Sarcoma: Kazal Brief Flashcards
Dermatome of lower limb
Inguinal region L1
Pocket L2
Below pocket L3
Medially L4
Laterally L5
Small toe S1
Differential diagnosis of thigh swelling
Sir it can be soft tissue origin or bony origin
In soft tissue origin it can be
Age middle age
- undifferentiated pleomorphic/MFH
- Liposarcoma
- MPNST
-fibrosarcoma
- clear cell sarcoma
- synovial sarcoma
bony origin
- osteosarcoma
- ewings sarcoma
(Age : 15 tell ewings first)
Differential diagnosis of knee joint swelling
soft tissue origin
- MFH
-LPS
MPNST
FS
Synovial sarcoma
bony
- osteosarcoma
- ewings sarcoma
Why need bone scan
To see further bone tumor as it may cause skip metastases in case of bone tumor
When you need PET CT
In case of bony origin
- if T3/T4
- high grade
In case of soft tissue origin
- early can be done
Importance of CT scan in sarcoma
To see bony involvement
Lymph node involvement
Extension of tumor: bony
Why MRI is needed
To see soft tissue delineation
Lymph node involvment
To see muscle compartment
Neurovascular involvment
Joint cavity involvement
Bone marrow involvement
IHC marker: ES
CD99
IHC: OS ; Liposarcoma
Sat B2: OS
CDK4: liposarcoma
IHC: leioyomyosarcoma
SMA, H-caldesmon
IHC: MPNST;
S-100
IHC: rhabdomyosarcoma
Actin
Myo D
Myoglobin
Synovial sarcoma: IHC
EMA
TLE1
Role of Neo adjuvant RT
.1.Borderline operable tumor to improve chance of R0 resection
2. Tumors with anticipated marginal resection (skull base, paranasal sinus, retroperitoneum)
3. Tumors close to neurovascular bundle
4. Situations where post OP Rt volume might leads significant late toxicities
Indication of adjuvant RT
Post OP RT: indication:
1. Large tumor >5cm
2. Deep seated tumor
3. High grade tumor (G2-3), margin positive even if <5cm
4. +ve margin: high grade
5. R1/R2 resection
6. Limb conserving wide excision/ limited surgery
7. Virtually all tumors in head and neck (because complete excision unlikely)
8. After surgery for recurrent sarcoma, if not previously irradiated.
