Distinguishing features that can aid in narrowing the diagnosis of a soft-tissue mass are the size, depth, consistency, and mobility of the mass. Typically, masses that are superficial and less than 5 cm in size tend to be benign, whereas, masses that are greater than 5 cm or found deep to the fascia have a higher likelihood of being malignant.
How is soft tissue mass diagnosed and treated?
Jul 10, 2020 · For any mass that has not been definitively determined as benign following a thorough evaluation, biopsy before resection is warranted. Depending on the location, small (<3 cm) subcutaneous masses may be considered for excisional biopsy. For all other indeterminate masses, needle biopsy is warranted.
What is a soft tissue mass?
Lesion Density. The internal composition of a soft-tissue mass may be surmised from its CT density, with fat measuring −130 to −70 HU, fluids measuring 0–30 HU, and muscle and soft tissues measuring 40–60 HU [ 40 ].
Which features can aid in narrowing the diagnosis of soft-tissue mass?
May 02, 2022 · A soft tissue mass, also known as a soft tissue tumor or sarcoma, is a malignant growth that forms in the connective, soft tissues of the body, such as the muscles, tendons, and blood vessels. Considered a rare condition, there are a variety of masses which may be diagnosed in any part of the body. Despite the diversity associated with soft ...
Is a newly found soft tissue mass an emergent condition?
Stage II: Stage II is divided into stages IIA (smaller than 5 cm) and IIB (larger than 5 cmrs) for soft tissue tumors of the head and neck, extremities (arms and legs), gastrointestinal tract and retroperitoneum (the part of your body behind your abdomen).
What is the average size of a soft tissue sarcoma?
What is a large soft tissue mass?
What size are sarcoma lumps?
What percentage of soft tissue masses are malignant?
What is considered a large lipoma?
How do I know if I have sarcoma or lipoma?
...
At a Glance: Sarcoma vs. Lipoma.
| Sarcoma | Lipoma | |
|---|---|---|
| How it feels | Firm. Unable to be moved with pressure from fingers. | Squishy. You can push it around. |
What is stage1 sarcoma?
What stage is high grade sarcoma?
What is considered a large sarcoma?
Can you tell if a mass is cancerous without a biopsy?
Should a lipoma be removed?
Is a soft tissue mass cancerous?
What is the imaging modality of choice for the majority of soft tissue tumors?
MRI is the imaging modality of choice for the majority of soft-tissue tumors. When imaging is not definitive for a benign process, then needle biopsy or referral is indicated. Keywords: benign; biopsy; chemotherapy; malignant; MRI; radiation therapy; resection; sarcoma; soft tissue; staging.
What is the most common soft tissue tumor?
Lipoma. Lipoma is the most common soft-tissue tumor that will be encountered by an orthopaedic surgeon and is one of the few soft-tissue masses that can be definitively identified on imaging. On MRI, the mass simply needs to be compared to the subcutaneous fat. A lipoma will demonstrate the same imaging features as subcutaneous fat on all MRI ...
What is atypical lipoma?
When treating the larger variety of lipoma , it is important to be aware of a variant known as atypical lipoma/well-differentiated liposarcoma (ALT/ WDL). This variant can be classified as a low-grade malignancy with higher recurrence rates than typical lipomas but, when located in the extremity, rarely dedifferentiate or metastasize. For this reason, marginal resection is appropriate with the knowledge that the recurrence rate is higher than garden variety lipomas. On imaging, atypical lipomas tend to be larger, more septated, and less homogenous on MRI when compared with standard lipomas 5 ( Figure 3 ). Following resection, atypical lipomas can be identified solely by histologic features, but when equivocal, the authors of a 2016 study have identified FISH for MDM2 as the ancillary study of choice. 6
Why are popliteal cysts not homogenous?
Popliteal cysts can become quite large and are not always homogenous on MRI because of debris, loose bodies, or hemorrhage that can accumulate in the cyst. The lining of the cyst will show enhancement on contrast MRI and can be quite thickened and septated because of inflammation.
