Types
Sarcoma - synovial sarcoma most common
Malignant melanoma
Hemangioendothelioma
Sarcoma
| Synovial sarcoma | Clear cell sarcoma |
Epitheliod sarcoma |
Fibrosarcoma | Acral Myxoinflammatory Fibroblastic Sarcoma |
|---|---|---|---|---|
|
Most common 50% Spread via lymphatics |
Highly malignant Common in foot & ankle Usually 2nd/3rd decade
|
Nodule on the dorsum of the foot Young adults
|
Appear like ganglion / giant cell tumor Low grade Don't metastasise but can recur locally
|
|
| Wide / radical excision +/- radiotherapy | Wide excision +/- chemotherapy | Wide excision | Management depends on histological grade | Marginal excision |
www.boneschool.com/soft-tissue-sarcoma
Synovial Sarcoma
Consider it for every foot lump
Diagnosis often delayed
- varied presentation
- slow growing / rapid growing
- painful / painless lump
Peak incidence 20-50
Spread via lymphatics (rare for sarcoma)
X-ray - soft tissue mass (+/- Ca++)
MRI - aggressive on appearance
Prognosis - size can predict outcome
Treatment - wide excision + radiotherapy
Malignant melanoma
Common in the foot
May be subungal
- differential diagnosis is hematoma
- melanoma pigmentation does not move with time
Treatment - wide excision
Hemangioendothelioma
Vascular tumor in bones or soft tissue
- any age
- multiple on same extremity
- difficult to predict which will behave aggressively
- wide excison +/- DXRT