腺泡状软组织肉瘤41例临床分析

本文综合国内报告的腺泡状软组织肉瘤４１例，以２５～３５岁中青年男性多见，四肢占６３．４％，尤以下肢多发，肿瘤生长慢，平均病程７年。单纯肿块切除２７例，平均２．５年内７例复发，１３例分别出现肺、脑、骨及十二指肠等转移，６例死亡，术后平均死亡时间１．５年；单纯切除术后化疗１例，于术后１．５年死于转移；单纯切除术后局部放疗１例，１１年后死于肺转移；７例截肢者有２例于１７年后死于肺、脑转移，５例生存；单纯切除加中药治疗２例，随访４年未见复发及转移。     

251例软组织肉瘤临床分析

目的：探讨软组织肉瘤的治疗及影响预后的因素。方法：对251例软组织肉瘤患者的治疗情况及随访结果进行回顾性分析,计算生存率并作单因素及多因素分析。结果：本组患者1、3.5、10年无瘤生存率分别为67.74％、57.16％、52.41％、38.60％。总生存率1年81.01％、3年67.75％、5年60.79％、10年49.23％。Log-rank时序检验结果显示原发与复发、病理分级、病理类型、肿瘤大小、部位、侵犯血管与否、解剖深度、切缘、主要治疗方法、术后辅助治疗、有无血行转移、手术方式对生存率影响差异都有显著性意义。COX回归分析显示患者年龄、肿瘤的病理类型、病理分级、肿瘤大小、有无转移及手术切缘是影响预后的主要因素。结论：软组织肉瘤的治疗提倡广泛切除术及三维切除,合理应用综合治疗及个体化治疗。     

软组织肉瘤的诊断和治疗：软组织肉瘤的临床分型及热点问题

软组织（soft tissue）是指除骨骼、淋巴造血组织和神经胶质以外的所有非上皮性组织，包括纤维组织、脂肪组织、平滑肌组织、横纹肌组织和脉管组织。各种实质脏器的支持组织（supportive tissue）也属软组织范畴。以往将起源于上述组织的肿瘤定义为软组织肿瘤，目前认为，包括软组织肿瘤在内的所有肿瘤均起自于多潜能性前驱细胞（multipotential precursor cell）或称干细胞（stem cell）。     

成人软组织肉瘤的研究进展概况（文献综述）

软组织肉瘤不多见，预后不佳。近年分析有关预后因素，对治疗作了一些改进。肢体ＳＴＳ以保肢手术成为主流，截肢率下降；辅助性放疗有效果，但化疗的益处甚微。腹模后和内脏ＳＴＳ以手术切除为主。肺转移在切除后，１／３病人有３年以上的生存率。局部复发的治疗也较前积极。     

腺泡状软组织肉瘤22例临床治疗分析

目的探讨腺泡状软组织肉瘤的临床治疗和预后。方法对１９７３～１９９６年间收治的２２例腺泡状软组织肉瘤患者的临床资料进行回顾性分析。结果２２例均接受手术治疗,其中１７例行肿瘤局部切除,５例行扩大切除。７例病理误诊为其他软组织肿瘤（占３２％）。９例术后进行了预防性辅助放疗和（或）化疗。对２１例患者随访４个月至９年。６例患者术后复发（占２８％）,１３例出现肺转移（占６２％）,５例在随访８个月至４年５个月时死亡（占２４％）,６例患者生存５年以上。全组经ＫａｐｌａｎＭｅｉｒｅ生存率计算其３年、４年、５年生存率分别为８３％、７５％及６６％。结论腺泡状软组织肉瘤多需病理学诊断,肿瘤局部切除是复发和转移最重要的因素,术后预防性辅助治疗对局部复发和转移没有明显的控制作用,对出现肺转移的患者采取多程标准化疗方案进行治疗,临床效果尚满意     

原发性腹膜后软组织肉瘤的诊断与治疗

目的：探讨原发性腹膜后软组织肉瘤的诊断及治疗方法。方法：回顾性分析1995年8月～2006年5月收治的12例原发性腹膜后软组织肉瘤患者的临床资料,并就其临床表现、辅助检查及手术方法进行讨论。结果：12例中,男3例,女9例,年龄27～73岁,平均55岁。体检发现者3例,有腹部或腰部疼痛症状者6例,腹部包块者2例,下肢疼痛者1例。肿瘤最大径5～21cm,平均11cm,均行手术切除。手术时间120-360min,平均210min;失血200～1500ml,平均524ml,其中输血5例,占41％,输血4001000ml,平均600ml。同时切除右肾1例,右半结肠1例,无重大手术并发症。病理检查结果为脂肪肉瘤5例,平滑肌肉瘤3例,神经纤维肉瘤2例,恶性纤维组织细胞瘤1例,横纹肌肉瘤1例。随访8例,时间3～60个月,平均28个月,2例分别于术后6、9个月复发,再次行手术切除,1例术后1．5年因肝、肺转移而死亡,2例术后3～12个月局部复发,无法手术切除,转行放、化疗。结论：原发性腹膜后软组织肉瘤术前主要靠影像学检查诊断;手术完整切除是其主要的有效治疗手段。     

