Soft tissue tumors
Oncology / / August 12, 2017
To identify tumors originating from muscles, tendons, ligaments, connective tissue, blood vessels and nerves, are widely used in the literature, the term "soft tissue tumors."The artificial union of tumors developing in the so-called soft tissue, is permissible only in the clinical-anatomical sense.
Malignancies soft tissues include:
1) all the tumors developing from mesenchymal tissues except bone tumors of the internal organs of mesenchymal origin (LM stomach, uterus sarcoma, etc.), and tumors of hematopoietic and reticuloendothelial tissue...
2) peripheral nerve tumors.
According to the summary published data, these tumors are rare and account for 0.3-0.4% of all malignant tumors.
Sexual predisposition to diseases of soft tissue tumors not.They occur at any age, but mainly in people older than 25 years.About 2/3 of all soft tissue tumors located on the extremities in the large muscle arrays (hip, pelvic and shoulder girdle).
Causes of soft tissue tumors clarified enough.We only know that the m
classification of soft tissue tumors
1. fibrous tissue: fibroma, desmoid (invasive fibroid), xanthoma, ksantofibroma (fibroksantoma, histiocytoma), dermatofibrosarcoma protuberans, fibrosarcoma, alveolar soft tissue sarcoma.
2. slime tissue: myxoma.
3. Adipose tissue: lipoma, fetal lipoma (hibernoma), liposarcoma.
4. Muscle tissue: leiomyoma, rhabdomyoma, zernistokletochnaya mioblastoma (mioblastomioma), leiomyosarcoma, rhabdomyosarcoma, a malignant zernistokletochnaya mioblastoma (malignant mioblastomioma).
5. Vascular tissue: capillary hemangioma (benign hemangioendothelioma), cavernous hemangioma (cavernoma), arterial hemangioma (arteriovenous angioma, hemangioma ratsemoznaya), lymphangioma (cystic hygroma), glomus tumor (angioneuroma) hemangiopericytoma, hemorrhagic Kaposi's sarcoma, malignant hemangioendothelioma(hemangiosarcoma), malignant hemangiopericytoma.
6. joints, tendon sheath and joint bags: Sinovioma benign, giant cell tumor of tendon sheath and joints, synovial sarcoma (malignant Sinovioma).
Symptoms Symptoms of soft tissue tumors are usually scarce.The main symptom is a local definition of the tumor, often by the patient.Usually these tumors are painless, do not disturb function, and therefore very little concern to the patient.Quite often the reason for seeking medical attention are neuralgia, ischemia and other related to the pressure of the tumor on a nerve or blood vessel symptoms.
As the growth of the tumor, along with local symptoms may appear common: weight loss, fever, general malaise.In some sarcomas can occur expressed by episodic attacks of hypoglycemia.There may be other endogenous disorders, including hyperthyroidism and pituitary dysfunction.Sarcomas, giving these disorders tend to be larger.Most often they are fibrosarcoma, but may be other tumors.
Due to the paucity of clinical diagnosis of soft tissue tumors is very difficult.It is especially difficult to differentiate benign from malignant tumors.
to select the correct treatment in all cases it is necessary to know the histology of the tumor.Morphological data together with clinical treatment and determine the nature largely prognosis.For small and superficial lesions biopsy it is both therapeutic measures: make excision of the lesion widely within healthy tissues.In other cases, produce a closed or open biopsy.Conventional x-ray region of the tumor, as a rule, does not help in differential diagnosis.With the localization of tumors in the limbs and in the retroperitoneal space is very important arterial angiography, by which usually reveal a chaotic network of newly formed blood vessels, "blood depot" and "bags".Angiography also enables differentiated sarcomas, benign tumors and inflammatory processes and is of great importance in terms of the choice of method of surgical intervention (the presence or absence of growing into great vessels).
Treatment For treatment of soft tissue tumors used surgical, radiation and drug methods, and combinations thereof.The main treatment - benign soft tissue tumors and most malignant is surgical.
Surgical treatment is used in two forms: wide excision and amputation (disarticulation) limbs.
Indications and contraindications to a particular method of treatment is quite difficult.Wide excision is indicated for sarcomas is not very significant for the size of the tumor, located relatively shallow and retained displaceability in the absence of their germination in the main vessels, bone and nerve trunks.
amputation is shown in the following cases:
1) tumor can not be removed by wide excision;
2) wide excision of the tumor to save the limb, which can not be used (poor circulation and nerve supply);
3) failure of multiple intact operations;
4) the palliative amputation due to bleeding, intolerable pain, smell (decay, bleeding tumors).
When performing a wide excision of the tumor should be removed without exposure, in the whole musculo-fascial compartment within the anatomic zones of attachment of the affected muscles.Relapses after wide excision sarcomas constitute not less than 30%.At the same time, the emergence of relapse doubles the chances of the patient to die of sarcoma.
amputation should be made above the level of the muscle group that is affected by the tumor.
soft tissue sarcomas have a pronounced ability to selectively hematogenous metastasis through the lungs.
Some forms of soft tissue sarcomas metastasize also lymphogenous way to regional lymph nodes;are angiosarcoma, rabdomioblastomy malignant Sinovioma and fibrosarcoma.In this connection, when the location of said sarcomas in close proximity to the regional lymph nodes advisable to remove them en bloc along with the tumor.
radiation treatment as an independent method usually does not lead to recovery from soft tissue sarcomas.Currently, radiation therapy is used in the following cases:
1) in the preoperative period to reduce the size of the tumor and the translation of inoperable tumors operable.Approximately 70% of all soft tissue tumors available pronounced therapeutic effect;
2) postoperative radiation therapy in the absence of confidence in the radical surgery;
3) radiotherapy with palliative goals when, due to some circumstances can not be performed the operation.