Skip to main content

Clinical Evaluation and Management of Benign Soft Tissue Tumors of the Extremities

  • Chapter
  • First Online:
Orthopaedic Oncology

Part of the book series: Cancer Treatment and Research ((CTAR,volume 162))

Abstract

Benign lesions comprise a majority of soft tissue tumors. It has been estimated that their incidence outnumbers that of malignant tumors by a factor of at least 100 [1]. While history and physical examination can start the diagnostic process, imaging including the use of magnetic resonance imaging can be more helpful. Biopsy of these tumors is sometimes necessary and can be performed in a number of ways, often in conjunction with definitive treatment. Specific diagnostic and treatment strategies for a number of the more commonly encountered benign soft tissue tumors including lipomas, pigmented villonodular synovitis and hemangiomas are reviewed. An algorithm for the management of benign soft tissue tumors is discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Rydholm A, Berg NO (1983) Size, site and clinical incidence of lipoma. Factors in the differential diagnosis of lipoma and sarcoma. Acta Orthop Scand 54(6):929–934

    Article  CAS  PubMed  Google Scholar 

  2. Gartner L, Pearce CJ, Saifuddin A (2009) The role of the plain radiograph in the characterisation of soft tissue tumours. Skeletal Radiol 38(6):549–558

    Article  PubMed  Google Scholar 

  3. Kransdorf MJ, Murphey MD (2000) Radiologic evaluation of soft-tissue masses: a current perspective. AJR Am J Roentgenol 175(3):575–587

    Article  CAS  PubMed  Google Scholar 

  4. De Schepper AM, Ramon FA, Degryse HR (1992) Statistical analysis of MRI parameters predicting malignancy in 141 soft tissue masses. Rofo 156(6):587–591

    Article  PubMed  Google Scholar 

  5. Razek A et al (2012) Assessment of soft tissue tumours of the extremities with diffusion echoplanar MR imaging. Radiol Med 117(1):96–101

    Article  CAS  PubMed  Google Scholar 

  6. Hatakenaka M et al (2008) Apparent diffusion coefficients of breast tumors: clinical application. Magn Reson Med Sci 7(1):23–29

    Article  PubMed  Google Scholar 

  7. Lakkaraju A et al (2009) Ultrasound for initial evaluation and triage of clinically suspicious soft-tissue masses. Clin Radiol 64(6):615–621

    Article  CAS  PubMed  Google Scholar 

  8. Weekes RG et al (1985) Magnetic resonance imaging of soft-tissue tumors: comparison with computed tomography. Magn Reson Imaging 3(4):345–352

    Article  CAS  PubMed  Google Scholar 

  9. Kasper B et al (2010) Positron emission tomography in patients with aggressive fibromatosis/desmoid tumours undergoing therapy with imatinib. Eur J Nucl Med Mol Imaging 37(10):1876–1882

    Article  PubMed  Google Scholar 

  10. Mankin HJ, Lange TA, Spanier SS (1982) The hazards of biopsy in patients with malignant primary bone and soft-tissue tumors. J Bone Joint Surg Am 64(8):1121–1127

    CAS  PubMed  Google Scholar 

  11. Mankin HJ, Mankin CJ, Simon MA (1996) The hazards of the biopsy, revisited. Members of the Musculoskeletal Tumor Society. J Bone Joint Surg Am 78(5):656–663

    CAS  PubMed  Google Scholar 

  12. Balach T, Stacy GS, Haydon RC (2011) The clinical evaluation of soft tissue tumors. Radiol Clin North Am 49(6):1185–1196, vi

    Google Scholar 

  13. Strauss DC et al (2010) The role of core needle biopsy in the diagnosis of suspected soft tissue tumours. J Surg Oncol 102(5):523–529

    Article  CAS  PubMed  Google Scholar 

  14. Kasraeian S et al (2010) A comparison of fine-needle aspiration, core biopsy, and surgical biopsy in the diagnosis of extremity soft tissue masses. Clin Orthop Relat Res 468(11):2992–3002

    Article  PubMed Central  PubMed  Google Scholar 

  15. Kaffenberger BH, Wakely PE Jr, Mayerson JL (2010) Local recurrence rate of fine-needle aspiration biopsy in primary high-grade sarcomas. J Surg Oncol 101(7):618–621

