Excision Of Soft Tissue Tumor Research Articles

The Burden of Unplanned Excision of Soft Tissue Tumours in Developing Countries: A 10-Years’ Experience at a Regional Cancer Centre

Background: Local recurrence in soft tissue sarcomas is the major onus of the disease which could result in nonfunctioning extremities. The local recurrence of soft tissue tumours is the major morbidity and cause for this is the unplanned surgery at inexperienced peripheral centers. We noticed that a major proportion approximate one fourth patient with soft tissue tumours presented in outdoor, were with residual or recurrent lesion. Aim: The aim was to examine the clinical and pathological profile of soft tissue tumours that had undergone unplanned excision in aspect to the natural event of recurrence in respect to surgery which has been performed. Materials and methods: In total, 126 patients who had undergone prior surgery of the tumour without oncological planning presented to our institute with residual or recurrent soft tissue tumours between January 2005 to December 2014 were analyzed in a retrospective study. Results: There were a total of 126 patients analyzed. The mean age was 44.3 ± 16.9 years. Average duration from previous unplanned excision to presentation was 5.3 months (1-57 months). 29 patients were presented immediately after the first surgery with clinical residual lesion with a diagnosis of soft tissue sarcoma, while 97 patients presented after apparent local recurrence. Most of the tumours were almost evenly distributed among low and high grade (40.5% vs. 59.5%), superficial and deep seated (48.4% vs. 51.6%), and <5 cm in size (62.9%). 99 (78.6%) patients presented within 24 months after unplanned excision. 22 (17.4%) patients were presented with distant metastasis also with local recurrence. Conclusion: The appropriate planning regarding as diagnosis as treatment purpose for the soft tissue sarcoma without assuming the soft tissue mass as benign lesion. It helps to reduce the morbidity due to recurrence after inadequate surgical excision.

Multi-Level Total En Bloc Spondylectomy for Solitary Lumbar Metastasis of Myxoid Liposarcoma

This article reports a case of solitary lumbar metastasis of myxoid liposarcoma treated by multi-level total en bloc spondylectomy. Myxoid liposarcoma has a predisposition to initial metastasis at an extrapulmonary site including bone. However a bone scan and FDG-PET, which are generally used for a whole-body screening of metastasis, are not sensitive to bone metastasis from myxoid liposarcoma. These situations make it difficult to achieve curative resection of a bone metastasis, especially in the spine. The patient was a 54-year-old man who had an intralesional excision of soft tissue tumor in the right thigh. He had an additional expansive excision due to the histological diagnosis of myxoid liposarcoma at the initial surgery. Four years postoperatively, L3 metastasis expanding to the adjacent vertebrae was detected using magnetic resonance imaging. Plain radiographs and computed tomography showed no evidence of the tumor involving the lumbar spine. A bone scan was false-negative although FDG-PET showed mild uptake. There was no other metastasis on the further examination. Multi-level total en bloc spondylectomy was performed using a combined posterior-anterior approach. The lumbar nerves were dissected and preserved. The vertebral bodies of L2, 3 and the upper half of L4, which had been invaded by the tumor, were removed en bloc using an anterolateral extraperitoneal approach. He had no local recurrence or further metastasis until he died of ischemic cardiac disease 14 months postoperatively.

The MR imaging appearances and natural history of seromas following excision of soft tissue tumours

Fluid collections (seromas) may accumulate at the site of surgery following excision of musculoskeletal soft tissue tumours. The aim of this retrospective study was to review the magnetic resonance (MR) imaging features of postoperative seromas identifying changes over time on follow-up scans. A total of 170 MR scans from 80 patients were reviewed showing one or more seromas. All patients had undergone previous surgery for a musculoskeletal soft tissue tumour. The typical MR appearances of a seroma were shown to be a well-defined oval or rounded (54%) soft tissue mass, arising at the site of previous surgery, with a thin, dark pseudocapsule, surrounding soft tissue oedema (80%), homogeneous contents that are hypointense (relative to adjacent muscle) on T1-weighted images (74%) and hyperintense on T2-weighted and STIR images (79%). Approximately one-quarter of cases revealed atypical features including hyperintense contents on T1-weighted (26%) and/or heterogeneous contents on T2-weighted images (21%), reflecting the breakdown of blood products and organization of the fluid collection. A distinctive fine feathery pattern arising from the inner surface of the seroma or from septations was identified in 10% of cases. In those patients who underwent one or more follow-up scans, the volume of the seromas decreased in 66% cases, remained unchanged in 15% and increased in 19%. Seromas are not an uncommon finding (<10% of cases) following surgery for a soft tissue tumour. The majority of cases show the typical MR features of a fluid collection. The pitfalls in differentiating an atypical seroma from a recurrent soft tissue sarcoma are discussed.

The pectoralis major muscle flap—a first choice for shoulder disruption injuries

Significant soft tissue losses may follow surgical excision of soft tissue tumours or areas of radionecrosis. These procedures are planned and the anatomical relationships of the axilla are usually left undisturbed. Because of its long pedicle and axis of rotation the latissimus dorsi muscle flap is usually the first choice for shoulder reconstruction. With gleno-humeral disruption the third part of axillary artery and its terminal branches are at risk of injury. In these circumstances the reliability of the latissimus dorsi cannot be guaranteed. We present five such cases treated in South Africa by the senior author. All were reconstructed using a pectoralis major muscle flap.