Why are popliteal cysts considered separately?
Popliteal cysts in children are considered separately because typically they are not associated with intra-articular pathology and may not always communicate with the joint. The fluid may involve the semimembranosus-gastrocnemius or subgastrocnemius bursa and usually resolve spontaneously without treatment.
What are the different types of lipoma?
Several variants of lipoma exist: angiolipoma, fibrolipoma, spindle cell lipoma, hibernoma. Not only do these variants differ histologically from a lipoma, they also display unique chromosomal aberrations. The imaging features can also be variable when compared with a classic lipoma.
What are the characteristics of a benign mass?
Size, consistency, depth, and absence or presence of growth are all important features to consider. Masses that are small, soft, superficial, and dormant are most likely benign and may be observed. Firm, deep, and enlarging masses require a higher level of suspicion.
Where do soft tissue masses come from?
Soft tissue masses can emerge anywhere in the body, and specialists cross the spectrum of physician expertise. Orthopedic oncologists tend to perform resections from the arms and legs, pelvis, spine and occasionally the chest wall; general surgical oncologists tend to operate when tumors are located in the abdomen or pelvis. Otolaryngologists and/or neurosurgeons typically perform surgery to remove head and neck tumors. Spinal specialists often assist with spinal surgeries.
Why is it important to diagnose soft tissue tumors?
Prompt and accurate diagnosis is important to help avoid debilitating complications. Soft tissue tumors often are not physically debilitating, at least initially, and this contributes to their ability to grow undetected. Patients who notice a mass more than 5 cm (2 inches) at its longest point, or which is painful to the touch, should consult a physician.
How many new sarcomas are diagnosed annually in the US?
Some 10,000 new soft tissue and bone sarcomas (cancerous growths) are diagnosed annually in the United States. Benign soft tissue tumors are discovered at a significantly higher rate than sarcomas.
What kind of surgeons do soft tissue surgery?
Orthopedic oncologists tend to perform resections from the arms and legs, pelvis, spine and occasionally the chest wall; general surgical oncologists tend to operate when tumors are oriented in the abdomen or pelvis. Otolaryngologists and/or neurosurgeons typically perform surgery to remove head and neck tumors. Spinal specialists often assist with spinal surgeries. Vascular surgeons may be necessary if reconstruction of a an artery is necessary.
Why do hematomas need to be recurrence?
They merit attention because they could be cancerous. A sprain or hematoma that lasts longer than six weeks merits additional medical scrutiny for the possible presence of a soft tissue tumor. The risk of recurrence is related to the type of tumor, the adequacy of initial surgical excision, and the tumor’s location.
How painful is a benign tumor?
Benign masses are more likely to be painful to the touch, such as with an abscess. Benign tumors also tend to grow more slowly, and many are smaller than 5 cm (2 inches) at their longest point. Sarcomas (cancerous growths) more often are painless.
How long does it take for a soft tissue tumor to heal?
Such misperceptions can contribute to delayed diagnoses of soft tissue tumors – often as long as three to six months after the patient's initial discovery of a bump or lump.
What is soft tissue tumor?
Soft-tissue tumors are defined as mesenchymal proliferations that occur in extraskeletal nonepithelial tissues of the body , excluding the viscera, meninges, and lymphoreticular system [1, 2]. CT has long been used to characterize the composition and anatomic location of soft-tissue masses [3-5] and has been known for several decades to be able to distinguish benign from malignant processes [6, 7]. Recently, MRI has become the diagnostic technique of choice because of its excellent soft-tissue contrast for this large and heterogeneous group of tumors with many overlapping features [8-11]. However, the ubiquity of CT, its faster examination times, and its superior patient tolerance compared with MRI have contributed to its exponential growth in utilization, even with regard to musculoskeletal examinations [12]. This fact dictates that the radiologist be familiar with CT features of soft-tissue tumors, as well as mimickers of tumors; moreover, the radiologist must be aware of what distinctive information is provided by CT compared with MRI.
