Soft tissue sarcomas involving the extremities and the limb girdles: a review

Myxoid liposarcoma of the ankle: a case report

Myxoid liposarcoma occurs predominantly in the deep soft tissues of the extremities, and tends to metastasize to a wide range of soft tissue or bone locations. We report a case of myxoid liposarcoma arising in the ankle of a 19-year-old man. A diagnosis of myxoid liposarcoma was made by open biopsy, and a wide resection requiring plastic surgical reconstruction was performed. Cytogenetic analysis of the resected tumor exhibited a reciprocal translocation t(12;16)(q13;p11) as the sole anomaly, which is found in more than 90% of myxoid liposarcoma cases. The patient had no evidence of local recurrence or metastasis within 7 years of follow-up. Although myxoid liposarcoma is rare in the ankle, it should be considered in the differential diagnosis of a painless soft tissue mass in this region.

Synovial sarcoma arising in the foot: case report

Synovial sarcomas occur primarily in the soft tissue structures adjacent to the joints and tendons of the extremities. A diagnostic dilemma exists when the clinical presentation is similar to that of an infection or soft tissue trauma. We report a case of soft tissue sarcoma of the foot in a previously healthy 19-year-old male who presented after hitting his right foot against a refrigerator. Initial radiographs were negative; however, 6 weeks later plain radiographs revealed destruction of the metatarsals. Histologic analysis on a specimen obtained via fine-needle aspiration confirmed the diagnosis of primary synovial sarcoma. Further workup revealed metastases to the lungs. An amputation at Chopart's joint was performed. Primary synovial sarcoma in the foot can mimic infection or edema from a traumatic event. Clinicians should always be suspicious of soft tissue masses and keep neoplastic processes in the list of differentials.

From the archives of the AFIP: Imaging of synovial sarcoma with radiologic-pathologic correlation

Synovial sarcoma is the fourth most common type of soft-tissue sarcoma, accounting for 2.5%-10.5% of all primary soft-tissue malignancies worldwide. Synovial sarcoma most often affects the extremities (80%-95% of cases), particularly the knee in the popliteal fossa, of adolescents and young adults (15-40 years of age). Despite its name, the lesion does not commonly arise in an intraarticular location but usually occurs near joints. Histologic subtypes include monophasic, biphasic, and poorly differentiated; the cytogenetic aberration of the t(X;18) translocation is highly specific for synovial sarcoma. Although radiographic features of these tumors are not pathognomonic, findings of a soft-tissue mass, particularly if calcified (30%), near but not in a joint of a young patient, are very suggestive of the diagnosis. Cross-sectional imaging features are vital for staging tumor extent and planning surgical resection; they also frequently reveal suggestive appearances of multilobulation and marked heterogeneity (creating the "triple sign") with hemorrhage, fluid levels, and septa (creating the "bowl of grapes" sign). Two features associated with synovial sarcoma that may lead to an initial mistaken diagnosis of a benign indolent process are slow growth (average time to diagnosis, 2-4 years) and small size (< 5 cm at initial presentation); in addition, these lesions may demonstrate well-defined margins and homogeneous appearance on cross-sectional images. Synovial sarcoma is an intermediate- to high-grade lesion, and, despite initial aggressive wide surgical resection, local recurrence and metastatic disease are common and prognosis is guarded. Understanding and recognizing the spectrum of appearances of synovial sarcoma, which reflect the underlying pathologic characteristics, improve radiologic assessment and are important for optimal patient management.

Myxoid liposarcoma of the ankle

Liposarcomas are among the most common soft tissue sarcomas, but are rarely found in the foot or ankle. Certain types of liposarcomas, which range from well-localized low-grade entities to highly aggressive neoplastic lesions, may resemble common benign soft tissue lesions. Myxoid liposarcoma is the most common type of liposarcoma and is important to recognize and differentiate from a benign soft tissue lesion because it may be a limb-threatening and/or life-threatening tumor. A thorough literature review and perplexing case study of myxoid liposarcoma of the ankle is presented.

Clinical outcome after neoadjuvant thermoradiotherapy in high grade soft tissue sarcomas

In the treatment of soft tissue sarcomas, hyperthermia has been demonstrated to enhance tumor necrosis from radiation therapy. The current study reports the clinical course of patients treated with this neoadjuvant therapy regimen. Forty-four patients with deep, undisturbed, nonmetastatic, high grade soft tissue sarcomas completed a neoadjuvant treatment protocol with combined hyperthermia and radiation therapy followed by wide surgical resection. Negative surgical margins were obtained in 40 patients. There was one local recurrence, thus yielding a local control rate of 97.5%. All other failures were either through regional lymphatic spread or pulmonary metastasis. As a group, the patients at 36 months had a 72% overall and a 58% disease-free survival. The most common pathologic diagnosis was malignant fibrous histiocytoma (MFH), which demonstrated a 36-month survival of 52% vs. 82% for others (P = 0.02). Tumor size was not prognostically significant for disease free or overall survival (P = 0.13). Those patients with surgical margins < 1 cm had a significantly lower disease-free survival and overall survival in a multivariate analysis (P = 0.02 and P = 0.006, respectively). Overall survival did not correlate with either the number of hyperthermia treatments received or the amount of tumor necrosis. Although this neoadjuvant protocol results in excellent local control rates, overall survival rates are comparable to adjuvant therapy employing radiation alone.

Myxoid liposarcoma. Light and electron microscopic investigation

Liposarcoma is an important soft tissue sarcoma. It requires careful classification into types, since prognosis varies considerably with histological appearance. In this case a myxoid sarcoma is shown to contain cells resembling fetal fat with active pinocytosis, and some scanty signet-ring cells. Their ultrastructural appearances are described.