Soft tissue sarcomas of the extremities - imaging and surgical planning

Congress:

ESSR 2019

Poster Number:

P-0074

Type:

Educational Poster

Keywords:

Neoplasia, Surgery, MR, Musculoskeletal soft tissue

Authors:

J. Mota Louro¹, J. S. F. Pinto², J. Maciel³, P. Varzim², M. França⁴; ¹Braga/PT, ²Porto/PT, ³Aveiro/PT, ⁴Maia/PT

DOI:

10.26044/essr2019/P-0074

DOI-Link:

https://dx.doi.org/10.26044/essr2019/P-0074

Fig. 1: The greatest dimension of the tumor is used to classify the T stage according...

Fig. 2: STS should be classified as deep (A) or superficial (B) in relation to the deep...

Fig. 3: A- Rhabdomyosarcoma affecting the superficial posterior and deep posterior...

Learning objectives

To review the most important imaging findings for surgical planning that should be evaluated during the locoregional staging of Soft Tissue Sarcomas (STS) of the extremities.

Background

STS are rare malignant tumours originating from mesenchymal tissue at any body site but mostly arising in an extremity (59%). STS staging classifications are evolving, but imaging, namely MRI, is an essential tool for the initial evaluation of these patients, as its soft tissue resolution permits excellent delineation of the extent of the tumour and its relation to adjacent structures.

Imaging findings OR Procedure Details

We reviewed MRI studies performed at our institution, during the initial evaluation of patients with a diagnosis of STS of the extremities, to illustrate findings relevant for surgical planning, such as tumour size, location, depth extension, peritumoral oedema, neurovascular and bone/joint invasion. STS commonly present as an enlarging, painless mass. Distant metastatic disease is uncommon, being more frequent in large, deep and high-grade tumours. Initial evaluation of a soft tissue mass encompasses clinical history, physical examination, imaging, and histologic evaluation through biopsy. STS patient should...

Conclusion

STS of the extremities are a group of rare and heterogeneous neoplasms mostly managed at tertiary and specialised hospitals. Nevertheless, every Radiologist should be familiarized with their evaluation as initial imaging is commonly performed outside these centres.

References

Elsorafy K, Ashford RU (2015) (i) Management of soft tissue sarcoma. Orthop Trauma 29:155–159 Caracciolo JT, Letson GD. Radiologic Approach to Bone and Soft Tissue Sarcomas. Surg Clin North Am. 2016;96(5):963-76. Jagannathan JP, Tirumani SH, Ramaiya NH. Imaging in Soft Tissue Sarcomas: Current Updates. Surg Oncol Clin N Am. 2016;25(4):645-75. Manaster BJ. Soft-tissue masses: optimal imaging protocol and reporting. AJR Am J Roentgenol. 2013;201(3):505-14. Kenney RJ, Cheney R, Stull MA, Kraybill W. Soft tissue sarcomas: current management and future directions. Surg Clin North Am. 2009;89(1):235-47,...