History of present illness
According to patient he was alright
until 7 years back then he noticed a
swelling on proximal arm, initially it
was small in size, gradually it increased
in size and became huge within 4
There is no hx of trauma, fever, weight
loss and pain.
GPE, CVS, CNS, Respiratory, GIT & Urinary systems
Systemic symptoms such as fever, weight loss, and
night sweat are absent.
Past medical & Surgical History
He has operated three times for same mass.
He has received 3 dose of chemotherapy and radiation in 2017.
•5 sons & 2 daughter
Round shaped mass on anterolateral aspect of right
proximal arm , skin over the swelling is lost and
Margins of mass is red and there is no dilated vein
Previous surgical scar is present.
No visible muscle wasting of arm, forearm & wrist.
Evaluation for site of potential metastasis
Lymph nodes metastasis occur in less than 3 %
For extremity lesion lung is the principle site for
AJCC/UICC staging system for soft tissue sarcomas
T1: <5 cm
T1a: Superficial to muscular fascia
T1b: Deep to muscular fascia
T2: >5 cm
T2a: Superficial to muscular fascia
T2b: Deep to muscular fascia
N1: Regional lymph node involvement
Small low grade tumor <5 cm resected with 2 cm
margin may not require radiation
Adjuvant radiotherapy should be added to surgical
1. if excission margin is close
2. if extra muscular involvement is present
3. if local recurrence would result in sacrifice of major
neurovascular bundle or amputation.
It improves local recurrence but not survival
Can be given as brachytheraphy or intraoperative
Brachytheraphy for high grade lesion
External beam radiation therapy for large >5cm high or
low grade leission
Intraoperative radiotherapy can be given in case of
Can be given as preoperative and post operative
Can improve local control but not survival
Doxorubicin and Ifosfamide have response rate of 20%
Used only in advance disease
Combination with radiation or neoadjuvant therapy
Lung is most common site of mets.
Median survival after metastatic disease is 8 to 12
Resection of pulmonary mets can give 5 year survival
of 32 % if all mets can be removed
>3 mets poor prognosis