Schedule Slot

Soft tissue sarcomas are rare, heterogeneous malignancies that require accurate pre-therapeutic classification for optimal treatment planning. Ultrasound-guided core needle biopsy is widely used as a minimally invasive diagnostic method, but its reliability compared with open incisional biopsy remains debated.

In this single-center retrospective study, all patients who presented in 2021 to the Sarcoma Center Kiel (UKSH) with an indeterminate soft tissue or bone lesion and underwent ultrasound-guided core needle biopsy were identified. Inclusion criteria were a single sonography-guided core needle biopsy and subsequent surgical resection with histopathologic confirmation. Patients with coagulation disorders, terminal disease, infection, high-risk tumor location for ultrasound-guided access, or primary bone tumors were excluded. Core needle biopsy was performed with 14G automated core biopsy devices under ultrasound guidance. Diagnostic accuracy of core needle biopsy regarding tumor dignity (benign vs malignant), histologic subtype, and grading was calculated using the final resection histology as reference.

Twenty-eight patients underwent ultrasound-guided core needle biopsy, of whom 23 subsequently had surgical resection and were included in the primary analysis. Mean age was 61.96 ± 19.06 years (range 24–93), and 52.17% were female. Histopathologic diagnoses after resection most frequently included lipoma (n = 6), liposarcoma (n = 5), and pleomorphic sarcoma (n = 2); overall, 43.48% of tumors were soft tissue sarcomas. In 10 sarcoma cases, grading distribution was G3 in 50.0%, G1 in 30.0%, and G2 in 20.0%. Core needle biopsy achieved 100.0% accuracy for distinguishing benign vs malignant lesions and 100.0% concordance for histologic subtype and grading compared with resection specimens. In all nine cases, differentiation between G1 liposarcoma and lipoma by core needle biopsy was correct.

In this retrospective single-center cohort, ultrasound-guided core needle biopsy demonstrated excellent reliability for pre-therapeutic assessment of soft tissue tumors, including soft tissue sarcoma, with perfect concordance in dignity, subtype, and grading relative to resection histology. These findings support ultrasound-guided core needle biopsy as a safe, accurate, and resource-efficient standard diagnostic procedure in specialized sarcoma centers.

Soft tissue sarcomas (STS) are a heterogenous group of malignancies which require a complex treatment involving local excision and adjuvant therapies, of which the surgical one is of particular importance presenting different challenges both for the tumor excision as well as for the reconstructive procedure employed. The choice for reconstruction is strongly based on the tumor location, size and type, as well as the expected defect resulting after the wide excision and the struggle to achieve like-to-like reconstruction, while maintaining form and function.

We evaluated the surgical and reconstructive approaches used in our center by performing a retrospective analysis on 48 patients diagnosed with different types of STS which underwent surgery. We gathered their main demographical data, the frequency of each type of sarcoma, their localization as well as the reconstructive method preferred. Our hospital being mostly a trauma center we wanted to study the current status in this particular setting, the frequency and the particularities of STS that we are faced with as well as the opportunity of transforming into a referral center. As such, we have also obtained the hospital’s ethic committee approval.

The mean patient age was 59.47 and the most frequent site was that of the lower limb in 52% of cases, followed by the upper limb in 29.2% and the other regions in 18.75%.
When studying their histology we found a predominance of liposarcomas in 20.8% of cases, 16.7% fusiform cell sarcomas, 14.6% dermatofibrosarcoma protuberans, 10.4% leiomyosarcomas, 10.4% myxofibrosarcomas, 8.3% synovial, 8.3% undifferentiated, 4.16% epithelioid, 4.16% angiosarcomas and 2% Kaposi.
All of the cases required tumor excision - 31 cases by direct closure, 10 cases required flaps, 9 cases skin grafts (usually combined with flaps), while 2 patients necessitated amputation.

The treatment STS is a complex one and requires a multidisciplinary approach which needs to be tailored to the particularities and necessities of each patient. Whichever solution is chosen, obtaining free margins remains the most important element offering the chance of oncological cure while lowering the risk of recurrence. We treated most of our cases with limb-sparring techniques, using also microsurgical techniques, we had a small rate of recurrence, while leaving the amputations only to the most severe of cases.

Massive chest wall defects represent a complex reconstructive challenge requiring close collaboration between thoracic and reconstructive surgeons. This study aimed to identify factors influencing surgical outcomes following extensive chest wall resection, using clinical data and Patient-Reported Outcome Measures (PROMs).

