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Surgery Finals 2nd Sem > Soft Tissue sarcoma > Flashcards

Soft Tissue sarcoma Flashcards

1
Q

Rare tumors

A
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2
Q

Most common site of soft tissue sarcoma

A

Extremeity 59%
Trunk 19%
Retroperitoneum 13%
Head and neck 9%

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3
Q

Most common histologic types of soft tissue sarcoma in adults (excluding Kaposis sarcoma)

A 
Malignant fibrous histiocytoma 28%
Leiomyosarcoma 12%
Liposarcoma 15%
Synovial sarcoma 10%
Malignant peripheral nerve sheath tumors 6%
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4
Q

Most common soft tissue sarcoma of childhood

A

Rhabdomyosarcoma

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5
Q

Sarcomas do not seem to result from the progression or differentiation of benign soft tissue tumors except

A

Malignant peripheral nerve sheath tumors

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6
Q

Clinical behavior of most soft tissue sarcomas is similar and iis determined by

A

Anatomic location

Depth
Grade
Size

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7
Q

The most dominant pattern of metastasis is

A

Hematogenous in the lungs

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8
Q

Lymphnode metastases are

A

Rare

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9
Q

Is a well established risk factor for soft tissue sarcoma

A

External radiation therapy

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10
Q

Incidence of sarcomas has been reported among patients treated for cancer

A 
Breast
Cervix
Ovary
Testes
Lymphatic system
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11
Q

Radiation exposure

Post irradiation sarcomas, the most common histologic types were

A

Osteogenic sarcoma
Malignant fibrous histiocytoma
Angiosarcoma
Lymphangiosarcoma

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12
Q

Radiation exposure

Usually diagnosed at advanced stages and generally have a poor prognosis

A

Post irradiation

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13
Q

Chemicals linked to soft tissue sarcoma

A

Phenoxyacetic acid

Chlorophenols

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14
Q

Several chemical carcinogen shave been associated with hepatic angiosarcomas

A

Thorium oxide (thoratrast)
Vinyl chloride
Arsenic

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15
Q

Patient with soft tissue sarcoma linked to chemicals died due to

A

Massive blood loss

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16
Q

No casual relationship has been establish

A

Trauma

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17
Q

Filarial infections

A

Lymphangiosarcoma

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18
Q

Oncogenes identified in association with soft tissue sarcoma

A

MDM2
N-MYC
C-erB2
ras

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19
Q

Oncogenes produce specific oncoproteins that either play a role

A

Nuclear function
Cellular signal transduction
Function as growth factors
Growth factor receptors

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20
Q

Two tumor suppressor genes that are most relevant to soft tissue tumors

A

Retinoblastoma tumor suppressor gene

P53 tumor suppressor gene (most common 30-60%)

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21
Q

Can lead to development of retinoblastoma or sarcoma of soft tissue and bone

A

Mutations or deletion of RB

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22
Q

Most common mutation in human solid tumors and have been reported in 30-60% of soft tissue

A

Mutations in the p53

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23
Q

Known as recklinghausen’s disease

Occurs in approximately 1 every 3000 persons

A

Neurofibromatosis type 1

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24
Q

Neurofibromatosis type 1

Due to mutations in the

A

NF-1 tumor suppressor gene

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25
Q

Neurofibromatosis type 1

How many percent have mutation in NF-1

A

50%

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26
Q

Initial assessment

Most commonly presents as

A

Asymptomatic mass

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27
Q

Initial assessment

The size at presentation is usually associated with the

A

Location of the tumor

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28
Q

Initial assessment

Smaller tumor located at the

A

Distal extremities

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29
Q

Initial assessment

Tumors can grow quite large before becoming apparent

A

Proximal extremities and

Retroperitoneum

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30
Q

Initial assessment

Soft tissue sarcoma often grow in a

A

Centrifugal fashion

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31
Q

Initial assessment

Impingement on bone or neurovascular bundles produces

A

Pain
Edema
Swelling

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32
Q

Initial assessment

Retroperitoneal soft tissue sarcoma almost always presents as a

A

Large asymptomatic mass

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33
Q

Initial assessment

Patient may present with

A

Obstructive gastrointestinal symptoms

Neurologic symptoms

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34
Q

Initial assessment

The differential diagnosis of a soft tissue mass includes benign lesions including

A

Lipomas
Lymphangiomas
Leiomyomas
Neuromas

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35
Q

Initial assessment

In addition to sarcomas, other malignant lesions such as

A

Primary or metastatic carcinomas
Melanomas
Lymphomas

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36
Q

Initial assessment

Small lesion not changed for years

A

Closely observed

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37
Q

Initial assessment

All other tumors considered

A

Biopsy to establish definitive diagnosis

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38
Q

Diagnostic imaging

Purposes

A 
Local extent of tumor
Stage
Biopsy
Benign or 
Monitor tumor changes
Recurrences
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39
Q

Diagnostic imaging

Provide useful information on primary bone tumors but they are not useful in the evaluation of soft tissue sarcomas of the extremeties

A

Radiographs X- ray

40
Q

Diagnostic imaging

For primary sarcomas to assess for lung metastases

A

Chest radiography

41
Q

Diagnostic imaging

High grade lesions
Tumor larger than 5cm
T2

A

Computed tomography

42
Q

Diagnostic imaging

Preferred technique for evaluating retro peritoneal sarcomas

A

CT scan

43
Q

Diagnostic imaging

Soft tissue sarcomas of the extremities

A

MRI

44
Q

Diagnostic imaging

Guiding fine needle aspiration or core biopsy for initial diagnosis or at recurrence

A

Ultrasonography

CT scan

45
Q

Ultrasonography

For patient cannot undergo

A

MRI

46
Q

Ultrasonography

Useful adjunct to MRI when findings are

A

Indeterminate

Delineating adjacent

47
Q

Assess the extent of soft tissue tumor

A

Contrast-enhanced CT

48
Q

Detailed survey of the abdomen and pelvis and delineate adjacent organs and vascular structures

A

Current CT technique

49
Q

CT may be useful if MRI is not available or cannot be used

A

For extremity sarcoma

50
Q

CT of the abdomen and pelvis should be done when histologic assessment of an extremity sarcoma reveals

A

Myxoid liposarcoma

51
Q

Accurately delineates muscle groups and distinguishes among bone, vascular structures, and tumor.

