Soft Tissue Tumors of the Groin and Inguinal Region

  • Stefano Radaelli
  • Chiara Colombo
  • Marco Fiore
  • Alessandro Gronchi


Soft tissue sarcomas (STSs) are rare tumors accounting for 1% of all adult malignancies. Due to their histological variety and heterogeneous anatomical presentation, treatment may be extremely complex, requiring peculiar expertise. Before planning any therapeutic approach, core needle percutaneous biopsy is mandatory and although surgery with negative margins is the mainstay of cure, complementary chemo and radiation therapies are often advocated, especially in high grade tumors. STSs of the groin and inguinal region account between 5 and 10% of all soft tissue malignancies, arising from the inguinal canal, the spermatic cord and the anatomical structures within the femoral triangle. Exceptionally giant retroperitoneal sarcoma may herniate through the abdo-inguinal ring. All these presentations are frequently misdiagnosed as inguinal or crural hernia, enlarged lymph nodes or testicular malignancies. Given the particular constraints of the inguinal region, in order to achieve adequate margins to increase the chance of locoregional control, surgery usually requires extensive soft tissue and visceral resections often combined with vascular and plastic complex reconstructions. In the very rare cases of lymphatic metastases, radical groin lymph node dissection may be performed, potentially with curative intent. Due to the rarity of the disease and the complexity of the diagnostic and therapeutic process, patients presenting with suspicious of STSs must always adressed to national referral centers.


  1. 1.
    ESMO/European Sarcoma Network Working Group. Soft tissue and visceral sarcomas: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2014;25(Suppl 3):iii102–12.CrossRefGoogle Scholar
  2. 2.
    Stiller CA, Trama A, Serraino D, Rossi S, Navarro C, Chirlaque MD, Casali PG, RARECARE Working Group. Descriptive epidemiology of sarcomas in Europe: report from the RARECARE project. Eur J Cancer. 2013;49(3):684–95.PubMedCrossRefGoogle Scholar
  3. 3.
    Toro JR, Travis LB, Wu HJ, Zhu K, Fletcher CD, Devesa SS. Incidence patterns of soft tissue sarcomas, regardless of primary site, in the surveillance, epidemiology and end results program, 1978–2001: an analysis of 26,758 cases. Int J Cancer. 2006;119(12):2922–30.PubMedCrossRefGoogle Scholar
  4. 4.
    Cormier JN, Pollock RE. Soft tissue sarcomas. CA Cancer J Clin. 2004;54(2):94–109.PubMedCrossRefGoogle Scholar
  5. 5.
    Swallow CJ, Catton CN. Local management of adult soft tissue sarcomas. J Am Acad Orthop Surg. 2009;17(1):40–7.CrossRefGoogle Scholar
  6. 6.
    Gilbert NF, Cannon CP, Lin PP, Lewis VO. Soft-tissue sarcoma. J Am Acad Orthop Surg. 2009;17(1):40–7.PubMedCrossRefGoogle Scholar
  7. 7.
    Fletcher CD, Hogendoorn P, Mertens F, Bridge J. WHO classification of tumours of soft tissue and bone. 4th ed. Lyon: IARC Press; 2013.Google Scholar
  8. 8.
    Spiguel A. Soft tissue sarcomas. Cancer Treat Res. 2014;162:203–23.PubMedCrossRefGoogle Scholar
  9. 9.
    Garcia-Ortega DY, Villa-Zepeda O, Martinez-Said H, Cuellar-Hübbe M, Luna-Ortiz K. Oncology outcomes in retroperitoneal sarcomas: prognostic factors in a retrospective cohort study. Int J Surg. 2016;32:45–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Callegaro D, Fiore M, Gronchi A. Personalizing surgical margins in retroperitoneal sarcomas. Expert Rev Anticancer Ther. 2015;15(5):553–67.PubMedCrossRefGoogle Scholar
  11. 11.
    Raut CP, Miceli R, Strauss DC, Swallow CJ, Hohenberger P, van Coevorden F, Rutkowski P, Fiore M, Callegaro D, Casali PG, Haas RL, Hayes AJ, Honore C, Cannell AJ, Jakob J, M S, Fairweather M, Pollock RE, Bonvalot S, Gronchi A. External validation of a multi-institutional retroperitoneal sarcoma nomogram. Cancer. 2016;122(9):1417–24.PubMedCrossRefGoogle Scholar
  12. 12.
    Sanfilippo R, Miceli R, Grosso F, Fiore M, Puma E, Pennacchioli E, Barisella M, Sangalli C, Mariani L, Casali PG, Gronchi A. Myxofibrosarcoma: prognostic factors and survival in a series of patients treated at a single institution. Ann Surg Oncol. 2011;18(3):720–5.PubMedCrossRefGoogle Scholar
  13. 13.
    Sambri A, Bianchi G, Righi A, Ferrari C, Donati D. Surgical margins do not affect prognosis in high grade myxofibrosarcoma. Eur J Surg Oncol. 2016;42(7):1042–8.PubMedCrossRefGoogle Scholar
  14. 14.
    Fuglø HM, Maretty-Nielsen K, Hovgaard D, Keller JØ, Safwat AA, Petersen MM. Metastatic pattern, local relapse, and survival of patients with myxoid liposarcoma: a retrospective study of 45 patients. Sarcoma. 2013;2013:548628.PubMedPubMedCentralCrossRefGoogle Scholar
  15. 15.
    Haniball J, Sumathi VP, Kindblom LG, Abudu A, Carter SR, Tillman RM, Jeys L, Spooner D, Peake D, Grimer RJ. Prognostic factors and metastatic patterns in primary myxoid/round-cell liposarcoma. Sarcoma. 2011;2011:538085.PubMedPubMedCentralCrossRefGoogle Scholar
  16. 16.
    Vlenterie M, Jones RL, van der Graaf WT. Synovial sarcoma diagnosis and management in the era of targeted therapies. Curr Opin Oncol. 2015;27(4):316–22.PubMedCrossRefGoogle Scholar
  17. 17.
