World Health Organization Reporting System for Soft Tissue Cytopathology: Risk of malignancy and reproducibility of categories among observers.

INTRODUCTION: In 2024, the World Health Organization (WHO) is scheduled to publish the WHO Reporting System for Soft Tissue Cytopathology (WHORSSTC). This system establishes categories with well-defined definitions, criteria, and estimated risks of malignancy (ROMs) for soft tissue tumors. The estimates of ROM are based on a relatively small number of published studies. Interobserver reproducibility is not addressed in the reporting system even though reproducibility of a reporting system is highly important. METHODS: A manual search of one authors personal consultation files and teaching set (L.J.L.) was conducted for all cytologic specimens of soft tissue tumors accessioned between January 1, 1985 and December 31, 2022. Only cases with documented surgical pathology follow-up were included in the study. Slides from each case were evaluated independently by three cytopathologists with each case assigned to one of the WHORSSTC categories. A ROM for each of the WHORSSTC categories was calculated. Interobserver agreement was evaluated by the kappa and weighted kappa statistics. RESULTS: Risk for malignancy by category were: Category 1: 0%, Category 2: 28%, Category 3: 57%, Category 4: 47%, Category 5: 63%, and Category 6: 88%. Kappa statistics for agreement between raters varied from 0.2183 to 0.3465 and weighted kappa varied from 0.3778 to 0.5217. CONCLUSIONS: The WHORSSTC showed a progression of malignancy risk from the category "benign" (28%) to the category "malignant" (88%). Interobserver agreement was only fair.

Clinical activity in general practice before sarcoma diagnosis: an Australian cohort study.

BACKGROUND: Increased time to diagnosis in sarcoma is associated with poor prognosis and patient outcomes. Research is needed to identify whether opportunities to expedite the diagnosis of sarcoma in general practice exist. AIM: To examine pre-diagnostic GP clinical activity before sarcoma diagnosis. DESIGN AND SETTING: An Australian retrospective cohort study using hospital registry data (Australian Comprehensive Cancer Outcomes and Research Database [ACCORD]) linked to two primary care datasets (Patron and MedicineInsight). METHOD: The frequency of general practice healthcare utilisation events (general practice attendances, prescriptions, blood test, and imaging requests) were compared in 377 patients with soft tissue sarcoma (STS) and 64 patients with bone sarcoma (BS) in the year pre-diagnosis. Poisson regression models were used to calculate monthly incidence rate ratios (IRR) for the 24 months pre-diagnosis and estimate inflection points for when healthcare use started to increase from baseline. RESULTS: In the 6 months pre-diagnosis, patients with sarcoma had a median of 3-4 general practice attendances, around one-third had a GP imaging request (33% [n = 21] BS and 36% [n = 134] STS), and approximately one in five had multiple imaging requests (19% [n = 12] BS and 21% [n = 80] STS). GP imaging requests progressively increased up to eight-fold from 6 months before sarcoma diagnosis (IRR 8.43, 95% confidence interval [CI] = 3.92 to 18.15, P<0.001) and general practice attendances increased from 3 months pre-diagnosis. CONCLUSION: Patients with sarcoma have increased GP clinical activity from 6 months pre-diagnosis, indicating a diagnostic window where potential opportunities exist for earlier diagnosis. Interventions to help identify patients and promote appropriate use of imaging and direct specialist centre referrals could improve earlier diagnosis and patient outcomes.

Demographic and clinical profile of 1106 adult soft tissue sarcoma patients: A single institutional prospective database experience from India.

