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IntroductionExtremity Sarcoma ServiceMyself and Bas Masri200 Sarcomas per yearMonday clinic every weekMultidisciplinary service
ProblemSignificant % of patients
Delay in diagnosisInappropriate surgeryCompromises Limb SalvageRequires more RT/Chemo/Amputations
BUT – huge overlap between benign and malignant
PresentationPresent as
Mass8mm up to 50cm or morePainless or painfulGrow slowly or quicklySoft or firm or hard
PresentationSuspicious if:
>5cmGrowingDeep to the fascia
Look for systemic conditionsNFFamily History Li Fraumeni
WorkupMRI Guidelines
All lesions >5 cmAll deep lesionsAll rapidly growing lesions
(I do MRI for everything – my pre-test probability is >70%)
BiopsyFNA
50% accuracy. So toss a coin instead
Core BiopsyRequires experienced pathologist98% accuracyMake sure leave a scar
Open BiopsyIf needs an open biopsy – refer it.