    Article  PubMed  Google Scholar 

  16. Kilpatrick SE et al (1998) The role of fine-needle aspiration biopsy in the initial diagnosis of pediatric bone and soft tissue tumors: an institutional experience. Mod Pathol 11(10):923–928

    CAS  PubMed  Google Scholar 

  17. Schwartz HS, Spengler DM (1997) Needle tract recurrences after closed biopsy for sarcoma: three cases and review of the literature. Ann Surg Oncol 4(3):228–236

    Article  CAS  PubMed  Google Scholar 

  18. National Guideline C. ACR Appropriateness Criteria® follow-up of malignant or aggressive musculoskeletal tumors. http://www.guideline.gov/content.aspx?id=32617&search=Malignant+neoplasm+musculoskeletal+. Accessed 14 Dec 2013

  19. Murphey MD et al (2004) From the archives of the AFIP: benign musculoskeletal lipomatous lesions. Radiographics 24(5):1433–1466

    Article  PubMed  Google Scholar 

  20. Myhre-Jensen O (1981) A consecutive 7-year series of 1331 benign soft tissue tumours. Clinicopathologic data. Comparison with sarcomas. Acta Orthop Scand 52(3):287–293

    Article  CAS  PubMed  Google Scholar 

  21. Lopez-Tomassetti Fernandez EM et al (2012) Intermuscular lipoma of the gluteus muscles compressing the sciatic nerve: an inverted sciatic hernia. J Neurosurg 117(4):795–799

    Google Scholar 

  22. Sampson CC et al (1960) Liposarcoma developing in a lipoma. Arch Pathol 69:506–510

    CAS  PubMed  Google Scholar 

  23. Murphey MD et al (1999) From the archives of the AFIP. Imaging of musculoskeletal neurogenic tumors: radiologic-pathologic correlation. Radiographics 19(5):1253–1280

    Article  CAS  PubMed  Google Scholar 

  24. Bancroft LW et al (2002) Soft tissue tumors of the lower extremities. Radiol Clin North Am 40(5):991–1011

    Article  PubMed  Google Scholar 

  25. Jee WH et al (2004) Extraaxial neurofibromas versus neurilemmomas: discrimination with MRI. AJR Am J Roentgenol 183(3):629–633

    Article  PubMed  Google Scholar 

  26. Kehoe NJ, Reid RP, Semple JC (1995) Solitary benign peripheral-nerve tumours. Review of 32 years’ experience. J Bone Joint Surg Br 77(3):497–500

    CAS  PubMed  Google Scholar 

  27. Weiss SW, Langloss JM, Enzinger FM (1983) Value of S-100 protein in the diagnosis of soft tissue tumors with particular reference to benign and malignant Schwann cell tumors. Lab Invest 49(3):299–308

    CAS  PubMed  Google Scholar 

  28. Kim SM et al (2012) Surgical outcome of schwannomas arising from major peripheral nerves in the lower limb. Int Orthop 36(8):1721–1725

    Article  PubMed Central  PubMed  Google Scholar 

  29. Park MJ, Seo KN, Kang HJ (2009) Neurological deficit after surgical enucleation of schwannomas of the upper limb. J Bone Joint Surg Br 91(11):1482–1486

    Article  CAS  PubMed  Google Scholar 

  30. Lee SH et al (2001) Results of neurilemoma treatment: a review of 78 cases. Orthopedics 24(10):977–980

    CAS  PubMed  Google Scholar 

  31. Mahajan D, Billings SD, Goldblum JR (2011) Acral soft tissue tumors: a review. Adv Anat Pathol 18(2):103–119

    Article  PubMed  Google Scholar 

  32. Monaghan H, Salter DM, Al-Nafussi A (2001) Giant cell tumour of tendon sheath (localised nodular tenosynovitis): clinicopathological features of 71 cases. J Clin Pathol 54(5):404–407

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  33. Payne WT, Merrell G (2010) Benign bony and soft tissue tumors of the hand. J Hand Surg Am 35(11):1901–1910

    Article  PubMed  Google Scholar 

  34. Dorwart RH et al (1984) Pigmented villonodular synovitis of synovial joints: clinical, pathologic, and radiologic features. AJR Am J Roentgenol 143(4):877–885