BACKGROUND: Adult soft tissue sarcomas (STS) are rare and diverse. Current management is based on limited literature from the West. Therefore, data from different geographical regions is required, including the low-middle-income countries. This is our experience managing adult sarcomas in the tertiary cancer center of North India. MATERIALS AND METHODS: This is a retrospective analysis of the structured sarcoma database of patients treated in the surgical oncology department between 1992 and 2020. The descriptive analysis includes demography, site distribution, diagnosis, histopathology variations, prior surgical interventions, and stage. RESULTS: A total of 1106 soft tissue sarcoma patients were treated in three decades. Age distribution was 13%, 43%, 31%, and 11% in <20, 21-40, and 41-60 and >60 years, respectively. The male-to-female ratio was 1.73. The anatomical distribution was 17%, 42%, 23%, 7%, 7%, and 3% in upper extremity, lower extremity, trunk, retroperitoneum, head and neck, and viscera, respectively. Overall, 49% of patients had undergone prior suboptimal surgeries at community hospitals. Common histology subtypes were synovial sarcoma (18%), undifferentiated pleomorphic sarcoma (UPS) (13%), dermatofibrosarcoma protuberans (12%), and liposarcoma (9%). A pathological discordance of 13% was identified between the initial and the final histologies. Overall, 61% of tumors were high-grade. Memorial Sloan Kettering Stages II and III were present in 33% and 35% of patients, respectively. CONCLUSIONS: This is one of the largest single institutional experiences of STS from the Asian population. Mostly young adults were affected with male preponderance. The lower extremity and trunk were common subsites. Frequent histologies were synovial sarcoma and UPS. A high rate of suboptimal surgical intervention at the community level and pathological discordance was noted. This study highlights the need to establish prospective structured databases for capturing quality information related to rare malignancies and providing insights for future research.

Treatments and prognostic factors for bone and soft tissue sarcoma in non-urban areas in Japan.

BACKGROUND: Although bone and soft tissue sarcoma is recognized as a rare cancer that originates throughout the body, few comprehensive reports regarding it have been published in Japan. PATIENTS AND METHODS: Bone and soft tissue sarcomas were tabulated from the Cancer Registries at eight university hospitals in the Chugoku-Shikoku region. Prognostic factors in cases were extracted in a single facility and have been analyzed. RESULTS: From 2016 to 2019, 3.4 patients with bone and soft tissue sarcomas per a general population of 100,000 were treated at eight university hospitals. The number of patients who underwent multidisciplinary treatment involving collaboration among multiple clinical departments has been increasing recently. In the analysis carried out at a single institute (Ehime University Hospital), a total of 127 patients (male/female: 54/73) with an average age of 67.0 y (median 69.5) were treated for four years, with a 5-year survival rate of 55.0%. In the analysis of prognostic factors by multivariate, disease stage and its relative treatment, renal function (creatinine), and a patient's ability of self-judgment, and a patient's mobility and physical capability were associated with patient prognosis regarding bone and soft tissue sarcomas. Interestingly, age did not affect the patient's prognosis (> 70 vs ≦ 70). CONCLUSIONS: Physical and social factors may affect the prognosis of patients with bone and soft tissue sarcomas, especially those living in non-urban areas.

Tumores y seudotumores primarios de la mano en adultos. Análisis epidemiológico de casos, manejo y evolución / Primary tumours and pseudotumors of the hand in adults. epidemiological analysis of cases, management and evolution

Resumen: Introducción: Los tumores en la mano son poco frecuentes y los tumores malignos son particularmente raros; sin embargo, las lesiones seudotumorales primarias de la mano, como gangliones, son muy frecuentes. La mayoría de los tumores que se encontraron en el hueso y tejido blando pueden presentarse de igual manera en la mano, pero su frecuencia y distribución es distinta. A pesar de la baja incidencia de los tumores benignos y malignos en la mano, éstos pueden ser localmente invasivos o comprometer su función. El objetivo principal de este estudio es determinar la epidemiología, tipos, localización y manejo de los tumores y seudotumores de la mano en adultos en población mexicana. Material y métodos: Se diseñó un estudio retrospectivo mediante revisión de expedientes clínicos de pacientes de nuestra institución con diagnóstico de tumores o seudotumores en la mano de Enero de 2007 a Diciembre de 2016 evaluando variables como edad, género, lateralidad, abordaje diagnóstico, estirpe histológica, localización y tratamiento. Resultados: Nuestro estudio comprende 215 pacientes con una edad promedio de 44.23 años, predominantemente mujeres. Los seudotumores son los que con más frecuencia se detectan (quiste sinovial), seguidos de los tumores benignos de tejido blando, tumores óseos benignos y, por último, los tumores malignos. Discusión: Después de todo, sólo sugerimos una clasificación para la mano que es sencilla y reproducible y dar orientación para el tratamiento. La necesidad de un sistema de clasificación es inminente para estandarizar los diagnósticos, guiar futuras investigaciones, enfocar tratamientos y preservar la función de la mano, independientemente de la epidemiología que se observe.