腹膜后软组织肉瘤的诊断和治疗

腹膜后软组织肉瘤(retroperitoneal soft-tissue sar-coma,RPS)是临床上少见的恶性肿瘤,占所有恶性肿瘤的1%和所有软组织肉瘤的10%,在美国平均每年新增发病约1 000例[1-2]。由于其位置深,临床表现无特异性,早期难以发现,因此诊断有一定困难。近年来,随着影像学诊断技术的发展,R     

带血管蒂组织瓣移植在治疗四肢软组织肉瘤中的应用

目的 探讨带血管蒂组织瓣移植术在四肢软组织肉瘤中的应用与体会。 方法 回顾性分析2005年7月至2009年7月新疆医科大学附属肿瘤医院行带血管蒂组织瓣移植治疗16例四肢软组织肉瘤的临床资料。结果 1例足底内侧动脉皮瓣部分坏死,经二次游离皮片植皮后愈合。1例腓肠肌内侧头肌瓣结合游离植皮术后,边缘出现坏死,经换药后痂下愈合。其余14例病人组织瓣均全部存活,16例病人在生存期内同部位未见肿瘤复发。结论 四肢软组织肉瘤能够通过局部扩大切除术及带血管蒂的皮瓣移植术达到局部的控制,避免生存期内接受截肢术。     

Postradiation soft tissue sarcoma: a multiinstitutional analysis of 14 cases in Japan

Radiation therapy (RT) is commonly used to treat malignant tumors, but it leads to side effects and complications. Postradiation sarcomas developing from a previously irradiated area are especially vicious to deal with, though their occurrence is rare. This article focuses on the clinical manifestations, pathological characteristics, and therapeutic effects concerning postradiation soft tissue sarcomas (PRSTSs). A series of 14 PRSTSs treated between 1979 and 2000 in five hospitals in Japan were analyzed. Their histological types were malignant fibrous histiocytoma (eight cases), extraskeletal osteosarcoma (four cases), fibrosarcoma (one case), and leiomyosarcoma (one case). The primary diagnoses, RT history, latent period, and outcome of treatment were studied retrospectively. The original tumors included uterine cancer (seven cases), breast cancer (four cases), synovial sarcoma (one case), squamous cell carcinoma (one case), and Hodgkins disease (one case). There were 13 women and 1 man, with ages ranging from 23 to 77 years (mean 58 years) at the time of the appearance of the PRSTS. RT doses ranged from 48 to 91Gy (mean 62Gy). The latent period from RT to the occurrence of the PRSTS varied from 4 to 27 years (mean 12.6 years). Altogether, 4 of 13 patients (31%) had recurrence of the sarcoma after resection. Of the 10 patients whose tumors were removed with a wide margin, one had a local recurrence; 3 cases were performed with a marginal margin and all 3 had a local recurrence. One of three who underwent RT and one of five who underwent chemotherapy (CT) responded. Of the 14 patients, 6 (42.9 %) survived continuously disease free, 2 (14.3%) died from other causes, 2 (14.3%) has an unknown outcome, and 4 (28.6 %) died of the disease during the follow-up period of 16–36 months (mean 24 months). The deaths due to other causes included an esophageal cancer and a wound infection. The prognosis of the PRSTS patients was not poor if the tumor could be removed with a wide surgical margin. Because adjuvant therapies including RT and CT had a poor effect on PRSTSs, the primary treatment of PRSTSs should be radical resection with a wide margin.     

Metachronous bilateral soft tissue sarcoma of the extremities

Background and aims Synchronous and heterochronous multiple soft tissue sarcoma of the extremities is very rare. Out of 1,201 of our patients, 4 patients presented with symmetrical bilateral soft tissue sarcoma of the extremities. The aim of this study was to identify possible reasons for this unusual manifestation of sarcomas. Materials and methods The patients’ data was acquired by review of the patients’ charts and follow-up information was gathered by phone calls to the patients or their relatives and their general practitioners. Results All tumours were located at the extremities and were diagnosed as leiomyosarcoma in two patients, malignant fibrous histiocytoma and clear cell sarcoma in one patient each. No other individual or family history of cumulation of neoplasms was known in the patients. The median interval between the diagnoses was 3 1/2 years (range: 4 months to 9 1/2 years). In two patients a second primary sarcoma of the same entity was considered the most likely diagnosis, whereas in one patient a contralateral lymph node metastasis and in one other patient an atypical soft tissue metastasis had to be taken into account. A positive family history with a father with malignant fibrous histiocytoma may indicate a hereditary predisposition in one patient. Aside from irradiation effects, exposition to other carcinogenic agents or genetic predisposition, the reasons for the clustering of soft tissue sarcoma in one same patient remain still unclear. Only one patient, although suffering from disseminated metastatic disease was living at follow-up time, the other three patients had already died. Conclusion The interpretation of the bilateral manifestation of soft tissue sarcoma remains open, but predicts an unfavourable outcome.     

