Soft tissue sarcomas of the extremity

Neoadjuvant intraarterial chemotherapy of soft tissue sarcomas

A group of 51 patients with extremity sarcomas of soft-tissue origin received preoperative intraarterial (i.a.) chemotherapy via a percutaneously placed catheter. Treatments were performed as a series of chemotherapy cycles, giving a total of 129, and were carried out in the form of short-term infusions consisting of doxorubicin and cisplatin, which lasted for 20-40 min. These i.a. infusions were combined with complementary methods, such as a tourniquet, occlusion-infusion and chemoembolization. In 3 patients complete remission and in 21 partial remission was registered, while in 27 patients only minimal response could be achieved, although in this latter group necrosis of eight tumors proved to be of significant value. In 43 of 51 patients successful limb salvage surgery was carried out.

Cytodiagnosis of soft tissue tumors

The only acceptable definitive diagnosis of a soft tissue mass is histologic or cytologic examination. In recent years, fine-needle aspiration cytology is used in more and more centers for diagnosis of soft tissue masses. We studied 196 aspiration cytologies performed on soft tissue lesions. Out of these, in 48 cases a definitive surgical procedure or open biopsy for histology and further evaluation were performed. There were 25 sarcomas and 23 benign tumors. There was one false negative cytologic result in this group; no false positive cytologies were detected. It seems that cytodiagnosis of soft tissue masses performed by an experienced pathologist is the method of choice, permitting a good diagnostic evaluation, with almost none of the traumatic and oncologic disadvantages of the other methods of biopsy.

Clinical features of malignant haemangiopericytomas and haemangioendotheliosarcomas

The clinical features of 23 patients with malignant vascular tumours, referred for treatment in the period 1968-85, are described. The tumours consisted of 15 haemangioendotheliosarcomas (angiosarcomas) and 8 malignant haemangiopericytomas. Ten haemangioendotheliosarcomas were located in skin or mucous membranes and 5 in viscera and deep soft tissues. None of the 8 haemangiopericytomas were superficially located. One cutaneous haemangioendotheliosarcoma arose in a lymphoedematous leg, while 4 others occurred in previously irradiated areas. There was one case of a Thorotrast-induced hepatic haemangioendotheliosarcoma. No predisposing factors could be demonstrated in the cases of malignant haemangiopericytoma. Median survival was 11 months for the haemangioendotheliosarcomas and 19 months for the haemangiopericytomas. Patients who were operable at the time of admission had a longer median survival (37 months) than those who presented with advanced disease (5 months). Local control was obtained by surgery in 3 cases and by radiation therapy in 2. No complete responses were seen on chemotherapeutic regimens.

Nonosseous sarcomas in a military hospital

This is a retrospective review of 67 patients with soft tissue or visceral sarcomas treated during 1973-1982. There were 40 males and 27 females. The mean age was 36 with a range of 1 to 77 years of age. The most common histologic subtypes were rhabdomyosarcoma (19%), malignant fibrohistiocytoma (13%), fibrosarcoma, leiomyosarcoma, dermatofibrosarcoma protuberans (12% each), and liposarcoma (10%). Among the 42 soft tissue sarcomas 33% occurred in the trunk, 35% and 21% in the lower and upper extremities, and 10% in the head and neck region. Among the 25 visceral sarcomas, 16% were in the thorax, 56% involved abdominal or retroperitoneal organs, and 28% were in the head and neck region. Overall, 33 of the 54 patients with early sarcomas were treated by surgical resection alone while 21 others had postoperative adjuvant radiotherapy and/or chemotherapy. Factors influencing survival are presented and patterns of metastasis discussed. Overall, 45% of the patients showed metastatic disease either at diagnosis (15%) or during the follow-up period (30%). The lung was involved in two-thirds of the cases and was the most common site of spread. In patients with rhabdomyosarcoma and malignant fibrohistiocytoma, regional lymph node metastasis was noted in 36% and 17%, respectively.

Liposarcoma of the soft tissues

A case report presents a liposarcoma of the extremities and an overall review of this disease entity. Past and present histologic classifications of liposarcoma are discussed, as are the clinical behavior and treatment options in relation to the surgical stage of the tumor. The importance of a well-planned biopsy site is stressed.