Soft Tissue Sarcomas : A Clinicopathological Study And Review
*Ranveer Singh Rana3
, Gautam Chandra1, Mananjay Prasad2, Rajeev Ranjan Kumar4, Abhinav Shekhar5,
1 Senior resident Deptt. Of surgery Rims, Ranchi-834009
2 Senior resident Deptt. Of surgery Vmmc, Safdurjang ( india)
3 Asst. Prof.Deptt. Of surgery Gmc, Haldwani
4 Senior resident Gen. Surgery Aiims, New delhi
5 Jra Gen surgery Rims, Ranchi
Corresponding author: Dr Ranveer Singh Rana, Department of surgery GMC,Haldwani, Tel: +918579002240, Email:firstname.lastname@example.org,
Citation: Dr Ranveer Singh Rana et al.(2017) soft tissue sarcomas : a clinicopathological study and review. Int J Cancer Epid &
Copyright: © Dr Ranveer Singh Rana, This is an open-access article distributed under the terms of the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are
Recieved Date: March 10, 2017; Accepted Date:
March 20, 2017; Published Date:
March 23, 2017.
AIM: We reviewed cases of soft-tissue sarcoma to gain insight into the presentation, treatments and outcomes for this rare disease and
to determine various factors associated with outcomes.
METHODS:This is a retrospective study of histologically confirmed cases of soft tissue sarcoma seen at RIMS Ranchi over a period of
2 years between Jan 2012 and Dec. 2014. Data were retrieved from patients’ files and analyzed using SPSS computer software version
RESULTS: A total of 30 cases were studied. Male to female ratio was 4:1. Mean age of presentation was 46.5 ± 9.2 years. Most common
site was lower limb (46.7%) followed by upper limb(16.7%). The vast majority of patients (56.7%) presented with large tumors of ≥10
cm in diameter. Lymph node metastasis at the time of diagnosis was recorded in 23.3% of cases and distant metastasis was present in
30% cases. Liposarcoma (30.0%) was the most common histopathological type followed by fibrosarcoma (23.3%). Surgical excision was the most common surgical procedure performed in 76.7% of cases. Surgical site infection was the most common complication in 43.0% of patients. Local recurrence was noted in 16.0% of cases. Mortality rate was 43.3%.
CONCLUSION: In conclusion, soft tissue sarcomas are aggressive tumor and has a high propensity for metastasis. Early diagnosis and
complete excision of a small primary tumor is important in the treatment of soft tissue sarcomas.
Soft tissue sarcomas(STS), a rare heterogenous group of neoplasm,
can arise from striated muscle cells (53%) and are called as
rhabdomyosarcomas and remaining group (47%) consists
of a heterogenous collection of subtypes referred to as nonrhabdomyosarcoma
soft tissue sarcomas (NRSTS).[1,2] There are
three modalities of treating patients with STS. These are surgery,
radiation therapy for control of residual bulk or microscopic tumor
and systemic combination chemotherapy for primary cytoreduction
and eradication of gross and micrometastases. Surgery includes
complete resection of the primary tumor with surrounding
margins of uninvolved tissue during the initial surgery and any
subsequent operation. Debulking procedures have no value as
initial biopsy and neo-adjuvant therapy results in shrinkage of
the tumor allowing complete resection at second look operation.
[3,4] However, approximately 40% to 50% of patients eventually
develop distant metastases, primarily in the lung. [3-5] In these
instances the potential for cure drastically decreases and the 5-year
survival ranges from 25% to 30% in spite of aggressive surgical
management of metastases.[3-5]
The objective of the current study was to review cases of softtissue
sarcoma to gain insight into the presentation, treatments and outcomes for this rare disease and to determine various factors
associated with outcomes.
Materials and Methods
This descriptive, cross sectional study of histologically confirmed
cases of soft tissue sarcoma seen at Rajendra Institute Of Medical
Sciences, Ranchi was conducted over a period of 2years between
Jan 2012 and Dec. 2014.
The charts of the patients with diagnosis of the sarcoma were
reviewed after formal approval from the Institutional Ethical
Review Board. Only adult patients with age of more than 16 years
were included. The data was analyzed in SPSS version 16.0. The
descriptive analysis was done for the demographics and clinical
characteristics of the patients. The Chi square test was applied for
univariate analysis for determining the significance of individual
categorical variables for recurrence.
A total of 30 cases were studied. Male to female ratio was 4:1.
Mean age of presentation was 46.5 ± 9.2 years. Most common
site was lower limb (46.7%) followed by upper limb(16.7%).
[Figure-1] The vast majority of patients (56.7%) presented with
large tumors of ≥10 cm in diameter. [Figure- 2]
The soft tissue sarcomas included Synovial sarcoma,
Leiomyosarcoma, Fibrosarcoma, Liposarcoma and other rare
sarcomas. The Liposarcoma was found in 9 patients (30%),
followed by Fibrosarcoma 7 patients (23.3%), MFH in 6 patients
(20%), Rhabdomyosarcoma in 4 patients ( 13.3%) and the other
rare sarcomas in less than 13% of the cases. (Figure 3 Pie chart)
Only 46.7 % patients had localised disease at the time of
presentation , lymph node metastasis at the time of diagnosis was
recorded in 23.3% of cases and distant metastasis was present in
30% cases. The median follow up duration was 44 months (18-72
Localised disease with or without metastasis was present in 21
cases, out of which 16 underwent wide local excision, 4 had
debulking and 1 patient had amputation. 9 patients presented with distant metastasis and two of them underwent amputation due to
gangrene. [ Figure- 4]. Local recurrence was seen in five cases and at the end of three years 17 patients were alive.
