Common benign tumors are lipomas, fibromas, angiolipomas, benign fibrous histiocytomas, neurofibromas, schwannomas, hemangiomas, tendon cell tumors, myxoma.
Benign lesions of soft tissue rarely metastasize, but are often large and deep. However, some entities behave very aggressively. A diagnosed invasion of nearby tissues increases the chance of incomplete removal and the possibility that the tumor will return.
In adults, the most common benign soft tissue tumor is lipoma. Children have a Baker cyst. Most often, both adults and children have lipoma and hemangioma.
Benign skin tumors, tumor-like proliferation of skin tissues develop in most cases painlessly in the form of single or multiple nodes or growths. More often they are localized in the upper limbs, on the trunk, face. In most cases, the neoplasms are covered with skin with normal color, less often - pink. There are formations with different colors ranging from yellowish - brown to black and blue.
The most common symptom is an unexpectedly palpable tumor, in second place are various kinds of pain that precede the appearance of the tumor, and the third is the appearance of a painful tumor.
The nature of pain, as a rule, is moderate and inconstant, they do not have such intusiveness as in the case of primary bone tumors, and are most often manifested during functional loads or palpation of the tumor. When the tumor grows into the bone, the pains become permanent, and when localized in the region of the large nerve trunks, a picture of neuritis or plexitis can develop.
Types of benign neoplasms
Fibroma. It comes from fibrous connective tissue and can be found wherever the latter exists. There are solid fibromas, represented by a dense consistency node, and soft fibromas, characterized by a flabby consistency. Favorite localization of soft fibroids, usually growing on the leg, is the subcutaneous tissue of the genital organs and the anal region. Fibromas grow extremely slowly, clearly delimited from the surrounding tissues, motile.
Lipoma. Formed from adipose tissue. It is most often located in the subcutaneous tissue, but may be located in any part of the body where there is adipose tissue (for example, in the retroperitoneal space). In women, lipomas are noted 3-4 times more often than in men, but age does not matter. Sometimes there are multiple lipomas (lipomatosis). The tumor is often characterized by a lobular structure, a soft texture. It is not soldered to the skin and is mobile in relation to the surrounding tissues. Lipoma growth is slow. Its size is different, sometimes quite significant. If there is a large amount of connective tissue in the lipoma, the tumor is referred to as fibrolipome. However, this diagnosis is made mainly after histological examination.
Myoma. It develops from muscle tissue and can be localized in any part of the body where there is muscle tissue. A tumor arising from striated musculature is called a rhabdomyoma, and a smooth tumor is called a leiomyoma. In the soft tissues are found mainly rhabdomyomas, located, as a rule, on the limbs. The disease occurs equally often in people of both sexes, usually occurs at a young age. Tumors grow slowly, have a densely elastic consistency, are mobile, separated from surrounding tissues, painless. Since the fibroids are in the thickness of the muscles and do not cause anxiety to the patients, by the time the patients go to the doctor, they are usually quite large.
Hemangioma. It is a tumor emanating from the blood vessels. It is noted most often at children's and young age. Depending on the localization, the following groups of hemangiomas are distinguished: predominantly the skin, the musculoskeletal system as a whole, and parenchymal organs. In soft tissues, cavernous, racemic and intermuscular hemangiomas are most common. They are formed mainly in the subcutaneous tissue and muscles of the lower extremities. The clinical picture of hemangioma is characterized by two main features: pain and the presence of swelling (tumor). Its consistency is soft or densely elastic. Dense consistency is usually found with a relatively low content of functioning vessels in the tumor. With a large number of functioning vascular cavities, the consistency of hemangioma is soft. If the tumor is connected with a large arterial vessel, then it can pulsate, and then vascular noise is determined above it. The color of the skin over the tumor is different and depends on the depth and growth of hemangioma. If the tumor is located deep in the muscle tissue and even continues to grow in the direction of the bones of the limb, the skin color above it may not change. With a shallow localization of the tumor and its growth in the subcutaneous tissue, the color of the skin can change from bluish to bright purple. When squeezed, such a tumor is reduced in size, and the color of the skin becomes less intense. The pains in hemangiomas, as a rule, are indicative of a far-reaching pathological process affecting the deep muscle tissue and nerves of the extremities.
Glomusnuyu tumor (tumor Barre-Masson). It occurs most often in childhood and middle age, predominantly in males. Favorite localization of the tumor are the nail phalanges. In the overwhelming majority of cases, the glomus tumor is single, but sometimes there may be several of them at one site. The leading symptom is a sharp burning pain when pressing on the tissue in which the tumor is located. Clinically, the glomus tumor becomes noticeable quite a long time after the onset of pain. In most cases, it is rounded, elastic consistency, with a diameter of 1 to 3 cm. The skin over the tumor is often bluish in color.
Giant cell synovioma. This tumor is usually located in those places where there is a synovial membrane. Celebrated at the age of 30-50 years, with women more often. In the overwhelming majority of cases, the giant cell tumor is located on the upper limbs in the region of the tendon sheaths of the hand, less often on the hand, foot, and close to the radiocarpal and ankle joints. The giant cell synovioma grows slowly in the form of a bumpy round or oval knot of moderately dense consistency, delimited from the surrounding tissues. Sometimes it consists of several nodes with a single fibrous capsule. Occasionally, the tumor is associated with the skin.
Neuroma. Occurs from Schwann nerve sheath cells. Localized along the nerve trunks. Occurs at any age. Mainly affected upper limbs, neck and head. A tumor can be single or multiple, growing slowly in the form of a clearly delimited node. The size of neuromas is from several millimeters to 3-4 cm in diameter. Tumor dense consistency. One of the characteristic signs is soreness with pressure.
Neurofibroma. Develops from the membranes of the nerves. It is observed in men and women of any age. Most often localized in the intercostal and sciatic nerves. Neurofibromas are mainly represented by single nodes, however, there is also multiple neurofibromatosis, known as Recklinghausen disease. Neurofibromas grow slowly, have a rounded shape, a smooth surface and a densely elastic consistency. Pressing on the tumor causes pain along the nerve. The size of the neurofibroma can be different, sometimes reaching 15-20 cm in diameter.
Diagnosis and treatment
The main methods of diagnosis: biopsy, physical examination, ultrasound diagnostics. Most benign tumors are subject to surgical treatment and amputation. The main indications for surgery for benign soft tissue tumors are an increase in the size of the neoplasm, chronic traumatization, and a high risk of malignancy.
The main methods of treatment: surgical removal (resection, excision with a scalpel), liposuction (pumping out the contents of the tumor with a syringe), taking steroids (limiting tumor growth, but not removing it), laser removal, cryotherapy (using liquid nitrogen). A combination of methods may be used. The healing takes about two weeks, depending on the location and damage to other types of tissue.
TUMOR FROM FATTY TISSUE
Lipomas are the most frequent benign tumors of adipose tissue. Most of them are located under the skin. Lipoblastomas and hibernous also belong to benign adipose tissue tumors.
Liposarcomas - Malignant tumors of adipose tissue. Most often found on the hip and in the retroperitoneal space in individuals aged 50-65 years. Some liposarcomas grow very slowly, others - are characterized by rapid growth.
MUSCLE TISSUE TUMORS
There are two types of muscles: smooth and striated. Smooth muscles are in the internal organs (stomach, intestines, blood vessels, uterus) and contract involuntarily, regardless of our desire, and we can not control their activity. The striated (skeletal) muscles allow movement with the arms, legs, and other parts of the body. These movements depend on our desire.
Leiomyoma are benign smooth muscle tumors and are most commonly detected in women in the uterus.
Leiomyosarcoma - malignant tumors of smooth muscles, which can develop in any part of the body, but most often localized in the retroperitoneal space and internal organs. Rarely they are found in the muscles of the arms and legs.
Rhabdomyomas refer to benign striated muscle tumors.
Rhabdomyosarcoma - Malignant tumors of the striated muscles. Most often develop on the upper and lower extremities, but can also be detected in the head and neck, bladder and vagina. The disease is most often diagnosed in children.
Frequency of soft tissue sarcomas
In 2002, 3055 cases of soft tissue sarcomas in adults were detected in Russia. The incidence rate for both sexes was 2.1. In children, soft tissue sarcoma makes up 4-8% of all malignant tumors. 5-9 cases of such cases per 1 million children are recorded annually.
In the United States in 2004, approximately 8,680 cases of soft tissue sarcomas can be detected (4,760 cases in males and 3,920 in females). These data apply to children and adult patients.
Soft tissue tumors
The group of soft tissue tumors includes a wide range of diverse neoplasms. In children, benign tumors, for the most part, come from blood vessels or from fibrous tissues. Among malignant neoplasms, soft tissue sarcoma (MTS) is more common in children than in adults (10% and 2%, respectively). Unfortunately, this includes very severe nosological forms. These lesions are classified as myogenic, fibromatous, vascular, neurogenic, lipomatous, myxoid, and pseudosarcomatous. And a number of other neoplasms can be placed in any of the listed categories.
Soft tissue tumors are histologically subdivided on the basis of their similarity to mature tissues of a certain type to a greater extent than depending on the type of tissue from which they develop. The relative incidence of soft tissue tumors in children is presented in table 72-5.
A significant difference is detected between MTS in adults and in children. More than half of MTS in children is rabdomiosarcoma. Fibromatous tumors in frequency are in second place among MTS in children. The most frequent localization of MTS in childhood is the head, neck, and urogenital tract, while in adults localization of the extremities and in the retroperitoneal space prevails. Rhabdomyosarcoma is discussed in Chapter 70, vascular tumors in Chapter 65. Issues of smooth muscle tumors are not discussed here, since these tumors are extremely rare in children.
Clinical approach. Although it is proved that the majority of soft-tissue tumors in children are benign, it is better to err by removing a benign tumor without evidence than to not diagnose it and, accordingly, to leave a malignant neoplasm undone. In addition to a thorough examination of the history, examination and physical examination, it is necessary to carry out magnetic resonance imaging (MRI) and / or CT. MRI is more effective in cases where it is necessary to determine the spread of the tumor and the involvement of vital structures.
Biopsy of soft tissue malignant neoplasms is very important. A biopsy should be performed by the surgeon who, in case of detection of malignancy, will operate on the patient. Small tumors, the removal of which can be carried out without serious cosmetic and functional consequences, do not present any particular problems.
Superficial tumors should be excised together with the oval area of the skin covering them. It is necessary to make a longitudinal incision on the extremities, since during repeated operations one has to face great difficulties if the biopsy was performed from a transverse incision. Careful hemostasis should be carried out, since a hematoma in a wound can accumulate malignant cells in itself, which contributes to local dissemination of the tumor.
For large tumors or tumors located in areas where complete excision of the tumor is not possible, an open (incisional) diagnostic biopsy is performed. The selection should be done directly through the tumor, but not through the surrounding muscles. Damage to the neurovascular structures should be avoided. Often, puncture biopsy (using a thin needle or Tru-Cut) is often very useful, but it is often difficult to accurately determine the type of tumor histologically.
In addition, tumor seeding can occur during biopsy. The biopsy canal should be excised during the main operation. It is unreasonable to move from biopsy to extensive resection based on the results of a study of frozen sections.
There is a well-proven relationship (Li-Fraumeni) between MTS in children and the development of malignant tumors in other family members. Some factors concerning a child with MTS (an infant boy with a specific histological pattern) indicate an increased risk for mothers and siblings. The mothers of these patients have a significantly higher incidence of breast cancer, and therefore they should be periodically examined using screening methods.
Survival in MTS is closely related to the adequacy of surgical intervention. Do not forget the old saying that the surgeon should try not to “see” the tumor (meaning “from the inside”) during surgery (that is, not to “enter”, not to “infiltrate” it). For limb tumors, preoperative chemotherapy and radiation therapy can reduce the size of the tumor and thus increase its “resectability”. In general, the prognosis for children, including infants, is better for certain types of tumors than for adults with the same tumors.
Fibromatous and fibrogistiocytic tumors. Fibromatous and fibrogistiocytic tumors are a group of diverse, not clearly defined neoplasms. It is currently believed that many of the fibroids develop from myofibroblasts. Pathologists refer most of the fibroids in children simply to "unclassified fibromatosis." The most common fibrous lesion in children is aggressive fibromatosis (desmoid).
Fibromatosis occurs in infants as well as in older children. The average age at which this pathology is detected is 7 years. The most frequent localization of the tumor is the head, neck and lower limbs. In the treatment of these benign tumors, the method of choice is a wide local excision with the preservation of vital structures, since the retention of tumor tissue (along the borders of resection) causes a higher recurrence rate. Local recurrence occurs quite often (in one third of patients), usually within a year after treatment. On malignant degeneration information is practically absent.
A special form is neck neck fibromatosis (“congenital torticollis”) - congenital fibromatosis of the sternocleidomastoid muscle, which is usually cured with the help of physiotherapy. Infantile myofibromatosis (congenital fibromatosis) is a lesion variant found only in infants.
Damage with this happens salt-tarnym, multiple or diffuse. Solitary congenital infantile myofibromatosis can have any localization. He does not regress, surgical treatment is not required. Recurrences are rare.