    Eilber FC, Dry SM. Diagnosis and management of synovial sarcoma. J Surg Oncol. 2008;97(4):314–20.PubMedCrossRefGoogle Scholar
  18. 18.
    James AW, Shurell E, Singh A, Dry SM, Eilber FC. Malignant peripheral nerve sheath tumor. Surg Oncol Clin N Am. 2016;25(4):789–802.PubMedCrossRefGoogle Scholar
  19. 19.
    Farid M, Demicco EG, Garcia R, Ahn L, Merola PR, Cioffi A, Maki RG. Malignant peripheral nerve sheath tumors. Oncologist. 2014;19(2):193–201.PubMedPubMedCentralCrossRefGoogle Scholar
  20. 20.
    Guillou L, Wadden C, Coindre JM, Krausz T, Fletcher CD. “Proximal-type” epithelioid sarcoma, a distinctive aggressive neoplasm showing rhabdoid features. Clinicopathologic, immunohistochemical, and ultrastructural study of a series. Am J Surg Pathol. 1997;21(2):130–46.PubMedCrossRefGoogle Scholar
  21. 21.
    Asano N, Yoshida A, Ogura K, Kobayashi E, Susa M, Morioka H, Iwata S, Ishii T, Hiruma T, Chuman H, Kawai A. Prognostic value of relevant clinicopathologic variables in epithelioid sarcoma: a multi-institutional retrospective study of 44 patients. Ann Surg Oncol. 2015;22(8):2624–32.PubMedPubMedCentralCrossRefGoogle Scholar
  22. 22.
    Baratti D, Pennacchioli E, Casali PG, Bertulli R, Lozza L, Olmi P, Collini P, Radaelli S, Fiore M, Gronchi A. Epithelioid sarcoma: prognostic factors and survival in a series of patients treated at a single institution. Ann Surg Oncol. 2007;14(12):3542–51.PubMedCrossRefGoogle Scholar
  23. 23.
    Tejwani A, Kobayashi W, Chen YL, Rosenberg AE, Yoon S, Raskin KA, Rosenthal DI, Nielsen GP, Hornicek FJ, Delaney TF. Management of acral myxoinflammatory fibroblastic sarcoma. Cancer. 2010;116(24):5733–9.PubMedCrossRefGoogle Scholar
  24. 24.
    Hwang S, Kelliher E, Hameed M. Imaging features of low-grade fibromyxoid sarcoma (Evans tumor). Skelet Radiol. 2012;41(10):1263–72.CrossRefGoogle Scholar
  25. 25.
    Billings SD, Giblen G, Fanburg-Smith JC. Superficial low-grade fibromyxoid sarcoma (Evans tumor): a clinicopathologic analysis of 19 cases with a unique observation in the pediatric population. Am J Surg Pathol. 2005;29(2):204–10.PubMedCrossRefGoogle Scholar
  26. 26.
    Cornillie J, van Cann T, Wozniak A, Hompes D, Schöffski P. Biology and management of clear cell sarcoma: state of the art and future perspectives. Expert Rev Anticancer Ther. 2016;16(8):839–45.PubMedCrossRefGoogle Scholar
  27. 27.
    Malchau SS, Hayden J, Hornicek F, Mankin HJ. Clear cell sarcoma of soft tissues. J Surg Oncol. 2007;95(6):519–22.PubMedCrossRefGoogle Scholar
  28. 28.
    Bianchi G, Charoenlap C, Cocchi S, Rani N, Campagnoni S, Righi A, Frisoni T, Donati DM. Clear cell sarcoma of soft tissue: a retrospective review and analysis of 31 cases treated at Istituto Ortopedico Rizzoli. Eur J Surg Oncol. 2014;40(5):505–10.PubMedCrossRefGoogle Scholar
  29. 29.
    Pennacchioli E, Fiore M, Collini P, Radaelli S, Dileo P, Stacchiotti S, Casali PG, Gronchi A. Alveolar soft part sarcoma: clinical presentation, treatment, and outcome in a series of 33 patients at a single institution. Ann Surg Oncol. 2010;17(12):3229–33. doi: 10.1245/s10434-010-1186-x.PubMedCrossRefGoogle Scholar
  30. 30.
    Portera CA Jr, Ho V, Patel SR, Hunt KK, Feig BW, Respondek PM, Yasko AW, Benjamin RS, Pollock RE, Pisters PW. Alveolar soft part sarcoma: clinical course and patterns of metastasis in 70 patients treated at a single institution. Cancer. 2001;91(3):585–91.PubMedCrossRefGoogle Scholar
  31. 31.
    Paolino G, Lora V, Cota C, Panetta C, Muscardin LM, Donati P. Early angiosarcoma of the scalp: a clinicopathological pitfall. Am J Dermatopathol. 2016;38(9):690–4.PubMedCrossRefGoogle Scholar
  32. 32.
    Choi JH, Ahn KC, Chang H, Minn KW, Jin US, Kim BJ. Surgical treatment and prognosis of angiosarcoma of the scalp: a retrospective analysis of 14 patients in a single institution. Biomed Res Int. 2015;2015:321896.PubMedPubMedCentralGoogle Scholar
  33. 33.
    Loss L, Zeitouni NC. Management of scalp dermatofibrosarcoma protuberans. Dermatol Surg. 2005;31(11 Pt 1):1428–33.PubMedGoogle Scholar
  34. 34.
    Gupta B, Verma N, Khurana N, Kumar JS. Dermatofibrosarcoma protuberans of the scalp, with fibrosarcomatous areas masquerading as epidermal inclusion cyst. BMJ Case Rep. 2016;2016:pii:bcr2016215427.CrossRefGoogle Scholar
  35. 35.
    Machado I, Llombart B, Calabuig-Fariñas S, Llombart-Bosch A. Superficial Ewing’s sarcoma family of tumors: a clinicopathological study with differential diagnoses. J Cutan Pathol. 2011;38(8):636–43.PubMedCrossRefGoogle Scholar
  36. 36.
