Soft Tissue Tumors Research Articles

Distinguishing benign and malignant myxoid soft tissue tumors: Performance of radiomics vs. radiologists.

Benign and malignant myxoid soft tissue tumors have shared clinical, imaging, and histologic features that can make diagnosis challenging. The purpose of this study is comparison of the diagnostic performance of a radiomic based machine learning (ML) model to musculoskeletal radiologists. Manual segmentation of 90 myxoid soft tissue tumors (45 myxomas and 45 myxofibrosarcomas) was performed on axial T1, and T2FS or STIR magnetic resonance imaging sequences. Eighty-seven radiomic features from each modality were extracted. Five ML models were trained to classify tumors as benign or malignant in 40 tumors and then tested with an additional 50 tumors using cross validation. The accuracy of the best ML model based on area under the receiver operating characteristic curve (AUC) was compared to the consensus diagnosis of three musculoskeletal radiologists. Correlation between radiologist confidence (equivocal, probably, consistent with) and accuracy was tested. The best ML classifier was a logistic regression model (AUC 0.792). Using T1 + T2/STIR images, the ML model classified 78% (39/50) of tumors correctly at a similar rate compared to 74% (37/50) by radiologists. When radiologists disagreed, the consensus diagnosis classified 50% of tumors (7/14) correctly compared to 86% (12/14) by the ML model, though this did not reach statistical significance. Radiologists had a cumulative accuracy of 91% (30/33) when they rated their confidence 'consistent with' compared to 61% (31/51) when they rated their confidence 'equivocal/probably' (P = 0.006). For cases when radiologists rated their confidence 'equivocal/probably', the ML model had 76% accuracy (39/51). A radiomic based ML model predicted benign or malignant diagnosis in myxoid soft tissue tumors similarly to the consensus diagnosis by three musculoskeletal radiologists. Radiologist confidence in the diagnosis strongly correlated with their diagnostic accuracy. Though radiomics and radiologists perform similarly overall, radiomics may provide novel diagnostic utility when radiologist confidence is low, or when radiologists disagree.

Management and outcomes of thoracic sarcomas - a collaboration between Orthopaedic Oncology and cardiothoracic surgery: seven-year clinical data from a tertiary referral centre

IntroductionSarcomas are rare cancers originating from mesenchymal tissues, manifesting in diverse anatomical locations, but notably in connective tissue, muscles and the skeleton. Thoracic sarcomas present a unique diagnostic and surgical challenge attributable to their rarity and pathoanatomy. Standard practice currently comprises wide surgical excision, often accompanied by adjuvant chemotherapy and/or radiotherapy. This approach necessitates a multidisciplinary team, ideally in specialised cancer centres. The Oxford Bone and Soft Tissue Tumour Service is one such centre, and routinely treats such cancers through collaboration between orthopaedic oncology and cardiothoracic surgeons, as well as members of the wider MDT. This study reports the current management and outcomes of primary thoracic sarcoma patients at the Oxford Sarcoma Service over a seven-year period.ObjectivesGiven the rarity of thoracic sarcomas, and their associated diagnostic and management complexities, our aim is to report on the treatment strategies and outcomes of primary thoracic sarcoma patients treated at the Oxford Sarcoma Service from 2017 to 2023.MethodsData pertaining to all thoracic sarcoma cases discussed in multidisciplinary meetings at the Oxford tertiary centre from 2017 to 2023 were retrieved from the local electronic database. These were analysed using appropriate statistical tests to determine significance of the various observations made.ResultsOf 113 identified cases, chondrosarcoma emerged as the most prevalent histological subtype among 22 distinct varieties. 58% of cases exhibited high-grade features. 32 sarcoma-related deaths occurred, with a mean time from diagnosis to death of 23.16 months. A notable association was observed between high-grade sarcomas and mortality (p = 0.0280). Surgical resection was performed in 77 cases, with 49% of these undergoing surgical resection alone i.e. the patient received no radio- or chemotherapy. Both surgical intervention (p < 0.0001) and clear margins (p = 0.0051) were significantly linked to improved survival. Local recurrence was noted in 28.6% of the 77 surgical cases, and predominantly in the high-grade sarcomas (81.8%). However, no statistical association was found between recurrence and margin status in our data.ConclusionOur results indicate that primary resection remains the cornerstone of thoracic sarcoma treatment, representing the single strongest independent factor for survival in treatable cases. Variability in outcomes and overall survival likely stems from factors such as histological diversity, predominance of high-grade sarcomas, and wide age range at diagnosis. Ongoing prospective database update and collaborative efforts across centres would further clarify prognoses and recommendations for specific tumours, based on observational data.