Multiple congenital infantile myofibromatosis is a combination of bone lesions (osteolytic), muscles, skin, and subcutaneous tissue, which rarely regresses. Generalized congenital infantile myofibromatosis usually leads to death during the first few weeks or months of life.
Another type of fibromatous tumor, which manifests itself in the first months of life and is localized on the extremities, is congenital fibrosarcoma-like fibromatosis (infantile fibrosarcoma). Concerning the aggressiveness of these tumors in infants there are different opinions. With localization on the head, neck and torso, local relapses occur with the same frequency as in limb lesions (that is, in about one third of cases), but more often metastases develop, usually in lymph nodes and lungs.
It is necessary to produce a wide excision of the tumor within healthy tissue. Although the role of chemotherapy and not clearly defined, but it is carried out before the operation, which contributes to the reduction of the tumor and thus makes possible complete resection. Overall survival is about 90%.
Fibrous hamartoma in infants is a rare tumor that usually occurs as a subcutaneous nodule in the armpit in boys. A simple excision is enough, since relapses rarely occur. A tendinous vaginal fibroma is a small benign tumor, usually localized in the wrist, hand, or fingers.
In a third of cases, the tumor is painful. A wide excision of the tumor was shown, since the frequency of relapses is significant (24%). Juvenile aponeurotic fibromatosis is a benign lesion, which also has a tendency to localize in the distal upper limb in children. The risk of local recurrence causes indications for widespread excision, if possible.
Aggressive fibromatosis (desmoid) is a non-metastatic neoplasm localized mainly in the head, neck, shoulder girdle and abdominal wall. This tumor has a tendency to local recurrence. It is also characterized by infiltrative growth along fascial structures with local and distant distribution.
In most cases, the tumor is detected in children older than 10 years. The clinical picture is the appearance of a tumor-like formation, slowly increasing. CT scan with intravenous injection of a contrast agent allows the tumor to be “outlined”. Surgical intervention should consist in wide excision, however, even with an adequately performed surgical intervention, this tumor, which has an infiltrating growth, can recur.
The presence of microscopic examination of the positive edges does not always mean the inevitability of tumor recurrence. It is advisable to carefully observe such patients with CT and NMR control every 2-3 months. In the presence of relapse, wide excision is absolutely indicated, often in combination with radiation therapy. In very rare cases, amputation may even be required.
Fibrosarcoma in older children and adolescents is usually localized on the extremities and manifests as a tumor-like mass. Its course does not differ from the course of fibrosarcoma in adult patients. More often the tumor occurs in boys. Treatment should consist in the mandatory very wide excision of the tumor within normal tissue.
Of course, you should always strive to preserve the limb, if only it is possible to remove the tumor completely. With common forms of the disease, chemotherapy and radiotherapy are indicated. The prognosis is determined by the stage of the tumor, its type and the adequacy of the surgical intervention. Indicators of 5-year survival exceed 60%.
Malignant fibrous histiocytoma (ZFG) has a significant proportion among soft tissue tumors in adults, but in children it accounts for 5% of these tumors. The origin of this fibrogistiocytic tumor is rather mesenchymal than histiocytic. Boys are somewhat more prone to the occurrence of ZFG. In children, the tumor is most often localized in the region of the lower extremities and the retroperitoneal space.
There are several types of tumors. Its angiomatous variant tends to affect children in early adolescence and usually develops on the limbs. Sometimes there is fever, weight loss, anemia. Half of the patients experience local relapses. This malignant and potentially life-threatening tumor requires extensive resection. It is necessary to do everything possible in order to preserve not only the limb, but also its function. The prognosis is more favorable with superficial tumors, with histological signs of inflammation and with small tumors.
This group of tumors includes histiocytoma, which appears as a small benign intradermal nodule, requiring only excision. There is a malignant variant. Juvenile xanthogranuloma occurs mainly in young children, including infants, and is usually localized in the scalp and neck.
Tumor nodules can be multiple. This tumor is characterized by spontaneous regression. Giant cell tumors of the tendon sheath are characterized by local recurrence, often with lesions of the bone, mainly in the area of the palmar surface of the fingers. Fibrous histiocytoma occurs in the dermis or subcutaneous tissues of the head, neck, groin, chest, lower extremities.
This tumor rarely metastasizes, but has a tendency to local recurrence, especially with inadequate resection. Giant cell fibroblastoma occurs predominantly in boys of infant age, usually in the subcutaneous tissues of the chest and axillary region. A wide excision of the tumor is necessary due to its tendency to local recurrence. This tumor may be associated with fibrous histiocytoma.
Neuromatous tumors. Of the peripheral neurogenic tumors in children, neurofibroma is most common. It may appear as a solitary mass (about 90%) in the skin or other tissues, or as multiple skin and subcutaneous nodules (von Recklinghausen's neurofibromatosis - NFR).
Neurological symptoms, surprisingly, are rarely noted. A simple solitary neurofibroma should be optimally excised with preservation of the corresponding nerve. However, neurofibromas are often unencapsulated and tend to invasive nerve sprouting, which makes it impossible to resect a tumor without harming the nerve involved.
In the case of extensive damage, implantation of tissue expanders is used, which allow for a relatively lengthening of the nerve. After that, resection of the tumor and primary anastomosis of the unaffected areas of the nerve are performed. With solitary neurofibromas, malignant degeneration rarely occurs. Removal of significant for the length of the nervous elements affected by the tumor is not shown. Resection of diffuse or multiple neurofibromatous nodes is usually impossible.
With multiple neurofibromatosis (NFR) in 5-7% of cases by the age of 20, malignancy occurs with the development of malignant schwannoma (neurofibrosarcoma). The result may be significant hypertrophy of the affected regional structures (eg, fingers, limbs). Rapid tumor growth, the appearance of pain, sensomotor symptoms, any unexplainable changes in the tumor zone or the development of new foci in patients with NFR are signs of sarcomatous degeneration.
Patients with NFR have an increased risk of developing other malignant neoplasms, including central nervous system tumors, pheochromocytomas, rhabdomyosarcomas, and non-lymphoid leukemia. The most frequent clinical manifestations of NFR in children are spots of the color of coffee with milk and spots resembling freckles in the axillary and inguinal areas.
Plexiform neurofibroma is almost always combined with NFR. Large nerve trunks are usually involved in the process. The main problem is connected with the local aggressive behavior of the tumor, although otherwise it is completely benign and can disguise local malignancy. For this reason, morphologists should carefully examine this tumor. Scheintorakalny and plexiform neurofibromas are very prone to malignancy.