    Ulusan S, Koc Z, Canpolat ET, Colakoglu T. Radiological findings of primary retroperitoneal Ewing sarcoma. Acta Radiol. 2007;48(7):814–8.PubMedCrossRefGoogle Scholar
  37. 37.
    Gronchi A, Colombo C, Raut CP. Surgical management of localized soft tissue tumors. Cancer. 2014;120(17):2638–48.PubMedCrossRefGoogle Scholar
  38. 38.
    Gilbert NF, Cannon CP, Lin PP, Lewis VO. Soft-tissue sarcoma. J Am Acad Orthop Surg. 2009;17(1):40–7.PubMedCrossRefGoogle Scholar
  39. 39.
    Gronchi A, Guadagnolo BA, Erinjeri JP. Local ablative therapies to metastatic soft tissue sarcoma. Am Soc Clin Oncol Educ Book. 2016;35:e566–75.PubMedCrossRefGoogle Scholar
  40. 40.
    Fong Y, Coit DG, Woodruff JM, Brennan MF. Lymph node metastasis from soft tissue sarcoma in adults. Analysis of data from a prospective database of 1772 sarcoma patients. Ann Surg. 1993;217(1):72–7.PubMedPubMedCentralCrossRefGoogle Scholar
  41. 41.
    Riad S, Griffin AM, Liberman B, Blackstein ME, Catton CN, Kandel RA, O'Sullivan B, White LM, Bell RS, Ferguson PC, Wunder JS. Lymph node metastasis in soft tissue sarcoma in an extremity. Clin Orthop Relat Res. 2004;426:129–34.CrossRefGoogle Scholar
  42. 42.
    Gronchi A, Raut CP. Treatment of localized sarcomas. Hematol Oncol Clin North Am. 2013;27(5):921–38.PubMedCrossRefGoogle Scholar
  43. 43.
    Rosenberg SA, Tepper JE, Glatstein EJ, et al. The treatment of softtissue sarcomas of the extremities: prospective randomized evaluations of (1) limb-sparing surgery plus radiation therapy compared with amputation and (2) the role of adjuvant chemotherapy. Ann Surg. 1982;196:305–15.PubMedPubMedCentralCrossRefGoogle Scholar
  44. 44.
    Yang JC, Chang AE, Baker AR, et al. A randomized prospective study of the benefit of adjuvant radiation therapy in the treatment of soft tissue sarcomas of the extremity. J Clin Oncol. 1998;16:197–203.PubMedCrossRefGoogle Scholar
  45. 45.
    Lee J, Park YJ, Yang DS, et al. Treatment outcome of conservative surgery plus postoperative radiotherapy for extremity soft tissue sarcoma. Radiat Oncol J. 2012;30(2):62–9.PubMedPubMedCentralCrossRefGoogle Scholar
  46. 46.
    Davis AM, O'Sullivan B, Bell RS, et al. Function and health status outcomes in a randomized trial comparing preoperative and postoperative radiotherapy in extremity soft tissue sarcoma. J Clin Oncol. 2002;20(22):4472–7.PubMedCrossRefGoogle Scholar
  47. 47.
    Pervaiz N, Colterjohn N, Farrokhyar F, et al. A systematic meta-analysis of randomized controlled trials of adjuvant chemotherapy for localized resectable soft-tissue sarcoma. Cancer. 2008;113(3):573–81.PubMedCrossRefGoogle Scholar
  48. 48.
    Woll PJ, Reichardt P, Le Cesne A, et al. Adjuvant chemotherapy with doxorubicin, ifosfamide, and lenograstim for resected soft-tissue sarcoma (EORTC 62931): a multicentre randomised controlled trial. Lancet Oncol. 2012;13(10):1045–54.PubMedCrossRefGoogle Scholar
  49. 49.
    Frustaci S, Gherlinzoni F, De Paoli A, et al. Adjuvant chemotherapy for adult soft tissue sarcomas of the extremities and girdles: results of the Italian randomized cooperative trial. J Clin Oncol. 2001;19(5):1238–47.PubMedCrossRefGoogle Scholar
  50. 50.
    Gronchi A, Stacchiotti S, Verderio P, Ferrari S, Martin Broto J, Lopez-Pousa A, Llombart-Bosch A, Dei Tos AP, Collini P, Jurado JC, De Paoli A, Donati DM, Poveda A, Quagliuolo V, Comandone A, Grignani G, Morosi C, Messina A, De Sanctis R, Bottelli S, Palassini E, Casali PG, Picci P. Short, full-dose adjuvant chemotherapy (CT) in high-risk adult soft tissue sarcomas (STS): long-term follow-up of a randomized clinical trial from the Italian Sarcoma Group and the Spanish Sarcoma Group. Ann Oncol. 2016;27(12):2283–8.PubMedCrossRefGoogle Scholar
  51. 51.
    Edmonson JH, Ryan LM, Blum RH, et al. Randomized comparison of doxorubicin alone versus ifosfamide plus doxorubicin or mitomycin, doxorubicin, and cisplatin against advanced soft tissue sarcomas. J Clin Oncol. 1993;11:1269–75.PubMedCrossRefGoogle Scholar
  52. 52.
    Gronchi A, Ferrari S, Quagliuolo V, Martin Broto J, Lopez-Pousa A, Grignani G, Ferraresi V, Blay J-Y, Rutkowski P, Merlo FD, Marchesi E, Ledesma P, Dei Tos AP, Bague Rosell S, Coindre J-M, Morosi C, Stacchiotti S, Picci P, Bruzzi P, Casali PG. Full-dose neoadjuvant anthracycline + ifosfamide chemotherapy is associated with a relapse free survival (RFS) and overall survival (OS) benefit in localized high-risk adult soft tissue sarcomas (STS) of the extremities and trunk wall: Interim analysis of a prospective randomized trial. Ann Oncol. 2016;27:LBA6_PR.Google Scholar
  53. 53.