Therapeutic rigid bronchoscopy for endobronchial glomus tumors: a case series

BackgroundGlomus tumors (GTs) are rare, comprising only 2% of all soft tissue tumors. Pulmonary GTs are exceptionally rare, with fewer than 80 cases reported to date. Little is known about the therapeutic outcomes of rigid bronchoscopy for endobronchial GT.MethodsThis is a case series of four patients with endobronchial GT who underwent therapeutic rigid bronchoscopy between February 2021 and June 2024.ResultsThe ages of the patients in our series ranged from 32 to 75 years, and all patients were male. Cough and blood-tinged sputum were present in all patients with endobronchial GT. The tumor sizes ranged from 1 to 3 cm. Complete endoscopic resection and laser cauterization via rigid bronchoscopy were achieved in two patients. One patient had incomplete resection of a 3-cm tumor in the segmental bronchus that showed radiological evidence of bronchial wall invasion. This patient subsequently underwent lobectomy seven months after bronchoscopic resection. The fourth patient was lost to follow-up. There was no mortality throughout the follow-up periods that ranged from 2.8 to 42.5 months. Factors favoring successful rigid bronchoscopy resection for endobronchial GT include a benign tumor in the central airways without bronchial wall invasion.ConclusionEndoscopic resection and laser cauterization using rigid bronchoscopy may be a viable option for patients with endobronchial GT when surgery is not practical.Clinical trial numberNot applicable.

Important changes to the 2022 WHO classification of testicular tumours : Aguide for diagnostics

The 5thEdition of the "WHO Classification of Tumours: Urinary and Male Genital Tumours" introduces several significant updates to the classification of testicular tumours. These updates include revised terminology for special germ cell tumour subtypes (neuroectodermal and neuroendocrine tumours) of the testis. Additionally, the signet-ring stromal tumour and myoid gonadal stromal tumour have been introduced as distinct entities within the sex-cord stromal tumours. Moreover, new combined sections have been created for lymphatic neoplasms and soft tissue tumours of the urinary and male genital tract.

Characterization of a pleomorphic rhabdomyosarcoma cell line

Pleomorphic rhabdomyosarcoma (PRMS) is an extremely rare soft tissue tumor with dismal prognosis that has a higher incidence in adults compared to the other RMS subtypes. The unique PRMS cell line BH1522 was established from a pleural effusion of a lung metastasis and the characteristics of this cell line were compared to two embryonal type RMS (ERMS) cell lines. The affected patient had been treated by surgery, several cycles of chemotherapy and thoracoscopy of the lung metastases. Chemosensitivity of the PRMS cell lines was checked using cytotoxicity assays and oncogene-related and phosphoproteins by Western blot arrays. The BH1522 cell line proved to be chemosensitive to conventional chemotherapeutics and the Son of Sevenless 1 homolog (SOS1) inhibitor BAY-293 that inhibited proliferation and suppressed MYC activity. Results of the novel functional BH1522 tests corroborate published tumor sequencing data that demonstrated alterations in receptor tyrosine kinase/MAPK, PI3K/AKT and mutated p53 as suspected drivers of malignant growth.

Trends in Venous Thromboembolic Events and Anticoagulation Prescriptions for Orthopaedic Surgery of the Shoulder.

