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The Importance of Accurate Diagnosis in Managing Benign and Malignant Soft Tissue Masses

Soft tissue masses often present a diagnostic challenge for healthcare professionals, given the overlap in symptoms between benign and malignant tumors. Accurate diagnosis is crucial for determining the appropriate course of treatment, and failure to do so can lead to delays and potentially harmful outcomes.

HCN Medical Memo
The diagnostic ambiguity of soft tissue masses underscores the need for a thorough evaluation and possibly early referral to a surgical oncologist. Misdiagnosis can lead to “unplanned oncologic excisions,” which have been shown to result in higher rates of recurrence and increased morbidity and mortality. Therefore, a high index of suspicion and utilization of diagnostic tools like MRI and CT-guided core biopsy are essential for optimal patient outcomes.

Key Points
  • More than 99% of soft tissue masses are benign, but distinguishing features can be subtle.
  • Rapid growth and size greater than 5 cm are indicators of potentially malignant masses.
  • A study found malignancy rates of 22% for masses less than 5 cm, 16% for those less than 3 cm, and 14% for those less than 2 cm.
  • Up to one-third of sarcomas present as superficial masses, according to Dr. Katia Papalezova, a surgical oncologist at Montefiore Medical Center.
  • Lack of systemic symptoms should not lower the clinician’s index of suspicion for malignancy.

“A common misconception is that patients with a malignant tumor will appear ill as is often seen in patients with disseminated non-musculoskeletal malignancies. But a lack of coexistent symptoms should not lower the clinician’s index of suspicion for malignancy.”
– Katia Papalezova, MD, Surgical Oncologist at Montefiore Medical Center and an Assistant Professor of Surgery at the Albert Einstein College of Medicine

Additional Points
  • More than 13,000 people in the US will be afflicted by malignant soft tissue masses in 2023, with more than 5,000 expected to die.
  • Delays in diagnosis are common due to lack of pain and low index of suspicion.
  • MRI with and without contrast is the standard diagnostic tool, followed by CT-guided core biopsy for suspicious masses.
  • Principles of surgery for soft tissue sarcoma include wide excision of the primary tumor with appropriate margins.

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