Common soft tissue tumor of extremities include: malignant fibrohistiocytomas (MFH), malignant peripheral nerve sheath tumor, angiosarcoma, and occasionally giant cell tumor of the bone.
Key elements to note: size and location of the tumor, relationship to adjacent neurovascular structures and bone, involvement of these structures, and lymph node status. Review recent imaging (x-ray/CT/MRI) results to guide the dissection.
Measure the length and circumference (including the circumference at the level of the tumor)
Carefully dissect the subcutaneous fat, muscles, and major arteries, veins, and nerves around the tumor
Once the extent of the tumor is determined, remove the entire area with a good margin of normal tissues.
Use blunt dissection to determine the tumor relationship with the structures previously mentioned.
Orderly sample the tumor so that the extent of tumor and relationship with neurovascular structure can be correlated microscopically later.
Quickly dissect the soft tissues from the rest of the extremity, looking for other foci of tumor or other lesions
Cut the major bones of the extremities longitudinally with a band saw to examine the tumor extension.
Received unfixed, labeled with the patient name, medical record number and “____”, is a ____ cm long right / left, upper / lower extremity amputated at _______ (e.g. ___ cm above the knee / mid lower leg / at ___ joint) with ___ cm ____ (i.e., tibia) bone shaft protruding from the soft tissue margin. The specimen includes a ___ cm segment of ___ (e.g. upper arm, forearm) with a maximum diameter of __ cm, and a __ cm ___ (e.g. hand). There is a well-healed ___ cm linear scar / biopsy site on the skin at _______ aspect overlying a visible / palpable soft tissue / bone mass. A large ___ (deeply seated / superficial) ___ (firm, fluctuant / soft) mass is palpable in _____ . A longitudinal incision is made and the blunt dissection reveals a __ x __ x __ cm, ___ (round / oval ) ___ (solid / cystic) ___ (cutaneous / subcutaneous / intramuscular) mass in the ____ (mid portion of the extremity) approximately __ cm from the closest proximal resection margin. The tumor is ___ (encasing / infiltrating into / in juxtaposition to / __ cm from) a nearby neurovascular bundle (or adjacent bone). The cut surface is _____ with ____ (punctuated necrosis / hemorrhage / cystic changes). Invasion of a large ____ (vessel) is noted. There are no / ___ separate satellite tumor nodules of ___ cm and ___cm in diameter in the soft tissue within ___ cm from the main tumor. Longitudinal slice of the _____ bone reveals ____ (changes) bone cortex and ____ (color, trabeculae) marrow. The ___ joint is ___. Representative sections are submitted as follows: