Frassica F J, Khanna J A, McCarthy E F
Department of Orthopedics and Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Magn Reson Imaging Clin N Am. 2000 Nov;8(4):915-27.
Soft tissue masses are common in both children and adults. Clinicians must evaluate patients carefully to avoid management errors. The most effective management decisions are made when a working group composed of clinicians, radiologists, and pathologists participates in the interpretation of the imaging studies. Plain-film radiographs and MR imaging scans are the two main imaging modalities used in patients with soft tissue masses. The working group assimilates the clinical and radiographic data to determine if they can identify the nature of the soft tissue mass. When the group can assign a definitive diagnosis, the lesion is designated as a determinate lesion. Determinate lesions include lipomas, ganglions, hemangiomas, neurofibromas, diabetic myonecrosis, muscle tears, myositis ossificans (heterotopic ossification), and pigmented villonodular synovitis. When the process cannot be identified, the lesion is classified as indeterminate. All soft tissue sarcomas are indeterminate lesions. Many benign lesions are also indeterminate. Common examples include schwannomas, myxomas, and giant cell tumor of tendon sheath. Based on the clinical and radiologic features, these diagnoses may be suspected, but because of the inability to distinguish them from sarcomas based on the MR imaging features, they are usually classified as indeterminate. When lesions are judged to be determinate, observation or excisional biopsy are the two major treatment choices. When lesions cannot be identified on the imaging studies, incisional or needle biopsy is performed to establish a diagnosis. Once a diagnosis is made, the proper management choice can be selected. Inappropriate excisional biopsy is the major treatment error in the management of soft tissue tumors. When a high-grade soft tissue sarcoma is resected with multiple positive margins, the risk of local failure after definitive resection is much higher than if the patient had been treated initially with only a needle or incisional biopsy. Also, if a major complication, such as an infection, a major wound-healing problem, or contamination of the major neurovascular structures, occurs at the time of incisional biopsy, amputation of the limb may be necessary. Inappropriate excisional biopsy can occur when a surgeon is not familiar with the features of sarcomas or when a radiologist mistakenly interprets the signal features as a benign lesion.
软组织肿块在儿童和成人中都很常见。临床医生必须仔细评估患者，以避免管理失误。当由临床医生、放射科医生和病理科医生组成的工作小组参与影像学研究的解读时，才能做出最有效的管理决策。平片X线摄影和磁共振成像扫描是软组织肿块患者使用的两种主要影像学检查方法。该工作小组整合临床和影像学数据，以确定他们是否能够识别软组织肿块的性质。当该小组能够做出明确诊断时，病变被指定为确定性病变。确定性病变包括脂肪瘤、腱鞘囊肿、血管瘤、神经纤维瘤、糖尿病性肌坏死、肌肉撕裂、骨化性肌炎（异位骨化）和色素沉着绒毛结节性滑膜炎。当无法识别病变过程时，病变被分类为不确定性病变。所有软组织肉瘤都是不确定性病变。许多良性病变也是不确定性病变。常见的例子包括神经鞘瘤、黏液瘤和腱鞘巨细胞瘤。根据临床和放射学特征，可能会怀疑这些诊断，但由于无法根据磁共振成像特征将它们与肉瘤区分开来，它们通常被分类为不确定性病变。当病变被判定为确定性病变时，观察或切除活检是两种主要的治疗选择。当在影像学检查中无法识别病变时，进行切开活检或针吸活检以确立诊断。一旦做出诊断，就可以选择合适的管理方案。不适当的切除活检是软组织肿瘤管理中的主要治疗错误。当高级别软组织肉瘤在切除时切缘多处阳性，最终切除后局部复发的风险比患者最初仅接受针吸活检或切开活检时要高得多。此外，如果在切开活检时发生重大并发症（如感染、严重的伤口愈合问题或主要神经血管结构的污染），可能需要截肢。当外科医生不熟悉肉瘤的特征或放射科医生错误地将信号特征解释为良性病变时，就会发生不适当的切除活检。