In most cases, plexiform neurofibromas occur as a painless mass, often described as a “bag of worms.” Hypoesthesia or hyperesthesia may occur. One third of patients have orthopedic problems. Always, if possible, a complete resection of the tumor within healthy tissue should be performed. However, such an intervention is often not possible due to anatomical and functional factors.
Neurolemmoma (schwannoma) is a benign solitary tumor that develops from Schwann cells and is not associated with NFR. It is a slowly growing neoplasm arising from nerve sheaths. Clinically, the tumor is a painless formation, during percussion of which Tinel's symptom is determined (paresthesia in the form of a tingling sensation distal to the percussion site, produced in the affected nerve zone).
Nerve dysfunction rarely occurs. These tumors are predominantly capable of resecting the tumor with preservation of the nerve, since these are usually encapsulated formations that can be separated from the nerve without much difficulty.
Malignant schwannomas (neurofibrosarcomas) are relatively rare tumors, which account for less than 5% of all MTS in children. In children, approximately half of these tumors develop with NFR.
They are found mainly in older children and adolescents and are localized in the region of the limbs, abdomen and body. Surgery should be a wide resection, including excision of the segment of the affected nerve, as these are potentially fatal tumors. Chemotherapy may be effective for common stages of the disease. The value of radiation therapy is rather limited. The prognosis for malignant schwannomas is poor.
Lipomatous and myxoid tumors. Lipomatous tumors in children are less common than in adults. Mature lipomas - delimited fatty tumors localized under the skin. Lipomatosis is multiple skin and subcutaneous tumor deposits. More than 3/4 lipoblastomas occur in infants in the first year of life. The most frequent localization - limbs. Histologically, these tumors are indistinguishable from myxoid liposarcoma, which occurs in adults. Lipoblastoma is characterized by the absence of metastasis, but the occurrence of local recurrences (14%).
Well-demarcated encapsulated tumors are termed lipoblastomas, diffuse - lipoblastomatosis. Together with the growth and development of the patient, these tumors tend to mature rather than malignancy. Other rare fatty tumors that are sometimes found in children include hibernoma (a tumor consisting of brown fat), lipofibromatosis hamartoma (localized congenital gigantism, usually on the palmar surface along the median and ulnar nerves), the sacrococcygeal lipoma, as well as intraosseous and paraostal lipomas.
Liposarcoma is rare in children. 99% of these tumors occur in adult patients. Most liposarcomas that develop in children are of the myxoid type, and occur predominantly in older children in the lower extremities. These tumors tend to give local relapses, but rarely metastasize. The preferred treatment is widespread excision of the tumor within healthy tissue.
Benign myxoma, like its malignant version of myxosarcoma, is extremely rare in children.
Pseudosarcomatous and mixed tumors. Pseudosarcomas are an insufficiently well-defined type of tumors, developing, as expected, from myofibroblasts. Nodular fasciitis (pseudosarcomatous fasciitis) is characterized by the presence of solitary, small, painless lesions with fuzzy edges, located in the subcutaneous fascia. Typically, these nodules occur in the forearm, at least - on the head, neck or lower extremities. The tumor usually grows in depth, germinating in the subcutaneous layer and in the muscles.
As with other pseudosarcomas, progression proceeds very quickly. Other lesions belonging to this group include cranial fusciitis (fibroblastic tumor in the cranial region, as a rule, in infants), intravascular fasciitis (multi-site lesion of the vascular wall or adjacent to the vessel), and inflammatory pseudo-tumors (lesion deep fascia, often combined with anemia, fever and weight loss).
Ossificatory myositis manifests itself as a deep-seated, calcified painless mass, usually located in the lower half of the body. Sometimes it turns out that there was a trauma before the development of myositis in history. Histologically, these tumors are characterized by the formation of ectopic bone tissue and connective tissue proliferation, and can sometimes be mistaken for extraosseous osteosarcoma. Generalized hereditary autosomal dominant form occurs in infants with the corresponding phenotype.
Synovial sarcoma is a tumor of unclear histogenesis, occurring in older children and young adult patients, with a predominance in male patients. It accounts for 10% of all MTS in childhood. The most frequent localization is the lower limbs, especially in the area of the knee joint. Often a tumor also occurs in the area of the hands and feet.
Deeply located and often difficult to determine by palpation, the tumor is not necessarily adjacent to the synovial membrane and is rarely located in the cavity of the joint. Usually, before the correct diagnosis is made, the patient has pain for 1–2 years. In almost one third of cases, calcifications are detected. These tumors are prone to relapses and metastases. The basis of treatment is widespread excision of the tumor and chemotherapy in combination with radiation therapy or without it. Another approach is possible - amputation and chemotherapy (without radiation therapy).
If possible, regional lymph nodes are excised. Amputation is necessary in cases where it is impossible to remove a tumor within healthy tissue, and therefore it is impossible to preserve a limb. Almost half of the patients revealed metastases. The prognosis depends on the stage and size of the tumor and the adequacy of the resection performed. Factors indicating a favorable prognosis are: the prolonged existence of pain, the presence of calcifications, the small size of the tumor (
The group of soft tissue tumors includes a wide range of diverse neoplasms. In children, benign tumors, for the most part, come from blood vessels or from fibrous tissues. Among malignant neoplasms, soft tissue sarcoma (MTS) is more common in children than in adults.
Mesenchymoma of the liver and rhabdomyosarcoma of the intrahepatic bile ducts are rare in children. More than 95% of the liver malignant tumors found in children are hepatoblastomas or hepatocellular carcinomas.
Benign tumors Edit
Fibromas and fibroblastomas usually grow expansively and have clear boundaries, fibromatosis is characterized by the absence of clear boundaries of the lesion due to infiltrative growth. Fibroma fibroma is a tumor formed by mature fibrous connective tissue. There are more than ten morphological variants of fibroids (elastofibroma, dense fibroma, soft fibroma and others), but, as a rule, their clinical course is not significantly different. In addition to soft tissue, fibroma can form in bones (desmoplastic bone fibroma, odontogenic fibroma). Fibroblastoma fibroblastomas differ from fibroids in a number of characteristics of tumor cells, however, the intercellular component is also represented mainly by collagen fibers. Benign tumors of myofibroblasts are named myofibroma, myofibromatosis and myofibroblastoma.
Among benign forms of fibromatosis fibromatosis is most common neck fibromatosis (congenital torticollis) - the growth of fibrous tissue in the lower third of the sternocleidomastoid muscle in newborns. The fibrous tissue at the same time forms a knot of irregular shape with a diameter of usually 1-2 cm
Benign fibrous proliferative lesions also include (1) nodular fasciitis, (2) proliferative fasciitis, (3) proliferative myositis and (4) ossifying myositis.