There is a paucity of literature discussing anticoagulation prescribing patterns after upper extremity orthopedic surgery. The purpose of this study is to use a large national database to identify trends in adverse events and anticoagulation prescribing following orthopedic shoulder surgery. The TriNetX Research Network was utilized to identify all patients undergoing orthopedic shoulder surgery between January 2004 and December 2022. Patient information was stratified by year and type of surgery including arthroplasty, arthroscopy, soft tissue procedures, bony procedures, fractures, tumor resection, and amputation. Data collected included patient sex, age, race and ethnicity. Rates of postoperative anticoagulation medications, deep vein thrombosis, and postoperative bleeding were recorded within 1 month of surgery. A sub-analysis was performed comparing propensity matched cohorts of patients with a preoperative hypercoagulable diagnosis compared to a non-hypercoagulable cohort. Statistical significance was defined as P < .05. The overall rate of VTE and postoperative bleeding for the collective cohort was low (1.3% and 0.1% respectively). The highest rate of VTE events was 2019 (1.8%). The overall rate of patients receiving anticoagulation medication was 15.6% during the study period. The year with the highest rate for anticoagulation prescribing was 2015 for all shoulder surgery (19.2%). Patients undergoing amputation and arthroplasty procedures experienced the highest overall rates of postoperative anticoagulation prescribing (51.8 and 47.6% respectively), while tumor resection and arthroscopy procedures experienced the fewest (6.2% and 6.6% respectively). Patients with a hypercoagulable diagnosis experienced VTEs at significantly higher rates (7.0% versus 0.9%, respectively) and received more anticoagulation medications compared to the non-hypercoagulable group (20.6% versus 15.5%) CONCLUSION: The rate of VTE and bleeding related events for orthopedic shoulder surgeries is low. However, there is an increased rate of VTE in patients with hypercoagulability risk factors and in those undergoing arthroplasty, amputation, and fracture fixation.

Canadian Association of Radiologists Cancer Diagnostic Imaging Referral Guideline.

The Canadian Association of Radiologists (CAR) Cancer Expert Panel is made up of physicians from the disciplines of radiology, medical oncology, surgical oncology, radiation oncology, family medicine/general practitioner oncology, a patient advisor, and an epidemiologist/guideline methodologist. The Expert Panel developed a list of 29 clinical/diagnostic scenarios, of which 16 pointed to other CAR guidelines. A rapid scoping review was undertaken to identify systematically produced referral guidelines that provide recommendations for one or more of the remaining 13 scenarios. Recommendations from 21 guidelines and contextualization criteria in the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) for guidelines framework were used to develop the recommendation for these scenarios. During recommendation formulation, one additional scenario was mapped to an existing CAR guideline scenario, leaving 12 scenarios with new recommendations. The guideline focuses on cancer diagnosis and does not cover cancer staging, follow-up, and surveillance. This guideline presents the methods of development and the referral recommendations for suspected pancreatic cancer, suspected liver cancer, incidental liver mass, incidental colon mass or suspected colon cancer, suspected anal cancer, suspected penile cancer, suspected cervical cancer, suspected endometrial/uterine cancer, suspected vulvar cancer, suspected vaginal cancer, suspected haematologic malignancies, and suspected skin cancer. The guideline also points to other CAR guidelines for suspected neck, thyroid, brain, lung, intracardiac/pericardial, esophageal/gastric, renal, adrenal, bladder, testicular, prostate and ovarian cancers, suspected soft tissue mass or tumour, suspected bone tumour, suspected bone tumour --myeloma, suspected spine tumours, and incidental lung cancer.

Common Comorbidities and a Comparison of 4 Comorbidity Indices in Patients Undergoing Orthopaedic Oncology Surgery.

