Instructional Course Lecture   |    
Instructional Course Lectures, The American Academy of Orthopaedic Surgeons - Evaluation, Diagnosis, and Classification of Benign Soft-Tissue Tumors*†
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*Printed with permission of The American Academy of Orthopaedic Surgeons. This articles will appear in Instructional Course Lectures, Volume 45, The American Academy of Orthopaedic Surgeons, Rosemont, Illinois, 1996.
†No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
‡Department of Orthopaedic Surgery, Johns Hopkins Medicine, 601 North Carolina Street, Baltimore, Maryland 21287—0882.
§420 Delaware Street, S.E., Minneapolis, Minnesota 55455.

An Instructional Course Lecture, The American Academy of Orthopaedic Surgeons
J Bone Joint Surg Am, 1996 Jan 01;78(1):126-40
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Lumps and bumps on the extremities and trunk are common presentations to physicians and surgeons. These growths range from benign neoplasms and cystic structures based in the epidermis and dermis to malignant neoplasms arising within the structures below the deep fascia. These soft-tissue lesions are classified according to the direction of differentiation of the mesenchymal tissue (Table I). Most soft-tissue lesions are benign; however, benign and malignant soft-tissue lesions can present in a similar fashion. In addition, the diverse lesions within the classification system and the unfamiliarity of many pathologists with soft-tissue lesions may make the correct diagnosis difficult. The annual incidence of new sarcoma cases in the United States is about 5000. While Enzinger and Weiss11 suggested that there are at least 100 benign soft-tissue tumors for every malignant tumor examined by a pathologist, the incidence of benign lesions is unknown. This heavy preponderance of benign lesions in patients presenting for medical care mandates that any physician who is planning to treat or excise such lesions be familiar with the characteristics of the potentially malignant mass in order to avoid compromising optimum treatment. Sarcomas may occur in the head and neck areas, the trunk, or the extremities. The buttock and thigh are the most common locations of the most frequent soft-tissue sarcomas. As many of these lesions occur in the extremities, the orthopaedist will see many of these patients and be expected to provide an appropriate workup, referral, or definitive treatment. Soft, mobile, well defined subcutaneous masses are usually benign. In general, one should consider any mass below the deep fascia as potentially malignant, particularly if the mass is firm and immobile. Soft-tissue neoplasms are not necessarily painful and may grow to a relatively large size in the buttock, shoulder girdle, or thigh before they are obvious to the patient. A history of rapid growth usually suggests a malignant process. However, characteristics evident on modern imaging studies may define the lesion as benign rather than malignant. We will describe the management of patients who have a soft-tissue mass, the classification and staging of benign neoplasms, and the common characteristics and recommended treatment of the most frequently encountered lesions as well as some of the more troublesome, less common lesions.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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