Nodular fasciitis is a rapidly growing nodule (about 1 cm per week), located in the subcutaneous tissue, skeletal muscles, or associated with their fascia, the lesion rarely exceeds 3 cm in diameter and usually has clear boundaries. After removal recurs rarely. The rapid growth of the nodule in the early stage of the process and high cellularity with signs of atypia of tumor cells simulate sarcoma, therefore, earlier (classification of soft tissue tumors WHO, 1969) nodular fasciitis was called pseudosarcomatous fibromatosis. Proliferative fasciitis is called a similar lesion, in the tissue of which large fibroblasts are detected. The same process in skeletal muscle is called proliferative myositis. Myositis with signs of bone metaplasia is called ossifying myositis, while the lesion in the skeletal muscle is not associated with bone.
Locally aggressive tumors Edit
TO superficial fibromatosis refer (1) palm fibromatosis (Dupuytren's contracture Dupuytren’s contracture) and (2) fibromatosis of the sole (Ledderhoze disease Ledderhose’s disease). Fibromatosis of desmoid type (desmoid tumors) - deep fibromatosis, characterized by pronounced proliferation of active fibroblasts. Distinguish (1) abdominal (in the thickness of the anterior abdominal wall), (2) intra-abdominal (in the abdominal organs, especially in the mesentery of the small intestine) and (3) extra-abdominal (at localization of the process outside the abdominal wall and abdominal organs) variants of desmoid tumors.
To locally aggressive tumors can also be attributed angiofibroma nasopharynxcommon in boys in the second decade of life. This tumor is characterized by locally-destroying growth, often recurs after removal.
Close to deep fibromatosis is idiopathic retroperitoneal fibrosis (Ormond's disease). The disease occurs predominantly in adult males. At the same time in the retroperitoneal space there is a growth of coarse fibrous connective tissue, squeezing the ureters (fibrous periureteritis), which leads to hydronephrosis. Less common fibrous periaortitis. Sometimes similar processes develop in the mediastinum (fibrous mediastinitis), in the thyroid gland (fibrous thyroiditis Riedel), in the liver (primary sclerosing cholangitis), in the tissues of the orbit (orbit pseudotumor). In such cases of common lesions, the disease is indicated by the term systemic idiopathic fibrosis (multifocal fibrosclerosis).
Rarely metastatic tumors Edit
The most common rare metastatic tumors of this group are (1) solitary fibroid and 2) hemangiopericytoma. Solitary fibroid occurs in various organs, but more often comes from the pleura. In 90% of cases, it grows exophytic, rising on the surface of the visceral pleura, but in 10% of cases it grows into the lung tissue. Hemangiopericytoma haemangiopericytoma is often localized in the soft tissues of the hips, pelvis and retroperitoneal space. In some cases, accompanied by hypoglycemia.
Malignant tumors Edit
Among the malignant tumors of fibroblasts and myofibroblasts are more common adult non-specific fibrosarcoma. Non-specific adult fibrosarcoma is a node with no clear boundaries with a diameter of usually more than 3 cm, located in the deep soft tissues of the predominantly lower extremities. It has been established that this type of tumor often develops several years, sometimes decades, after irradiation. In typical cases, microscopic examination of the tumor revealed long intertwining bundles of spindle-shaped cells (drawing "ears"). Fibrosarcoma of young children (congenital and up to 5 years of life) proceeds relatively favorably (the 5-year survival rate with it reaches 85%), therefore, it is rarely metastatic, and not malignant tumors ..
Fibrogistiocytic tumors called fibrous tissue tumors with the presence of macrophages (histiocytes) in the stroma, as well as aberrant expression of histiocytic markers by tumor cells. Tumors in this case do not develop from histiocytes (such tumors belong to hemoblastosis). Category so-called fibrogistiocytic tumors is controversial. Some authors propose to consider these tumors among neoplasms of unknown origin.
TO benign fibrogistiocytic tumors refer (1) benign fibrous histiocytoma, (2) xanthoma, (3) xanthogranuloma, (4) reticulohistiocytoma and some others to rarely metastasizing — (1) bulging dermatofibrosarcoma Daria — Ferran, (2) atypical fibroxanthoma, (3) plexiform fibrogisyocytic tumor. Malignant fibrogistiocytic neoplasms denoted by the general term malignant fibrous histiocytoma (undifferentiated pleomorphic sarcoma). Of the listed forms of xanthoma, the group of fibrogistiocytic neoplasms is conditional; they are a focal accumulation of macrophages actively phagocyting lipids, primarily cholesterol, and therefore are not tumors, but tumor-like lesions. They can be regarded as peculiar granulomas (phagocytomas).
A specific feature of fibrogistiocytic neoplasms, other than atypical fibroxanthoma, is invasive growth, therefore the borders of the nodule (node) are fuzzy, and if the benign tumors of this group are improperly removed, relapses are not uncommon (they should be excised within healthy tissue).
Endotheliocyte blood vessel tumors Edit
Four groups of endothelial vascular tumors are distinguished: (1) benign, (2) border locally aggressive, (3) border rarely metastatic, and (4) malignant. Mature benign tumors blood vessels are called hemangiomas. Border locally aggressive tumor is an hemangioendothelioma resembling Kaposi's sarcoma (caphoseform hemangioendothelioma). TO rarely metastatic tumors refer (1) Kaposi's sarcoma, (2) retiform hemangioendothelioma and (3) combined hemangioendothelioma. Malignant endotheliocytic tumors blood vessels are (1) angiosarcoma and 2) epithelioid hemangioendothelioma.
Depending on the number of hemangiomas secrete solitary and multiple hemangiomas. Multiple hemangiomas are also referred to by the term. hemangiomatosis. Treat hemangiomatosis (1) progressive skin hemangiomatosis Daria, (2) Kazabach syndrome — Merritt, (3) Maffucci Syndrome and (4) haferkamp syndrome.
Progressive skin hemangiomatosis Daria characterized by the presence of increasing in size and in the number of skin hemangiomas, which may be complicated by consumption of thrombocytopenia and DIC.
Kazabach syndrome — Merritt - giant hemangiomas of the skin with the development of thrombocytopenia intake and DIC.
Maffucci Syndrome - option olle disease (enchondromatosis of bones, mainly fingers and toes) in combination with multiple capillary and cavernous hemangiomas of the soft tissues of the fingers.
Haferkamp syndrome - Generalized hemangiomatosis of bones. The disease progresses rapidly, ending in death. The invasive growth of intraosseous hemangiomas leads to deformation of bones, their destruction (pathological fractures), and the displacement of myeloid tissue from spongy substance with the development of hypoplastic anemia.