    Article  CAS  PubMed  Google Scholar 

  35. Adelani MA, Wupperman RM, Holt GE (2008) Benign synovial disorders. J Am Acad Orthop Surg 16(5):268–275

    PubMed  Google Scholar 

  36. Tyler WK et al (2006) Pigmented villonodular synovitis. J Am Acad Orthop Surg 14(6):376–385

    PubMed  Google Scholar 

  37. Hosalkar HS et al (2008) Musculoskeletal desmoid tumors. J Am Acad Orthop Surg 16(4):188–198

    PubMed  Google Scholar 

  38. Gronchi A et al (2003) Quality of surgery and outcome in extra-abdominal aggressive fibromatosis: a series of patients surgically treated at a single institution. J Clin Oncol 21(7):1390–1397

    Article  CAS  PubMed  Google Scholar 

  39. Merchant NB et al (1999) Extremity and trunk desmoid tumors: a multifactorial analysis of outcome. Cancer 86(10):2045–2052

    Article  CAS  PubMed  Google Scholar 

  40. Spear MA et al (1998) Individualizing management of aggressive fibromatoses. Int J Radiat Oncol Biol Phys 40(3):637–645

    Article  CAS  PubMed  Google Scholar 

  41. Acker JC, Bossen EH, Halperin EC (1993) The management of desmoid tumors. Int J Radiat Oncol Biol Phys 26(5):851–858

    Article  CAS  PubMed  Google Scholar 

  42. Ballo MT, Zagars GK, Pollack A (1998) Radiation therapy in the management of desmoid tumors. Int J Radiat Oncol Biol Phys 42(5):1007–1014

    Article  CAS  PubMed  Google Scholar 

  43. Zlotecki RA et al (2002) External beam radiotherapy for primary and adjuvant management of aggressive fibromatosis. Int J Radiat Oncol Biol Phys 54(1):177–181

    Article  PubMed  Google Scholar 

  44. Azzarelli A et al (2001) Low-dose chemotherapy with methotrexate and vinblastine for patients with advanced aggressive fibromatosis. Cancer 92(5):1259–1264

    Article  CAS  PubMed  Google Scholar 

  45. Mace J et al (2002) Response of extraabdominal desmoid tumors to therapy with imatinib mesylate. Cancer 95(11):2373–2379

    Article  CAS  PubMed  Google Scholar 

  46. Chugh R et al (2010) Efficacy of imatinib in aggressive fibromatosis: Results of a phase II multicenter Sarcoma Alliance for Research through Collaboration (SARC) trial. Clin Cancer Res 16(19):4884–4891

    Article  CAS  PubMed  Google Scholar 

  47. Poon R et al (2001) Cyclooxygenase-two (COX-2) modulates proliferation in aggressive fibromatosis (desmoid tumor). Oncogene 20(4):451–460

    Article  CAS  PubMed  Google Scholar 

  48. Tsukada K et al (1992) Noncytotoxic drug therapy for intra-abdominal desmoid tumor in patients with familial adenomatous polyposis. Dis Colon Rectum 35(1):29–33

    Article  CAS  PubMed  Google Scholar 

  49. Canavese F et al (2008) Surgical outcome in patients treated for hemangioma during infancy, childhood, and adolescence: a retrospective review of 44 consecutive patients. J Pediatr Orthop 28(3):381–386

    Article  PubMed  Google Scholar 

  50. Tang P et al (2002) Surgical treatment of hemangiomas of soft tissue. Clin Orthop Relat Res 399:205–210

    Article  PubMed  Google Scholar 

  51. Donnelly LF, Adams DM, Bisset GS 3rd (2000) Vascular malformations and hemangiomas: a practical approach in a multidisciplinary clinic. AJR Am J Roentgenol 174(3):597–608

    Article  CAS  PubMed  Google Scholar 

  52. Kiran KR et al (2012) Skeletal Muscle Haemangioma: a cause for chronic pain about the knee: a case report. Case Rep Orthop 2012:452651

    PubMed Central  PubMed  Google Scholar 

  53. Brown RA, Crichton K, Malouf GM (2004) Intramuscular haemangioma of the thigh in a basketball player. Br J Sports Med 38(3):346–348

