Soft Tissue Sarcomas

Diagnosis:
Tissue diagnosis is the key - need to differentiate from other disease processes
1) FNA is rarely diagnostic
2) Core needle biopsy is the primary modality:
- try to follow straight tract to lesion - remember you'll have to resect the biopsy tract
- prior imaging will help to guide route of biopsy, image guided biopsy may also be useful
3) if core biopsy is not diagnostic then open incisional biopsy may be necessary
- <5cm can consider exicisonal biopsy
- if >5cm do incisional biopsy reducing flaps and ensuring hemostasis

Pathology:
LN Mets are rare (2-3%): Some subtypes do have a higher association with LN mets (~20-30%) and you should resect LNs if positive, some even advocate doing SLNB in these cases:
- Synovial
- Epitheliod
- Clear Cell
- Rhabdomyosarcoma

Most common subtype in Children: Rhabdomyosarcoma
Most common subtype in Adults: Malignant Fibrous Histiocytoma