Comorbidity indices are used to help to estimate patients' length of hospital stay, care costs, outcomes, and mortality. Increasingly, they are considered in reimbursement models. The applicability of comorbidity indices to patients undergoing orthopaedic oncology surgery has not been studied. The purpose of this study was to determine the predominant comorbidities in patients undergoing orthopaedic oncology surgery and to evaluate the predictive value of these indices. Patient demographic characteristics, diagnoses, and preoperative comorbidities were collected retrospectively on 300 patients undergoing orthopaedic oncology surgery between January 2014 and March 2023. In this study, 3 subsets of 100 patients each with malignant primary bone tumors, malignant primary soft-tissue tumors, or osseous metastatic disease were randomly selected. Comorbidities were tabulated and weighted according to the guidelines of the Charlson Comorbidity Index (CCI), the National Institute on Aging/National Cancer Institute (NIA/NCI) index, the van Walraven Index, and the Agency for Healthcare Research and Quality (AHRQ) Index. Two-tailed bivariate Pearson correlations were performed to assess the relationship between the indices and between each index and patient outcomes. Comorbidities in our patient population were compared with those published in other studies. The predominant comorbidities in patients undergoing orthopaedic oncology surgery were hypertension, deficiency anemias, metastatic disease, recent unintended weight loss or being underweight, and fluid or electrolyte disorders. The percentage of patients with certain comorbidities exceeded those reported in other cancer, orthopaedic, and inpatient populations. The 4 comorbidity indices had variable correlation when assessing our patient population. The number of comorbidities and the weighted scores from all indices demonstrated little to no correlation with length of stay and survival in our patient sample. The prevalence of many comorbidities in patients undergoing orthopaedic oncology surgery is greater than those reported in other patient populations. Commonly utilized indices demonstrate variable correlation with one another. With these tools, there was little to no correlation between comorbidities and patient outcomes in our patient population. The comorbidities deemed protective in these tools may underestimate the true assessment of the comorbidities in patients undergoing orthopaedic oncology surgery. This highlights the importance of developing tools to properly assess the comorbidities in defined patient populations, especially as these models are used to set benchmarks for measuring patient outcomes; assessing quality, efficiency, and safety; and determining reimbursement criteria. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Fibrosarcomatous Dermatofibrosarcoma Protuberans With COL1A1-PDGFB Fusion in a 2-Year-Old Child: A Rare Occurrence With Spectrum of Histopathological Findings and Review of Literature.

Dermatofibrosarcoma protuberans (DFSP) is an intermediate-grade fibroblastic neoplasm commonly seen in young and middle-aged patients and rarely in pediatric patients. Fibrosarcomatous transformation is common in adults but extremely uncommon in children. Here, we present a case of a 2-year-old child who presented with a progressively enlarging subcutaneous mass in the knee. Histopathological examination revealed a spindle cell tumor with a storiform and fascicular pattern. Immunohistochemistry showed variable cluster of differentiation 34 (CD34) expression, with positivity in storiform areas and negativity in fascicular regions. Next-generation sequencing confirmed the diagnosis by detecting a collagen type I alpha 1 (COL1A1)-platelet-derived growth factor subunit B (PDGFB) fusion, with the PDGFB breakpoint in exon 2 (chromosome 22) and COL1A1 in intron 47 (chromosome 17). This case represents only the fifth reported instance of fibrosarcomatous DFSP in a child under 10 years old. While wide local excision remains the standard treatment for DFSP, targeted therapy with imatinib may be considered for unresectable, recurrent, or metastatic cases, though guidelines for pediatric patients are not yet established. This case highlights the importance of molecular testing in confirming the diagnosis of rare pediatric soft tissue tumors and contributes to the limited literature on fibrosarcomatous DFSP in very young children.

Radiological Challenges in Diagnosing a Rare Intraparotid Lipoma: A Case Report

Lipomas are benign tumors of soft tissues, primarily consisting of adipose tissue, and are extremely rare within the parotid gland. They are seldom included in the differential diagnosis of parotid tumors. These tumors grow slowly, are frequently asymptomatic, and are often difficult to diagnose clinically. Nonetheless, magnetic resonance imaging (MRI) remains the most effective diagnostic tool for guiding the diagnosis. The primary treatment for these tumors is complete surgical removal, which minimizes the risk of recurrence and confirms the diagnosis.

A Rare Case of Neonatal Desmoid Tumor Leading to Severe Aortic Coarctation: Review of Literature and Case Report.

