adj), Tryosine kinase inhibitors/ DTIC/ combinations Thermoablation/ Cryoablation Endocrine therapy- (SERM ex. Tamoxifen) – 60% response Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe DFSP dermatofibrosarcoma protuberans Management- Deep Bx for diagnosis. Imaging to assess margins Wide local excision May need flap closure or SSG If positive margins- resect more Radiotherapy as adjuvant or R1 resections Recurrences with + margins post resection = TKI Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe  Sarcomas Introduction Uncommon, 1% new cancers 100 benign STT : 1 sarcoma 50 y age / 50% extremities/ 50% mortality Red flag signs – painful / deep/ > 4 cms/ rapid growth Bx for diagnosis. >100 subtypes (liposarcoma commonest) CT staging and CT or MRI for sarcoma definition and association with structures Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe  Sarcomas Management MDT Surgery – if no mets or as palliative procedure Radiotherapy Chemotherapy- modest effect Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe Surgery Biopsy Marginal Wide (includes pseuocapsule) Radical Planned + margins LRR 3% Unplanned + margins 30% LRR Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe Surgery Limb sparing versus amputation LSS + RTx- same survival as amputation Higher recurrence rate May require amputation Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe Radiotherapy Alone +/- other modalities Improves local control 50% Sarcomas get RTx Curative and palliative intent Preservation organ function Can be given before surgery to Cosmesis downsize tumour Limited by critical structures Less toxicity Resource limitation Worse wound healing Post surgery as adjuvant tx More toxic More long-term fibrosis Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe  Conclusion STT common Benign lesions = excise Aggressive lesions and Sarcomas need MDT input Desmoids- multiple tx options Surgery still mainstay Sarcomas Uncommon Stage Surgery + RTx main tx option if not metastatic Medicine and Health Sciences | EyeNzululwazi ngezoNyango neMpilo | Geneeskunde en Gesondheidswetenskappe