Sarcoma

Talk

• Where is the lesion?
• How big it is?
• What is the tumor doing? Wide/narrow margin of transition
• What is the bone doing in response?
  • Zone of transition
  • Periosteal reaction
• Is the lesion making matrix?
• Is cortex eroded?
• Is there soft tissue mass?

Approach

• MDT approach
• After initial History and examination
• Get more information about lesion “Local staging”
  • Xray
  • USG
  • CT,MRI
• Early Biopsy to avoid unnecessary staging inv if lesion is benign
• Systemic staging
  • CT chest abdomen and pelvis
  • Bone scan
  • Bone marrow
• Never assume a solitary lesion to be metastasis
• Do not rush to fix

Biopsy Principles

• Longitudinal incisions
• Single muscle compartment
• Must not communicate with critical NV structures
• If open meticulous homeostasis to prevent seeding
• Drain in line with incision if used
• Discuss with pathologist
• M/C is percutaneous tru cut

Maligant tumor arising from connective tissue

Definitions

• Tumour: Abnormal growth of tissue characterised by
  • Abnormal cellular proliferation
  • Continues to grow after initial stimulus
  • No structure or functional organisation
  • No use to host
• Malignant: Predisposition to local and distant metastatic invasion and destruction
• Benign: No distant metastasis

Other facts

• WHO 2013 classification
• Pseudocapsule: Grows centrifugally to compress normal tissue
• Reactive zone: Area of edema and neovascularisation characterised by inflammatory cells and micro nodules of tumor

Margins

• Intralesional: through tumor
• Marginal: through reactive zone
• Wide marginal: through cuff of normal tissue
• Radical: entire compartment