Desmoid tumors are a rare entity, especially in the pediatric population. There are no reports of such a tumor in newborns. They are associated with high rates of morbidity and mortality, even though they are benign soft tissue tumors. This is due to them exhibiting locally aggressive growth with the compression or invasion of adjacent structures. Abdominal localization is most commonly reported, although there are reports of mediastinal desmoid tumors. We present the case of a 6-day male patient with a mediastinal desmoid tumor that led to severe aortic coarctation with hemodynamic instability. The tumor also compressed the left pulmonary artery and obstructed the left main bronchus. The initial management consisted of successful emergency surgery with partial resection of the tumor mass and coarctation repair. In the postoperative setting, the patient evolved with severe respiratory dysfunction which was managed with tracheostomy, allowing weaning the child from the mechanical ventilation one month after surgery, along with chemotherapy. We also review the literature, focusing on the management of desmoid tumors.

Calcified chondroid mesenchymal neoplasm: a clinicopathological and molecular analysis

AimsCalcified chondroid mesenchymal neoplasm (CCMN) is a recently identified category of soft tissue neoplasms defined by cartilage or cartilaginous matrix formation and FN1 gene fusions. Its rarity and similarities to...

Epidemiology and clinicopathological features of soft tissue tumors in adolescents: a cross-sectional study

BackgroundSoft tissue tumors (STTs) in adolescents are relatively rare, and their characteristics and behavior have not been well studied in this age group. The aim of this study was to describe the clinicopathologic patterns of STTs in adolescents aged 10–19 years according to the 2020 WHO classification.MethodA 10-year retrospective cross-sectional study of 632 surgical samples from adolescents was conducted at a tertiary health facility to determine the frequency, histological patterns and characteristics of STTs in this population. The data were analyzed via SPSS 23.ResultsSTTs accounted for 12.5% of all histologically diagnosed lesions in adolescents, with a mean age of 15 ± 2.9 years, 54.4% occurring in females and 35.4% in middle adolescents. The majority (64.56%) of STTs were benign, while malignant and intermediate-grade neoplasms accounted for 25.32% and 10.13%, respectively. Vascular tumours were the most common, followed by adipocytic and fibroblastic/myofibroblastic tumours, with hemangiomas being the most common. The most prevalent symptom was a painless mass (82.3%), with the head and neck (25.3%) being the most commonly involved body site. Most of the STTs patients presented within the first two years of occurrence (36.7%, n = 29/79). However, age, age group and sex were not significantly associated with the WHO grades of these STTs.ConclusionThis study provided valuable insights into the characteristics and behavior of STTs in adolescents, highlighting the importance of early diagnosis and management. These findings suggest that adolescent STTs affect females more than males , involve the head and neck more and are more benign, with vascular tumours being the most common type of STT in this age group.

Clinical Efficacy of Ultrafast Dynamic Contrast-Enhanced MRI Using Compressed Sensing in Distinguishing Benign and Malignant Soft-Tissue Tumors.

To evaluate the clinical efficacy of ultrafast dynamic contrast-enhanced (DCE)-MRI using a compressed sensing (CS) technique for differentiating benign and malignant soft-tissue tumors (STTs) and to evaluate the factors related to the grading of malignant STTs. A total of 165 patients (96 male; mean age, 61 years), comprising 111 with malignant STTs and 54 with benign STTs according to the 2020 WHO classification, underwent DCE-MRI with CS between June 2018 and June 2023. The clinical, qualitative, and quantitative parameters associated with conventional MRI were also obtained. During post-processing of the early arterial phase of DCE-MRI, the time-to-enhance (TTE), time-to-peak (TTP), initial area under the curve at 60 s (iAUC60), and maximum slope were calculated. Furthermore, the delayed arterial phase parameters of DCE-MRI, including Ktrans, Kep, Ve, and iAUC values and time-concentration curve (TCC) types, were determined. Clinical and MRI parameters were statistically analyzed to differentiate between benign and malignant tumors and their correlation with tumor grading. According to logistic regression analysis, the TTE value (P < 0.001) of the early arterial phase and Ve (P = 0.039) and iAUC (P = 0.006) values of the delayed arterial phase, as well as age, location, peritumoral edema, and contrast heterogeneity on conventional MRI, were significant (P = 0.001-0.015) in differentiating benign and malignant tumors. Among all the quantitative parameters, the TTE value had the highest accuracy, with an area under the receiver operating characteristic curve of 0.902. The grading of malignant tumors was significantly correlated with peritumoral edema; CE heterogeneity; visual diffusion restriction; minimum and mean ADC; TTP, Kep, and Ve values; and the TCC graph (all P < 0.05). Among the quantitative parameters obtained using ultrafast DCE-MRI, early arterial phase TTE was the most accurate for distinguishing between benign and malignant tumors.

