The clinical and anatomical concept of "soft tissue" as defined by WHO in 1969 includes all non-epithelial extraskeletal tissues: smooth and striated muscles, synovial tissue, tendons and ligaments, muscle fat, subcutaneous fat or hypodermis, connective tissues (fibrous), nerve cells and vascular tissue. Neoplasms in them are soft tissue tumors. Among them are any tumors of the above tissues and tumors of an unclear lesion of embryogenesis.
Causes of soft tissue tumors
Their reasons are not fully understood even today. Some provoking factors for the development of soft tissue tumors are known. It could be:
- unfavorable heredity (for example, tuberous sclerosis causes sarcoma);
- chemical carcinogens of any origin;
- genetic disorders are not excluded;
- presence of herpes and HIV viruses in the body;
- ionizing radiation, reduced immunity;
- soft injurytissues (they lead to oncology in more than half of cases);
- presence of scar tissue;
- bone pathologies may precede tumors;
- some diseases, such as Recklinghausen's disease.
Often, benign tumors can become malignant. According to statistics, malignant tumors of soft tissues in general oncopathology occupy about 1%. There are no sexual and age degradations, but most often these neoplasms occur after 25 years. And after 80 years, this figure already exceeds 8%. Favorite localization - lower limbs, neck, abdomen, etc.
Classification
Systematization of soft tissue tumors is very complex, taking into account a variety of indicators. In the article, it is represented by the simplest divisions. Types of soft tissue tumors can be divided into mesenchymal (tumors of internal organs - sarcomas, leiomyomas) and PNS tumors. The type depends on the etiology of the neoplasm.
In WHO practice, classification is applied - soft tissue tumors are divided by type of tissue:
- from fibrous tissue;
- fatty;
- muscular;
- vascular;
- of synovial and serous membranes, cells of the peripheral nervous system (PNS);
- cartilage tissue.
All tumors are combined into 4 large divisions: benign, malignant, or borderline, locally aggressive and rarely metastasizing. Benign soft tumorstissues do not have cellular atypism, do not give metastases and rarely recur. Malignant ones have completely opposite properties, leading to the death of the patient. Borderline tumors (locally aggressive) recur without metastases; rarely metastasizing manifest themselves on this side in less than 2% of cases.
Tumor metastases are quantified:
- 1 point - 0-9 metastases;
- 2 points - 10-19;
- 3 points - more than 20 metastases.
Benign soft tissue tumors
Types of tumors:
- Lipoma - based on adipose tissue, localized in areas of the body with the presence of lipid tissue. It is palpated as a painless swelling of a soft-elastic consistency, it can grow for several years.
- Angiolipoma - formed on the blood vessels, more often diagnosed in children. Localized in the depth of the muscles. If not a concern, only observation is recommended.
- Hemangioma is a very common vascular tumor. More common in children. If there are no symptoms, no treatment is needed.
- Fibroma and fibromatosis - consists of fibrous tissue. Fibromas and fibroblastomas are prominent representatives. Fibroids contain cells of mature connective fibrous tissue; fibroblastomas are based on collagen fibers. They form the so-called. fibromatosis, among which such a tumor of the soft tissues of the neck as fibromatosis of the neck is more common than others. This tumor occurs in newborns on the sternocleidomastoid muscle in the form of a dense grain up to 20 mm in size. Fibromatosis is very aggressive and cangrow into adjacent muscles. Therefore, mandatory deletion is required.
- Neurofibroma and neurofibromatosis - is formed from cells of the nervous tissue in the nerve sheath or around it. The pathology is hereditary, with growth it can compress the spinal cord, then neurological symptoms appear. Prone to rebirth.
- Pigmented nodular synovitis is a tumor of synovial tissue (lining the inner surface of the joints). It often goes beyond the joint and leads to degeneration of surrounding tissues, which requires surgical treatment. Frequent localization - knee and hip joint. Develops after age 40.
Benign muscle tumors
The following tumors are benign:
- Leiomyoma is a tumor of smooth muscles. It has no age restrictions and is plural in nature. Has a tendency to rebirth.
- Rhabdomyoma - a tumor of the striated muscles on the legs, back, neck. According to the structure in the form of a nodule or infiltrate.