What is the role of CT in soft tissue?
One of the most important roles of CT is in providing useful clues for the characterization of soft-tissue lesions. CT has been shown to provide a more comprehensive assessment of soft-tissue tumors with regard to patterns of matrix mineralization and patterns of cortical and marrow involvement [13-15]. With 3D reconstructions, CT can also be a useful adjunct in the characterization of lesion vascularity [16]. In this article, we briefly review technical considerations for performing CT for the evaluation of soft-tissue masses, outline the role that CT plays for the diagnosis of these masses, and delineate what information may be gained for treatment planning. Four distinguishing features that can be used to characterize soft-tissue masses by CT are presented, including the mineralization pattern, density, pattern of bone involvement, and lesion vascularity.
What is mineralization in soft tissue?
Mineralization within soft-tissue masses can result from ossification or calcification or both [13] and produces the appearance of high-density material on radiographs or CT scans. The pattern and morphologic characteristics of mineralization can be a clue to a soft-tissue mass’s cause, and hence, suggest a histologic diagnosis. With MRI, the identification of mineralization within a soft-tissue mass is often limited because of the variable signal intensity of calcium [17, 18]. Also, subtle matrix mineralization that is not detectable by radiography is made apparent by CT [19-21]. Although it is not always possible with imaging, an attempt should be made to distinguish calcification, which is due to dystrophic or metabolic deposition of insoluble calcium phosphate salts in the soft tissues, from ossification, which marked by trabecular bone formation [19, 22] (Table 1).
What is the mineralization pattern of osteoid matrix?
Cloudlike matrix mineralization in a smooth pattern that progressively increases in density toward the center is typical of osteoid matrix (Fig. 6), although a ground-glass appearance can also be seen. In contrast, calcifications in rings and arcs, with or without dense punctate, stippled, or flocculent calcification, are classic for chondroid mineralization [38] (Fig. 7). The rings and arcs pattern of mineralization is due to calcification developing around lobules of cartilage. It should be noted that both of these patterns are associated with benign and malignant entities. In addition, other malignant soft-tissue tumors, particularly synovial cell sarcoma (Fig. 8), may exhibit metaplastic bone formation, though production of definitive osteoid matrix in such tumors is rare [29, 39].
What causes soft tissue calcification?
The myriad causes of dystrophic calcification include vascular (within thrombus), infectious, traumatic, autoimmune, and neoplastic causes [23]. Vascular calcifications, or phleboliths, are very common in asymptomatic individuals but can also be a feature suggestive of hemangiomas and venous vascular malformations [24-26]. Radiographs often show a radiolucent center, although this has been shown to be unreliable on CT, possibly because of differences in kilovoltage [27]. The association with a soft-tissue tail sign representing the vein or venous plexus in which it is located has been reported to be a specific CT feature of phleboliths, although it lacks sensitivity [28].
What plane is vascular mass on a 3D CT?
A, Volume-rendered 3D CT image in sagittal plane shows vascular mass, as evidenced by homogeneous contrast enhancement, associated with internal calcification.
What is a benign ossification?
Benign heterotopic ossification in the soft tissues can be seen after localized trauma, neurologic injury, or , rarely, in hereditary forms, such as myositis ossificans progressiva (now referred to as fibrodysplasia ossificans) [36]. The clinical history and distribution of the disease are important etiologic clues, with the hip, shoulder, knee, and elbow being the most commonly affected joints in the neurogenic form. Heterotopic ossification following trauma (myositis ossificans traumatica) is characterized initially by the appearance of floccular calcifications approximately 3 weeks after injury. After 6–8 weeks, lamellar bone with well-defined cortex forms [37]. Intermediate heterotopic ossification often shows a distinctive peripheral rim of dense mineralization, the so-called eggshell ossification [10], as seen in Figure 5. More mature heterotopic ossification often shows a well-defined peripheral cortex and inner trabecular pattern of mineralization.