Pediatric-type Myoid Neoplasms of Somatic Soft Tissue: A Clinicopathological and Molecular Genetic Study of 78 Tumors, Highlighting Indolent Clinical Behavior and Frequent SRF Gene Rearrangements.

Soft tissue tumors with smooth muscle differentiation are rare in pediatric patients. Despite often showing morphologic features sufficient for classification as "leiomyosarcoma" in adults (e.g., high cellularity, mitotic activity), clinical follow-up has shown only indolent behavior. The pathological features of recently reported SRF-rearranged "cellular myofibromas/myopericytomas", typically occurring in children, overlap with those of true smooth muscle tumors. We studied a large series of pediatric tumors with morphologic and immunohistochemical evidence of smooth muscle differentiation, with the goals of better understanding their natural history and molecular genetic features. Seventy-eight tumors were identified occurring in 45 males and 33 females, with a median age of 10 years. Clinical follow-up (50 patients; median 45.5 months) disclosed local recurrence in 7 patients (15%). No metastases or deaths due to disease occurred. Group 1 (73/78) tumors consisted of cellular fascicles of mildly to at most moderately atypical, bland, ovoid to spindled cells with distinctly eosinophilic cytoplasm, appreciable mitotic activity (median 5/50 HPF) and no necrosis. Group 2 tumors (5/78) showed greater cellularity, significant nuclear pleomorphism, and brisk mitotic activity (median 59/50 HPF). Subsets of group 1 tumors harbored SRF rearrangements (16/47) and all group 2 tumors showed TP53 biallelic inactivation (5/5). SRF fusion partners included CITED1, NCOA2, C3orf62, RELA, ARGFXP1, ARNTI2, ICA1L, and unknown (n=1). We conclude that the prognosis for pediatric tumors with smooth muscle differentiation that fall into group 1 is excellent. SRF rearrangements are present in a significant minority of tumors, typically showing features of smooth muscle, rather than myopericytic differentiation. A smaller subset with more worrisome morphologic features harbor biallelic inactivation of TP53. To emphasize their unique features, we propose the term "pediatric-type myoid neoplasms of somatic soft tissue," rather than simply "leiomyoma" or "leiomyosarcoma" for group 1 tumors and the designation of leiomyosarcoma in children should be limited to group 2 tumors.

Epidemiology and survival analysis according to the histologic subtype of pancreatic cancer: a population-based cohort study.

This study investigated epidemiologic features of patients with pancreatic cancer in Korea, according to the histologic subtypes. The Korea Central Cancer Registry data on patients with pancreatic cancer from 1999 to 2019 were reviewed. The 101,446 patients with pancreatic cancer (C25 based on the International Classification of Diseases, 10th revision) were allocated according to the following morphological codes: A, endocrine; B, carcinoma excluding cystic and mucinous; C, cystic or mucinous; D, acinar cell; and E, sarcoma and soft tissue tumor. The distribution of each pancreatic cancer subtype group in Korea from 1999 to 2019 was as follows: A, n = 3,101 (3.1%); B, n = 95,051 (93.7%); C, n = 2,856 (2.8%); D, n = 299 (0.3%); and E, n = 139 (0.1%). In group B, 49.2% of patients were aged >70 years, and half of them did not receive treatment within 4 months of diagnosis. In addition, only 30.9% of the patients were in the localized and regional stage in which surgical treatment was possible. Pancreatic cancer occurred more frequently in females than in males only in group C. Between 1999 and 2019, the average annual percentage changes in the age-specific incidence rates were positive in groups A (13.9%, P < 0.001), B (1.0%, P < 0.001), and C (6.5%, P = 0.025). Significant improvements in 5-year survival rates over time were observed in subtypes A, B, and C. The subgroups of pancreatic cancer show different epidemiologic features, including incidences, treatment rates, and prognoses.