Sarcomas represent the heterogeneous group of cancer with diverse
tumour biology. Wide local surgical resection with pathologically
proven negative margins is the most effective therapeutic approach
for cure of soft tissue sarcoma.
Most common sites for hematogenous dissemination are the
lungs and the liver.[4,6] Regional lymph node metastases are
uncommon. The majority of tumors are intermediate and high
grade and the most common histologies are liposarcoma and
leiomyosarcoma. Other histologies include malignant fibrous
histiocytoma (MFH), malignant peripheral nerve sheath tumor
(MPNST), rhabdomyosarcoma, Ewing sarcoma, synovial
sarcoma, hemangiopericytoma, and fibrosarcoma.[4,6] History
and physical examination, computed tomography (CT) and/or
magnetic resonance imaging (MRI) to evaluate the primary tumor
and regional lymph nodes, and CT scans of the chest and liver to
detect possible distant metastases are initial diagnostic modalities.
In presence of symptoms, MRI brain and bone scans are indicated.
Biopsy should be reserved for patients who are being considered
for preoperative radiotherapy (RT) and/or chemotherapy, patients
who have inoperable disease, and patients with hematogenous
metastases. If surgery is the initial treatment, then a tissue diagnosis
may be obtained at the time of the definitive procedure.
Patients with STS are staged according to the American Joint
Committee on Cancer (AJCC) staging system .
Musculoskeletal Tumor Staging System stratification is determined
by histologic grade as nearly all tumors are deep .
The mainstay of treatment for patients with STS is surgery. We
primarily see patients with high
grade tumours referred for adjuvant chemotherapy or for palliative
chemotherapy in unresectable cases. Adjuvant chemotherapy
have demonstrated a reduction in local and distant recurrence
rate and trend towards improved overall survival with adjuvant
chemotherapy . Addition of ifosfamide to doxorubicin-based
regimens may have a somewhat higher antitumor activity on
with advanced or metastatic soft-tissue sarcoma[10,11,12].
Radiotherapy has also been used for improving the local control
both before and after surgery depending on the individual case of
high grade and large soft tissue sarcoma .
The treatment of patients with STS remains challenging. A
substantial subset of patients have incompletely resectable disease,
and marginal margins are achieved in the majority of patients who
macroscopic total resection with a subsequent high likelihood of
- Stojadinovic A, Leung DH, Hoos A, Jaques DP, Lewis JJ,
Brennan MF. Analysis of the prognostic significance of microscopic
margins in 2,084 localized primary adult soft tissue sarcomas. Ann
- Gerrand CH, Bell RS, Wunder JS, et al. The influence of
anatomic location on outcome in patients with soft tissue sarcoma
of the extremity. Cancer. 2003;97:485–492.
- Rehders A, Hosch SB, Scheunemann P, Stoecklein NH, Knoefel
WT, Peiper M. Benefit of surgical treatment of lung metastasis in
soft tissue sarcoma. Arch Surg. 2007;142:70– 75.
- Liebl LS, Elson F, Quaas A, Gawad KA, Izbicki JR. Value of
repeat resection for survival in pulmonary metastases from soft
tissue sarcoma. Anticancer Res. 2007;27:2897–2902.
- S. Agarwala, Paediatric rhabdomyosarcomas and
nonrhabdomyosarcoma soft tissue sarcomas, J Indian Assoc
Pediatr Surg / Jan-Mar 2006 / Vol 11 / Issue 1
- Lewis JJ, Leung D, Woodruff JM, Brennan MF. Retroperitoneal
soft-tissue sarcoma: analysis of 500 patients treated and followed
at a single institution. Ann Surg. 1998;228:355–365.
- American Joint Committee on Cancer. Soft tissue sarcoma. In:
Greene FL, Page DL, Fleming ID, editors. AJCC cancer staging
manual. New York: Springer, 2002:193–200.
- Enneking WF, Spanier SS, Goodman MA. Current concepts
review. The surgical staging of musculoskeletal sarcoma. J Bone
Joint Surg. 1980;62:1027–1030.
- Tierney JF, Stewart LA, Parmar MKB, Sarcoma Meta-analysis
Collaboration: Adjuvant chemotherapy for localised resectable
soft-tissue sarcoma of adults: meta-analysis of individual data.
Lancet 1997, 350(9092):1647-54
- Antman K, Crowley J, Balcerzak SP, et al. An intergroup phase
III randomized study of doxorubicin and dacarbazine with or
without ifosfamide and mesna in advanced soft tissue and bone
sarcomas. J Clin Oncol. 1993;11:1276– 1285.
- Edmonson JH, Ryan LM, Blum RH, et al. Randomized
comparison of doxorubicin alone versus ifosfamide plus
doxorubicin or mitomycin, doxorubicin, and cisplatin against
advanced soft tissue sarcomas. J Clin Oncol. 1993;11:1269–1275.
- Casali PG, Picci P. Adjuvant chemotherapy for soft tissue
sarcoma. Curr Opin Oncol. 2005;17:361–365.
- Yang JC, Chang AE, Baker AR, Sindelar WF, Danforth DN,
Topalian SL, DeLaney T, Glatstein E, Steinberg SM, Merino MJ,
Rosenberg SA: Randomized prospective study of the benefit of
adjuvant radiation therapy in the treatment of soft tissue sarcomas
of the extremity. J Clin Oncol 1998, 16(1):197-203.