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Diagnosing Benign Soft Tissue Tumors: A Visual Guideline from Presentation through Treatment

March 01, 2017

Contributors: Ian O'Connor, BS; James C Wittig, MD, FAAOS; Alexander P Decilveo; Alexander P Decilveo

Benign soft-tissue tumors are more common than bone and soft-tissue sarcomas. Approximately 500,000 benign soft-tissue tumors are diagnosed in the United States each year. The most common benign soft-tissue tumors are lipoma, hemangioma, fibromatosis/desmoplastic fibroma, myxoma, schwannoma/neurilemmoma, neurofibroma, and giant cell tumor of the tendon sheath. These tumors primarily occur in adolescents and middle-aged adults. Benign soft-tissue tumors originate from the muscles, ligaments, nerves, and blood vessels and may affect almost any anatomic compartment, most commonly the extremities and the trunk. Some tumors have a predilection for certain anatomic locations, such as giant cell tumors of the tendon sheath, which have a predilection for the volar aspect of the fingers and the hand. Clinically, soft-tissue tumors vary in appearance and behavior. These masses may be slow growing, asymptomatic, and painless (ie, lipoma) or symptomatic and painful (ie, schwannoma, giant cell tumor of the tendon sheath, and fibromatosis). Some tumors may be locally aggressive or differentiate into a malignant tumor. For example, the diffuse form of a giant cell tumor of the tendon sheath is considered a locally aggressive and destructive lesion with a high rate of recurrence after excision. Desmoplastic fibroma may differentiate into a grade 1 fibrosarcoma, and all retroperitoneal fatty tumors are considered malignant because of their anatomic location. The aforementioned tumors must be monitored closely for malignant transformation. In general, radiographic imaging of benign soft-tissue tumors is nonspecific; however, certain signals may be characteristic. Histopathologic studies are diverse among soft-tissue masses but help in differentiating benign tumors from their malignant counterparts. Management ranges from observation to marginal excision to wide excision. Some asymptomatic lesions can be observed; however, excision is the preferred treatment option if the lesion is painful, large (>5 cm), or deep seated. Depending on the entity, chemotherapy and/or radiation may be recommended; however, their use is controversial. Patients in whom a benign soft-tissue tumor is suspected should be referred to an orthopaedic oncologist for treatment.