oncology
Soft Tissue Sarcoma
advanced
6 min
28 marks
6 questions
Clinical Scenario
A 55-year-old man presents with a 6-month history of a growing lump in his left thigh. It is painless but has been increasing in size. He has no systemic symptoms. On examination, there is a 10cm firm, deep mass in the anterior thigh. It is fixed to underlying structures but not to skin. There is no lymphadenopathy. MRI shows a heterogeneous mass deep to the fascia, >5cm in size.
Axial T2-weighted MRI of the left thigh showing a large, heterogeneous soft tissue mass in the anterior compartment. The mass is well-circumscribed with high T2 signal and areas of necrosis. It displaces the femoral vessels but does not encase them. The size (>5cm), depth (deep to fascia), and heterogeneous appearance are concerning for high-grade sarcoma. Biopsy is required before treatment.
Image source: Open Access medical literature (NIH/PubMed Central) • CC-BY License
Questions
Question 1 (4 marks)
What are the clinical features that suggest malignancy in a soft tissue mass?
Question 2 (5 marks)
Describe the imaging and biopsy approach for soft tissue tumors.
Question 3 (6 marks)
What are the principles of surgical management?
Question 4 (5 marks)
Discuss the role of radiation therapy in soft tissue sarcoma.
Question 5 (4 marks)
What is the role of chemotherapy and targeted therapy?
Question 6 (4 marks)
Describe the common subtypes and their prognosis.
Exam Day Cheat Sheet
Must Mention
- •Warning signs: >5cm, deep, growing
- •Core needle biopsy along future excision
- •Wide margin: 1cm or fascial plane
- •Limb salvage >95%
- •Pre-op RT: smaller field, more wound issues
- •Chemotherapy: limited role except specific subtypes
Common Pitfalls
- •Wrong biopsy approach
- •Excisional biopsy of large mass
- •Missing radiation role
- •Wrong margin requirements
- •All chemo works equally
- •Wrong survival by stage