Soft tissue tumors of the musculoskeletal system: (iv) Soft tissue sarcomas: General features, evaluation, imaging, biopsy and treatment

Soft tissue sarcomas are uncommon tumors of the musculoskeletal system. These tumors may present in an insidious and non-specific fashion. Many physicians are not familiar with the clinical presentation, pathologic features, biopsy techniques and management of these malignancies. Common features of many sarcomas include: 1) large size (> 5 cm); 2) hard or firm texture on palpation; and 3) deep location. Soft tissue sarcomas may also present as small, mobile, and superficial tumors. Plain radiographs in two planes are the first imaging modality to be obtained. Magnetic resonance imaging has evolved as the dominant imaging modality to define the anatomic features and to help characterize the nature of the lesion. Biopsy is a crucial step in management and must be performed carefully. Multi-modality treatment (surgical resection, radiation, and chemotherapy) have dramatically improved local control rates and allows the clinician to offer limb salvage to over 90% of patients with extremity sarcomas.