Sarcoma- Surgical

Perspective
Lucas Henn

Mass
Delays common- nonspecific symptomshematoma vs pulled muscle
Biopsy mass is no Hx of trauma or after 6
weeks of trauma
Biopsy any mass greater than 5 cm or new,
enlarging, or symptomatic mass
Head, Neck, Trunk, Extr: painless usually
Retroperitoneal mass: palp, or pain, fullness,
early satiety

Diagnosis
Excisional Biopsy: smaller masses (<
5cm)
- Risk malig low, take pseudocapsule
Incisional Biopsy: > 5 cm
- Definitive therapy later, scar incorp in
next wide re-excision
CT guided FNA- minimized tumor
spillage for retro and intra-abd

QuickTime and a
TIFF (LZW) decompressor
are needed to see this picture.

Pathology
Defined by tumor tissue type not tissue of
origin
Grade most important for prognosis and
treatment
Low: little cellular atypia, few mitosis, no
necrosis
Intermediate: atypia, some mitoses, little/no
necrosis
High: atypia, mitosis, necrosis

Extremity
Wide local excision- definitive therapy
3-5 cm margins around tumor
Deep margin: try for 1 uninvolved
fascial plane
Take nerves/vessels unless low grade
Amp

QuickTime and a
TIFF (LZW) decompressor
are needed to see this picture.

Retroperitoneal
Most patients die of the disease- even low
grade- due to late diagnosis
Symptoms are after large size
Therapy: Wide local excision- complete in
only 50%- sometime have to take adjacent
organs
Leave Clips: for post op XRT- may try intra op
XRT
Chemo not effective

Bone
Most Malignant bone tumors are mets
or blood
Osteosarcoma: most common primary
sarcoma: lung mets 25% at diagnosisencompases Ewings sarcoma
Plain films: irregular, poorly defined
borders- Onion Skin- core biopsy
(unlike soft tissue sarcoma)

QuickTime and a
TIFF (LZW) decompressor
are needed to see this picture.

QuickTime and a
TIFF (LZW) decompressor
are needed to see this picture.

Bone- treament
Tumor excision
Limb sparing surgery with joint
reconstruction vs. radical amputation
Also XRT for Ewings

Unresectable

Can be treated with radiation

Need higher doses
Need near 65-75 Gy
Local control in about 30% of patients

Pulmonary Mets
Patients may get 20-30% five year
survival with pulm met resection
Need fewer than 4 mets and a 12
month disease free interval
More aggressive with younger patients