What is the pathophysiology of metastasis in soft-tissue tumors?

Updated: Dec 03, 2018
  • Author: Vinod B Shidham, MD, FRCPath; Chief Editor: Omohodion (Odion) Binitie, MD  more...
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Answer

Regional lymph node involvement is rare in soft-tissue sarcomas; fewer than 4% of cases have nodal metastases at presentation. Lymph node involvement is more frequent in epithelioid sarcoma, rhabdomyosarcoma, synovial sarcoma, and clear cell sarcoma. Carcinoma and melanoma should be included in the differential diagnosis for any mass presenting with lymph node metastases.

Many patients with high-grade soft-tissue sarcomas, as well as a few with the low-grade type, progress to metastatic disease, even after adequate local control of the primary tumor has been achieved. The lung is by far the most common site of metastasis, which occurs in up to 52% of patients with high-grade lesions. [5]

Although most patients do not have clinically evident metastases at the time of presentation, they may have occult micrometastases that eventually manifest clinically. This would appear to be an impetus for the development of chemotherapeutic methods of systemic disease control. At present, however, this is a controversial area of investigation, and it is uncertain whether systemic chemotherapy can improve long-term survival rates for patients with high-grade sarcomas.


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