    Vagnoni V, Brunocilla E, Schiavina R, Borghesi M, Passaretti G, Gentile G, Fiorentino M, Martorana G. Inguinal canal tumors of adulthood. Anticancer Res. 2013;33(6):2361–8.PubMedGoogle Scholar
  54. 54.
    Coleman J, Brennan M, Alektiar K, et al. Adult spermatic cord sarcomas: management and results. Ann Surg Oncol. 2003;10:669–75.PubMedCrossRefGoogle Scholar
  55. 55.
    Brooks AD, Bowne WB, Delgado R, et al. Soft tissue sarcoma of the groin: diagnosis, management and prognosis. J Am Coll Surg. 2001;193:130–6.PubMedCrossRefGoogle Scholar
  56. 56.
    Faguendes MA, Zietman AL, Althausen AF, et al. The management of spermatic cord sarcoma. Cancer. 1996;77:1873–6.CrossRefGoogle Scholar
  57. 57.
    Ballo MT, Zagars GK, Pisters PW, et al. Spermatic cord sarcoma: outcome, patterns of failure and management. J Urol. 2011;166:1306–10.CrossRefGoogle Scholar
  58. 58.
    Longbotham JH, Joyce RP. Retroperitoneal liposarcoma presentino as spermatic cord tumor. Urology. 1987;30:276.PubMedCrossRefGoogle Scholar
  59. 59.
    Baldassarre E, Santacroce C, Barone M, Torino G, Siani A, Valenti GG, Chir G. Retroperitoneal well-differentiated liposarcoma presenting as an incarcerated inguinal. Hernia. 2007;28(8–9):315–7.Google Scholar
  60. 60.
    Forciea B. An eText of human anatomy and physiology, pp 232–6.Google Scholar
  61. 61.
    Gray H. Anatomy of the human body, pp 279–84.Google Scholar
  62. 62.
    Saladin KS. Human anatomy, McGraw Hill, pp 310–7.Google Scholar
  63. 63.
    Croce E, Olmi S. Chirurgia della parete addominale, Masson, pp 21–39.Google Scholar
  64. 64.
    George A, Grimer R. Early symptoms of bone and soft tissue sarcomas: could they be diagnosed earlier? Ann R Coll Surg Engl. 2012;94(4):261–6.PubMedPubMedCentralCrossRefGoogle Scholar
  65. 65.
    Ilaslan H, Schils J, Nageotte W, Lietman SA, Sundaram M. Clinical presentation and imaging of bone and soft-tissue sarcomas. Cleve Clin J Med. 2010;77(Suppl 1):S2–7.PubMedCrossRefGoogle Scholar
  66. 66.
    Johnson CJ, Pynsent PB, Grimer RJ. Clinical features of soft tissue sarcomas. Ann R Coll Surg Engl. 2001;83(3):203–5.PubMedPubMedCentralGoogle Scholar
  67. 67.
    Potter BK, Adams SC, Qadir R, Pitcher JD, Temple HT. Fungating soft-tissue sarcomas. Treatment implications and prognostic importance of malignant ulceration. J Bone Joint Surg Am. 2009;91(3):567–74.PubMedCrossRefGoogle Scholar
  68. 68.
    Fernández EL, Plasencia LD, Palma JP, Pallares AC. Giant ulcerated pleomorphic liposarcoma of the chest wall. J Thorac Oncol. 2007;2(12):1126–7.PubMedCrossRefGoogle Scholar
  69. 69.
    Valverde J, Vinagreiro M, Gouveia P, Koch P, Soares V, Gomes T. Sarcoma the great “masquerader” hematoma/deep vein thrombosis manifestation. Int J Surg Case Rep. 2016;28:348–51.PubMedPubMedCentralCrossRefGoogle Scholar
  70. 70.
    Niimi R, Matsumine A, Kusuzaki K, Okamura A, Matsubara T, Uchida A, Fukutome K. Soft-tissue sarcoma mimicking large haematoma: a report of two cases and review of the literature. J Orthop Surg (Hong Kong). 2006;14(1):90–5.CrossRefGoogle Scholar
  71. 71.
    Collin T, Blackburn AV, Milner RH, Gerrand C, Ragbir M. Sarcomas in the groin and inguinal canal—often missed and difficult to manage. Ann R Coll Surg Engl. 2010;92(4):326–9.PubMedPubMedCentralCrossRefGoogle Scholar
  72. 72.
    Bell RS, O'Sullivan B, Mahoney JL, Nguyen C, Langer F, Catton C. The inguinal sarcoma: a review of five cases. Can J Surg. 1990;33(4):309–12.PubMedGoogle Scholar
  73. 73.
    Bertelsen CA, Eilber FR. Paraneoplastic syndromes with soft-tissue sarcoma: a report of two unusual cases. J Surg Oncol. 1983;24(3):170–2.PubMedCrossRefGoogle Scholar
  74. 74.
    Bisagni G, Boni C, Fornaciari G, Gherlinzoni F. Soft tissues sarcoma with acute paraneoplastic hepatic dysfunction: case report. Tumori. 1996;82(5):499–501.PubMedGoogle Scholar
  75. 75.
    Buvarp Dyrop H, Vedsted P, Rædkjær M, Safwat A, Keller J. Routes to diagnosis for suspected sarcoma: the impact of symptoms and clinical findings on the diagnostic process. Sarcoma. 2016;2016:8639272.PubMedPubMedCentralCrossRefGoogle Scholar
  76. 76.
    Siegel GW, Biermann JS, Chugh R, Jacobson JA, Lucas D, Feng M, Chang AC, Smith SR, Wong SL, Hasen J. The multidisciplinary management of bone and soft tissue sarcoma: an essential organizational framework. J Multidiscip Healthc. 2015;8:109–15.PubMedPubMedCentralGoogle Scholar
  77. 77.
    Amini B, Jessop AC, Ganeshan DM, Tseng WW, Madewell JE. Contemporary imaging of soft tissue sarcomas. J Surg Oncol. 2015;111(5):496–503.PubMedCrossRefGoogle Scholar
  78. 78.