In general, the symptoms of benign formations are very poor, manifestations can occur only with the growth of a tumor with compression of the nerve trunk or vessel.
Malignant soft tissue tumors
Almost all of them are sarcomas, which account for 1% of all oncologies. The most common age of onset is 20-50 years. Sarcoma develops from connective tissue cells that are still in the developmental stage and are immature. It can be cartilage, muscle, fat,vascular tissue, etc. In other words, sarcoma can occur practically everywhere and does not have a strict attachment to one organ. On cut, the sarcoma resembles pinkish-white fish meat. It is more aggressive than cancer and has:
- infiltrating growth into adjacent tissues;
- after removal in half of the patients it recurs;
- metastasizes early (to the lungs most often), only with abdominal sarcoma - to the liver;
- has explosive growth, in terms of the number of fatalities is in 2nd place.
Types of soft tissue sarcomas and their manifestations
Liposarcoma - occurs wherever there is tissue with a large amount of fat, most often on the thigh. It has no clear boundaries, it is easily palpated. Growth is slow, rarely metastasizes.
Rhabdomyosarcoma, or RMS, is a tumor that affects striated muscle tissue. It most often affects men over 40 years of age. The tumor in the form of a dense fixed knot is located in the middle of the muscles, does not cause pain, is palpated. Favorite locations are neck, head, pelvis and legs.
Leiomyosarcoma is a tumor that affects smooth muscle tissue. Occurs rarely, usually in the uterus. It is considered a silent tumor and manifests itself only in the later stages. Discovered by chance in other research.
Hemangiosarcoma is a tumor of the blood vessels. Localized in the depths of the muscles, soft in structure, painless. These include Kaposi's sarcoma, hemangiopericytoma, and hemangioendothelioma. The best known is Kaposi's sarcoma (formed from immature vascular cells when exposed to the herpes 8 virus).type; characteristic of AIDS).
Lymphangiosarcoma - formed from lymphatic vessels.
Fibrosarcoma - arises from the connective tissue, often localized in the muscles of the legs and trunk. On palpation, it is relatively mobile, has the appearance of a tubercle of a round or oval shape. Can grow to large sizes. Occurs more often in women.
Synovial sarcoma - can be diagnosed at any age. Painful on palpation, due to poor absorption of the membrane in the joint, pus or blood easily accumulates. If there is a cyst inside the tumor, it is elastic when palpated. If it contains calcium s alts, it is hard.
Nervous tissue sarcomas - neurogenic sarcomas, neurinomas, sympathoblastomas, etc. Since we are talking about nervous tissue, in half of the patients, the formation of a tumor is accompanied by pain and neurological symptoms. The growth of tumors is slow, the favorite place of appearance is the lower leg and thigh. This tumor is rare and occurs in middle-aged men. The tumor is usually large-tuberous, in a capsule; sometimes it may consist of several nodes located along the nerve trunk. On palpation, it is defined as "soft-elastic consistency", but with clear boundaries, may contain calcareous inclusions and then becomes hard. Pain and other symptoms are rare. In close proximity to the skin, it can grow into it, with a bone it can grow there too. Metastases are rare, mostly to the lungs. Relapses are frequent. Summarizing what has been said, it should be recalled that most tumors haveelastic or hard consistency. If areas of softening are found, they indicate the disintegration of the tumor.
Borderline tumors
By their behavior, they resemble benign formations, but suddenly, for unclear reasons, they begin to metastasize:
- Protruding dermatofibrosarcoma - a tumor in the form of a large node above the skin. Grows very slowly. When it is removed, half of the patients relapse, there are no metastases.
- Atypical fibroxanthoma - may occur with an excess of ultraviolet radiation in elderly patients. Localized in open areas of the body. It looks like a well-defined node, which can be covered with ulcers. May metastasize.
Clinical picture
Malignant tumors of soft tissues at the initial stages grow imperceptibly, without showing themselves. In 70% of patients, they are found by chance in other studies and become the only symptom. If the formation is adjacent to a large nerve trunk, formed from the sheaths of a sensitive nerve, or grows into a bone, a symptom of pain is characteristic. More often, the tumor has limited mobility in transverse displacement, looks like a single node. It does not grow into the nerve trunks, but shifts them to the side. When sprouting into the bone, it becomes immobile.
