C h a p t e r 62

Soft Tissue

Sarcomas and

Lymphomas

What are they?

Sarcoma means what in GREEK?

Sarcomas are more common in upper or lower extremities?

How common are they?

What is the median age at diagnosis?

What are the risk factors?

Name the following types of malignant sarcoma:

Fat

Soft tissue tumors, derived from mesoderm

“Fish flesh”

50% of sarcomas are in the extremities and are 3.5 more common in the lower extremity (thigh)

0.6% of malignant tumors

55 years

“RALES”: Radiation

AIDS (Immunosuppression) Lymphedema

Exposure to chemicals

Syndromes (e.g., Gardner’s/Li-Fraumeni)

Liposarcoma

466 Section II / General Surgery

Define excisional biopsy.

Define incisional biopsy.

What is the orientation of incision for incisional biopsy of a suspected extremity sarcoma?

Define core biopsy.

What determines histologic grade of sarcomas?

Define the following American Joint Committee for Cancer Staging (AJCC) Sarcoma Stages:

Stage I

Stage IIA

Stage IIB

Stage III

Stage IV

Biopsy by removing the entire mass

Biopsy by removing a piece of the mass

Longitudinal, not transverse, so that the incision can be incorporated in a future resection if biopsy for sarcoma is positive

Large-bore needle that takes a core of tissue (like a soil sample)

1.Differentiation

2.Mitotic count

3.Tumor necrosis

Grade 1 well differentiated Grade 2 moderately differentiated Grade 3 poorly differentiated

Well differentiated (grade 1), any size, no nodes, no metastases

5 cm, grade 2 or grade 3

5 cm, grade 2

Positive nodes or 5 cm and grade 3

Distant metastases

What is a pseudocapsule and what is its importance?

Outer layer of a sarcoma that represents compressed malignant cells; microscopic extensions of tumor cells invade through the pseudocapsule into adjacent structures—thus, definitive therapy must include a wide margin of resection to account for this phenomenon and not just be “shelled-out” like a benign growth

What is the treatment?

What surgical margins are obtained?

What is the “limb-sparing” surgery for extremity sarcoma?

What is the treatment of pulmonary metastasis?

What tests should be done in the follow-up?

What syndrome of lymphangiosarcoma arises in chronic lymphedema after axillary dissection for breast cancer?

Surgical resection and radiation (with or without chemotherapy)

2 cm (1 cm minimum)

Avoidance of amputation with local resection and chemoradiation

Surgical resection for isolated lesions

Physical examination, CXR, repeat CT/ MRI of the area of resection to look for recurrence

Stewart-Treves syndrome

What are the indications for a “staging laparotomy” in Hodgkin’s disease?

Rarely performed

Most experts rely on CT scans, PET scans, bone marrow biopsy, and other directed imaging and biopsies