The diagnosis and treatment of the epithelioid sarcomas involving the peripheral nerves

Epithelioid sarcomas are rare soft tissue tumors and have possibility to involve the peripheral nerve and present as sensory and motor disorders. The symptoms are similar to those of nerve compression diseases. This situation is extremely rare in clinic and was only reported as several case reports in literature. It can be easily ignored and misdiagnosed in clinic and may bring out severe outcomes. From January 2003 to December 2017, a retrospective analysis of ten patients with epithelioid sarcomas which involved the peripheral nerves was made. The medical data, detailed clinical courses and the follow-up results were stated. In these cases, the tumors invaded the median nerve, ulnar nerve, radial nerve, brachial plexus, sciatic nerve and presented as relative symptoms. Early diagnosis and treatment are the keys to better prognosis. We recommended high-resolution ultrasound as a standard diagnostic tool for nerve compression syndromes not only reveal the morphological structure of the peripheral nerve, but also discover the tumor involving the nerve. Adequate surgical methods including wide resection and lymph node dissection if necessary. The manners of functional reconstruction need to be applied flexibly by the doctors. Postoperative rehabilitation is important for functional recovery. We want to share our experiences in the diagnosis and treatment to overcome this particular condition.

The use of interfascial blocks for complex analgesia in the surgical resicrion of soft tissue tumors in the chest area in kompanion animals

Achieving satisfactory results of surgical treatment of cancer patients is impossible without pain control both intraoperatively and in the early postoperative period. The inclusion of regional anesthesia in multimodal pain control protocols can significantly improve the quality of analgesia and accelerate patient recovery after surgery. Nevertheless, each method of interfascial plane block has its own indications, contraindications, and complications. The purpose of our study was to show the validity and effectiveness of the use of regional anesthesia in the form of interfascial plane blocks during surgical resection of soft tissue tumors in the chest area in companion animals. The study were included 49 animals (30 dogs and 19 cats) who underwent surgery resection of soft tissue tumors in the chest area. The criterion for the inclusion of animals in the study was the use of regional anesthesia in the form of interfascial plane blocks in the anesthesia protocol. As a result of the study, it was revealed that the combination of several interfascial blocks provides a significantly better level of analgesia in resection of volumetric formations in the early postoperative period, however, when performing a unilateral mastectomy, the combination of a transversus abdominis plane block with a erector spinae plane block does not reduce the postoperative pain level. In mastectomies involving the cranial mammary glands, the best result for postoperative anesthesia is shown by the use of serratus anterior plane block. The inclusion of interfascial plane blocks in the anesthesia protocol for oncological patients makes it possible to significantly reduce or eliminate the use of narcotic analgesics in the perioperative period and, accordingly, avoid side effects and complications associated with the use of narcotic drugs, which is especially important for debilitated and geriatric patients.

A Study on Safety and Efficacy of Zigzag Skin Incision in General Surgery Among Elective Cases of Acute Appendicitis, Inguinal Hernia and Soft Tissue Tumour - Randomized Controlled Trial