Diseases in which hemangiomas are localized in various organs (skin, internal organs, brain, eyes, bones) are called systemic hemangiomatosis. These include (1) Hippel — Lindau syndrome and (2) Sturge — Weber — Krabbe.
Hippel – Lindau Syndrome (retinocerebrovisceral angiomatosis) is characterized by the presence of vascular tumors in the retina, in the internal organs (liver, spleen) and in the central nervous system (usually in the cerebellum with appropriate neurological symptoms). In the internal organs are detected hemangiomas, in the retina and in the cerebellum - hemangioblastoma (vascular-rich tumors of unclear histogenesis).
Sturge – Weber – Crabbe syndrome - a combination, as a rule, of unilateral hemangiomas of the skin of the face in the area of innervation of the I or II branches of the trigeminal nerve, the choroid hemangiomas (resulting in glaucoma or retinal detachment) and the brain hemangiomas, which is manifested by the development of convulsive syndrome and hemiparesis / hemiplegia on the opposite swelling of the side of the body.
Kaposi's sarcoma Edit
Among borderline tumors of major importance Kaposi's sarcoma Kaposi's sarcoma is a tumor of undifferentiated vascular cells that develops against the background of immunodeficiency under the influence of the herpes virus type 8 (HHV-8). There are three main variants of the tumor: (1) senile, (2) epidemic and (3) iatrogenic. Sarcoma of Kaposi, as the name implies, develops in old age and is a tumor of low degree of malignancy. Epidemic (with HIV infection) and iatrogenic (due to drug immunosuppression) options have a high degree of malignancy. Usually Kaposi's sarcoma is a brownish-red soft plaque on the skin of the legs or feet.
Lymphatic endothelial cell tumors Edit
Mature tumors of the blood vessels are called lymphangiomas lymphangiomas, immature malignant tumor - lymphangiosarcoma lymphangiosarcoma. This group of neoplasms also includes a borderline rarely metastatic tumor - papillary intravascular angioendothelioma (Dab's tumor).
Lymphangiomas are most often formed by conventional capillary (capillary lymphangioma) or sharply extended (cavernous lymphangiomaa) lymphatic vessels. Lymphoangiosarcoma occurs predominantly in women. Basically, it is formed on the background of prolonged lymphostasis. Lymphangiosarcoma in women who underwent radical mastectomy for breast cancer (Stuart-Treves syndrome), usually develops 10 years after surgery.
Perivascular (pericytic) tumors Edit
TO perivascular tumors refer (1) glomus tumor and 2) myopericytoma. Distinguish benign and malignant glomus tumors glomus tumors. Benign Glomus TumorAs a rule, it is localized in the soft tissues of the fingers under the nail plate and is a bluish-red nodule with a diameter usually less than 1 cm. The tumor is painful. After removal often recurs.
Different benign and malignant tumors emanate from the serous membranes. TO benign neoplasms refer (1) well differentiated papillary mesothelioma, (2) multicystic mesothelioma and (3) adenomatoid tumor. Traditionally, this group is considered pleural plaque (reactive tumor-like process).
Malignant neoplasms serous integuments are (1) the so-called diffuse mesothelioma, (2) epithelial, (3) spindle cell (sarcomatoid) and (4) biphasic malignant mesothelioma. It has been established that asbestos may be the cause of the development of malignant pleural mesothelioma.
Currently, only two tumors are referred to as synovial tumors - benign and malignant tenosynovial giant cell tumors. Earlier this group included "Synovial" sarcoma "Synovial" sarcoma, but histogenetically it does not belong to synovial tumors, despite the fact that it is often located near the joints.
For benign neoplasms of this group are primarily myxoma - tumors constructed from connective tissue similar to mucosal tissue. Mixomas always grow invasive. When macromorphological study of their fabric is soft, homogeneous, translucent. Myxoma, which is rich in blood capillaries, is called angiomyxoma. It is somewhat more aggressive, but on the whole, according to formal features, it fits into the framework of a benign soft tissue neoplasm.
The most common malignant soft tissue tumor of unclear histogenesis is "Synovial" sarcomarepresented by variants of varying degrees of malignancy.Low-grade synovial sarcoma develops in patients younger than 15 years of age, in the case of localization in the distal extremities and with a node size of up to 5 cm in diameter.
There are four main groups of bone neoplasms: (1) bone tumors, (2) cartilage tumors, (3) giant-cell bone tumors, and (4) bone marrow tumors. Bone and cartilaginous tumors can primarily develop in soft tissues and internal organs.
Bone-forming tumors Edit
To mature benign osteogenic neoplasms refer (1) osteoma osteoma, (2) osteoid osteoma osteoid-osteoma and (3) benign osteoblastoma benign osteoblastoma. Immature malignant osteogenesis tumors are (1) aggressive osteoblastoma (malignant osteoblastoma) malignant osteoblastoma and osteosarcoma (osteogenic sarcoma) osteosarcoma.
Osteosarcoma - the most common primary malignant bone tumor. It mainly develops in the second decade of life in males. In old age, osteosarcoma usually forms on the background of Paget's disease of bones. Most often, osteosarcoma is localized in the metaphysis of the long tubular bones.
Osteosarcomas are divided into two main clinical and morphological options: (1) central (medullary) and 2) surface (peripheral). As a rule, the central osteosarcoma is a tumor of high degree of malignancy, peripheral - low.
Superficial osteosarcoma densely adheres to the bone surface or surrounds it in the form of a sleeve, without causing pronounced destruction of the cortical layer. Tumors tend to develop in the diaphysis of the long tubular bones. Radiographically, in most cases, radial linear darkening is detected in the tumor, as well as distal and proximal osteophytes ("Codman's Triangles"), formed by reactive osteogenesis during periosteum detachment along the periphery of the tumor. There are two main types of superficial osteosarcoma: (1) parostalny (juxtacortical) and 2) periosteal. Parosteal osteosarcoma is formed predominantly by tumor bone tissue, periosteal osteosarcoma consists mainly of tumor cartilage.
Cartilage tumors Edit
Mature benign cartilage tumors bones are (1) chondroma chondroma, (2) osteochondroma osteochondroma, (3) benign chondroblastoma benign chondroblastoma and (4) chondromyxoid fibroma chondromyxoid fibroma. Immature malignant tumor cartilage tissue is denoted by the term chondrosarcoma chondrosarcoma.
In contrast to chondromas, most of which are found in the peripheral parts of the limbs, chondrosarcoma arises mainly in the bones of the pelvis, ribs, humerus and femur. Chondrosarcoma is formed predominantly or completely in immature cartilage tissue without the formation of a tumor bone. There are four main options for chondrosarcoma: usual, juxtacortical (periosteal), mesenchymal and dedifferentiated.