    Fenstermacher MJ. Imaging evaluation of patients with soft tissue sarcoma. Surg Oncol Clin N Am. 2003;12(2):305–32.PubMedCrossRefGoogle Scholar
  79. 79.
    Knapp EL, Kransdorf MJ, Letson GD. Diagnostic imaging update: soft tissue sarcomas. Cancer Control. 2005;12(1):22–6.PubMedCrossRefGoogle Scholar
  80. 80.
    Aga P, Singh R, Parihar A, Parashari U. Imaging spectrum in soft tissue sarcomas. Indian J Surg Oncol. 2011;2(4):271–9.PubMedPubMedCentralCrossRefGoogle Scholar
  81. 81.
    Caracciolo JT, Letson GD. Radiologic approach to bone and soft tissue sarcomas. Surg Clin North Am. 2016;96(5):963–76.PubMedCrossRefGoogle Scholar
  82. 82.
    Mayerson JL, Scharschmidt TJ, Lewis VO, Morris CD. Diagnosis and management of soft-tissue masses. Instr Course Lect. 2015;64:95–103.PubMedGoogle Scholar
  83. 83.
    Fadul D, Fayad LM. Advanced modalities for the imaging of sarcoma. Surg Clin North Am. 2008;88(3):521–37, vi.PubMedCrossRefGoogle Scholar
  84. 84.
    Chou SS, Hippe DS, Lee AY, Scherer K, Porrino JA, Davidson DJ, Chew FS, Ha AS. Gadolinium contrast enhancement improves confidence in diagnosing recurrent soft tissue sarcoma by MRI. Acad Radiol. 2017;pii:S1076-6332(17)30012-0.Google Scholar
  85. 85.
    Chan WP. Magnetic resonance imaging of soft-tissue tumors of the extremities: a practical approach. World J Radiol. 2013;5(12):455–9.PubMedPubMedCentralCrossRefGoogle Scholar
  86. 86.
    Kig DM, Hackbarth DA, Kilian CM, Carrera GF. Soft-tissue sarcoma metastases identified on abdomen and pelvis CT imaging. Clin Orthop Relat Res. 2009;467(11):2838–44.CrossRefGoogle Scholar
  87. 87.
    Trieu J, Schlicht SM, Choong PF. Diagnosing musculoskeletal tumours: how accurate is CT-guided core needle biopsy? Eur J Surg Oncol. 2016;42(7):1049–56.PubMedCrossRefGoogle Scholar
  88. 88.
    Benz MR, Tchekmedyian N, Eilber FC, Federman N, Czernin J, Tap WD. Utilization of positron emission tomography in the management of patients with sarcoma. Curr Opin Oncol. 2009;21(4):345–51.PubMedCrossRefGoogle Scholar
  89. 89.
    Kubo T, Furuta T, Johan MP, Ochi M. Prognostic significance of (18)F-FDG PET at diagnosis in patients with soft tissue sarcoma and bone sarcoma; systematic review and meta-analysis. Eur J Cancer. 2016;58:104–11.PubMedCrossRefGoogle Scholar
  90. 90.
    Strauss DC, Qureshi YA, Hayes AJ, Thway K, Fisher C, Thomas JM. The role of core needle biopsy in the diagnosis of suspected soft tissue tumours. J Surg Oncol. 2010;102(5):523–9.PubMedCrossRefGoogle Scholar
  91. 91.
    Traina F, Errani C, Toscano A, Pungetti C, Fabbri D, Mazzotti A, Donati D, Faldini C. Current concepts in the biopsy of musculoskeletal tumors: AAOS exhibit selection. J Bone Joint Surg Am. 97(2):e7.Google Scholar
  92. 92.
    Mankin HJ, Mankin CJ, Simon MA. Members of the musculoskeletal tumor society: the hazards of the biopsy, revisited. J Bone Joint Surg Am. 1996;78(5):656–63.PubMedCrossRefGoogle Scholar
  93. 93.
    Liu PT, Valadez SD, Chivers FS, Roberts CC, Beauchamp CP. Anatomically based guidelines for core needle biopsy of bone tumors: Implications for limb-sparing surgery. Radiographics. 2007;27(1):189–205, discussion 206.PubMedCrossRefGoogle Scholar
  94. 94.
    Pohlig F, Kirchhoff C, Lenze U, Schauwecker J, Burgkart R, Rechl H, von Eisenhart-Rothe R. Percutaneous core needle biopsy versus open biopsy in diagnostics of bone and soft tissue sarcoma: a retrospective study. Eur J Med Res. 2012;17:29.PubMedPubMedCentralCrossRefGoogle Scholar
  95. 95.
    C S, Png W, Tan MH. Accuracy of core needle biopsy for musculoskeletal tumours. J Orthop Surg (Hong Kong). 2013;21(1):92–5.CrossRefGoogle Scholar
  96. 96.
    Colletti SM, Tranesh GA, Whetsell CR, Chambers LN, Nassar A. High diagnostic accuracy of core needle biopsy of soft tissue tumors: an institutional experience. Diagn Cytopathol. 2016;44(4):291–8.PubMedCrossRefGoogle Scholar
  97. 97.
    Trieu J, Schlicht SM, Oncol CPFEJS. Diagnosing musculoskeletal tumours: how accurate is CT-guided core needle biopsy? Eur J Surg Oncol. 2016;42(7):1049–56.PubMedCrossRefGoogle Scholar
  98. 98.
    Coran A, Di Maggio A, Rastrelli M, Alberioli E, Attar S, Ortolan P, Bortolanza C, Tosi A, Montesco MC, Bezzon E, Rossi CR, Stramare R. Core needle biopsy of soft tissue tumors, CEUS vs US guided: a pilot study. J Ultrasound. 2015;18(4):335–42.PubMedPubMedCentralCrossRefGoogle Scholar
  99. 99.
    Shives TC. Biopsy of soft-tissue tumors. Clin Orthop Relat Res. 1993;289:32–5.Google Scholar
  100. 100.
