Abstract
Finding a soft tissue mass in the superficial regions is a common event in daily clinical practice. Correct management of the diagnostic process is crucial to avoid blunders. Diagnosis is posed by pathology, although both imaging and a better understanding of the cellular and molecular mechanisms play an important a role in the characterization, staging and follow-up of soft tissue masses. Cellular and molecular mechanisms can explain either the development of chemo-resistance and the underlying pre- and post-surgery metastasis formation. These are mandatory to improve prognosis and unveil novel parameters predicting therapeutic response. Imaging mainly involves ultrasound and MR and is fundamental not only in diagnosis but also in the first step of therapy: the biopsy. Novel imaging techniques like Ultrasound Elastosonography, Dynamic Contrast-Enhanced MR imaging (DCE), Diffusion Weighted MR imaging (DWI) and MR Spectroscopy (MRS) are discussed. This paper aims at reviewing and discussing pathological methods and imaging in the diagnosis of soft tissue masses underscoring that the most appropriate treatment depends on advanced molecular and radiological studies.
Highlights
Soft tissue sarcomas (STS) represent 1 % of all malignant tumours [1, 2] with more than 50 histological subtypes associated with distinctive clinical and/or molecular profiles, prognosis and response to tailored therapy
Malignancy increases with age, and is significantly higher in adult patients compared to children where 75 % of masses are benign [3]
– Features of a solid lesion on Dynamic Contrast-Enhanced magnetic resonance (MR) imaging (DCE). – High Perfusion Insensitive Diffusion Coefficent (PIDC) values with easy diffusion Apparent Diffusion Coefficents (ADCs) maps on Diffusion Weighted MR imaging (DWI). These three features are very important because myxoid liposarcomas have less than 10 % mature fat, that is a low/intermediate signal intensity on T1-weighted images on conventional MR
Summary
Soft tissue sarcomas (STS) represent 1 % of all malignant tumours [1, 2] with more than 50 histological subtypes associated with distinctive clinical and/or molecular profiles, prognosis and response to tailored therapy. STS are mostly benign with an incidence of 100 to 1 and 75 % involve limbs. Malignancy increases with age, and is significantly higher in adult patients compared to children where 75 % of masses are benign [3]. High-grade STS are associated with a 50 % mortality rate [4, 5]. Surgical removal of tumours in association with radiation and chemotherapy has brought an increase in the 5year disease-free survival of localized STS, while clinical outcome of patients with advanced or metastatic disease remains strongly unfavorable.
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