Abstract: Introduction: Tumors in the hand are rare, and malignant tumors in the hand are peculiar; However, primary pseudotumoral lesions of the hand, such as ganglion, are very frequent. Most of the tumors found in the bone and soft tissue can be presented in the same way in the hand but their frequency and distribution is different. Despite the low incidence of benign and malignant tumors in the hand, these can be locally invasive or compromise the hand function. The main objective of this study is to determine the epidemiology, types, location and management of tumors and pseudotumors of the hand in adults in the Mexican population. Material and methods: We designed a retrospective study by review of clinical records of patients in our institution with diagnosis of tumors or pseudotumors in hand from January 2007 to December 2016 evaluating variables such as age, gender, laterality, Diagnosis, histological lineage, localization and treatment. Results: Our study comprises 215 patients with an average age of 44.23 years, predominantly women. Pseudotumors are the most frequently encountered (synovial cyst), followed by benign soft tissue tumors, benign bone tumors, and, finally, malignant tumors. Discussion: After all we suggests a possible new classification for the hand that is simple, reproducible and give guidance for treatment. The need for a classification system is imminent to standardize diagnostics, guide future research, focus treatments and preserve hand function.

A fifty-year review of soft tissue sarcomas in Jamaica: 1958-2007 / Cincuenta años de revisión de los sarcomas de tejidos blandos en Jamaica: 1958-2007

OBJECTIVE: To determine the distribution of histologic subtypes of soft tissue sarcomas (STS) in Kingston and St Andrew, Jamaica, according to age and topography. METHODS: From the Jamaica Cancer Registry (JCR) archives, all cases of STS diagnosed between 1958 and 2007 were extracted. For each case, age, gender, histological diagnosis and anatomical site of tumour were recorded. Patients were categorized according to age at diagnosis as: children (0-14 years) and adults (> 14 years), and the distribution of histologic diagnoses with respect to age and anatomical site were analysed. RESULTS: There were 432 cases (67 children, 364 adults, one person of unknown age) of STS recorded in the JCR over the 50-year period (218 males, 214 females). The commonest STS in adults were "sarcoma, not otherwise specified [NOS]" (20.1%), malignant fibrous histiocytoma [MFH] (17.9%), fibrosarcoma (12.4%), liposarcoma (10.7%) and malignant peripheral nerve sheath tumour [MPNST] (10.2%). In children, they were neuroblastoma (38.8%), rhabdomyosarcoma (23.9%), "sarcoma, NOS" (9%), fibrosarcoma (6%) and MFH (6%). In adults, the lower limb was the commonest location, followed by trunk and/or upper limb for MFH, fibrosarcoma and liposarcoma, and head and neck for MPNST. In children, head and neck was the commonest site for rhabdomyosarcoma, head and neck and upper limb for MFH, retroperitoneum for neuroblastoma and trunk for fibrosarcoma. CONCLUSION: A high proportion of soft tissue sarcomas in Jamaica are unclassified and the anatomical distribution of common classified sarcomas shows some differences with the literature. Limited access to immunohistochemistry/molecular diagnostics and increasing core biopsy diagnosis may contribute to these phenomena.

OBJETIVO: Determinar la distribución de subtipos histológicos de sarcomas de tejido blando (STB) en Kingston y Saint Andrew, Jamaica, según la edad y la topografía. MÉTODOS: De los archivos del Registro de Cáncer de Jamaica, se extrajeron todos los casos de STB diagnosticados entre 1958 y 2007. Para cada uno de los casos, se registró la edad, el género, el diagnóstico histológico, y el sitio anatómico del tumor. Los pacientes fueron clasificados de acuerdo con la edad en el momento del diagnóstico, bajo las categorías de niños (0-14 años) y adultos (> 14 años), y se analizó la distribución de diagnósticos histológicos con respecto a la edad y el sitio anatómico. RESULTADOS: Se registraron 432 casos de STB (67 niños, 364 adultos, una persona de edad desconocida) en el JCR en un período de 50 años (218 varones, 214 hembras). Los STB más comunes en los adultos fueron "el sarcoma no especificado [NE]" (20.1%), el histiocitoma fibroso maligno [HFM] (17.9%), el fibrosarcoma (12.4%), el liposarcoma (10.7%), y el tumor maligno de la vaina del nervio periférico [TMVNP] (10.2%). En los niños, se trató de los neuroblastomas (38.8%), los rabdomiosarcomas (23.9%), "los sarcomas NE" (9%), los fibrosarcomas (6%), y los HFM (6%). En los adultos, los miembros inferiores fueron el lugar más común, seguido del tronco y/o los miembros superiores para el HFM, el fibrosarcoma y el liposarcoma; y la cabeza y el cuello para el TMVNP. En los niños, la cabeza y el cuello fueron el sitio más común para el rabdomiosarcoma; la cabeza, el cuello y los miembros superiores para el HFM; el retroperitoneo para el neuroblastoma; y el tronco para el fibrosarcoma. CONCLUSIÓN: Una proporción alta de sarcomas de tejidos blandos en Jamaica no están clasificados, y la distribución anatómica de sarcomas clasificados comunes muestran algunas diferencias con la literatura. El acceso limitado a los diagnósticos moleculares/inmunohistoquímicos, y el aumento de los diagnósticos centrales, pueden contribuir a estos fenómenos.