    Dangoor A, Seddon B, Gerrand C, Grimer R, Whelan J, Judson I. UK guidelines for the management of soft tissue sarcomas. Clin Sarcoma Res. 2016;6:20. eCollection 2016PubMedPubMedCentralCrossRefGoogle Scholar
  101. 101.
    Randall RL, Bruckner JD, Papenhausen MD, Thurman T, Conrad EU III. Errors in diagnosis and margin determination of soft-tissue sarcomas initially treated at non-tertiary centers. Orthopedics. 2004;27(2):209–12.PubMedGoogle Scholar
  102. 102.
    Anastasiou I, Levis PK, Katafigiotis I, Karaolanis G, Palla VV, Felekouras E, Athanasiou A, Perdiki M, Mitropoulos D, Constantinides CA. High grade myofibroblastic sarcoma of paratesticular soft tissues. Case Rep Oncol Med. 2014;2014:Article ID 768379.Google Scholar
  103. 103.
    Radaelli S, Desai A, Hodson J, Colombo C, Roberts K, Gourevitch D, Gronchi A. Prognostic factors and outcome of spermatic cord sarcoma. Ann Surg Oncol. 2014;21:3557–63.PubMedCrossRefGoogle Scholar
  104. 104.
    Pisters PW, Leung DH, Woodruff J, Shi W, Brennan MF. Analysis of prognostic factors in 1,041 patients with localized soft tissue sarcomas of the extremities. J Clin Oncol. 1996;14:1679–89.PubMedCrossRefGoogle Scholar
  105. 105.
    Ballo MT, Zagars GK, Pisters PW, Feig BW, Patel SR, von Eschenbach AC. Spermatic cord sarcoma: outcome, patterns of failure and management. J Urol. 2001;166:1306–10.PubMedCrossRefGoogle Scholar
  106. 106.
    Rodríguez D, Aria F. Olumi Management of spermatic cord tumors: a rare urologic malignancy. Ther Adv Urol. 2012;4(6):325–34.PubMedPubMedCentralCrossRefGoogle Scholar
  107. 107.
    Enoch S, Wharton SM, Murray DS. Management of leiomyosarcomas of the spermatic cord: the role of reconstructive surgery. World J Surg Oncol. 2005;3:23.PubMedPubMedCentralCrossRefGoogle Scholar
  108. 108.
    Dangle P, Basavaraj DR, Bhattarai S, Paul AB, Biyani CS. Leiomyosarcoma of the spermatic cord: case report and literature review. Can Urol Assoc J. 2007;1:55–8.PubMedPubMedCentralGoogle Scholar
  109. 109.
    Balducci M, Di Rito A, Mantini G, Manfrida S, Chiesa S, Frascino V, D’Agostino GR, Valentini V, De Bari B. Role of radiotherapy in the treatment of fibrosarcoma of the spermatic cord: a case report and review of the literature. Tumori. 2011;97:e36–8.Google Scholar
  110. 110.
    Moroni M, Nesi G, Travaglini F, Rizzo M, Amorosi A, Dominici A. Rhabdomyosarcoma of the spermatic cord. A case report with review of the literature. Urol Int. 2003;71:114–7.PubMedCrossRefGoogle Scholar
  111. 111.
    Coleman J, Brennan M, Alektiar K, et al. Adult spermatic cord sarcomas: management and results. Ann Surg Oncol. 2003;10:669–75.PubMedCrossRefGoogle Scholar
  112. 112.
    Brooks AD, Bowne WB, Delgado R, et al. Soft tissue sarcoma of the groin: diagnosis, management and prognosis. J Am Coll Surg. 2001;193:130–6.PubMedCrossRefGoogle Scholar
  113. 113.
    Fagundes MA, Zietman LA, Althausen AF. The management of spermatic cord sarcoma. Cancer. 1996;77:1873–6.PubMedCrossRefGoogle Scholar
  114. 114.
    Kanso C, Roussel H, Zerbib M, Flam T, Debré B, Vieillefond A. Adult spermatic cord sarcoma: diagnosis and management. Prog Urol. 2011;21:53–8.PubMedCrossRefGoogle Scholar
  115. 115.
    Stewart RJ, Martelli H, Oberlin O, Rey A, Bouvet N, Spicer RD, et al. Treatment of children with nonmetastatic paratesticular rhabdomyosarcoma: results of the malignant mesenchymal tumors studies (MMT 84 and MMT 89) of the International Society of Pediatric Oncology. J Clin Oncol. 2003;21:793–8.PubMedCrossRefGoogle Scholar
  116. 116.
    Mizuno Y, Sumi Y, Nachi S, Ito Y, Marui T, Saji S, Matsutomo H. A case of a large retroperitoneal liposarcoma presenting as an incarcerated inguinal hernia. Hernia. 2006;10:439–42.PubMedCrossRefGoogle Scholar
  117. 117.
    Bhandarwar AH, Bakhshi GD, Borisa AD, Shenoy SS, Kori CG, Vora S. Giant recurrent retroperitoneal liposarcoma presentino as a recurrent inguinal hernia. Clin Pract. 2011;1:e130.PubMedPubMedCentralCrossRefGoogle Scholar
  118. 118.
    Hirofumi N, Yoshio N, Minoru H, et al. Retroperitoneal liposarcoma presenting as an indirect inguinal hernia. Acta Med Okayama. 2001;55:51–4.Google Scholar
  119. 119.
    Bognár G, Bereczky B, Barabás L, Diczházi C, Ondrejka P. Recurrent retroperitoneal liposarcoma presenting as an incarcerated femoral hernia. Magy Seb. 2009;62(1):30–3.PubMedCrossRefGoogle Scholar
  120. 120.
    Longbotham JH, Joyce RP. Retroperitoneal liposarcoma presenting as spermatic cord tumor. Urology. 1987;30:276–80.PubMedCrossRefGoogle Scholar
  121. 121.
