Soft tissue tumours: imaging strategy
Hervé J Brisse1, Daniel Orbach, Jerzy Klijanienko
1Department of Radiology, Institute Curie, 26 rue d'Ulm, Paris 75005, France. herve.brisse@curie.net
Insights
Common pediatric soft-tissue masses include vascular and fibrous tumors, often managed conservatively. Rhabdomyosarcomas are the most frequent malignant tumors, requiring multidisciplinary care and advanced imaging like MRI for diagnosis and treatment planning.
Area of Science:
- Pediatric Oncology
- Diagnostic Imaging
- Soft Tissue Pathology
Background:
- Soft-tissue masses in children encompass a range of benign conditions like vascular and fibrous tumors, alongside malignant rhabdomyosarcomas.
- Rhabdomyosarcomas constitute approximately 50% of all childhood soft tissue sarcomas.
- Conservative management is suitable for most benign soft-tissue masses.
Purpose of the Study:
- To outline the diagnostic and management strategies for pediatric soft-tissue masses.
- To emphasize the importance of a multidisciplinary approach and appropriate imaging modalities.
Main Methods:
- Initial assessment involves clinical examination, conventional radiography, and Doppler ultrasonography (US).
- Magnetic resonance imaging (MRI) is crucial for evaluating tumor aggressiveness and extent when initial methods are insufficient.
- Tissue sampling decisions are guided by MRI findings.
Main Results:
- Benign soft-tissue masses (vascular, fibrous, fibrohistiocytic) are common and often treatable conservatively.
- Rhabdomyosarcomas represent the most prevalent malignant soft-tissue tumors in children.
- Early diagnosis and staging using imaging are critical for effective management.
Conclusions:
- A multidisciplinary team approach is recommended for pediatric soft-tissue masses.
- Primary excision without a definitive diagnosis should be avoided.
- MRI is essential for comprehensive tumor assessment and guiding further interventions, including biopsy.
Abstract:
Vascular tumours and malformations, fibrous and fibrohistiocytic tumours and pseudotumours are the most common benign soft-tissue masses observed in children, and can be treated conservatively. Rhabdomyosarcomas are the most frequent malignant tumours, accounting for about half of soft tissue sarcomas. A child referred for a soft-tissue mass should ideally be managed by a multidisciplinary team and primary excision should be proscribed until a definite diagnosis has been established. Clinical examination, conventional radiography and US with Doppler represent the first-line examinations and are sometimes sufficient to make a diagnosis. In all other situations, MRI is mandatory to establish the aggressiveness and extension of the tumour. This technique provides the relevant data to guide the decision regarding tissue sampling.
