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Lymphadenopathy in Fungating Extremity Soft-Tissue Sarcoma: Metastasis or Reactive?

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Abstract

Background

Patients with fungating extremity soft-tissue sarcoma (STS) can develop lymphadenopathy, which can represent nodal metastasis or benign reactive adenopathy.

Methods

In 1787 patients with STS, 67 (3.7%) had fungating extremity STS. In the 62 patients who met our inclusion criteria, we evaluated prevalence and histopathology of lymphadenopathy, factors associated with lymphadenopathy and nodal metastasis, and prevalence of and factors associated with lung metastasis and survival time from fungation. Logistic regression and Cox proportional-hazards models were used to analyze node pathology, lung metastasis, and survival duration with α = 0.05.

Results

Lymphadenopathy occurred in 11 of 62 patients (18%), 6 with nodal metastasis and 5 with reactive adenopathy. The only factor associated with lymphadenopathy was location of primary tumor in the upper extremity (p = 0.02). No tumor characteristics were associated with nodal metastasis. In all five patients with reactive adenopathy, the condition was recognized within 3 days after tumor fungation. Lymphadenopathy recognized more than 3 days after tumor fungation was likely to be nodal metastasis. Forty-one percent of patients developed lung metastasis, which was not associated with presence of lymphadenopathy or any patient or tumor characteristic. Age, tumor size, and Black and Asian race were independently associated with greater risk of death.

Conclusions

Eighteen percent of patients with fungating extremity STS developed lymphadenopathy. Approximately half of cases represented nodal metastasis, and half represented reactive adenopathy. Lymphadenopathy that develops within 3 days after tumor fungation should increase suspicion for reactive adenopathy versus nodal metastasis.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Nicholas M. Siegel BS, Jad M. El Abiad MD, Carol D. Morris MD, MS & Adam S. Levin MD

  2. Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA

    Santiago A. Lozano-Calderón MD, PhD

  3. Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Carol D. Morris MD, MS & Adam S. Levin MD

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  1. Nicholas M. Siegel BS
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Correspondence to Adam S. Levin MD.

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Siegel, N.M., Lozano-Calderón, S.A., El Abiad, J.M. et al. Lymphadenopathy in Fungating Extremity Soft-Tissue Sarcoma: Metastasis or Reactive?. Ann Surg Oncol 28, 4695–4705 (2021). https://doi.org/10.1245/s10434-020-09305-9

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  • DOI: https://doi.org/10.1245/s10434-020-09305-9

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