Soft Tissue Tumours

Epidemiology

  • Benign soft tissue tumours far outnumber sarcomas
  • Sarcomas make up around 1% of adult cancers
  • Unplanned excision of unrecognised sarcoma is a common problem

Clinical Features

  • History of growth, pain, trauma, previous excision and radiotherapy
  • Family history of neurofibromatosis or Li-Fraumeni syndrome
  • Examine size, depth to fascia, mobility, transillumination, Tinel sign and regional nodes
  • Red flags are size over 5 cm, deep to fascia and increasing size
  • Pain and recurrence after excision also warrant sarcoma referral
  • Many sarcomas are painless

Investigations

Lipomatous Tumours, t1 weighted mri of an intramuscular lipoma of the thenar muscles
T1 weighted MRI of an intramuscular lipoma of the thenar muscles. Image by Chernev I, Tingey S, Wikimedia Commons, CC BY 4.0.
  • Ultrasound first for small superficial lumps
  • Contrast MRI for deep or indeterminate masses
  • Radiographs show calcification and bone involvement
  • Image guided core biopsy along the future resection line
  • CT chest staging for confirmed sarcoma
  • Whole body MRI for myxoid liposarcoma
  • Nodal assessment for synovial, clear cell and epithelioid sarcoma
  • Nodal assessment also for angiosarcoma and rhabdomyosarcoma

Differential Diagnosis

  • Benign, lipoma, schwannoma, neurofibroma, haemangioma and ganglion
  • Benign, nodular fasciitis and tenosynovial giant cell tumour
  • Desmoid fibromatosis is locally aggressive and intermediate
  • Undifferentiated pleomorphic sarcoma
  • Liposarcoma, including atypical lipomatous tumour, myxoid, pleomorphic and dedifferentiated subtypes
  • Myxofibrosarcoma infiltrates extensively along fascial planes
  • Synovial sarcoma in young adults around the knee and foot
  • Leiomyosarcoma and MPNST
  • Rhabdomyosarcoma in children

Management

  • Small superficial benign looking lesions excised or observed
  • Discuss suspected sarcoma at MDT before biopsy or surgery
  • Wide excision with a cuff of normal tissue
  • Radiotherapy for most intermediate and high grade sarcomas
  • Preoperative radiotherapy has fewer late effects but more wound complications
  • Chemotherapy standard for rhabdomyosarcoma and extraskeletal Ewing sarcoma
  • Re-excise scar and tumour bed after unplanned excision
  • Active surveillance first for desmoid fibromatosis
  • Marginal excision for limb atypical lipomatous tumour

Prognosis

  • Adverse factors are high grade, large size, depth, positive margins and metastasis
  • Lung is the commonest metastatic site

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.