soft tissue tumor
Introduction
Introduction to soft tissue tumors There are many kinds of soft tissue tumors, and the names are mixed, especially the pathological morphology of soft tissue malignant tumors. With the continuous improvement of their understanding, their pathological naming is often changed, which makes clinicians feel much more difficult during treatment than other malignant tumors. . Recently, there have been new changes in the pathological classification of soft tissue tumors, and some tumors have been renamed, such as synovial sarcoma changed to malignant tendon sheath giant cell tumor, etc., which is not found in any other tumor. basic knowledge The proportion of illness: 0.04% Susceptible people: no special people Mode of infection: non-infectious Complications: hypoglycemia
Cause
Soft tissue tumor cause
According to the current level of understanding of soft tissue tumors, its occurrence is not considered to be a single factor. There is a lot of evidence that ionizing radiation is the cause of sarcoma, for example, fibrosarcoma that occurs in the thoracic cavity after irradiation after mastectomy. In addition, it is also related to the following factors, such as congenital malformations, familial inheritance, foreign body stimulation, chemical stimulation, viral factors, and endocrine factors.
Prevention
Soft tissue tumor prevention
There is no effective preventive measure for this disease. Early detection and early treatment are the key to prevention.
Complication
Soft tissue tumor complications Complications hypoglycemia
There may be severe hypoglycemia.
Symptom
Soft tissue tumor symptoms Common symptoms Tumor body traction dull pain Hypoglycemia Calcified lymph node enlargement Lymphatic metastasis Ascites metabolism is strong
1. Lumps: Patients often see a painless mass for several months or more. The tumors are large and small, and the malignant tumors grow faster and larger. The diameter of malignant tumors is more than 5cm, and the growth rate is faster. The boundaries of tumors located in deep tissues are unclear.
2, pain: high grade sarcoma due to rapid growth, often accompanied by dull pain, if the tumor involves the adjacent nerve, pain is the primary symptom, sarcoma pain often prognosis is poor, Shiu stressed in 1989, the successful limb salvage case only 27 % had pain, and the pain in the amputation group was as high as 50%.
3, the hardness of the tumor, the smooth muscle component is more hard, while the blood vessels, lymphatic vessels and fat components are more soft.
4. Location: Fibrogenic tumors occur mostly in subcutaneous tissues; fat-derived tumors often occur in the buttocks, lower limbs and retroperitoneum; mesothelioma occurs mostly in the chest and abdominal cavity; smooth muscle-derived tumors occur in the abdominal cavity and trunk, synovium Sarcomas are prone to occur near joints and fascia.
5, activity: benign and low-grade malignant tumors, growth sites are often superficial, activity is greater, the growth site is deep or the surrounding tissue infiltration of the tumor, its activity is small, the retroperitoneal tumor is mostly fixed due to anatomical relationship .
6. Temperature: The soft tissue sarcoma is rich in blood supply, the metabolism is strong, the local temperature can be higher than the surrounding normal tissue, and the local temperature of the benign tumor is normal.
7, regional lymph nodes: soft tissue sarcoma can be transferred along the lymphatic, synovial sarcoma, rhabdomyosarcoma often have regional lymph nodes, sometimes fused into a group.
Examine
Soft tissue tumor examination
First, X-ray film inspection
X-rays help to further understand the extent of soft tissue tumors, transparency and its relationship with adjacent bones, such as clear boundaries, often suggesting benign tumors; if the boundary is clear and there is calcification, it suggests a highly malignant sarcoma, Most cases occur in synovial sarcoma, rhabdomyosarcoma and so on.
Second, ultrasound imaging inspection
The method can examine the volume range of the tumor, the envelope boundary and the echo of the tumor tissue inside the tumor, thereby distinguishing between benign or malignant, the malignant body is large and the boundary is unclear, and the echo is blurred, such as rhabdomyosarcoma, synovial muscle tumor, malignant fiber. Histopathology, etc., ultrasound examination can also lead to acupuncture and cytology examination of deep tumors. This method is an economical, convenient and non-destructive method.
Third, CT examination
Because CT has the characteristics of density resolution and spatial resolution of soft tissue tumors, it is also a commonly used method for diagnosing soft tissue tumors in recent years.
Fourth, MRI examination
It can compensate for the deficiency of X-ray CT by using it to diagnose soft tissue tumors. It shows the whole range of tissues from the longitudinal section with the full range of tumors. For retroperitoneal soft tissue tumors, the tumors of the pelvic cavity extending to the buttocks or thighs, the armpits The tumors and the images of the extent of tumor invasion to bone or bone marrow are clearer and are a good basis for developing treatment plans.
Fifth, pathological examination
1. Cytological examination: It is a simple, fast and accurate pathological examination method, which is most suitable for the following situations:
1 The ulcerated soft tissue tumor was obtained by smear or scraping method, and the microscopic examination confirmed the diagnosis.
2 The soft tissue sarcoma caused by the chest and ascites must be freshly taken from the fresh specimen, immediately centrifuged to concentrate, and then smeared.
3 puncture smear examination is suitable for tumors with large tumors, deep and intended for radiotherapy or chemotherapy, also suitable for metastatic lesions and recurrent lesions.
2. Clamp biopsy: soft tissue tumor has collapsed, cytology smear can not be diagnosed, can be taken biopsy.
3. Cut biopsy: This method is used in surgery. For larger limb tumors, when amputation is required, a biopsy should be performed before amputation in order to obtain a definitive pathological diagnosis. When the tumor is located in the chest, abdomen or retroperitoneum, it cannot be completely Excision can be done by cutting biopsy, after radiotherapy or chemotherapy.
4. Excision biopsy: For soft tissue tumors with small volume, it can be sent to the pathological examination together with the normal tissue around the tumor.
Diagnosis
Diagnosis and diagnosis of soft tissue tumor
diagnosis
According to the medical history and clinical manifestations, soft tissue tumors are not difficult to distinguish from non-neoplastic masses. The diagnosis points are as follows:
(1) The patient does not notice a painless progressive mass after a few weeks or months, and systemic symptoms such as fever, weight loss and general discomfort are rare.
(b) The clinically rare but important tumor-caused syndrome is hypoglycemia, often associated with fibrosarcoma.
(three) X-ray film inspection
X-rays help to further understand the extent of soft tissue tumors, transparency and its relationship with adjacent bones, such as clear boundaries, often suggesting benign tumors; if the boundary is clear and there is calcification, it suggests a highly malignant sarcoma, Most cases occur in synovial sarcoma, rhabdomyosarcoma and so on.
(4) Ultrasound imaging examination
The method can examine the volume range of the tumor, the envelope boundary and the echo of the tumor tissue inside the tumor, thereby distinguishing between benign or malignant, the malignant body is large and the boundary is unclear, and the echo is blurred, such as rhabdomyosarcoma, synovial muscle tumor, malignant fiber. Histopathology, etc., ultrasound examination can also lead to acupuncture and cytology examination of deep tumors. This method is an economical, convenient and non-destructive method.
(5) CT examination
Because CT has the characteristics of density resolution and spatial resolution of soft tissue tumors, it is also a commonly used method for diagnosing soft tissue tumors in recent years.
(6)) MRI examination
It can compensate for the deficiency of X-ray CT by using it to diagnose soft tissue tumors. It shows the whole range of tissues from the longitudinal section with the full range of tumors. For retroperitoneal soft tissue tumors, the tumors of the pelvic cavity extending to the buttocks or thighs, the armpits The tumors and the images of the extent of tumor invasion to bone or bone marrow are clearer and are a good basis for developing treatment plans.
(7) Pathological examination
1. Cytological examination: It is a simple, rapid and accurate pathological examination method, which is most suitable for the following situations: 1 ruptured soft tissue tumor, using smear or scraping method to obtain cells, microscopic examination Diagnosis; 2 soft tissue sarcoma caused by chest and ascites, must use freshly taken fresh specimens, immediately centrifuge sedimentation concentration, and then smear; 3 puncture smear examination for larger tumors, deeper and intended for radiotherapy or chemotherapy Tumors are also suitable for metastatic lesions and recurrent lesions.
2. Clamp biopsy: soft tissue tumor has collapsed, cytology smear can not be diagnosed, can be taken biopsy.
3. Cut biopsy: This method is used in surgery. For larger limb tumors, when amputation is required, a biopsy should be performed before amputation in order to obtain a definitive pathological diagnosis. When the tumor is located in the chest, abdomen or retroperitoneum, it cannot be completely Excision can be done by cutting biopsy, after radiotherapy or chemotherapy.
4. Excision biopsy: For soft tissue tumors with small volume, it can be sent to the pathological examination together with the normal tissue around the tumor.
Differential diagnosis
Soft tissue tumors should be differentiated from non-neoplastic masses.