Allot high- and poorly differentiated options conventional chondrosarcoma. The tumor is located in the central parts of the bone (central chondrosarcoma), destroys the surrounding bone tissue, has no clear boundaries, which can be revealed by X-ray examination. Juxtacortical Chondrosarcoma (low-grade tumor) is an analogue of periosteal osteosarcoma, but without signs of tumor osteogenesis. Mesenchymal and dedifferentiated chondrosarcoma belong to the high-malignant neoplasms. Dedifferentiated chondrosarcoma is one of the most malignant human tumors, more aggressive than osteosarcoma, usually develops in the elderly. The 5-year survival rate for this tumor is 10-15%.
Giant bone cell tumor Edit
Giant cell tumor of the bones (osteoclastoma) giant cell tumor of bone is an aggressive but rarely metastatic tumor. In addition to mononuclear tumor cells, it contains multinucleated cells similar to osteoclasts (hence the name of the tumor). As a rule, the tumor develops predominantly at the age of 20-40 years in the epiphyses of the long tubular bones. The giant cell tumor is an osteolytic tumor, originating in the epiphysis, near the articular cartilage, it further spreads and captures the entire epiphysis and the adjacent sections of the metaphysis. After removal, the giant cell tumor often recurs, sometimes metastasizes to the lungs. In the domestic literature the term is also used to refer to this tumor. osteoblastoclastoma.
Bone Marrow Tumors Edit
To the so-called bone marrow tumors include tumors of poorly differentiated mesenchymal cells. These tumors are tumors of a high degree of malignancy. The main one is Ewing's sarcoma Ewing's sarcoma, usually occurring at the age of 5–15 years, as a rule, in the diaphysis and metaphysis of the long tubular bones. When X-ray examination, the tumor looks mostly osteolytic, but the destruction of the bone is often combined with foci of osteogenesis. Often found periosteal osteogenesis with a characteristic X-ray picture "bulbous scales." Ewing's sarcoma early metastasizes to other bones, lungs and liver. In addition, it often develops primarily in several bones (multicentric tumor growth). Occasionally Ewing's sarcoma develops in the soft tissues and internal organs (Ewing's extraosseous sarcoma).
Risk factors for soft tissue sarcomas
Currently, several factors have been identified that increase the risk of developing soft tissue sarcomas.
Ionizing radiation responsible for the occurrence of 5% soft tissue sarcomas as a result of previous exposure to other tumors (for example, breast cancer or lymphoma). The average period between radiation exposure and detection of soft tissue sarcoma is 10 years.
Diseases in the family. It has been found that some hereditary diseases increase the risk of developing soft tissue sarcomas. These include:
- Neurofibromatosis, which is characterized by the presence of multiple neurofibromas (benign tumors) under the skin. In 5% of patients with neurofibromatosis, neurofibroma degenerates into a malignant tumor.
- Gardner syndrome leads to the formation of benign polyps and cancer in the intestines. In addition, this syndrome causes the formation of desmoid tumors (low-grade fibrosarcoma) in the abdomen and benign bone tumors.
- Li-Fraumeni Syndrome increases the risk of developing breast cancer, brain tumors, leukemia and adrenal cancer. In addition, patients with this syndrome have an increased risk of sarcomas of soft tissues and bones.
- Retinoblastoma (malignant tumor of the eye) may be hereditary. In children with this form of retinoblastoma, the risk of bone and soft tissue sarcoma is increased.
The only way to prevent the development of soft tissue sarcomas is (if possible) to eliminate known risk factors.
1. Classification of soft tissue tumors. Metastasis of sarcomas.
Soft tissue - all non-epithelial extraskeletal tissues, with the exception of the reticuloendothelial system, glia and tissues supporting specific organs and viscera.
Most malignant soft tissue tumors - sarcomas with predominant localization on the extremities (60%, of which 46% - on the lower extremities, 14% - on the upper ones), on the body (15-20%), on the head and neck (5-10%).
- true malignant tumors - sarcoma sarcoma,
- conditionally malignant (localized tumors that have infiltrative growth, but do not metastasize),
The name of the tumor is formed according to the scheme: cloth + ending "ohm" for benign neoplasms tissue + sarcoma (or blastoma) - for malignant. For example, a benign tumor from adipose tissue is a lipoma, a malignant tumor is a liposarcoma, from a fibrous tissue, fibroma and, accordingly, fibrosarcoma, etc. rhabdomyoma, rhabdomyosarcoma (mysh.tk), synovioma, synovial sarcoma
Metastasis: soft tissue sarcomas are characterized by:
1) the lack of a true capsule
2) the spread of the tumor along the muscle fibers, fascial plates, nerve sheaths and blood vessels (one of the main causes of relapse after simple excision of the tumor)
3) metastasis predominantly hematogenous: in 70-80% of cases in the lungs, less often in the bones and liver, metastases often occur in operated patients
4) lesion of regional lymph nodes in 2-20% of cases
2. Clinic of soft tissue sarcomas depending on the location, histological form and degree of spread.
- at the initial stages of development, the course of soft tissue sarcomas is usually asymptomatic, in 2/3 of patients the tumor (in the form of a painless node or swelling) is the first and only symptom
- palpation is determined by a single node of considerable size, rounded shape, not always correct outlines, unevenly dense, solid or elastic-elastic consistency, when palpating with two hands, the tumor on the limb is displaced only in the transverse direction, and when grown into the underlying bone remains stationary.
- pronounced pain syndrome is characteristic only for tumors that squeeze nerves or sprouting bone
- in the late stages, the skin over the tumor is purple cyanotic, infiltrated, the temperature is elevated, the saphenous veins are enlarged and ulcerated (especially typical of superficial tumors, rhabdomyoblastomas, angiosarcomas are very early expressed)
- if the tumor walling large arterial and nerve trunks - appropriate clinical symptoms (limb ischemia, paresis and paralysis)
- common phenomena in the developed stage of the disease: anemia, fever, loss of body weight, intoxication, increasing weakness.
3. Diagnostic methods and principles of treatment of patients with soft tissue sarcomas.
1. physical examination (examination, palpation) Pay particular attention to the dynamics of tumor development.
Sarcomas are characterized by a gradual increase in size or abrupt development, in which tumor growth is replaced by a period of stabilization. When referring a patient to an injury sustained in the past, the presence and duration of the luminous gap is established before the appearance of a palpable formation
- consistency, - nature of the surface, - size and shape of the tumor, - restriction of mobility in relation to the surrounding tissues - condition of regional lymph nodes and skin
«Alarms"(Suspected sarcoma of soft tissues: the presence of gradually increasing tumor formation, limiting the mobility of an existing tumor, the appearance of a tumor emanating from the deeper layers of soft tissues, the occurrence of swelling after a period of several weeks to 2-3 years or more after injury.