How to diagnose soft tissue mass?
A soft tissue mass diagnosis is generally confirmed through a variety of diagnostic tests. Initially, the attending physician may perform a physical examination and take a complete medical history. A biopsy, or small tissue sample, may be taken prior to the administration of further testing. Small tumors may be biopsied using either a fine-needle aspiration or a core biopsy, which involves the excision of a larger portion of the abnormal tissue. The partial or complete excision of a larger tumor may be conducted during a surgical biopsy, which requires the use of general anesthesia.
What is a soft tissue mass?
A soft tissue mass, also known as a soft tissue tumor or sarcoma, is a malignant growth that forms in the connective, soft tissues of the body, such as the muscles, tendons, and blood vessels. Considered a rare condition, there are a variety of masses which may be diagnosed in any part of the body. Despite the diversity associated with soft tissue tumor development, all diagnoses carry similar symptoms and treatment options. Treatment for this condition is dependent on the individual and the type, location, and extent of his or her cancer.
What causes a soft tissue mass to develop?
In some instances, the origin of the soft tissue sarcoma may be genetic. Hereditary conditions which may contribute to soft tissue mass development include Garner syndrome, neurofibromatosis, and inherited retinoblastoma. Additional causal factors may include exposure to chemicals, such as herbicides and vinyl chloride, and radiological material as utilized in radiation therapy.
What is the test for sarcoma?
The individual may undergo testing that includes a computerized tomography (CT) scan, traditional X-rays, or a positron emission tomography (PET) scan. Based upon test results, a determination is generally made regarding the extent, or staging, and grade of the soft tissue sarcoma.
Can a soft tissue tumor cause pain?
Individuals with a soft tissue mass may be asymptomatic during the tumor's early stages of development, meaning he or she experiences no symptoms. As the mass matures, the individual may experience discomfort if the mass induces pressure on surrounding tissues or nerves, localized discomfort that is situated in the vicinity of the mass, or a swelling or growth that wasn't present before. Although a soft tissue mass may develop in any part of the body, many abnormalities occur in the individual’s extremities, such as the arms or legs, or the torso.
What age do you get a malignant soft tissue tumor?
Malignant soft tissue tumors can occur at almost any age, but are most common in individuals between 50 and 70 years of age. Malignant fibrous histiocytoma (MFH), liposarcoma, and synovial sarcoma, neurosarcoma, rhabdosarcoma, fibrosarcoma, hemangiopericytoma, and angiosarcoma are among the most common of these tumors, but many other types exist.
How do malignant soft tissue tumors spread?
These cells can spread by travel through the blood stream or by travel through lymph vessels.
What are the sites of metastasis?
Other bones can also become sites of metastasis. Malignant soft tissue tumors are classified as "sarcomas.". These tumors are thought to arise from "connective tissues" other than bone, such as muscle, tendon, ligament, fat, and cartilage. They are rare.
Why do tumors grow so big?
Because soft tissue is very elastic, the tumors can grow quite large before they are felt. The first symptom is usually a painless lump. As the tumor grows and begins to press against nearby nerves and muscles, pain or soreness can occur.Any growing tumor should be recognized and evaluated promptly.
How rare are tumors?
They are rare. Only about 8,000 tumors of this type occur each year in the United States, representing only about 1% of all malignant tumors. They are technically different from the much more common cancers or "carcinomas," which are malignant tumors that arise from organs or gland tissue (e.g.
How many chances of a tumor spreading?
Pathologists are now able to examine many tumors under the microscope and divide tumors into high-grade tumors, which have a 70-90% chance of having spread, and low-grade tumors, where the chance of spread is low (less than 15%).
Does radiation therapy help with high grade tumors?
