Cytogenetics of soft tissue tumors

The incidence of soft tissue sarcoma in Dakshina Kannada: study in a District Government Hospital

BACKGROUND

We present a retrospective study depicting the incidence and outcome of soft tissue sarcomas (STSs) in patients admitted in a District Government Hospital situated in coastal belt of Southern India for a period of four and a half years. The hospital is a district referral centre catering to rural and urban poor population of 1,900,000 people.

METHODS

Histologically proven soft tissue STS patients admitted in Department of General Surgery in District Government Wenlock Hospital, Mangalore, from January 2002 to July 2007 were included in the study. The incidence, age distribution, gender distribution, histological subtypes, site of tumour, and clinical outcome were the parameters studied. The above parameters were then compared with Memorial Sloan and Kettering Cancer Centre (MSKCC) study.

RESULTS

Fifty-one cases of STS were reported out of 7674 (0.65%) patients with cancer in the said period. Ninety percent belonged to adolescents and adult age group. Liposarcoma (18%) is the most common subtype followed by leiomyosarcoma, Ewings' sarcoma. 66.6% originated in the extremities and rest being intra-abdominal and retroperitoneal. The age of presentation was a decade less than MSKCC study. The alarming yet expected fact was 35% of patients came with delayed presentation of the disease and refusal for surgery. Thirty-nine percent of patients were treated surgically.

CONCLUSION

Majority of patients presenting to our institution in advanced stage of the disease, indicating ignorance, fear and reluctance for surgery; as well as economic constraints, that delay early detection and initiation of proper treatment. The incidence appears to be increasing, targeting the younger population. There is a definite need to incorporate drug trials in rural set up so that patients can be benefited.

Biological continuum of benign, atypical, and malignant mesenchymal neoplasms - does it exist?

The characterization of specific cytogenetic and molecular abnormalities in benign and malignant soft tissue tumours has increased our understanding and knowledge of the biology of these rare neoplasms in recent years and has led to the modification of a number of traditional classification schemes. Contrary to popular belief, it is reasonable to propose that there exists a molecular, genetic, and morphological continuum of benign, atypical, and malignant mesenchymal neoplasms. The identification of characteristic molecular changes in benign lipomas, lipomas with minimal atypia, and atypical lipomatous tumours, well-differentiated liposarcomas supports the hypothesis of a stepwise process in the pathogenesis of these neoplasms. Not only are these findings important for our understanding of the biology of soft tissue tumours, but they also may increase diagnostic and prognostic accuracy.