Neobook — clinical reference

Soft tissue neoplasms may be benign, locally aggressive, or malignant sarcomas.
Benign soft tissue masses are at least 100 times more common than sarcomas
The evaluation and investigations are determined by the need to exclude or confirm the presence of the rarer, but malignant sarcomas.

Lipoma

These are soft, fatty neoplasms which most typically occur in the subcutaneous tissues. They have an indolent history, and will not cause local symptoms, other than mild discomfort.

Management is conservative unless they are large or unsightly, in which case a local excision is curative. The diagnosis can be made on clinical grounds in the majority of cases.

The following patients meet criteria for urgent referral with a soft tissue lesion:

Soft tissue mass >5 cm
Painful lump
Lump that is increasing in size
A lump of any size that is deep to the muscle fascia
Recurrence of a lump after previous excision

Sarcoma

Diagnosis and staging is best done with guidance of the surgical oncology unit responsible for care of the patient, and for practical purposes a patient with a suspected sarcoma must not have biopsies attempts prior to referral.

Aspiration cytology may be helpful in excluding haematomas and abscesses, but is inadequate in obtaining the finite diagnosis of a sarcoma.

The diagnosis can only be made by obtaining a generous amount of tissue for histological evaluation.

TruCut core biopsy is the preferred method of diagnosis. On certain occasions incision or excision biopsy is used, particularly for small (<5cm lesions), but the route must be able to incorporate the final excisional area should the lesion be a sarcoma.

Staging is performed by a CT scan of the area in question, together with that of the liver and lungs (a CT of the lungs may reveal metastases not shown on a radiograph). A liver enzyme profile is performed to determine hepatic metastases.

MRI scan or CT should be ordered to image the site of the soft tissue sarcoma.

Combined assessment

Patients are best managed by a multi-disciplinary team comprising of an oncology surgeon, orthopaedic surgeon, pathologist, oncologist and radiologist. Extensive patient counselling is essential.