Soft Tissue Sarcomas Diagnosis, Treatment and Prognosis

Soft tissue sarcoma (STS) is a catch-all classification referring to tumours that arise from the embryonic mesoderm and as such can occur anywhere in the body. Generally they are classified according to cellular lineages (morphology on H and E staining, or immu- nohistochemisty (iHC)) such as fibrosarcoma, peripheral nerve sheath tumour, myxosar- coma, liposarcoma, or leiomyosarcoma, but sometimes these distinctions are not clear and the generic term soft tissue sarcoma or spindle cell sarcoma are employed. Some tumours of mesoderm behave in a much more aggressive and less predictable fashion and these tend not to be included in StS, examples include lymphangiosarcoma, rhab- domyosarcoma, synovial cell sarcoma, haemangiosarcoma, chondrosarcoma, osteosar- coma. Surgical resection is the principal treatment for primary localised disease as StS are relatively chemo-insensitive and radiotherapy is more of value in a curative context as an adjunct to surgery. the great variation in anatomic location, factored with variable size and grade, can present significant problems when making a treatment plan.

STS are graded into low (i), intermediate (ii) and high (iii) grade tumours taking into account histological features such as mitotic rate, extent of necrosis and cellular differ- entiation.

Radiographs may yield some information regarding local behaviour, but may only con- firm the mass is of soft tissue density. ultrasound (esp Doppler) can be useful but cross sectional imaging (Ct or Mri) is the imaging of choice and is typically supportive of the diagnosis. Whereas Mri is traditionally regarded as superior for soft tissue detail, Ct (esp contrast Ct) offers a fast, simple, and accurate solution for all but the most complex StS. it is cheaper, equally as useful as Mri, and it has the advantage that imaging the thorax for metastatic disease can easily be performed at the same time. [...]