Recidiva local nos sarcomas de tecidos moles: fatores prognósticos / Local recurrence in soft tissue sarcoma: prognostic factors

OBJETIVO: Determinar os fatores prognósticos associados com a recorrência local nos pacientes submetidos a tratamento de sarcoma de tecidos moles em extremidades. MÉTODOS: Foram avaliados retrospectivamente 30 pacientes tratados por ressecção cirúrgica de sarcoma de tecidos moles localizados em extremidades, com seguimento 36,5 ± 12,2 meses. Foram avaliados como fatores prognósticos: idade, sexo, localização, profundidade, localização em compartimentos anatômicos, tamanho, manipulação prévia ao tratamento definitivo, margens cirúrgicas, grau de malignidade histológica, presença de necrose e invasão vascular à histologia. Estes fatores foram correlacionados com a ocorrência de recidiva local do tumor por uma análise univariada e multivariada, sendo considerados significativos valores de p = 0,05. RESULTADOS: A recorrência local apresentou correlação significativa, tanto na análise univariada como multivariada, com a localização extra-compartimental (p = 0,001) e com o alto grau de malignidade (p = 0,024). Não houve associação com a idade (p = 1,000), com o sexo (p = 1,000), com a localização em segmentos corporais (p = 0,544), com a profundidade (p = 0,288), com o tamanho (p = 0,694), com as margens cirúrgicas (p = 0,384), com a manipulação prévia (p = 0,461), com a presença de necrose (p = 0,461) ou invasão vascular (p = 1,000). CONCLUSÃO: A recorrência local apresentou correlação com a localização extra-compartimental e com o alto grau de malignidade dos tumores.

OBJECTIVE: To determinate the prognostic factors associated with the local relapse in patients treated for soft tissue sarcoma in extremities. METHODS: Retrospectively, 30 patients were evaluated after being treated with surgical resection of soft tissue sarcoma located in extremities, with a outcome of 36,5 ± 12,2 months. The prognostic factors evaluated were: age, sex, location, depth, location in the anatomic compartments, size, tumor previous manipulation, surgical margins, grade of histological malignance, presence of histological necrosis or histological vascular invasion. These factors were correlated with the local relapse of the tumor with a univariated and multivariated analysis with significance when p = 0,05. RESULTS: Local relapse presented significant correlaction in univariated and multivariated analysis with extra-compartimental location (p = 0,001) and with high grade histological malignance (p = 0,001). There was no significant association with age (p = 1,000), sex (p = 1,000), body location (p = 0,544), depth (p = 0,288), size (p = 0,694), surgical margins (p = 0,384), previous manipulation (p = 0,461), necrosis (p = 0,461) or with the presence of vascular invasion (p = 1,000). CONCLUSION: Local relapse presents correlaction with extra-compartimental location and with high grade malignancy tumors.

Apresentação clínica dos tumores sólidos mais comuns na infância e adolescência / Clinical presentation of the most common solid tumors in childhood and adolescent

O câncer infanto-juvenil é uma doença relativamente rara, sendo responsável por 0,5-3% do total de casos de câncer. Entretanto, ainda é causa de grande morbimortalidade em pacientes nessa faixa etária em nosso meio. Diagnóstico precoce e tratamento em centros especializados são essenciais para aumento da sobrevida em longo prazo. Objetivo: alertar o pediatra a respeito da importância do reconhecimento precoce das principais neoplasias malignas da infância e adolescência, dando ênfance à epedemiologia e apresentação clínica dos tumores sólidos. Métodos: foram selecionados 26 referências bibliográficas em pesquisa realizada nas base de dados Medline e no LILACS, em português, espanhol e inglês, utilizando-se as palavras-chave câncer infanto-juvenil, apresentação clínica, sobrevida.

