Soft tissue sarcomas are a heterogeneous group of tumors arising from the supporting extraskeletal mesenchymal tissues of the body—i.e., muscle, fascia, connective tissues, fibrous tissues, and fat.
Soft tissue sarcomas are a heterogeneous group of tumors arising from the supporting extraskeletal mesenchymal tissues of the body—i.e., muscle, fascia, connective tissues, fibrous tissues, and fat. They are rare lesions, constituting less than 1 percent of all cancers. There are wide morphologic differences among these tumors, probably resulting from the different cells of origin. However, like bone sarcomas, they all share certain biological and behavioral characteristics. The clinical, radiographic, and surgical management of most soft tissue sarcomas is identical, regardless of histogenesis.
Soft tissue sarcomas are a disease of adulthood, occurring most commonly in persons between 30 and 60 years of age. The sole exception is rhabdomyosarcoma, which occurs in young children. Approximately one-half of soft tissue sarcomas are found in the extremities; the remainder arise in the head/neck and trunk. The lower extremity is the most common anatomic site; 40 percent of all soft tissue sarcomas occur in this location. The anterior thigh (quadriceps) is the most common compartment, followed by the adductors and hamstrings. Most soft tissue sarcomas present as a painless mass. Systemic signs such as fever, weight loss, or anemia are rare. There are no useful laboratory screening examinations. Clinical suspicion is therefore crucial to diagnosis. Any adult presenting with an extremity mass must be presumed to have a sarcoma until proven otherwise and should be further evaluated. History of coincident trauma can often be especially misleading. Unfortunately, a presumptive diagnosis of lipoma, ganglion, hematoma, or muscle tear is often made, thereby delaying definitive evaluation and treatment.
At our institution, we treat many high-grade soft tissue with pre-operative chemotherapy. High-grade sarcomas of soft tissues often recur with surgery alone. Administration of chemotherapy before surgery shrinks the tumors (see figure, right) and allows for safer surgery with less risk of tumor recurrence. This also allows us to avoid using post-operative radiation therapy in nearly half of these patients.
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