2. tissue biopsy (puncture, incisional - the most optimal, excisional - to remove superficial tumors up to 5 cm in the largest dimension).
3. X-ray methods (radiography, CT)
4. ultrasound diagnostics
Principles of treatment of patients with soft tissue sarcomas:
1. Combined or complex treatment, the surgical method alone can be used only in the treatment of highly differentiated tumors with the condition of the possibility of performing a radical operation.
2. Principles of surgical interventions:
a) the place of the previous biopsy is removed along with the tumor
b) removal of the sarcoma is performed without exposing the tumor
c) the boundaries of tissue resection are marked with metal brackets (for planning postoperative radiotherapy)
d) in the case of non-radical removal of the tumor with the potential possibility of performing a radical operation, reoperation is shown.
- regional lymph nodes in the absence of signs of their defeat are not removed
- the protocol of the operation should indicate whether the integrity of the tumor was disrupted during its removal (possible contamination).
- Simple excision is used exclusively as a stage of morphological diagnosis of malignant tumors.
- Wide excision. In this operation, the tumor is removed within the anatomical zone, in a single unit with a pseudocapsule and a distance of 4–6 cm or more from the visible edge of the tumor. A wide local resection is used for tumors of low grade, superficial, located above the superficial fascia, in the skin, subcutaneous tissue (small fibrosarcomas, liposarcomas, desmoids).
- Radical organ-preserving operation provides removal of the tumor and the surrounding normal tissues with the inclusion of fascias and unchanged surrounding muscles in a single block, which are removed completely with clipping at the place of their attachment. If necessary, produce a resection of blood vessels, nerves, bones, resorting simultaneously to the corresponding reconstructive and plastic surgery. As necessary plastic. + urgent intraoperative histological examination of the clipping edges of the removed tissue block.
- Amputations and exarticulation of the limb are shown in cases where the implementation of a radical saving operation is not possible due to massive damage (involvement of the joints, bones, great vessels and nerves for a long time in the tumor process) and / or with the ineffectiveness of neoadjuvant treatment. If amputation / exarticulation is performed at a large distance from the tumor, postoperative radiotherapy is not performed.
3. Radiation treatment is carried out in the form of a pre- and postoperative course on the bed of a removed tumor, surrounding tissues with a 2 cm indent from the cut-off edges and a postoperative scar.
- If it is impossible to perform a radical organ-preserving operation and the patient refuses to perform a crippling operation, a course of radiation therapy is performed under a radical program ± chemotherapy
Incidence of kidney cancer.
Over the past ten years, Belarus has seen an increase in the number of cases of renal cell carcinoma annually from 1,275 cases in 2001 to 1,833 in 2010 (1.4 times).
11.1. Kidney Cancer Clinic.
Clinical symptoms: asymptomatic in most cases. May be hypertension, compression of the inferior vena cava.
SIGNS AND SYMPTOMS OF THE DISEASE
A tumor can be easily detected if it has arisen on the upper or lower extremities and at the same time has increased in size over several weeks or months. As a rule, a soft tissue tumor does not cause pain.
In the case of the development of soft tissue sarcoma, symptoms occur in the abdomen that are characteristic not only of a neoplastic disease. In 30-35% of cases, patients report pain in the abdomen. Sometimes the tumor squeezes the stomach and intestines or causes bleeding. If the tumor has reached a large size, then it can be felt in the abdomen.
Only in 50% of cases it is possible to detect the disease in the early stages, as the symptoms in patients with soft tissue sarcomas appear only when the tumor reaches a considerable size.
X-ray examination The rib cage is performed to detect the spread of soft tissue sarcomas to the lungs.
Ultrasound procedure (Ultrasound) allows you to examine the internal organs and tumor formation. CT scan (CT) makes it possible to determine the volume of local spread of the tumor, as well as to identify damage to the liver and other organs. In addition, CT is used during tumor puncture.
Magnetic resonance imaging (MRI) can give more detailed information about the tumor and the state of the internal organs compared to CT. This method is especially justified when examining the brain and spinal cord.
Positron emission tomography (PET) helps to clarify the prevalence of the tumor process in the body. The study uses radioactive glucose, which is actively absorbed by tumor cells. Biopsy (taking a piece of suspicious tumor tissue for research). According to a variety of studies, the only reliable method for establishing the diagnosis of soft tissue sarcoma is to examine the tumor under a microscope. This clarifies the type of sarcoma and the degree of malignancy (low, intermediate or high).
Surgery in patients with soft tissue sarcomas is to remove a tumor within healthy tissue. If the tumor is located on the limbs or trunk, then it is removed with a seizure of 2-3 cm of healthy tissue. When sarcoma is found in the abdomen, such removal of the tumor may be impossible due to the proximity of vital structures.
Previously, 50% of patients with soft tissue sarcomas of the upper and lower extremities performed amputation (removal of a part or the entire limb). Currently, such operations are performed in only 5% of patients. In other cases, operations are performed with the preservation of the limb in combination with radiation. At the same time, the survival rate of patients did not worsen.
Amputation of the limb is recommended only if the main nerves or arteries are involved in the tumor process.
Amputation is not recommended for patients in cases of lesions of distant organs, such as the lungs, when the removal of the main tumor and metastases is not possible.
In this case, it is advisable to assign chemotherapy and radiation to reduce the size of the tumor, and then try to perform the operation. The same tactics should be observed in patients with high-grade sarcomas, when the likelihood of metastasis is increased.
If a patient has distant metastases, then, as a rule, it is impossible to cure him using only surgery. However, with an isolated lung lesion, it is possible to surgically remove metastases. In such patients, 5-year survival is 20-30%.
What happens after the treatment is completed?
After the end of the entire treatment program, the patient should be under regular medical supervision. In addition, a survey is conducted as necessary.
To speed up recovery and reduce the symptoms of side effects of antitumor treatment, it is necessary to change the way of life whenever possible.
So, if you smoked, then you need to leave this bad habit. This step will improve your overall condition. If you have abused alcohol, it is necessary to significantly reduce the consumption of alcohol.
A quality and balanced diet with the inclusion of a sufficient amount of fruits and vegetables will help your recovery. A special diet may be necessary for patients who have undergone abdominal irradiation; you can get the necessary advice from a nutritionist.
If you have new or unexplained symptoms, you should immediately consult a doctor.