Background: Straight line, the conventional incision technique, is against the principle of plastic surgery when it is not along the minimal line of tension on body. This incisional technique is widely practiced by general surgeons whilst zigzag incision if used, would be advantageous as it facilitates in enhanced exposure to surgical field and aesthetically better scar. In this study zigzag incisional technique was evaluated in terms of safety and efficacy in elective surgery cases of acute appendicitis, inguinal hernia and soft tissue tumour. Methods: Stratified randomization done for the patients included in cases of general surgery like acute appendicitis, inguinal hernia and soft tissue tumor. These patients were divided in the two groups, conventional incision group and zigzag incision group. Exposure to the surgical field was recorded as qualitative- bad, good and excellent according to operating surgeon. Scar assessment was done after 1 week, 1 month and 6 months. Results: Upon comparison of result, it was observed with zigzag incision, the exposure to surgical field was better than conventional straight-line technique. Additionally, the surgical scar was aesthetically better compared to the straight incision used in general surgery cases like appendectomy, inguinal hernia repair, soft tissue tumor excision but there was no significant difference in case of hernia and appendicitis cases. Conclusion: Zigzag incision can be used safely in place of traditional incision in the elective general surgery cases of acute appendicitis, inguinal hernia and soft tissue tumour. Zigzag incision provides better exposure of surgical field although this is subjective measure of surgeon’s experience, shows statistically significant difference. Zigzag incision heals better than straight line and gives aesthetically better scar, it can be used in cases such as open appendectomy, open inguinal hernia repair and excision of soft tissue swelling. Keywords: Zigzag incision, Straight incision, aesthetic scar, exposure of surgical field.

Prospective evaluation of soft tissue tumors: Correlation of ST-RADS MRI reporting guidelines with histopathological findings

Introduction. Soft tissue tumors, ranging from benign to highly malignant, pose diagnostic challenges due to their histological diversity. MRI is the preferred imaging modality for these tumors, but variability in interpretation affects consistency. The Soft Tissue Reporting and Data System (ST-RADs), modeled after BI-RADS, offers a standardized approach for classifying soft tissue lesions based on MRI features, potentially improving diagnostic accuracy and reducing unnecessary biopsies. This study aims to validate the clinical utility of ST-RADs by correlating MRI findings with histopathological examination (HPE), providing evidence for its use in routine practice to enhance diagnostic confidence and optimize patient management. Purpose. This study aims to evaluate the efficacy of the Soft Tissue Reporting and Data System (ST-RADS) in diagnosing soft tissue tumors using Magnetic Resonance Imaging (MRI), correlating MRI findings with histopathological examination (HPE) outcomes. Knowledge generated. Diagnostic accuracy was found to be high, with a ROC AUC of 0.959. Epidemiological insights indicate that a significant portion of the affected population is over 40 years old, with a balanced gender distribution. Clinical utility highlights the potential to reduce invasive diagnostic procedures through a reliable, non-invasive, imaging-based classification. Histopathological correlation confirms that MRI findings are consistent with HPE diagnoses, further validating the reliability of ST-RADs. Methods. A prospective observational study was conducted over 18 months at Saveetha Medical College and Hospital, involving 40 patients with suspected soft tissue tumors. MRI scans were performed using a 1.5 Tesla MRI system and classified according to ST-RADS guidelines. Histopathological examination was used as the gold standard for diagnosis. Statistical analysis included frequency percentages and Receiver Operating Characteristic (ROC) curves. Results. The study primarily involved older adults, with 28 participants aged over 40 years (70%), including a significant portion aged 60-70 years (13 participants, 32.5%). The gender distribution was balanced, with 18 males (45%) and 22 females (55%). Diagnoses revealed 17 sarcomas (42.5%), 11 lipomas (27.5%), and 3 ganglion cysts (7.5%). Most lesions were benign, found in 27 cases (67.5%), and the ST-RADS classification demonstrated high diagnostic accuracy (ROC AUC = 0.959, P &lt; 0.0001). The optimal cutoff at ST-RADS 0-3 versus 4-5 provided a sensitivity of 92.31% and specificity of 85.19%, which is crucial for distinguishing benign from malignant tumors. Conclusion. The ST-RADS system provides a structured approach to MRI assessment of soft tissue tumors, facilitating accurate differentiation between benign and malignant lesions. Correlation with histopathological findings supports its clinical utility, potentially reducing the need for invasive procedures and guiding appropriate treatment strategies. Future enhancements and integration with advanced diagnostic tools could further improve diagnostic precision and patient care outcomes.