Jenkins Joanne M, Gupta Sanjay, Mahendra Ashish, Del Balso Christopher, Park Sam, Daniels Timothy, Halai Mansur
Department of Orthopaedics, Glasgow Royal Infirmary, Glasgow, G4 0SF, Scotland; Honorary Senior Clinical Lecturer, University of Glasgow, Scotland.
Department of Orthopaedics, Glasgow Royal Infirmary, Glasgow, G4 0SF, Scotland; Honorary Senior Clinical Lecturer, University of Glasgow, Scotland.
J Foot Ankle Surg. 2025 Jan-Feb;64(1):72-78. doi: 10.1053/j.jfas.2024.09.005. Epub 2024 Oct 5.
Fewer than 5 % of soft tissue sarcomas arise in the foot and ankle. It can be difficult to distinguish between benign and malignant lesions which leads to a delay in diagnosis. Initial inappropriate procedures limit options for limb salvage and increasing rates of local recurrence. Our aim is to improve understanding of the presentation and management of these rare tumors to reduce delays in diagnosis and decrease the occurrence of inappropriate or unwarranted procedures. A prospectively maintained database of 376 new referrals to the West of Scotland regional musculoskeletal oncology service for soft tissue lesions of the foot, ankle, and lower leg over a 10-year period was analysed retrospectively. An assessment was made of patient demographics, presentation, anatomical location, diagnosis, classification, management, and outcomes for all patients. Of all new referrals, 53.5 % were diagnosed with primary benign soft tissue tumors and 16 % with primary malignant soft tissue tumors. The most common primary benign tumor in our population was schwannoma (15.9 %) and primary malignant tumor was undifferentiated sarcoma (26.7 %). In the foot alone, soft tissue sarcomas most commonly occurred in the forefoot (44.4 %). The most common presenting complaints were rest pain and focal swelling. Symptoms were present for on average 7 months prior to referral. Death from disease in sarcomas was 41.7 % over a 10 year follow up period, higher than other body areas. Soft tissue sarcomas in the foot and ankle remain a diagnostic challenge. Local biopsies should only be performed following discussion with an oncology surgeon. We have provided a management protocol in order to reduce the number of inappropriate procedures performed in this group and expedite referral to specialist centres, optimising clinical outcomes and reducing the cost of litigation to healthcare services.
足部和踝关节发生的软组织肉瘤不到5%。良性和恶性病变难以区分，这导致诊断延迟。最初的不恰当治疗会限制保肢选择，并增加局部复发率。我们的目标是增进对这些罕见肿瘤的表现和治疗的了解，以减少诊断延迟，并减少不恰当或不必要治疗的发生。回顾性分析了一个前瞻性维护的数据库，该数据库包含了10年间转诊至苏格兰西部区域肌肉骨骼肿瘤服务中心的376例足部、踝关节和小腿软组织病变的新病例。对所有患者的人口统计学、表现、解剖位置、诊断、分类、治疗和结果进行了评估。在所有新转诊病例中，53.5%被诊断为原发性良性软组织肿瘤,16%被诊断为原发性恶性软组织肿瘤。在我们的研究人群中，最常见的原发性良性肿瘤是神经鞘瘤(15.9%)，原发性恶性肿瘤是未分化肉瘤(26.7%)。仅在足部，软组织肉瘤最常发生在前足(44.4%)。最常见的就诊主诉是静息痛和局部肿胀。症状出现至转诊的平均时间为7个月。在10年的随访期内，肉瘤的疾病死亡率为41.7%，高于身体其他部位。足部和踝关节的软组织肉瘤仍然是一个诊断难题。局部活检应仅在与肿瘤外科医生讨论后进行。我们提供了一个治疗方案，以减少该组中不恰当治疗的数量，并加快转诊至专科中心，优化临床结果，降低医疗服务的诉讼成本。