    Baldassarre E, Santacroce C, Barone M, Torino G, Siani A, Valenti G. Retroperitoneal well-differentiated liposarcoma presentino as an incarcerated inguinal hernia. G Chir. 2007;28(8/9):315–7.PubMedGoogle Scholar
  122. 122.
    Karakousis CP. Abdominoinguinal incision and other incisions in the resection of pelvic tumors. Surg Oncol. 2000;9(2):83–90.PubMedCrossRefGoogle Scholar
  123. 123.
    Karakousis CP. The abdominoinguinal incision in limb salvage and resection of pelvic tumors. Cancer. 1984;54(11):2543–8.PubMedCrossRefGoogle Scholar
  124. 124.
    Miyamoto S, Fujiki M, Nakatani F, Kobayashi E, Sakisaka M, Sakuraba M. Reconstruction of complex groin defects after sarcoma resection. Ann Plast Surg. 2017;78(4):443–7.PubMedCrossRefGoogle Scholar
  125. 125.
    Radaelli S, Fiore M, Colombo C, Ford S, Palassini E, Sanfilippo R, Stacchiotti S, Sangalli C, Morosi C, Casali PG, Gronchi A. Vascular resection en-bloc with tumor removal and graft reconstruction is safe and effective in soft tissue sarcoma (STS) of the extremities and retroperitoneum. Surg Oncol. 2016;25:125e131.CrossRefGoogle Scholar
  126. 126.
    Schwarzbach MH, Hormann Y, Hinz U, Bernd L, Willeke F, Mechtersheimer G, Böckler D, Schumacher H, Herfarth C, Büchler MW, Allenberg JR. Results of limb-sparing surgery with vascular replacement for soft tissue sarcoma in the lower extremity. J Vasc Surg. 2005;42(1):88–97.PubMedCrossRefGoogle Scholar
  127. 127.
    Bonardelli S, Nadari F, Maffeis R, Ippolito V, Saccalani M, Lussardi L, et al. Limb salvage in lower-extremity sarcomas and technical details about vascular reconstruction. J Orthop Sci. 2000;5:555–60.PubMedCrossRefGoogle Scholar
  128. 128.
    McGoldrick NP, Butler JS, Lavelle M, Sheehan S, Dudeney S, O'Toole GC. Resection and reconstruction of pelvic and extremity soft tissue sarcomas with major vascular involvement: Current concepts. World J Orthop. 2016;7(5):293–300.PubMedPubMedCentralCrossRefGoogle Scholar
  129. 129.
    Hohenberger P, Allenberg JR, Schlag PM, Reichardt P. Results of surgery and multimodal therapy for patients with soft tissue sarcoma invading to vascular structures. Cancer. 1999;85(2):396e408.CrossRefGoogle Scholar
  130. 130.
    Ghert MA, Davis AM, Griffin AM, Alyami AH, White L, Kandel RA, Ferguson P, O'Sullivan B, Catton CN, Lindsay T, Rubin B, Bell RS, Wunder JS. The surgical and functional outcome of limb-salvage surgery with vascular reconstruction for soft tissue sarcoma of the extremity. Ann Surg Oncol. 12(12):1102–10.Google Scholar
  131. 131.
    Yfadopoulos D, Nikolopoulos D, Novi E, Psaroudakis A. Primary superficial femoral vein leiomyosarcoma: report of a case. Surg Today. 2011;41:1649–54.PubMedCrossRefGoogle Scholar
  132. 132.
    Roland CL, Boland GM, Demicco EG, Lusby K, Ingram D, May CD, Kivlin CM, Watson K, Al Sannaa GA, Wang W-L, Ravi V, Pollock RE, Lev D, Cormier JN, Hunt KK, Feig BW, Lazar AJ, Torres KE. Primary vascular leiomyosarcoma: clinical observations and molecular variables. JAMA Surg. 2016;151(4):347–54.PubMedPubMedCentralCrossRefGoogle Scholar
  133. 133.
    Schwarzbach MHM, Hormann Y, Hinz U, Leowardi C, Böckler D, Mechtersheimer G, d Helmut F, Büchler MW, Allenberg J-R. Clinical results of surgery for retroperitoneal sarcoma with major blood vessel involvement. J Vasc Surg. 2006;44(1):46–55.PubMedCrossRefGoogle Scholar
  134. 134.
    Emori M, Hamada K, Omori S, Joyama S, Tomita Y, Hashimoto N, Takami H, Naka N, Yoshikawa H, Araki N. Surgery with vascular reconstruction for soft-tissue sarcomas in the inguinal region: oncologic and functional outcomes. Ann Vasc Surg. 2012;26(5):693–9.PubMedCrossRefGoogle Scholar
  135. 135.
    Covarelli P, Boselli C, Burini G, Parente B, Loschi D, Lenti M, Rulli A. Sarcoma of the thigh: radical excision with arterial reconstruction using the contralateral saphenous vein. Ann Surg Oncol. 2015;22:S334.PubMedCrossRefGoogle Scholar
  136. 136.
    Poppler LH, Davidge K, Lu JC, Armstrong J, Fox IK, Mackinnon SE. Alternatives to sural nerve grafts in the upper extremity. Hand. 2015;10:68–75.PubMedCrossRefGoogle Scholar
  137. 137.
    Melendez M, Brandt K, Evans GR. Sciatic nerve reconstruction: limb preservation after sarcoma resection. Ann Plast Surg. 2001;46(4):375–81.PubMedCrossRefGoogle Scholar
  138. 138.
    Mackinnon SE. Surgical management of the peripheral nerve gap. Clin Plast Surg. 1989;16(3):587–603.PubMedGoogle Scholar
  139. 139.
    Kang S, Yoo HJ, Kim HS, Han I. Soft tissue sarcoma misdiagnosed as benign peripheral neurogenic tumor. J Orthop Sci. 2015;20(1):180–5.PubMedCrossRefGoogle Scholar
  140. 140.