The skin over the soft tissue tumor already in the late stages becomes purple-bluish, edematous, grows into the surrounding tissues. The surface may ulcerate. The saphenous veins expand in the form of a subcutaneous mesh. There is local hyperthermia. In addition, the disease is no longer limited to the local clinic,general symptoms of intoxication join in the form of cachexia, fever, weakness of the whole organism.
Metastasis through the blood vessels - hematogenous, in 80% of cases occurs in the lungs. Among benign soft tissue tumors of unclear histogenesis, one can name myxoma, which is characterized by an irregular shape, contains a jelly-like substance and is most often localized in the heart chamber. Therefore, it is also called a cavity tumor. In 80% of patients, it occurs in the left atrium. Such tumors are invasive, that is, they quickly grow into neighboring tissues. It usually requires removal and, if necessary, plastic surgery.
Diagnosis
Diagnosis of soft tissue tumors is quite difficult due to the scarcity of clinical manifestations. If sarcoma is suspected, examination should begin with a biopsy. This is an important point of the study, since in the future a biopsy will provide complete information about the nature of the pathology.
X-ray is useful and informative only for solid tumors. It can show the dependence of the tumor on the neighboring bones of the skeleton.
If there is a localization of the formation on the legs, the abdominal cavity - arterial angiography becomes important. It makes it possible to accurately determine the location of the tumor, reveals a network of neovessels located randomly. Angiography is also needed to select the type of operation.
MRI and CT will show the prevalence of pathology, which determines the course of treatment. Ultrasound of soft tissue tumors is used as a means of primary diagnosis orto confirm a preliminary diagnosis. Ultrasound of soft tissues is widely used and indispensable for differential diagnosis.
Tumor treatment
Treatment of soft tissue tumors is based on 3 main methods - a radical operation, radio- and chemotherapy as complementary. Then such treatment will be combined and more effective. But the operation remains the main one.
Modern methods of removal of benign tumors
Today, 3 methods are used to remove benign soft tissue tumors:
- with a scalpel;
- CO2 laser;
- radio wave method.
The scalpel is used only for highly differentiated tumors that have a better prognosis in terms of recovery.
CO2-laser - when removing benign soft tissue tumors, it makes it possible to remove them efficiently and modernly. Laser treatment has many advantages over other methods and gives much better aesthetic results. In addition, it has an accurate focus, which does not damage neighboring surrounding tissues. The method is bloodless, the rehabilitation period is shortened, there are no complications. Removal of hard-to-reach tumors is possible.
With the radio wave method (on the apparatus "Surgitron") the incision of soft tissues is carried out by exposure to high frequency waves. This method does not give pain. "Surgitron" can remove fibromas and any other benign tumors on the chest, arms, neck.
BasicSurgery is the treatment for all malignant tumors. Surgical removal of soft tissue tumors is carried out by 2 methods: wide excision or amputation of the limb. Excision is used for medium and small tumors that have retained mobility and are located at a shallow depth. In addition, there should be no germination of them in the vessels, bone and nerves. Relapses after excision are at least 30%, they double the risk of death of the patient.
Indications for amputation:
- no possibility of wide excision;
- excision is possible, but the preserved limb will not work due to impaired innervation and circulation;
- other operations failed;
- previously performed palliative amputations led to unbearable pain, stench due to tissue breakdown.
Amputation of the limb is performed above the level of the tumor.
Radiation therapy as a monotherapy for sarcoma does not give any results. Therefore, it is used as a supplement before and after surgery. Before surgery, it affects the formation in such a way that it decreases in size and is easier to operate on. It can also help to make an inoperable tumor operable (70% of cases give a positive effect with this approach). Its use after surgery reduces the possibility of recurrence. The same can be said about chemotherapy - the use of a combined method is most effective.
Prognosis for 5-year survival for sarcomas has a very low percentage due to theirincreased aggressiveness. Much depends on the stage, type of tumor, age of the patient and the general status of the organism.
Synovial sarcoma has the worst prognosis, the survival rate for this disease is no more than 35%. The rest of the tumors, with early diagnosis, successful surgery and an adequate recovery period, have a greater chance of 5-year survival.
