8_soft

124

Tumours of Bone and Soft Tissues

Soft Tissues (ICD‐O‐3 C38.1, 2, C47‐49) Rules for Classification There should be histological confirmation of the disease and division of cases by histological type and grade.

The following are the procedures for assessing T, N, and M categories: T categories Physical examination and imaging N categories Physical examination and imaging M categories Physical examination and imaging

Anatomical Sites 1. Connective, subcutaneous, and other soft tissues (C49), peripheral nerves (C47) 2. Retroperitoneum (C48.0) 3. Mediastinum: anterior (C38.1); posterior (C38.2); mediastinum, NOS (C38.3)

Histological Types of Tumour The following histological types are not included: Kaposi sarcoma ▪▪ Dermatofibrosarcoma (protuberans) ▪▪ Fibromatosis (desmoid tumour) ▪▪ Sarcoma arising from the dura mater, brain, hollow viscera, or parenchymatous organs (with the exception of breast sarcomas) ▪▪ Angiosarcoma, an aggressive sarcoma, is excluded because its natural ­history is not consistent with the classification.

▪▪

Regional Lymph Nodes The regional lymph nodes are those appropriate to the site of the primary tumour. Regional node involvement is rare and cases in which nodal status is not assessed either clinically or pathologically could be considered N0 instead of NX or pNX.

Soft Tissues

125

T – Primary Tumour TX Primary tumour cannot be assessed T0 No evidence of primary tumour

Extremity and Superficial Trunk T1 Tumour 5 cm or less in greatest dimension T2 Tumour more than 5 cm but no more than 10 cm in greatest dimension T3 Tumour more than 10 cm but no more than 15 cm in greatest dimension T4 Tumour more than 15 cm in greatest dimension Retroperitoneum T1 Tumour 5 cm or less in greatest dimension T2 Tumour more than 5 cm but no more than 10 cm in greatest dimension T3 Tumour more than 10 cm but no more than 15 cm in greatest dimension T4 Tumour more than 15 cm in greatest dimension Head and Neck T1 Tumour 2 cm or less in greatest dimension T2 Tumour more than 2 cm but no more than 4 cm in greatest T3 Tumour more than 4 cm in greatest dimension T4a Tumour invades the orbit, skull base or dura, central compartment viscera, facial skeleton, and or pterygoid muscles T4b Tumour invades the brain parenchyma, encases the carotid artery, invades prevertebral muscle or involves the central nervous system by perineural spread Thoracic and Abdominal Viscera T1 Tumour confined to a single organ T2a Tumour invades serosa or visceral peritoneum T2b Tumour with microscopic extension beyond the serosa T3 Tumour invades another organ or macroscopic extension beyond the serosa

Bone & Soft Tissues

TNM Clinical Classification

126

Tumours of Bone and Soft Tissues

T4a Multifocal tumour involving no more than two sites in one organ T4b Multifocal tumour involving more than two sites but not more then 5 sites T4c Multifocal tumour involving more than five sites

N – Regional Lymph Nodes NX Regional lymph nodes cannot be assessed N0 No regional lymph node metastasis N1 Regional lymph node metastasis

M – Distant Metastasis M0 No distant metastasis M1 Distant metastasis

pTNM Pathological Classification The pT and pN categories correspond to the T and N categories. For pM see page 8.

Stage – Extremity and Superficial Trunk and Retroperitoneum Stage IA Stage IB Stage II Stage IIIA Stage IIIB Stage IIIB Stage IV

T1 T2,T3,T4 T1 T2 T3, T4 Any T Any T

N0 N0 N0 N0 N0 N1* Any N

M0 M0 M0 M0 M0 M0 M1

G1, GX Low Grade G1, GX Low Grade G2, G3 High Grade G2, G3 High Grade G2, G3 High Grade Any G Any G

Note * AJCC classifies N1 as stage IV for extremity and superficial trunk.

Stage – Head and Neck and Thoracic and Abdominal Viscera There is no stage for soft tissue sarcoma of the head and neck and thoracic and abdominal viscera.