Skip to main content

Advertisement

SpringerLink
Log in

A guide to oncological management of soft tissue tumours of the abdominal wall

  • Review
  • Published:
Hernia Aims and scope Submit manuscript

Abstract

Introduction

An abdominal mass is a common clinical presentation, and a small percentage of such patients will have an abdominal wall tumour with the two most common pathologies being fibromatosis and soft tissue sarcoma.

Methods

Here we present the available literature on the diagnosis and management of both fibromatosis and soft tissue sarcoma, in the context of our experience in a tertiary referral centre for sarcoma.

Results and discussion

Appropriate cross-sectional imaging and a pre-operative tissue diagnosis by percutaneous core biopsy are necessary to define management. Desmoid fibromatosis can be managed initially by observation with serial imaging, with surgery being reserved for those patients who demonstrate progression.  Soft tissue sarcoma can display a range of pathologies from relatively indolent tumours to locally aggressive sarcomas that can readily metastasise. An accurate pre-operative histological diagnosis and staging enables a multidisciplinary approach to management. This may include chemotherapy and radiotherapy, but the mainstay of treatment remains wide surgical resection and abdominal wall reconstruction. Patient outcomes are worse if referral is delayed or if the sarcoma is incompletely resected without an initial tissue diagnosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Rydholm A (1983) Management of patients with soft-tissue tumors. Strategy developed at a regional oncology center. Acta Orthop Scand Suppl 203:13–77

    CAS  PubMed  Google Scholar 

  2. IARC (2002) WHO classification of soft tissue tumours. IARC Press, Lyons

    Google Scholar 

  3. NICE (2006) Improving outcome for people with sarcoma, London

  4. Clark MA, Thomas JM (2005) Delay in referral to a specialist soft-tissue sarcoma unit. Eur J Surg Oncol 31(4):443–448

    Article  CAS  PubMed  Google Scholar 

  5. Lakkaraju A, Sinha R, Garikipati R, Edward S, Robinson P (2009) Ultrasound for initial evaluation and triage of clinically suspicious soft-tissue masses. Clin Radiol 64(6):615–621

    Article  CAS  PubMed  Google Scholar 

  6. Clark MA, Fisher C, Judson I, Thomas JM (2005) Soft-tissue sarcomas in adults. N Engl J Med 353(7):701–711

    Article  CAS  PubMed  Google Scholar 

  7. NICE (2011) Referral for suspected cancer

  8. Hayes AJ (2007) Soft Tissue Sarcoma. In: GJ P (ed) Textbook of Surgical Oncology. Informa Healthcare, USA, pp 369–378

  9. Pencavel T, Strauss DC, Thomas JM, Hayes AJ (2010) The surgical management of soft tissue tumours arising in the abdominal wall. Eur J Surg Oncol 36(5):489–495

    Article  CAS  PubMed  Google Scholar 

  10. Potter BK, Adams SC, Pitcher JD Jr, Temple HT (2008) Local recurrence of disease after unplanned excisions of high-grade soft tissue sarcomas. Clin Orthop Relat Res 466(12):3093–3100

    Article  PubMed  Google Scholar 

  11. Rehders A, Stoecklein NH, Poremba C, Alexander A, Knoefel WT, Peiper M (2009) Reexcision of soft tissue sarcoma: sufficient local control but increased rate of metastasis. World J Surg 33(12):2599–2605

    Article  CAS  PubMed  Google Scholar 

  12. Qureshi YA, Huddy JR, Miller JD, Strauss DC, Thomas JM, Hayes AJ (2012) Unplanned excision of soft tissue sarcoma results in increased rates of local recurrence despite full further oncological treatment. Ann Surg Oncol 19(3):871–877

    Article  CAS  PubMed  Google Scholar 

  13. Strauss DC, Qureshi YA, Hayes AJ, Thway K, Fisher C, Thomas JM (2010) The role of core needle biopsy in the diagnosis of suspected soft tissue tumours. J Surg Oncol 102(5):523–529

    Article  CAS  PubMed  Google Scholar 

  14. Fisher C (1996) Soft tissue sarcomas: diagnosis, classification and prognostic factors. Br J Plast Surg 49(1):27–33

    Article  CAS  PubMed  Google Scholar 

  15. Hughes TM, Thomas JM (2000) Sarcoma metastases due to iatrogenic implantation. Eur J Surg Oncol 26(1):50–52

    Article  CAS  PubMed  Google Scholar 

  16. Bonvalot S, Eldweny H, Haddad V, Rimareix F, Missenard G, Oberlin O, Vanel D, Terrier P, Blay JY, Le Cesne A, Le Pechoux C (2008) Extra-abdominal primary fibromatosis: aggressive management could be avoided in a subgroup of patients. Eur J Surg Oncol 34(4):462–468

    Article  CAS  PubMed  Google Scholar 

  17. Berri RN, Baumann DP, Madewell JE, Lazar A, Pollock RE (2011) Desmoid tumor: current multidisciplinary approaches. Ann Plast Surg 67(5):551–564

