35: Management of Soft Tissue Tumors - Dayton

Question 1

goals of tumor management

Answer 1

• identify leison
• rule out malignancy
• relieve pain
• prevent growth or spread to limit local destruction
• cosmetic improvement

Question 2

ratio of benign to malignant STM

Answer 2

100:1

most comm benign = ganglion and fibroma

most comm malignant = synovial sarcoma

Question 3

higher frequency malignancy in the …

Answer 3

hind-foot

Question 4

stages of benign tumors

Answer 4

stage 1 = latent, not growing

stage 2 = active, enlarging but not invading

stage 3 = aggressive, invade other structures

Question 5

carcinoma =

sarcoma =

Answer 5

carcinoma - epithelial cell origin

sarcoma - mesenchymal origin

Question 6

key diagnostic tool STM

Answer 6

biopsy

• MRI does not provide a definitive diagnosis

Question 7

which lesions should be biopsied?

Answer 7

• fast growing
• inflamed or ulcerated
• large masses
• painful, pruritic and otherwise symptomatic
• ulcerations present for greater than 4 wks
• non repsonsive to treatment
• pigmented lesions

Question 8

incisional vs. excisional biopsy

Answer 8

excisional biopsy preferred if …

• diagnosis and cure
• one procedure

incisional best if …

• complicated anatomy
• clinical suspicion of malignancy

Question 9

types of excisions

intracapsular

marginal

wide local

radical

Answer 9

intra-capsular

• excision w/i tumor capsule or magins
• de-bulking

marginal

• excision of entire tumore and capsule w/i minimal normal tissue

wide local excision

• excision of tumor and cuff of normal tissue

radical resection

• removal of entire anatomic compartment

Question 10

keys to incision location

****

Answer 10

• direct access to the tumor
• do not cross compartments
• consider the local anatomy
• consider subsequent care

Question 11

start from

Answer 11

normal to abnormal

Question 12

should culture and gout go in formalin?

Answer 12

nope

Question 13

benign vs. malignant properties

Answer 13

benign

• well differentiated
• normochromatic
• rare mitoses
• cells retain normal function
• encapsulated
• psuh local structures aside

malignant

• anaplastic
• pleomorphic
• hyperchromatic
• mitoses common
• normal function lost
• invade local structures

Question 14

lesions not to miss …

Answer 14

pigmented lesions

• high index of suspicion for malignancy
  
  • large/fast growing
  • assoc with ulceration
  • painful
• BIOPSY!