Diagnosis code soft tissue mass
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Large tumors that compress the neurovascular structures can cause edema due to the dilation of peripheral veins or decreased pulses distal to a site of arterial compression. A warm, red, swollen or fluctuant mass is typical of an abscess however, sarcomas can be warm to the touch secondary to tumor neovascularization and increased blood flow. When bleeding within a tumor occurs, blood is typically contained within the tumor capsule and rarely reaches the superficial tissues. Superficial bruising or ecchymosis is seen with a traumatic hematoma as it tracks along fascial planes. High-grade undifferentiated sarcoma in the wrist. In addition to localized pain, patients may experience neurogenic symptoms such as referred pain, paresthesia or a focal neurologic deficit if the mass compresses or incorporates a peripheral nerve. Thus, a benign tumor can be characterized as a “locally aggressive” tumor despite its inability to metastasize. When a benign tumor reaches a large size, it may result in the compression of vessels, nerves or vital organs. When symptoms do present, they are typically due to the size of the tumor causing mass effect on surrounding structures. Many practitioners mistakenly believe that there is no need for concern unless a mass is painful, when in fact, most malignant lesions are asymptomatic early on. A mass with a “waxing and waning” size suggests the presence of a ganglion cyst or hemangioma, but it is not typically a characteristic of a sarcoma. 16 A slowly growing mass suggests a benign nature, whereas, rapid growth over a period of weeks to months is concerning for a malignancy. Such symptoms are rarely present, even in patients with metastatic disease. A lack of co-existent constitutional symptoms such as fever, chills, night sweats or unintentional weight loss, should not lower the clinician’s index of suspicion for malignancy. Crystalline or inflammatory arthropathy, including Gout or rheumatoid arthritis, can also produce a red, warm and tender soft-tissue tophus or nodule.Ī common misconception is that patients with a malignant soft-tissue tumor will appear ill, as is often seen in patients with disseminated non-musculoskeletal malignancies. An abscess rises in the differential if the patient complains of constitutional symptoms in the setting of a slow healing wound or a rapidly enlarging, red, warm and tender mass. Antecedent trauma should be noted as a history of trauma suggests the presence of a hematoma or possibly myositis ossificans. Any changes in the size or growth rate of the mass should be noted, as well as any prior history of cancer. History taking should include questions designed to determine how long the mass has been present as well as the nature and duration of any associated symptoms. 3ĭespite the overlapping clinical features of benign and malignant soft-tissue tumors, in general, an accurate differential diagnosis can be formulated after a thorough history and physical exam has been performed. 2 Nearly one-third of sarcomas occur in the trunk and pelvis and 10% occur in the head and neck.
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Sarcomas occur more frequently in the lower extremities than in the upper extremities by a 2:1 ratio. In young adults, synovial sarcoma and epithelioid sarcoma are the most commonly diagnosed. When sarcomas occur in children, greater than 50% are Rhabdomyosarcomas. Soft-tissue sarcomas can occur at any age, although the majority are seen in patients 40 years of age or older. 1 Although carcinomas can potentially metastasize to the soft-tissues and lymphomas may occasionally invade muscle plains, malignant or cancerous tumors of the soft-tissues are collectively referred to as sarcomas. Most soft-tissue tumors are benign, outnumbering malignant tumors approximately 150:1 with roughly 20 malignant soft-tissue tumors per 1 million people in the United States. Soft-tissue tumors are common however, defining the true incidence of these tumors is difficult given that most go unrecognized or simply do not present for medical evaluation when the individual is unconcerned with the presence of an asymptomatic mass.