We performed a retrospective analysis of a prospectively maintained database including 23 consecutive reconstructions of massive chest wall defects performed between 2014 and 2023 at two university hospitals. PROMs were assessed prospectively in a cross-sectional fashion and included the Dyspnea Functional Limitation-10a questionnaire and selected BODY-Q domains (psychological distress, chest appearance, and scar satisfaction).

Reconstruction was performed using 16 pedicled and 1 free latissimus dorsi flaps, 3 deep inferior epigastric perforator (DIEP) flaps, 2 anterolateral thigh (ALT) flaps, 1 pectoralis major flap, and 1 vertical rectus abdominis myocutaneous (VRAM) flap. Synthetic mesh was implanted in 14 patients, and 2 patients required titanium scaffolding. The mean defect size was 220 cm²; most patients underwent resection of 2–3 ribs and partial sternectomy. Postoperative complications included 1 total and 1 partial flap loss, 5 wound dehiscences, 1 venous congestion, 2 seromas, and 2 incisional hernias; 8 patients required revision surgery. Pulmonary complications occurred in 6 patients. Radiotherapy was associated with a higher rate of surgical complications (83.3% vs. 35.3%; OR 9.17), although this did not reach statistical significance (Fisher’s exact test, p = 0.07). Preliminary PROM analysis demonstrated no significant correlation between defect complexity and BODY-Q scores.

Defect size and flap type did not significantly influence patient-reported satisfaction with chest wall appearance following reconstruction. The latissimus dorsi flap remains the primary reconstructive option for most extensive chest wall defects. Free tissue transfer should be considered a valuable backup strategy, given the microsurgical complexity and the impact of respiratory dynamics.

Limb-sparing reconstruction of long distal extraarticular femoral defect after sarcoma resection is challenging, but preserve function and quality of life. The Capanna technique— combining a free vascularized fibula with allograft or extracorporeally irradiated autograft—aims to provide durable biological reconstruction. This study evaluates its mid- to long-term outcomes of consecutive femoral reconstructions using this method.

We retrospectively reviewed thirteen patients (7 female/6 male; median age 13 years, range 5–37) with thigh sarcomas who underwent intercalary reconstruction using the Capanna technique between 2011 and 2024. Median follow-up was 49 months (range 13–174). Data included tumor histology, metastases, neoadjuvant therapy, graft type, resection length, fixation, complications, union time, and functional results assessed using the Musculoskeletal Tumor Society (MSTS) score.

Metastatic disease was present at diagnosis in 4/13 (31%). Neoadjuvant therapy was administered in 11/13 (85%); among evaluable cases (n=9), histologic response was good in 7 (78%) and poor in 2 (22%). Negative surgical margins were achieved in 12/13 (92%) evaluable resections (one distal low-grade positive). Three-dimensional cutting guides were used in 12/13 (92%). Resection length had a median of 19.3 cm (range 12–28); the structural graft length was 19.3 cm (12–28), and the vascularized fibula length was 19 cm (13–25). Documented union occurred at a median of 11 months proximally (range 6–44) and 12.5 months distally (range 4–25). Functional outcome was favorable, with a median MSTS score of 26/30 (range 22–30).

The Capanna technique provides reliable biological reconstruction for patients with distal femoral sarcomas, achieving high union rates and excellent functional outcomes with acceptable complications, supporting its role as an effective limb-sparing option.

Atypical fibroxanthoma (AFX) is a rare low-grade cutaneous sarcoma, typically managed with surgical excision. While 1 cm margins have historically been recommended as the standard of care, our unit advocates 6 mm excision margins. We aimed to describe our AFX cohort, evaluate management and recurrence, and assess if a 6 mm margin is adequate to ensure complete excision and avoid further surgery.

A retrospective review of patients treated for AFX between October 2014 and December 2024 was performed. Demographics, tumour characteristics, operative margins, histological clearance, reconstruction, recurrence, and re-operation rates were recorded. Associations between operative margin and recurrence or second operation were analysed using chi-squared testing.

A total of 106 patients with AFX were identified during the study period. The mean age of the cohort was 77.4 years (range 36-96) and 91.5% of patients were male. 73.5% of lesions excised were located on the scalp. Mean follow-up was 30.5 months, ranging from 0-21 months. Operative excision margins ranged from 1–20 mm. The most frequently used margin was 6 mm (n=37, 39%), followed by 10 mm (n=28, 35%). Recurrence occurred in 3 patients (2.8%). There was no significant association between margins <5 mm or 6 mm and recurrence (p=0.355, p=0.198). A significant relationship was shown between a narrow histological peripheral margin (<1mm) and use of an operative margin less than 5mm (p=0.05). Data demonstrated that a 6 mm margin was not associated with an increased need for re-excision or second operation, however margins >6 mm were (p=0.04). Of the three recurrences, initial operative margins were 6mm and 20mm. In the third case, a 6mm margin achieved adequate excision margins (peripheral 1mm, deep 1.5mm); however excision of a further 6mm was performed.