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  54. Crawford EA et al (2009) Ethanol sclerotherapy reduces pain in symptomatic musculoskeletal hemangiomas. Clin Orthop Relat Res 467(11):2955–2961

    Article  PubMed Central  PubMed  Google Scholar 

  55. Smith TP et al (1993) Transarterial embolization of vertebral hemangioma. J Vasc Interv Radiol 4(5):681–685

    Article  CAS  PubMed  Google Scholar 

  56. Ingari JV, Faillace JJ (2004) Benign tumors of fibrous tissue and adipose tissue in the hand. Hand Clin 20(3):243–248, v

    Google Scholar 

  57. King JB (1998) Post-traumatic ectopic calcification in the muscles of athletes: a review. Br J Sports Med 32(4):287–290

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  58. Drane WE (1984) Myositis ossificans and the three-phase bone scan. AJR Am J Roentgenol 142(1):179–180

    Article  CAS  PubMed  Google Scholar 

  59. Takahashi S et al (2008) Adult autopsy case with marked myositis ossificans: association with repetitive physical assault and battery. Leg Med (Tokyo) 10(5):274–276

    Article  Google Scholar 

  60. Cushner FD, Morwessel RM (1992) Myositis ossificans traumatica. Orthop Rev 21(11):1319–1326

    CAS  PubMed  Google Scholar 

  61. Illes T et al (1992) Characterization of bone forming cells in posttraumatic myositis ossificans by lectins. Pathol Res Pract 188(1–2):172–176

    Article  CAS  PubMed  Google Scholar 

  62. Beiner JM, Jokl P (2001) Muscle contusion injuries: current treatment options. J Am Acad Orthop Surg 9(4):227–237

    CAS  PubMed  Google Scholar 

  63. Sodl JF et al (2008) Traumatic myositis ossificans as a result of college fraternity hazing. Clin Orthop Relat Res 466(1):225–230

    Article  PubMed Central  PubMed  Google Scholar 

  64. McDermott EM, Weiss AP (2006) Glomus tumors. J Hand Surg Am 31(8):1397–1400

    Article  PubMed  Google Scholar 

  65. Dahlin LB, Besjakov J, Veress B (2005) A glomus tumour: classic signs without magnetic resonance imaging findings. Scand J Plast Reconstr Surg Hand Surg 39(2):123–125

    Article  PubMed  Google Scholar 

  66. Luna A, Martinez S, Bossen E (2005) Magnetic resonance imaging of intramuscular myxoma with histological comparison and a review of the literature. Skeletal Radiol 34(1):19–28

    Article  CAS  PubMed  Google Scholar 

  67. Nielsen GP, O’Connell JX, Rosenberg AE (1998) Intramuscular myxoma: a clinicopathologic study of 51 cases with emphasis on hypercellular and hypervascular variants. Am J Surg Pathol 22(10):1222–1227

    Article  CAS  PubMed  Google Scholar 

  68. Ho YY, Choueka J (2013) Synovial chondromatosis of the upper extremity. J Hand Surg Am 38(4):804–810

    Article  PubMed  Google Scholar 

  69. Ogilvie-Harris DJ, Saleh K (1994) Generalized synovial chondromatosis of the knee: a comparison of removal of the loose bodies alone with arthroscopic synovectomy. Arthroscopy 10(2):166–170

    Article  CAS  PubMed  Google Scholar 

  70. Schoeniger R et al (2006) Modified complete synovectomy prevents recurrence in synovial chondromatosis of the hip. Clin Orthop Relat Res 451:195–200

    Article  PubMed  Google Scholar 

  71. Garner HW, Bestic JM (2013) Benign synovial tumors and proliferative processes. Semin Musculoskelet Radiol 17(2):177–178

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Tessa Balach .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Erwteman, A.S., Balach, T. (2014). Clinical Evaluation and Management of Benign Soft Tissue Tumors of the Extremities. In: Peabody, T., Attar, S. (eds) Orthopaedic Oncology. Cancer Treatment and Research, vol 162. Springer, Cham. https://doi.org/10.1007/978-3-319-07323-1_9

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-07323-1_9

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-07322-4

  • Online ISBN: 978-3-319-07323-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics