Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
30 Cards in this Set
- Front
- Back
|
The majority of soft tissue tumors are __ tumors
|
benign
benign tumors are at least 100X more common than maligant soft tissue tumors |
|
|
Benign soft tissue tumors are typically located ___ and are less than ___ cm
|
superficially (99% of benign soft tissue tumors!)
<5cm |
|
|
Most STS (soft tissue sarcomas) occur in the ___(___%) with 10% in the ___ and ___
|
extremity (75%)
10% (trunk wall and retroperitoneum) |
|
|
__% of soft tissue sarcomas are classified as either:
1. high grade pleomorphic sarcoma (MFH-like) 2. liposarcoma 3. leiomyosarcoma 4. synovial sarcoma 5. MPNST |
75%!!
|
|
|
Breast cancer patients treated with XRT are at increased risk for sarcoma. The risk increase with dose (most received ___GY or more). The typical interval between XRT and tumor diagnosis is ___
|
50 GY or more
10 years |
|
|
Breast cancer patients treated with XRT: most secondary sarcomas are classified as __
|
>50% are MFH
|
|
|
Patients with germline mutations in the retinoblastoma gene have a significantly increased risk of post-irradiation sarcoma, usually __
|
osteosarcoma
|
|
|
Sarcomas associated with virus:
1. HHV8 2. EBV |
HHV8 - Kaposi sarcoma
EBV: smooth muscle tumors in immunodeficient patients |
|
|
Breast cancer patients that are status post lymphadenectomy are at risk for what sarcoma
|
angiosarcoma arsing in the setting of chronic lymphedema
(Stewart-Treves syndrome) |
|
|
Gardners syndrome
|
desmoid tumors
adenomatous polyposis osteomas epidermal cysts |
|
|
In __% of patients with NF type 1, a MPNST develops in a benign neurofibroma
|
2% (uncommmon!)
|
|
|
two examples of benign soft tissue tumors requring wide-local excision similar to that for a sarcoma
|
desmoid-type fibromatosis
intramuscular hemangioma - recurrences are frequent |
|
|
Excisional biopsy of a sarcoma is __
|
inappropriate!
should get a diagnostic biopsy for any superifical tumor >5cm or any size deep tumor prior to excision |
|
|
Most soft tissue sarcomas present as seemingly __ tumors
|
innocent tumors
- often painless - incidentally noticed - no effect on general health or function |
|
|
A superficial soft tissue tumor >5cm or any deep soft tissue tumor has a __% chance of being a sarcoma
|
10%
|
|
|
With all new sarcoma diagnosis the patient should get a baseline ___
|
chest CT
- for accurate staging - evidence of metastasis - 10% pts present with metastatic disease (most commonly to the lung) |
|
|
Soft tissue tumors are divided into 4 categories (behavior)
WHO |
1. benign
- usually do not recur locally - if they do, they are non-destructive and easily cured by complete excision 2. intermediate (locally aggressive) - often recur locally - infiltrative, locally destructive growth - DO NOT metatasize!! - require wide excision - example: desmoid-type fibromatosis 3. intermediate (rarely metastazing) - locally aggressive, as above - DO have potential for occasional distant metatasis (<2% chance) - metastatic risk cannot be reliable predicted based on morphology 4. malignant |
|
|
Two most important parameters in grading STS
|
1. mitotic index
2. extent of tumor necrosis |
|
|
STS grading mainly indicates the probability of __ and __, but is poor at predicting ___
|
1. metatasis
2. overall survival 3. local recurrence (this is mainly related to the quality of the excision) |
|
|
French Sarcoma Group grading systems evaluates __ parameters:
|
3 parameters:
1. tumor differentiation 2. mitotic count 3. tumor necrosis |
|
|
French Sarcoma Group grading system: tumor differentiation is scored__
|
1-3/3
1: sarcoma resembles normal adult mesenchymal tissue 2: sarcoma with recognizable histologic type 3: includes: - embryonal and undifferentiated sarcoma - sarcomas of doubtful type - synovial sarcomas - osteosarcomas - PNET |
|
|
What 3 soft tissue sarcomas (that are graded) are automatically scored a 3 for tumor differentiation
|
1. synovial sarcoma
2. osteosarcoma 3. PNET Therefore these tumors are automatically grade 2 or 3 |
|
|
French Sarcoma Group grading system: histologic grades are based on total score
|
Grade1: score 2-3 (low grade)
Grade 2: score 4-5 (intermediate grade) Grade 3: score 6-8 (high grade) |
|
|
French Sarcoma Group grading system: mitotic count is scored
|
score 1: 0-9/10 hpf
score 2: 10-19/ 10 hpf score 3: >/=20/ 10 hpf |
|
|
French Sarcoma Group grading system: tumor necrosis is scored
|
score 0: no necrosis
score 1: <50% tumor necrosis score 2: >/= 50% |
|
|
In contrast to the French Sarcoma Group, the NCI sarcoma grading system uses __% tumor necrosis to separate grade 2 from grade 3
|
15%
|
|
|
STS for which grading is NOT recommended: (6 entities)
|
- angiosarcoma
- extraskeletal myxoid chondrosarcoma - alveolar soft part sarcoma - clear cell sarcoma - epithelioid sarcoma - MPNST |
|
|
STS staging is based on both __ and __.
TNM systems incorporates: |
grade and clinical findings
1. histologic grade 2. tumor size and depth 3. regional LN involvement 4. distant metastasis |
|
|
Among STS, adjuvant and neoadjuvant or primary CTX is given for __ and __
|
1. Ewing's sarcoma
2. rhabdomyosarcoma |
|
|
Most common retroperitoneal sarcoma __
|
WD liposarc/dediff liposarc
- recur locally and multifocally in the retroperitoneum - distant mets ONLY in 20% cases of dediff liposarcoma CONTRAST: - high grade retroperitoneal leiomyosarcoma: >50% develop distant mets (lung and liver) |