Sarcomas de partes blandas en la infancia / Chilhood soft tissue sarcomas

Se revisaron los expedientes de 72 pacientes con diagnóstico de sarcoma de partes blandas, registrados entre 1980 y 1994 en el Instituto Nacional de Pediatría de México. La edad promedio entre los casos con rabdomiosarcoma fue de 5.9 años y de 10.3 años en los que tenían no-rabdomiosarcomas. El 86 por ciento de los casos correspondieron a rabdomiosarcomas y el 14 por ciento restante no-rabdomiosarcomas. El tipo histológico más común en los rabdomiosarcoma fue el embrionario, seguido por la variedad alveolar. El 95 por ciento de los rabdiomiosarcomas se diagnosticaron en estadio III y IV. Se revisaron dos grupos de tratamiento: un grupo de enfermos tratados entre 1980 y 1990 con el esquema VC (vincristina, actinomicina D y ciclofosfamida) y otro de pacientes tratados entre 1990 y 1994 con VACP (esquema VAC más cisplatino); no hubo diferencia entre uno y otro grupos en cuanto a la supervivencia (p = 0.11). Se detectaron 10 casos de sarcomas no-rabdomiosarcomas; el más frecuente (50 por ciento de los casos) fue el Schwanoma maligno; todos los pacientes acudieron en etapas avanzadas; de éstos, sólo cuatro se encuentran con vida

Sarcoma de partes blandas: estudio comparativo de dos decenios / Sarcoma of soft parts: a comparative study of two decades

Se revisan todos los pacientes con diagnostico histologico de sarcoma de partes blandas atendidos en el INOR, durante los anos 1963-1982, comparandose la incidencia, la distribucion por grupos etareos y el sexo, asi como la localizacion del tumor, la histologia, el tratamiento y la sobrevida. Se senala que las tasas de incidencia se mantuvieron sin variacion en el periodo asi como la atencion de pacientes en etapas tardias, pero que en el decenio 1973-1982, se logro un aumento de la sobrevida de los casos gracias al manejo multidisciplinario y a una metodologia adecuada de diagnostico y estadiamiento

Sarcomas de partes moles no adulto / Soft tissue sarcomas in adult patients

Os autores apresentam uma revisäo sobre sarcomas de partes moles (SPM), mostrando que säo tumores raros, com etiologia e epidemiologia pouco conhecidas, apesar de recentes avanços no campo da genética e biologia molecular. O diagnóstico dos SPM é de fácil realizaçäo por sua localizaçäo preferencial em membros, tronco, cabeça e pescoço, porém, muitas vezes seu tratamento é retardado por falta de um encaminhamento correto e rápido do paciente. Quanto ao estadiamento, além do tamanho do tumor (T), comprometimento linfonodal (N) e metástases (M), o grau de diferenciaçäo (G) tem fundamental importância. Quanto ao tratamento, até a década de 70, a cirurgia era a única arma disponível, mas, nos últimos anos, como na oncologia de um modo geral, a abordagem multidisciplinar através da associaçäo da radioterapia e quimioterapia, os resultados de tratamento com controle local e preservaçäo do membro tornaram-se animadores. Porém, o controle sistêmico da doença ainda é um desafio para o oncologista

Estudio estadístico de las neoplasias de la cavidad bucal / Statistical study of oral neoplasms

Las neoplasias bucales constituyen un grupo numeroso y variable de lesiones que deben ser conocidas profundamente por el estomatólogo, dada su responsabilidad en el diagnóstico de éstas; conocimiento que debe abarcar, además de las características clínicas, los aspectos relacionados con su frecuencia y características histológicas. Basado en estos elementos se realiza este estudio con los objetivos de determinar la incidencia de las neoplasias bucales en nuestro medio durante el período 1982 a 1988. Se analizaron los siguientes parámetros: clasificación de acuerdo con el tipo hístico, edad, sexo, localización anatómica y la correspondencia entre los diagnósticos clínicos e histológicos

Variáveis associadas com as neoplasias malignas dos tecidos moles da cavidade oral: estudo caso controle / Soft tissue in the oral cavity: A case-control study

