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December 28, 2024
Soft tissue masses in children are a topic of significant concern for parents and caregivers. These growths can range from benign and harmless to serious and malignant.
This comprehensive guide will delve into the world of paediatric soft tissue masses, aiming to inform and reassure caregivers about what to expect and how to proceed when faced with such a diagnosis.
Soft tissue masses are abnormal growths or lumps that develop in the body’s soft tissues, including muscles, fat, fibrous tissue, nerves, and blood vessels. These masses can appear anywhere on the body and may vary significantly in size, texture, and mobility.
Soft tissue masses in children are relatively rare compared to adults, but their unique presentation and behaviour necessitate specialised care. These growths may be benign (non-cancerous), malignant (cancerous), or reactive (caused by inflammation or infection).
Pediatric soft tissue masses can vary widely in their nature and underlying causes. They are generally classified as either benign, malignant, or non-neoplastic. Here’s an overview of the common types:
Benign soft tissue masses refer to non-cancerous growths that develop in the soft tissues of the body, including muscle, fat, nerves, and blood vessels. These masses can present as lumps or bumps under the skin and are usually painless. Common types of benign soft tissue masses include lipomas, fibromas, and haemangiomas. Lipomas are the most common type and consist of fatty tissue growths, while fibromas are composed of fibrous tissue and may be associated with trauma or inflammation. Haemangiomas are made up of blood vessels and can appear as red or purple lumps on the skin.
In most cases, benign soft tissue masses do not require treatment unless they cause discomfort or affect function. However, it is important to have any new or changing mass evaluated by a healthcare professional to rule out any potential concerns for malignancy.
Malignant soft tissue masses refer to abnormal growths that develop in the body’s soft tissues, such as muscles, tendons, and fat. These masses are characterised by uncontrolled cell growth and have the potential to spread to other parts of the body, making them a serious health concern. Common types of malignant soft tissue masses include sarcomas, which can arise from any location in the body. Early detection and intervention are key in managing malignant soft tissue masses effectively and improving patient outcomes.
Reactive or inflammatory masses, also known as pseudotumors, are localised tissue reactions that mimic the appearance and behaviour of malignant tumours. These masses can be caused by a variety of factors, including infection, trauma, foreign bodies, or autoimmune disorders. While reactive masses are typically benign and non-cancerous, they can exhibit aggressive growth patterns that may raise concern for malignancy.
Here are the primary causes grouped by their underlying nature:
Vascular malformations are anomalies in blood vessels or lymphatic channels, such as haemangiomas and arteriovenous malformations. Cystic lesions are caused by developmental anomalies or tissue remnants, like dermoid cysts. Accessory or supernumerary structures refer to extra tissues, such as additional fingers or rudimentary limbs.
Abscesses are pockets of pus caused by bacterial infections, granulomas are chronic inflammation typically caused by tuberculosis or fungal diseases, and reactive lymphadenopathy is when lymph nodes swell due to nearby infections or systemic illnesses.
Hematomas are collections of blood caused by trauma that can resemble a soft tissue mass. Myositis ossificans is when abnormal bone forms in muscle tissue after trauma. Foreign Body Reactions are mass-like lesions caused by the body’s inflammatory response to retained foreign materials.
Neurofibromatosis Type 1 causes the growth of neurofibromas and malignant peripheral nerve sheath tumours (MPNST). Some familial syndromes, such as Li-Fraumeni and Beckwith-Wiedemann, may increase the risk of developing soft tissue masses.
While uncommon, some soft tissue masses in children are malignant and can arise due to mutations in cells that lead to uncontrolled growth.
The presentation of soft tissue masses varies based on their type, location, and underlying cause. Common symptoms include:
The diagnostic approach to pediatric soft tissue masses involves a systematic evaluation to differentiate between benign and malignant causes and to guide appropriate treatment. Below is a step-by-step approach:
When taking a patient’s history, it is important to note the onset and duration of the mass (whether it is congenital or acquired), any symptoms they are experiencing (such as pain or fatigue), and the growth pattern of the mass (slow growth is usually benign, rapid growth may indicate malignancy). It is also important to ask about any history of trauma or infections, as well as any family history of certain syndromes.
During the physical examination, the location, size, consistency, mobility, skin changes, and regional lymph nodes should be assessed to help determine the nature of the mass (benign or malignant).
Imaging methods like ultrasound, MRI, and CT are crucial for determining the size, depth, and nature of masses and their relationship to surrounding structures. Ultrasound is good for superficial and vascular lesions, while MRI is best for soft tissue masses. CT is useful for calcifications and bone involvement, but may not be preferred in children due to radiation exposure. X-ray is used to identify bone involvement and other options like Doppler ultrasound and PET-CT are used for evaluating vascular flow and detecting malignancies and metastases.