Preoperative hyperthermochemoradiotherapy for soft tissue sarcoma

We investigated the efficacy of preoperative hyperthermia combined with radiation therapy and systemic chemotherapy (hyperthermochemoradiotherapy; HCRT) as a multimodality limb-sparing approach for soft tissue sarcomas. From January 1991 to December 1994, HCRT was performed in 13 patients with soft tissue sarcomas at our institute. Hyperthermia, with an intratumoral temperature of ≥42.0°C, was given for 1 h for a total of eight to ten times. Radiation therapy (30–40 Gy) was given at 200 cGy per fraction. Two cycles of chemotherapy were given before surgery. It took 4–5 weeks to accomplish the HCRT, and surgery was performed 3 weeks later. Partial response (PR) was achieved in 3 patients and no change (NC) was shown in 10. The mean reduction of tumor volume was 20.2%. Pathological examination of the resected specimen revealed 10%–100% tumor necrosis (mean 76.4%). There was no correlation between histologic response and reduction of tumor volume. Limb-sparing surgery was feasible in 12 patients (92.3%) and the final limb salvage rate was 84.6%. No local recurrence was observed during a mean follow-up time of 25 months. Four patients developed distant metastases and 2 patients died of the disease. The results of this study indicate that HCRT is an effective treatment for limb-threatening soft tissue sarcomas.     

Reconstructive treatment of soft tissue sarcoma of the upper extremity

Limb-sparing surgery is currently the cornerstone of treatment for most patients with soft-tissue sarcoma of the upper extremity. To achieve the best outcome, the reconstructive surgeon must be part of a multidisciplinary team and is required to have a thorough understanding of the whole treatment concept. This article provides an update for the current surgical management of patients with soft tissue sarcoma of the upper extremity. Relevant nonsurgical aspects are also highlighted.     

Calcifying haematoma mimicking a soft tissue sarcoma and myositis ossificans

We describe a case of calcifying haematoma in a 78-year-old war veteran with a mass in his right lower leg. The likely differential diagnosis of myositis ossificans and soft tissue sarcoma was worked up. We discuss some of the difficulties of diagnosis despite having computed tomography and magnetic resonance imaging examinations and the unexpected final diagnosis of calcifying haematoma that was made on incisional biopsy.     

Reconstructive plastic surgery in soft tissue sarcomas of the extremities

Summary Limb-sparing resection in combination with radio/chemotherapy is recommended in cases of soft tissue sarcomas of the extremities. Plastic surgery techniques and clinical results in 69 patients with 71 malignant soft tissue tumors who had hadergone resection, as well as additional reconstructive procedures for functional improvement, are discussed. The integration of patients suffering from soft tissue sarcomas of the extremities into the treatment protocols of interdisciplinary tumor boards is recommended. Plastic surgery salvage procedures (including microsurgical free-tissue transfer) are discussed in detail. If the patient is judged unsuitable for these procedures or if distalization is not possible, amputation is the final option.     

Superficial extremity soft tissue sarcoma: An analysis of prognostic factors

Background: Experience with soft tissue sarcoma has suggested that superficial tumors have a favorable prognosis. We evaluated the prognostic features of this subset of sarcoma. Methods: Prospective data on 215 patients presenting to Memorial Sloan-Kettering Cancer Center with primary extremity superficial soft tissue sarcomas between July 1, 1982 and July 1, 1996 were analyzed. Superficial sarcomas were defined as subcutaneous tumors not invading the investing fascia of the muscle. Analysis was by univariate and multivariate tests for local recurrence, metastasis, and tumor mortality. Results: Ninety (42%) patients were over 50 years of age, 115 (53%) had high-grade tumors, 53 (25%) had tumors 5 cm, and 18 (8%) had positive margins following definitive resection. Median follow-up was 45 months (range 2 days to 151 months), 31 (14%) patients had local recurrences, 20 (9%) had distant metastases, and 15 (7%) died of disease. Five- and 10-year actuarial disease-specific survivals were 91% and 85%, respectively. On multivariate analysis, age >50 years predicted local recurrence (RR 5.7; 95% CI, 2.4–13.3;p<0.0001). High grade (RR 4.2; 95% CI, 1.4–12.7;p<0.006), and size 5 cm (RR 4.4; 95% CI, 1.8–11;p<0.002) predicted distant metastases. High grade (RR 7; 95% CI, 1.5–31.4;p<0.003), size 5 cm (RR 6.9; 95% CI, 2.3–20.8;p<0.0006), and positive margins (RR 3.8; 95% CI, 1.2–12.4;p<0.006) predicted tumor mortality. Conclusion: Primary superficial extremity soft tissue sarcomas have a favorable prognosis. Size and grade of superficial tumors are the strongest factors in predicting survival.Presented at the 50th Annual Cancer Symposium of The Society of Surgical Oncology, Chicago, Illinois, March 20–23, 1997.