Estudo caso controle realizado para identificar fatores de risco dos carcinomas dos tecidos moles da boca. Foram entrevistados trezentos e vinte e quatro pacientes, distribuidos em dois grupos, 162 com cancer dos tecidos moles da cavidade oral e 162 portadores de neoplasias maligna em outras localizaçöes, que se presume näo relacionadas às variáveis estudadas. Os dados coletados foram analisados por um modelo multivariado: regressäo logística para dados univariados, segundo técnica de Cordeiro e Paula(7). As provas estatística indicaram que os dois grupos eram homogêneos com relaçäo a fatores que poderiam conduzir a resultados tendenciosos. Foram consideradas trinta e duas variáveis e dezesseis mostraram-se associadas: história de tabagismo, serviço doméstico, trabalhoo externo, história de etilismo, continuidade no hábito de fumar, história de câncer anterior, anemia, uso prolongado de determinadas drogas, tocador de instrumento de sopro, portador de prótese móvel, consumidor de cerveja, ingestäo de pimenta, presença de dente estragado traumatizado, continuidade no hábito de beber, fumante de cigarros de papel e história de câncer familiar. A maior associaçäo foi verificada com o tabagismo, os expostos ao fumo apresentaram uma probabilidade de risco aproximadamente oito vezes maior do que os näo expostos. O trabalho externo, o serviço doméstico e a história de etilismo, também, se mostraram fortemente associados

Tumores del soma, 1981-1987 / Tumors of soma, 1981-1987

Se revisaron 323 historias clínicas de pacientes con afección tumoral, que fueron atendidos en el Servicio de Ortopedia del Hospital "Dr. Ernesto Guevara de la Serna" en el período comprendido entre 1981 y 1987, con el objetivo de conocer aspectos generales como edad, sexo y especificamente tipo de tumores, localización, síntoma inicial, tiempo transcurrido entre consulta, diagnóstico, etcetera

Tumores malignos de partes blandas estudio-clinico-patologico de 99 casos / Maling tumour of softhy parts: clinic patologic-study of 99 cases

Se presenta una revision de los tumores malignos de partes blandas en tres hospitales de la ciudad de La Paz, en un periodo de cinco a diez años. Las neoplasias mas frecuentes son el rabdomiosarcoma, el fibrosarcoma y el liposarcoma. Se presenta la frecuencia por sexo, edad, localizacion anatomica y, en algunos casos, el subtipo histologico. Se discuten los pocos casos diagnosticados como mesenquimoma maligno y del sarcoma indiferenciado. Los resultados se comparan con casuisticas de exterior

Sarcomas de partes blandas: análisis de su comportamiento / Soft tissue sarcomas: analysis of its behaviour

Se estudian 200 casos de sarcomas de partes blandas que abarcan las variedades histológicas más frecuentes inscriptas en el Instituto Nacional de Oncología y Radiobiología durante los años 1963 a 1972 conjuntamente con la información obtenida por el Registro Nacional del Cáncer acerca de estos tumores y los trabajos publicados por nuestro centro desde 1963 a 1983 para analizar el comportamiento de esta enfermedad, y llegar a la conclusión de que los tumores malignos de las partes blandas son lesiones que se observan con relativa poca frecuencia, pero su incidencia y mortalidad han tenido tendencia a elevarse constantemente en los últimos años. La enfermedad se observa en todas las edades de preferencia por encima de los 30 años, y predomina en el sexo masculino, y son los tipos histológicos fundamentales: fibrosarcoma, liposarcoma y rabdomiosarcoma. Los miembros inferiores ocupan el primer lugar en cuanto a localización, pero la enfermedad está muy estrechamente relacionada con la Histología. El sinoviosarcoma y el neurofibrosarcoma se comportan como las lesiones más agresivas por su alto poder de metastización y su elevado índice de metástasis pulmonares y ganglionares. El tratamiento más adecuado es el que contempla el empleo de las armas terapéuticas fundamentales: Cirugía, radiaciones y poliquimioterapia como un todo sincrónico, ajustable, donde se aplica cada una de ellas en el momento requerido. La supervivencia global de 5 años fue del 39%, que está en dependencia con la extensión y localización de la lesión, la edad de presentación, el tipo histológico, el grado de diferenciación tumoral y el tratamiento empleado, como factores fundamentales