A biopsy is important for accurately diagnosing suspected malignant tumours. Different types include fine needle aspiration for lymphadenopathy, core needle biopsy for soft tissue tumours, excisional biopsy for small masses, and incisional biopsy for large or deep masses.
Complete Blood Count (CBC) is used to check for anaemia, infection, or leukaemia-related masses, while inflammatory markers like C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are used for infections. Serum tumour markers like Alpha-fetoprotein (AFP) or lactate dehydrogenase (LDH) can detect specific tumours, and cultures are done for febrile masses with suspected sepsis.
Histopathology confirms tumour type and malignancy, IHC identifies specific markers for tumour origin, and cytogenetics and molecular studies detect genetic abnormalities in the tumour.
In suspected malignancies or complex cases, a multidisciplinary team approach is critical, involving:
Regular follow-up appointments are essential to monitor the response to treatment and check for any signs of recurrence. Imaging tests and clinical evaluations are conducted to assess the progression of the condition and identify any potential complications.
Treatment depends on the type, size, location, and nature of the mass. Options include:
Multi-disciplinary treatment planning for paediatric soft tissue masses involves a team of healthcare professionals collaborating to determine the most effective treatment plan for each case. By considering factors such as the type and location of the tumour, stage of disease, potential risks and benefits of different treatments, and patient preferences, multi-disciplinary teams can offer a holistic approach to care for young patients. This collaborative effort helps ensure children receive the best possible care and achieve optimal outcomes in their treatment journey.
Targeted therapies and immunotherapy have transformed treatment for paediatric soft tissue masses, providing more effective and less toxic options than traditional chemotherapy. These personalised approaches target specific molecules or pathways crucial for cancer cell growth while sparing normal cells, improving survival rates and quality of life for young patients. Tyrosine kinase inhibitors, monoclonal antibodies, and immune checkpoint inhibitors are showing promise in certain soft tissue sarcomas, reducing long-term side effects associated with conventional treatments.
However, challenges remain in identifying suitable targets and overcoming resistance mechanisms to ensure sustained efficacy. Continued research and clinical trials are essential to further optimize targeted therapies and immunotherapy for paediatric soft tissue masses.
Surgical removal and reconstruction of soft tissue masses in children is a complex procedure that requires careful planning, skilled surgeons, and meticulous post-operative care. Early detection and treatment are important due to the range of benign and malignant masses. The surgical team must evaluate the mass carefully before determining the best method of removal, with a focus on preserving healthy tissues during surgery to reduce complications.
Reconstruction techniques may involve skin grafts, flaps, or other methods to restore function and cosmesis while minimising scarring. Post-operatively, close monitoring and follow-up care are essential to ensure optimal healing and long-term outcomes for paediatric patients undergoing surgical excision for soft tissue masses.
Chemotherapy and radiation therapy are commonly used in the treatment of paediatric soft tissue masses, which can include tumours such as rhabdomyosarcoma, synovial sarcoma, or malignant fibrous histiocytoma. Chemotherapy involves the use of powerful drugs to target and destroy cancer cells throughout the body. This treatment is often used in combination with surgery and/or radiation therapy to improve outcomes for patients.
Radiation therapy uses high-energy beams to kill cancer cells at specific locations within the body. Both chemotherapy and radiation therapy come with potential side effects such as nausea, fatigue, hair loss, and an increased risk of infection.
However, these treatments have been shown to be effective in shrinking tumours, preventing recurrence, and improving survival rates among children with soft tissue masses. It is crucial for healthcare professionals to closely monitor patients undergoing these treatments and provide comprehensive supportive care to manage any adverse reactions they may experience.
The outlook depends on the type of mass, its location, and whether it is benign or malignant. Most benign masses have an excellent prognosis with appropriate treatment or observation. Early detection and aggressive treatment improve survival rates for malignant masses.
Regular follow-up appointments are crucial to monitor for recurrence or complications. Long-term follow-up may include imaging and physical examinations, particularly for malignant masses.
Facing a diagnosis of a soft tissue mass for a child can be overwhelming for families. Support systems and resources can make the journey more manageable which can include:
Paediatric soft tissue masses encompass a wide spectrum of conditions, ranging from benign and self-limiting to serious and life-threatening. Early recognition, accurate diagnosis, and timely treatment are vital to ensure the best outcomes for affected children. By staying informed and working closely with healthcare providers, families can navigate this challenging journey with confidence and hope.
If you suspect your child has a soft tissue mass, consult a paediatrician or specialist promptly to determine the next steps in care.
The most common paediatric soft tissue tumour is rhabdomyosarcoma, a malignant tumour originating in skeletal muscle.
Rhabdomyosarcoma is a malignant tumour of soft tissues arising from immature skeletal muscle cells, commonly affecting children and adolescents.
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