    Article  CAS  PubMed  Google Scholar 

  18. Tolan S, Shanks JH, Loh MY, Taylor B, Wylie JP (2007) Fibromatosis: benign by name but not necessarily by nature. Clin Oncol (R Coll Radiol) 19(5):319–326

    Article  CAS  Google Scholar 

  19. Garonzik Wang JM, Leach SD (2008) Truncal sarcomas and abdominal desmoids. Surg Clin North Am 88(3):571–582, vi–vii

    Google Scholar 

  20. Clark SK, Phillips RK (1996) Desmoids in familial adenomatous polyposis. Br J Surg 83(11):1494–1504

    Article  CAS  PubMed  Google Scholar 

  21. Lopez R, Kemalyan N, Moseley HS, Dennis D, Vetto RM (1990) Problems in diagnosis and management of desmoid tumors. Am J Surg 159(5):450–453

    Article  CAS  PubMed  Google Scholar 

  22. Fiore M, Rimareix F, Mariani L, Domont J, Collini P, Le Pechoux C, Casali PG, Le Cesne A, Gronchi A, Bonvalot S (2009) Desmoid-type fibromatosis: a front-line conservative approach to select patients for surgical treatment. Ann Surg Oncol 16(9):2587–2593

    Article  PubMed  Google Scholar 

  23. Phillips SR, A’Hern R, Thomas JM (2004) Aggressive fibromatosis of the abdominal wall, limbs and limb girdles. Br J Surg 91(12):1624–1629

    Article  CAS  PubMed  Google Scholar 

  24. Gronchi A, Raut CP (2012) Optimal approach to sporadic desmoid tumors: from radical surgery to observation. Time for a consensus? Ann Surg Oncol 19(13):3995–3997

    Article  PubMed  Google Scholar 

  25. Sutton RJ, Thomas JM (1999) Desmoid tumours of the anterior abdominal wall. Eur J Surg Oncol 25(4):398–400

    Article  CAS  PubMed  Google Scholar 

  26. Mullen JT, Delaney TF, Kobayashi WK, Szymonifka J, Yeap BY, Chen YL, Rosenberg AE, Harmon DC, Choy E, Yoon SS, Raskin KA, Petur Nielsen G, Hornicek FJ (2012) Desmoid tumor: analysis of prognostic factors and outcomes in a surgical series. Ann Surg Oncol 19(13):4028–4035

    Article  PubMed  Google Scholar 

  27. Bertani E, Chiappa A, Testori A, Mazzarol G, Biffi R, Martella S, Pace U, Soteldo J, Vigna PD, Lembo R, Andreoni B (2009) Desmoid tumors of the anterior abdominal wall: results from a monocentric surgical experience and review of the literature. Ann Surg Oncol 16(6):1642–1649

    Article  PubMed  Google Scholar 

  28. Stojadinovic A, Hoos A, Karpoff HM, Leung DH, Antonescu CR, Brennan MF, Lewis JJ (2001) Soft tissue tumors of the abdominal wall: analysis of disease patterns and treatment. Arch Surg 136(1):70–79

    Article  CAS  PubMed  Google Scholar 

  29. Lev D, Kotilingam D, Wei C, Ballo MT, Zagars GK, Pisters PW, Lazar AA, Patel SR, Benjamin RS, Pollock RE (2007) Optimizing treatment of desmoid tumors. J Clin Oncol 25(13):1785–1791

    Article  PubMed  Google Scholar 

  30. Gronchi A, Casali PG, Mariani L, Lo Vullo S, Colecchia M, Lozza L, Bertulli R, Fiore M, Olmi P, Santinami M, Rosai J (2003) Quality of surgery and outcome in extra-abdominal aggressive fibromatosis: a series of patients surgically treated at a single institution. J Clin Oncol 21(7):1390–1397

    Article  CAS  PubMed  Google Scholar 

  31. Peng PD, Hyder O, Mavros MN, Turley R, Groeschl R, Firoozmand A, Lidsky M, Herman JM, Choti M, Ahuja N, Anders R, Blazer DG 3rd, Gamblin TC, Pawlik TM (2012) Management and recurrence patterns of desmoids tumors: a multi-institutional analysis of 211 patients. Ann Surg Oncol 19(13):4036–4042

    Article  PubMed Central  PubMed  Google Scholar 

  32. Schimmack S, Buchler MW, Weitz J (2009) Surgical therapy of abdominal and trunk soft tissue sarcomas. Chirurg 80(3):202–208

    Article  CAS  PubMed  Google Scholar 

  33. Karlsson P, Holmberg E, Samuelsson A, Johansson KA, Wallgren A (1998) Soft tissue sarcoma after treatment for breast cancer—a Swedish population-based study. Eur J Cancer 34(13):2068–2075

    Article  CAS  PubMed  Google Scholar 

  34. Myhre-Jensen O (1981) A consecutive 7-year series of 1331 benign soft tissue tumours. Clinicopathologic data. Comparison with sarcomas. Acta Orthop Scand 52(3):287–293

    Article  CAS  PubMed  Google Scholar 

  35. Costa J, Wesley RA, Glatstein E, Rosenberg SA (1984) The grading of soft tissue sarcomas. Results of a clinicohistopathologic correlation in a series of 163 cases. Cancer 53(3):530–541

