Benign Soft Tissue Tumors
Benign tumors of soft tissue are more common than benign tumors of bone. They can occur at almost any site, both within and between muscles, ligaments, nerves, and blood vessels. These tumors vary widely in appearance and behavior. Some tumors can be quite aggressive. Invasion of nearby tissues increases the chance of an incomplete excision and the possibility that the tumor will come back. Your surgeon may use specialized techniques and even radiation therapy to reduce the risk of recurrence.
Among the most common tumors which can be classified as benign soft tissue tumors are lipoma, angiolipoma, fibroma, benign fibrous histiocytoma, neurofibroma, schwannoma, neurilemmona, hemangioma, giant cell tumor of tendon sheath, and myxoma. Some conditions, like nodular fasciitis, are not tumors, but may require similar treatment. A small number of these tumors may be related to an underlying inherited condition.
The majority of the tumors in this category are benign tumors of fat called lipomas. Lipomas frequently occur just beneath the skin as a soft painless bulge which grows slowly over a period of months to years. These tumors represent very little risk to the patient and can be adequately treated by a "marginal excision" which is commonly described as "shelling out the tumor." This type of treatment has a high rate of success. However, not all of these lumps need to be removed. Your physician may determine that the lipoma needs only to be observed. Some of these lipomas are deep below the fascia or with the muscle group. Care needs to be taken to distinguish these deep "lipomas" from cancers and lower grade cancers.
In settings where the tumor is not a benign lipoma, the strategy of "shelling out the tumor" can spread a tumor, which might otherwise be easily treated by a more careful surgical procedure. Malignant tumors that are discovered unexpectedly can often be spread in this way.
Therefore, if the lump does not feel like a lipoma, if it is seen to grow, or causes pain, it should be assessed carefully and thoughtfully. Often the use of MRI scans can assist in determining both the location and the internal characteristics of the tumor.
A soft tissue mass, which does not have the appearance of a lipoma on MRI, needs to be approached more cautiously. Often, a minimally invasive biopsy is desirable, prior to commitment to any larger surgical procedure. The vast majority of benign soft tissue tumors can be treated with a single clean surgical procedure and minimal risk to surrounding normal blood vessels, nerves, muscle or bone. This provides the patient with the greatest possible functional recovery and the least chance of local recurrence of the tumor. In general, the orthopaedic surgeon should consider a biopsy before proceeding with an excision of a tumor. Only on rare occasions should the orthopaedic surgeon consider resection without a biopsy.
What are the symptoms?
Benign soft tissue tumors may or may not cause pain and vary widely in appearance. If the tumor grows or causes pain, it should be assessed by a doctor.
What are my treatment options?
Depending on the type of tumor you have, your doctor may or may not recommend surgery. Tumors are removed surgically with the goal of minimizing risk to surrounding normal blood vessels, nerves, muscle or bone.
What are the risks of surgery?
Risks include nerve injury, infection, bleeding, and stiffness.
How do I prepare for surgery?
- Complete any pre-operative tests or lab work prescribed by your doctor.
- Arrange to have someone drive you home from the hospital.
- Refrain from taking aspirin and non-steroidal anti-inflammatory medications (NSAIDs) one week prior to surgery.
- Call the appropriate surgery center to verify your appointment time. If your surgery is being done at Cleveland Clinic, call 216.444.0281.
- Do not eat or drink anything after midnight the night before surgery.
Are there exercises I can start now prior to surgery?
Patients with lower extremity procedures most likely will require crutches. Physical therapy, including crutch instruction, is easier to accomplish before the surgery.
What do I need to do the day of surgery?
- If you currently take any medications, take them the day of your surgery with just a sip of water.
- Do not wear any jewelry, body piercing, makeup, nail polish, hairpins or contacts.
- Leave valuables and money at home.
- Wear loose-fitting, comfortable clothing.
What happens after surgery?
A post-operative instruction sheet will be provided.
How long is the recovery period after surgery?
The recovery period depends upon the bone lesion and location. Wound healing takes about two weeks. If bone healing is necessary, the physician may require patients to protect the extremity for six weeks from major forces such as full weight-bearing.
What is the rehab after surgery?
Depending on the procedure, physical therapy for crutch use, range-of-motion and strengthening may be required.
How can I manage at home during recovery from the procedure?
Instructions from the physician will be provided. These will vary according to the procedure.
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