A

MRI

52
Q

Soft tissue sarcomas of the extremities ususally present on MRO as

A

Heterogenous mass

53
Q

MRI

May be seen in tumor

A

Hemorrhage

Cystic or necrotic changes

54
Q

Performed if adjacent vascular structures must be delineated

A

Magnetic resonance angiography

55
Q

Diagnosing most soft tissue sarcomas

A

Fine needle aspiration

56
Q

Procedure choice to confirm or rule out the presence of a metastatic focus or local recurrence

A

Fine needle aspiration

57
Q

Fine needle aspiration

Often subjected to fine needle aspiration biopsies in the clinical setting

A

Superficial lesions

58
Q

Fine needle aspiration

Require an interventional radiologist to perform the technique under sonographic or CT guidance

A

Deeper tumors

59
Q

Fine needle aspiration

Diagnostic accuracy rates for the fine needle aspiration biopsy of primary tumors range

A

60-96%

60
Q

Safe, accurate, economical diagnostic procedure for diagnosing sarcomas

A

Core needle biopsy

61
Q

Core needle biopsy

Sample obtained used for several Dx test such as

A

Electron microscopy
Cytogenic analysis
Flow cytometry

62
Q

Core needle biopsy

Reported complication rate

A

Less than 1 percent

63
Q

Core needle biopsy

More accurately pinpointing the location of tumor

A

Use of CT guide

64
Q

Core needle biopsy

Accuracy

A

93% compared with diagnostic given at the time of definitive treatment

65
Q

Reliable diagnostic method that allows adequate tissue to be sampled for definitive and specific histologic identification of bone or soft tissue sarcomas

A

Open or incisional biopsy

66
Q

Most reliable of the diagnostic methods,
Accurate histologic diagnosis
Grading in more than 95% of soft tissue sarcomas

A

Open biopsy

67
Q

Entire tumor is remove

A

Excisional biopsy

68
Q

Superficial extremity or truncal lesions smaller than 3cm

A

Excisional biopsy

69
Q

Excisional biopsy

Should not be done for lesions of

A

Hands and feet

70
Q

Excisional biopsy

Percent of recurrence

A

30-40%

71
Q

May cause postoperative complications that could ultimately delay definitive therapy

A

Excisional biopsy

72
Q

Pathologic classification

A

More prognostic significance

73
Q

Pathologic classification

Tumors with limited metastatic potential include

A

Desmoids also called well differentiated liposarcoma
Dermatofibrosarcoma protuberans
Hemangiopericytomas

74
Q

Pathologic classification

Tumors with an intermediate risk of metastatic spread usually have a large myxoid component and include

A

Myxoid liposarcoma
Myxoid malignant fibrous histiocytoma
Extra skeletal chondrosarcoma

75
Q

Pathologic classification

Highly aggressive tumors that have substantial metastatic potential are

A 
Angiosarcoma
Clear cell sarcomas
Rhabdomyosarcoma- most aggressive 
Synovial sarcomas
Leiomyosarcomas
76
Q

Primary tumor

A

T1 tumor

77
Q

Regional lymph nodes

A

N0 no regional lymph node

N1 regional

78
Q

Distance metastasis

A

M0 - no distant

M1- distant

79
Q

Histologic grade

A

G1- well differentiated
G2- moderately differentiated
G3- poorly differentiated
G4- undifferentiated

80
Q

Most important prognostic factor for patients with sarcomas

A

Histologic grade

81
Q

Histologic grade

Feature that define grade are

A 
Cellularity
Differentiation
Pleomorphism
Necrosis
Number of mitoses
82
Q

Histologic grad

Shown to predict the development of metastases and overall survival

A

Tumor grade

83
Q

Histologic grade

Metastatic potential

A

5-10% low grade
25-30% intermediate
50-60% high grade tumors

84
Q

Recognized to be an important prognostic variable in soft tissue sarcoma

A

Tumor size

85
Q

Tumor size

T1 lesion
T2 lesion

A

5cm or smaller

Larger than 5cm

86
Q

Tumor size can provide more accurate prognostic information

A

5 year survival rate percentage

15 cm - 33%

87
Q

Lymph node metastasis of soft tissue is rare,

A

Less than 5% manifest nodal spread

88
Q

Nodal metastasis

Yung may mga incidence

A

Rhabdomyosarcoma
Epithelioid sarcoma
Malignant fibrous histiocytoma

89
Q

Nodal disease

A

Designated as stage 4 disease

90
Q

Distant metastasis

Occur most often in

A

Lungs

91
Q

Distant metastasis

Pulmonary metastasis

A

May survive for long periods after surgical resection and chemotherapy

92
Q

Distant metastasis

Other potential sites

A

Bone
Brain
Liver

93
Q

Distant metastasis

High incidence of liver and peritoneal metastasis

A

Visceral and retro peritoneal sarcoma

94
Q

Yung part 2 start sa treatment,

A

Sayo na kung gawan mo ba ng BS

95
Q

Sarcomas represent

A

1% of adult tumors

15% of pediatric tumors

Surgery Finals 2nd Sem (5 decks)

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