    Article  CAS  PubMed  Google Scholar 

  36. Trojani M, Contesso G, Coindre JM, Rouesse J, Bui NB, de Mascarel A, Goussot JF, David M, Bonichon F, Lagarde C (1984) Soft-tissue sarcomas of adults; study of pathological prognostic variables and definition of a histopathological grading system. Int J Cancer J Int du Cancer 33(1):37–42

    Article  CAS  Google Scholar 

  37. van Unnik JA, Coindre JM, Contesso C, Albus-Lutter CE, Schiodt T, Sylvester R, Thomas D, Bramwell V, Mouridsen HT (1993) Grading of soft tissue sarcomas: experience of the EORTC Soft Tissue and Bone Sarcoma Group. Eur J Cancer 29A(15):2089–2093

    Article  PubMed  Google Scholar 

  38. Jensen OM, Hogh J, Ostgaard SE, Nordentoft AM, Sneppen O (1991) Histopathological grading of soft tissue tumours. Prognostic significance in a prospective study of 278 consecutive cases. J Pathol 163(1):19–24. doi:10.1002/path.1711630105

    Article  CAS  PubMed  Google Scholar 

  39. Edge SB BD, Compton CC (2010) AJCC cancer staging manual, 7th edn. Springer, Berlin

  40. Baldini EH, Goldberg J, Jenner C, Manola JB, Demetri GD, Fletcher CD, Singer S (1999) Long-term outcomes after function-sparing surgery without radiotherapy for soft tissue sarcoma of the extremities and trunk. J Clin Oncol 17(10):3252–3259

    CAS  PubMed  Google Scholar 

  41. Patrikidou A, Domont J, Cioffi A, Le Cesne A (2011) Treating soft tissue sarcomas with adjuvant chemotherapy. Curr Treat Options Oncol 12(1):21–31. doi:10.1007/s11864-011-0145-5

    Article  PubMed  Google Scholar 

  42. Karakousis CP (2010) Refinements of surgical technique in soft tissue sarcomas. J Surg Oncol 101(8):730–738

    Article  PubMed  Google Scholar 

  43. Kaushal A, Citrin D (2008) The role of radiation therapy in the management of sarcomas. Surg Clin North Am 88(3):629–646, viii

    Google Scholar 

  44. Adjuvant chemotherapy for localised resectable soft-tissue sarcoma of adults: meta-analysis of individual data. Sarcoma Meta-Analysis Collaboration (1997). Lancet 350(9092):1647–1654

  45. Alvegard TA, Sigurdsson H, Mouridsen H, Solheim O, Unsgaard B, Ringborg U, Dahl O, Nordentoft AM, Blomqvist C, Rydholm A et al (1989) Adjuvant chemotherapy with doxorubicin in high-grade soft tissue sarcoma: a randomized trial of the Scandinavian Sarcoma Group. J Clin Oncol 7(10):1504–1513

    CAS  PubMed  Google Scholar 

  46. Bramwell V, Rouesse J, Steward W, Santoro A, Schraffordt-Koops H, Buesa J, Ruka W, Priario J, Wagener T, Burgers M et al (1994) Adjuvant CYVADIC chemotherapy for adult soft tissue sarcoma-reduced local recurrence but no improvement in survival: a study of the European Organization for Research and Treatment of Cancer Soft Tissue and Bone Sarcoma Group. J Clin Oncol 12(6):1137–1149

    CAS  PubMed  Google Scholar 

  47. Singer S, Corson JM, Demetri GD, Healey EA, Marcus K, Eberlein TJ (1995) Prognostic factors predictive of survival for truncal and retroperitoneal soft-tissue sarcoma. Ann Surg 221(2):185–195

    Article  CAS  PubMed  Google Scholar 

  48. Gadd MA, Casper ES, Woodruff JM, McCormack PM, Brennan MF (1993) Development and treatment of pulmonary metastases in adult patients with extremity soft tissue sarcoma. Ann Surg 218(6):705–712

    Article  CAS  PubMed  Google Scholar 

  49. Storm HH (1998) Survival of adult patients with cancer of soft tissues or bone in Europe. EUROCARE Working Group. Eur J Cancer 34(14 Spec No):2212–2217

    Google Scholar 

  50. Tzeng CW, Smith JK, Heslin MJ (2007) Soft tissue sarcoma: preoperative and postoperative imaging for staging. Surg Oncol Clin N Am 16(2):389–402

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

K.J.W and A.J.H declare no conflict of interest.

Author information

Authors and Affiliations

  1. Academic Section of Vascular Surgery, Imperial College London, London, UK

    K. J. Williams

  2. Department of Sarcoma and Melanoma, The Royal Marsden Hospital, Fulham Road, London, SW11 6JJ, UK

    A. J. Hayes

Authors
  1. K. J. Williams
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. J. Hayes
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. J. Hayes.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Williams, K.J., Hayes, A.J. A guide to oncological management of soft tissue tumours of the abdominal wall. Hernia 18, 91–97 (2014). https://doi.org/10.1007/s10029-013-1156-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10029-013-1156-x

Keywords

Search

Navigation