    Tsuchihara T, Nemoto K, Arino H, Amako M, Murakami H, Yoshizumi Y. Sural nerve grafting for long defects of the femoral nerve after resection of a retroperitoneal tumour. J Bone Joint Surg Br. 2008;90(8):1097–100.PubMedCrossRefGoogle Scholar
  141. 141.
    Das Gupta TK, Brasfield RD. Solitary malignan-t Schwannoma. Ann Surg. 1970;171(3):419–28.PubMedPubMedCentralCrossRefGoogle Scholar
  142. 142.
    LoGiudice JA, Haberman K, Sanger JR. The anterolateral thigh flap for groin and lower abdominal defects: a better alternative to the rectus abdominis flap. Plast Reconstr Surg. 2014;133:162–8.PubMedCrossRefGoogle Scholar
  143. 143.
    Kayano S, Sakuraba M, Miyamoto S, et al. Comparison of pedicled and free anterolateral thigh flaps for reconstruction of complex defects of the abdominal wall: review of 20 consecutive cases. J Plast Reconstr Aesthet Surg. 2012;65:1525–9.PubMedCrossRefGoogle Scholar
  144. 144.
    Ninkovic M, Kronberger P, Harpf C, et al. Free innervated latissimus dorsi muscle flap for reconstruction of full-thickness abdominal wall defects. Plast Reconstr Surg. 1998;101:971–8.PubMedCrossRefGoogle Scholar
  145. 145.
    Johannesmeyer D, Smith V, Cole DJ, Esnaola NF, Camp ER. The impact of lymph node disease in extremity soft-tissue sarcomas: a population-based analysis. Am J Surg. 2013;206:289–95.PubMedCrossRefGoogle Scholar
  146. 146.
    Can Atalay Æ, Altinok M, Besim Seref Æ. The impact of lymph node metastases on survival in extremity. Soft tissue sarcomas. World J Surg. 2007;31:1433–7.PubMedCrossRefGoogle Scholar
  147. 147.
    Behranwala KA, A’Hern R, Omar AM, Thomas JM. Prognosis of lymph node metastasis in soft tissue sarcoma. Ann Surg Oncol. 2004;11(7):714–9.PubMedCrossRefGoogle Scholar
  148. 148.
    Sherman KL, Kinnier CV, Farina DA, Wayne JD, Laskin WB, Agulnik M, Attar S, Hayes JP, Peabody T, Peabody T. Examination of national lymph node evaluation practices for adult extremity soft tissue sarcoma. J Surg Oncol. 2014;110(6):682–8.PubMedCrossRefGoogle Scholar
  149. 149.
    Mentzel T, Calonje E, Wadden C, Camplejohn RS, Beham A, Smith MA, Fletcher CD. Myxofibrosarcoma. Clinicopathologic analysis of 75 cases with emphasis on the low-grade variant. Am J Surg Pathol. 1996;20(4):391–405.PubMedCrossRefGoogle Scholar
  150. 150.
    Wagner LM, Kremer N, Gelfand MJ, Sharp SE, Turpin BK, Nagarajan R, Tiao GM, Pressey JG, Yin J, Dasgupta R. Detection of lymph node metastases in pediatric and adolescent/young adult sarcoma: sentinel lymph node biopsy versus fludeoxyglucose positron emission tomography imaging—a prospective trial. Cancer. 2017;123(1):155–60.PubMedCrossRefGoogle Scholar
  151. 151.
    Andreou D. Sentinel node biopsy in soft tissue sarcome. In: Andreou D, Tunn PU, editors. Treatment of bone and soft tissue sarcomas. New York, NY: Springer; 2009. p. 25–36.CrossRefGoogle Scholar
  152. 152.
    Maduekwe UN, Hornicek FJ, Springfield DS, Raskin KA, Harmon DC, Choy E, Rosenberg AE, Nielsen GP, TF DL, Chen YL, Ott MJ, Yoon SS. Role of sentinel lymph node biopsy in the staging of synovial, epithelioid, and clear cell sarcomas. Ann Surg Oncol. 2009;16:1356–63.PubMedCrossRefGoogle Scholar
  153. 153.
    Blazer DG III, Sabel MS, Sondak VK. Is there a role for sentinel lymph node biopsy in the management of sarcoma? Surg Oncol. 2003;12:201–6.PubMedCrossRefGoogle Scholar
  154. 154.
    Ruka W, Emrich LJ, Driscoll DL, Karakousis CP. Prognostic significance of lymph node metastasis and bone, major vessel, or nerve involvement in adults with high-grade soft tissue sarcomas. Cancer. 1988;62:999–1006.PubMedCrossRefGoogle Scholar
  155. 155.
    Ecker BL, Peters MG, McMillan MT, Sinnamon AJ, Zhang PJ, Kelz RR, Roses RE, Drebin JA, Fraker DL, Karakousis GC. Implications of lymph node evaluation in the management of resectable soft tissue sarcoma. Ann Surg Oncol. 2017;24(2):425–33.PubMedCrossRefGoogle Scholar
  156. 156.
    Gaakeer HA, Albus-Lutter CE, Gortzak E, Zoetmulder FA. Regional lymph node metastases in patients with soft tissue sarcomas of the extremities, what are the therapeutic consequences? Eur J Surg Oncol. 1988;14(2):151–6.PubMedGoogle Scholar
  157. 157.
    Mazeron JJ, Suit HD. Lymph nodes as sites of metastases from sarcomas of soft tissue. Cancer. 1987;60:1800–8.PubMedCrossRefGoogle Scholar
  158. 158.
    Al-Refaie WB, Andtbacka RH, Ensor J, et al. Lymphadenectomy for isolated lymph node metastasis from extremity soft-tissue sarcomas. Cancer. 2008;112:1821–6.PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Stefano Radaelli
    • 1
  • Chiara Colombo
    • 1
  • Marco Fiore
    • 1
  • Alessandro Gronchi
    • 1
  1. 1.Sarcoma Service, Department of SurgeryFondazione IRCCS Istituto Nazionale dei TumoriMilanItaly

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