AFX is a rare tumour with limited published data. Within this cohort, recurrence was low. Statistical analysis demonstrated that a 6mm excision margin was safe and not associated with recurrence or an increased requirement for re-excision or second operation in this cohort. Margins >6 mm increased resonstructive burden. Recurrence occurred in one patient treated with a 6mm excision margin, but was also observed in two patients with greater excision margins. Larger prospective studies may be beneficial to assess the safety of different surgical margins.

Atypical Fibroxanthoma (AFX) and Pleomorphic Dermal Sarcoma (PDS) are rare cutaneous spindle cell neoplasms that share overlapping histological features but differ in clinical behavior. AFX is typically confined to the dermis with an indolent course, whereas PDS may extend into subcutaneous tissue and carry a higher risk of recurrence and metastasis. This 10-year retrospective review analyzes the demographic and clinical profiles of patients diagnosed with AFX and PDS between 2012 and 2022.

A retrospective review of pathology and clinical follow-up data between 2012 and 2022 was performed. Information analyzed included patient demographics, anatomical tumor site, diagnosis, and treatment outcome. Cases with confirmed histopathological diagnosis of AFX or PDS were included.

Total cases reviewed: 73
Atypical Fibroxanthoma: 24 cases (32.9%)
Pleomorphic Dermal Sarcoma: 49 cases (67.1%)
Gender distribution:
Male: 59 (80.8%), Female: 14 (19.2%)
Age range: 47 – 91 years (Mean: ~73 years)
Anatomical site:
Scalp: 61% (most common site for both AFX and PDS),Forehead: 18%,Cheek/neck/ear: 21%
Treatment:
Wide local excision (WLE): 72%,Mohs micrographic surgery: 8%,Excision + reconstruction: 14%,Referral to tertiary MDT (multidisciplinary team): 6%
Recurrence and progression:
4 AFX cases (16.6%) recurred locally (no metastasis), 8 PDS cases (16.3%) showed aggressive or recurrent behavior, with 2 showing transformation from AFX to PDS.

AFX and PDS predominantly affected elderly males with a strong predilection for sun-exposed scalp regions. While both tumors were treated primarily by wide local excision, PDS demonstrated higher recurrence and progression rates than AFX. These findings support close clinical surveillance, particularly for lesions with subcutaneous invasion or recurrent AFX.

AFX and PDS both peak in elderly males on sun-exposed sites, highlighting cumulative UV exposure as a potential driver.The rate of local recurrence for PDS justifies aggressive excision margins and multidisciplinary follow-up.Occasional transformation from AFX to PDS underscores the continuum between these entities

Plexiform neurofibromas (PNFs) are benign tumors associated with neurofibromatosis type 1 (NF1) which may cause substantial functional and psychosocial morbidity. Surgical resection is often necessary but is technically challenging due to the dysplastic and diffuse vascularity of these lesions, with an infiltrative growing pattern higher risk of intraoperative bleeding. Surgical challenges are increased in elderly patients due to the presence of comorbidities and tissue fragility. We describe the surgical and hemostatic challenges associated with management of PNF in an elderly patient.

A 70-year-old female patient with NF1 presented with a progressively enlarging mass at the left flank causing significant contour asymmetry . A previous resection performed 20 years earlier had been complicated by severe intraoperative hemorrhage. Preoperative MRI revealed a subcutaneous PNF of 40x25 cm without neither muscle infiltration, nor neurological involvement. Following interdisciplinary consultation, the patient underwent partial resection of the mass via a hemicircular dermolipectomy approach.

Intraoperative hemostasis was challenging due to the diffuse vascular network and infiltrative growth pattern. Visible bleeding was mainly controlled using vascular clips. After layered suture of the skin an incisional negative pressure wound therapy device was applied to the surgical site. Intravenous tranexamic acid was administered postoperatively. A postoperative symptomatic hemoglobin drop required blood transfusion, otherwise the peri- and postoperative course was uneventful, with discharge of the patient at day 5. Histology confirmed the benign neurofibroma without atypia. Functional and cosmetic outcomes at 3 months postoperatively were satisfactory.

PNFs in elderly NF1 patients may pose distinct surgical challenges due to progressive tumor growth, extensive vascularity and tissue fragility. Meticulous hemostatic approach, combining electoro-coagulation, vascular clipping and antifibrinolytics is advantageous in surgical treatment of extensive NF-1 lesions and guarantees reduced perioperative morbidity and improved surgical outcomes