Soft tissue tumours:

Muscle, fat, fibrous tissue, blood vessels, peripheral nerves
Benign lesions
1. Lipoma
  1. Benign adipose tissue tumour, usually subcutaneous, sites where adipose tissue is normally present
  2. Middle/late adult life
  3. Well circumscribed, resemble mature fat
  4. Subtypes: fibrolipoma, chondroid lipoma, spindle cell lipoma, pleomorphic lipoma, angiolipoma
2. Ganglia
  1. In vicinity of joints, sometime tendon sheaths
  2. Myxoid softening and cystic degeneration of tissues of joint capsule or tendon sheath
  3. Dorsal hand, wrist, foot, ankle, knee, spine --> not lined by true synovium, do not communicate
Aggressive benign
1. Fibromatoses
  1. Well differentiated fibroblastic proliferations, infiltrative growth pattern, aggressive, repeated local recurrence
  2. Classification
    1. Deep/musculo-aponeurotic/desmoid tumours
      1. 5-10cm, firm, grey, scar-like
      2. Spindle cells, fibroblastic, collagen stroma, infiltrative growth
    2. Superficial: Dupytron's contracture
Pseudosarcomatous
1. Nodular fasciitis
  1. Young adults --> arms, trunk, neck
  2. Rapid growth of tender mass, associated with fascia --> infiltration of subcutis, muscle, fascia
  3. Spindle cell proliferation, stroma rich with ground substance, infiltrative, mitotically active, no malignant potential
Liposarcoma
1. Adult --> thigh, retroperitoneum
2. Large, well-circumscribed, unencapsulated
3. Low grade: myxoid, well-differentiated
4. High grade: round cell, pleomorphic
Synovial sarcoma
1. 5-10% of soft tissue sarcomas, high grade
2. Young adults, M>F, 80% knee/ankle
3. Other sites: head, neck, retroperitoneum, mediastinum
4. Enlarging mass, pain, infrequent systemic symptoms
5. Well circumscribed, pink/grey
6. Monophasic or biphasic, poor differentiation
  1. Biphasic: carcinomatous & sarcomatous
7. t(x;18)
8. Poor prognosis
Diagnosis takes into account history, location, radiological apperance --> differential diagnosis
1. Prebiopsy planning required --> inappropriate biopsy leads to wrong diagnosis or healing complications
  1. Fine needle aspiration
  2. Diagnostic closed core biopsy
  3. Open biopsy/curettage
  4. Formal resection
  5. Open biopsy creates complication, but less invasive procedures might not obtain enough tissue for diagnosis
2. Diagnosis of chromosomal abnormality

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Soft tissue tumours:

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	Created by Emma Jones over 10 years ago