The addition of chemotherapy for the highest-grade tumors reduces the rate at which high-grade tumors return and may improve the rate of cure. The use of specialized radiation therapy techniques has significantly reduced the likelihood of tumors coming back at the site where they have been removed. Often, depending on the type of tumor, preoperative radiation therapy or chemotherapy (or a combination of the two) may be used to make some of these tumors more easily resected with adequate margins.
What is the diagnosis of soft tissue lesion?
The diagnosis of a soft tissue lesion requires a modicum of clinical information and adequate, well-processed tissue. At a minimum, the pathologist should be apprised of patient age, tumor location, and its growth characteristics. In some cases, the results of imaging studies, particularly magnetic resonance imaging (MRI), enhance one’s understanding of the clinical extent of the lesion and its relationship to normal structures (see Chapter 3 ).
What is the first step in diagnosing a lesion?
The first and most important step in reaching a correct diagnosis is careful scrutiny of conventionally stained sections at low-power magnification. Useful microscopic features that can be identified at this point include the size and depth of the lesion, its relation to overlying skin and underlying fascia, and the nature of the borders (e.g., pushing, infiltrative).
How are sarcomas removed?
Most extremity sarcomas are removed with wide local excision, usually combined with preoperative or postoperative radiotherapy. Ideally, such specimens are received fresh and unfixed so that tissue for ancillary studies can be obtained. As with many other surgical specimens, the margins should be marked with permanent ink and blotted dry before the dissection of the specimen. After the incision, the gross characteristics of the tumor should be noted. If malignancy is suspected, a careful assessment of the tumor as to its surroundings is mandatory. This includes the location of the lesion (e.g., subcutis, muscle), its size, its relation to vital structures (e.g., bone, neurovascular bundle), and the relative amount of necrosis, if it can be judged grossly. Size is important for providing an accurate T descriptor for the surgeon if the lesion is a sarcoma. Lesions less than 5 cm are classified as T1, whereas those larger than 5 cm are classified as T2. An assessment of the degree of necrosis is important for untreated sarcomas because this parameter is used in most grading systems, including the French (FNCLCC) system. The extent of necrosis in lesions treated with preoperative irradiation or chemotherapy is also important to note because it helps the clinician assess the efficacy of therapy, although it does not carry the same implication as necrosis in an untreated lesion. Often, the gross appearance of the tumor is deceptive. Sarcomas may appear well circumscribed, and benign tumors occasionally infiltrate. Use of the term encapsulation can be misleading and can invite inadequate excision by shelling out, or enucleating, the tumor. In reality, sarcomas lack a true capsule and instead are surrounded by a compressed zone of normal tissue, known as a pseudocapsule .
Why is palpation important for soft tissue?
Because subcutaneous soft tissue tumors are easily recognized, they are often resected, without sufficient imaging analyses ...
Is an excision necessary for a soft tissue tumor?
Sometimes, an adequately wide excision is necessary, which is considered the minimum necessary procedure to eradicate the lesion. As noted above, clinicians who see patients with subcutaneous soft tissue tumors are encouraged to have sufficient knowledge and experience regarding the diagnosis and treatment.
Can soft tissue sarcoma be detected subcutaneously?
The proper diagnosis and treatment planning for subcutaneous soft tissue sarcoma is very important. Soft tissue tumors can occur anywhere in the body, but if they occur subcutaneously, patients can easily notice a subcutaneous soft tissue mass.
What is a lipoma soft tissue tumor?
Lipomatous soft-tissue tumors are the most common neoplasms encountered by physicians. They range from benign lipomas to high-grade liposarcomas. Unplanned excisions of sarcomas are commonly due to the presumptive diagnosis of lipoma and can be avoided by understanding their diagnostic magnetic resonance imaging appearance.
What is the most common neoplasm?
Lipomatous soft-tissue tumors are the most common neoplasms encountered by physicians. They range from benign lipomas to high-grade liposarcomas. Unplanned excisions of sarcomas are commonly due to the presumptive diagnosis of lipoma and can be avoided by understanding their diagnostic magnetic reso …
Is liposarcoma a biopsy?
Well-differentiated liposarcomas are histologically identical to atypical lipomatous tumors but have a markedly worse prognosis secondary to their anatomic location. Masses that lack isointense signal to subcutaneous fat on MRI may represent a sarcoma and require a biopsy before definitive treatment.
Soft Tissue Masses: Diagnosis and Surgery For Benign and Cancerous Tumors
Basics of Soft Tissue Masses
- Soft tissue tumors are cell growths that emerge nearly anywhere in the body: in tendons, muscles, ligaments, cartilage, nerves, blood vessels, fat, and other tissues. Patients commonly refer to these masses as lumps or bumps. See Figures 1 and 2. Figure 1 illustrates the appearance of a patient who presented with a benign soft tissue mass in the arm. Figure 2 illustrates the appeara…
Incidence and Acquisition
- Incidence
Some 10,000 new soft tissue and bone sarcomas (cancerous growths) are diagnosed annually in the United States. Benign soft tissue tumors are discovered at a significantly higher rate than sarcomas. Soft tissue tumors affect every segment of the population. However, sarcomas occu… - Acquisition
Evidence suggests that some genetic disorders and mutations predispose people to benign and cancerous soft tissue tumors. Exposure to radiation and environmental carcinogens has been associated with soft tissue tumors. Kaposi’s sarcoma is an example of an infection-induced sof…
Symptoms & Effects on Daily Life
- Initial symptoms
Soft tissue tumors offer little warning. They can emerge as a lump or bump slowly or quickly in any part of the body. The emergence of the mass itself is the most common symptom. It is usually round or oval in its dimensions. It often is painless, causing notice or discomfort only in … - Progression
Depending on the tumor’s etiology, it can grow quickly or slowly. Some soft tissue masses that are initially benign can transform into malignancies. This is often heralded by an abrupt increase in the size of a previously quiescent mass. Research suggests that a malignant mass that emerge…
Risk Factors
- Lifestyle risk factors
Lifestyle and diet are not thought to play a role in the emergence of soft tissue tumors – benign or cancerous. - Injury & trauma risk factors
Historically there have been many case associations between trauma and soft tissue masses, but data does not support trauma as the cause of such masses. More likely is that the trauma drew medical attention to the existing tissue mass. One exception would be a ganglion cyst, a commo…
Prevention
- Soft tissue tumors cannot be prevented, per se, but any discovered mass of unknown etiology that is growing should be evaluated by a specialist. Any sprain or hematoma that lasts longer than six weeks merits additional medical scrutiny.
Diagnosis
- Patients presenting with soft tissue masses are evaluated and their clinical history taken. Diagnostic tests might include X-ray, magnetic resonance imaging (MRI), positron emission tomography (PET) scan, computed tomography (CT) scan, bone scan, and angiogram. See Figures 3 and 4 below. Figure 3 illustrates the appearance of a soft tissue mass on MRI. This “fa…
Treatment
- Upon diagnosis, a soft tissue mass can be observed or prepared for removal from the patient’s body. Benign fat tumors (lipoma), for example, can be observed, rather than removed, with a recommendation of routine surveillance for the patient – an MRI every six to 12 months, depending on the tumor’s location. Patients have lived for decades with slow-growing benign tu…
Additional Resources
Research
- Condition research
Benign tumors do not always require removal or further treatment. With cancerous tumors, a significant volume of ongoing research studies treatment methods. Novel chemotherapy drugs are being tested in multicenter clinical trials, and researchers are trying to identify molecular tar… - Pharmaceutical research
Many new drugs are being tested in clinical trials to treat soft tissue tumors. These trials take time especially because sarcomas (cancerous growth) are rare. Much effort is being focused on drugs to treat those patients with very advanced disease – disease that has metastasized.