Research Article | Volume 8 - Issue 1 | Article DOI :
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Chigblo S. Pascal¹*, Odry Agbessi¹, Hamza Gaya¹, Abiodun Padonou¹, François Amossou², Oswald Goukodadja¹, Aristote Hans-Moevi Akue¹, and Claude Schwartz³
¹Department of Orthopaedic and Trauma, CNHU-HKM, Cotonou, Benin
²Department of Surgery, CHUD-OP Porto-Novo, Benin
³Clinique des Trois Frontières, Saint-Louis, France
Corresponding Author:
Chigblo S Pascal, Department of Orthopaedic and Trauma, CNHU-HKM, Cotonou, Benin
Keywords
Tumors; Soft Parts; Benign; Malignant; Imaging.
Abstract
Introduction: Soft tissue tumors of the musculoskeletal system are uncommon. They include a large heterogeneous group of extraskeletal mesenchymal neoplasm lesions. The aim of this work was to establish their epidemiological and clinical profile in Cotonou
Methodology: This is a retrospective study of all the patients admitted to the traumatology-orthopedics department of Benin reference hospital. For tumors of the soft tissues of the musculoskeletal system over a period of thirteen years (2009-2021). Only complete files were considered.
Results: 55 patients were selected. The average age was 39.7 years. The predominance was slightly male with a sex ratio of 1.2. Reasons for consultation, included swelling (52cases), pain (18cases), aesthetic (8cases) or functional discomfort (3cases). Ulcerations were noted in 8 cases. The tumors were less than 5 cm in 40 cases and greater than 5 cm in 15cases. Tumors were more common in the head (8cases), wrist (8cases), foot (7cases), hand (6cases) or knee (6cases). The radiological assessment included standard radiography (36cases), ultrasound (14cases), computed tomography (4cases) and MRI (2cases). There were 51 cases of benign tumors and 04cases of malignant tumors. Benign tumors were dominated by lipomas (24cases) and cysts (15cases). As malignant tumors, we found, a liposarcoma, a rhabdomyosarcoma, a melanoma, a squamous cell carcinoma.
Conclusion: Tumors of the soft tissues of the musculoskeletal system are infrequent in Cotonou. They present a varied epidemiological profile and clinical aspects. The low MRI completion rate in imaging evaluation remains a real challenge in our working conditions. Ulcerated tumors are potentially malignant tumors.
Citation
Pascal CS, Agbessi O, Gaya H, Padonou A, Amossou F et al. (2025) Epidemiology of Musculoskeletal Soft Tissue Tumors in Cotonou. SM J Orthop 8: 3.
INTRODUCTION
Soft tissue tumors are abnormal cell proliferation developed to the detriment of connective tissue and its differentiated varieties which are adipose tissue, muscle tissue, vascular tissue, synovial tissue, aponeurotic tissue and the envelopes of the peripheral nerves [1,2]. They include benign tumors, which are frequent and histologically varied, and malignant tumors that are much rarer [2-6]. Some tumors are intermediate in nature, exhibiting locally aggressive behaviour, with a low to moderate tendency to metastasize [3]. Their diagnosis is first clinical but in front of the fear of the discovery of a sarcoma, a biopsy will often be necessary [7,8]. The purpose of this work was to establish their epidemiological and clinical profile at the Benin reference hospital [9].
MATERIAL AND METHOD
This was a retrospective, descriptive and analytical study, carried out in the department of trauma-orthopaedics and reconstructive surgery of the National University Hospital of Cotonou. It includes records of patients admitted for soft tissue tumours over a 13 - years period from January 2009 to December 2021 [10]. These records had to be complete, including personal, history, clinical and paraclinical data. The data were compiled and analyzed using EXCEL 2016 software. The STROBE guidelines [11] were followed in the development of this work.
RESULTS
Fifty-five files (55 patients) were retained, representing an incidence of 4.23 cases per year. There were 30 men and 25 women, i.e. a sex - ratio of 1.2. The average age was 39.74 years with extremes of 15 and 67 years. Three age peaks were noted (Figure 1). Swelling was the main reason for consultation, found in 52 cases, or 94.55 %. It was associated with pain in 18 cases, or 32.73 %. An aesthetic concern (8 cases) or functional deficiency (3 cases) was also found (Figure 2). Clinically, all patients were in good general condition; a fever was noted in one case (on an ulcerated and infected tumour).
Figure 1: Distribution of patients by age.
Figure 2: Distribution of patients according to their complaints.
Tumours were most often located in the head (8 cases), wrist (8 cases), foot (7 cases), hand (6 cases) and knee (6 cases). Overall, the upper limb was affected in 38.2 %, the lower limb in 34.5 %, the head and trunk in 27.3 % (Table I). The mean tumour size was 5 cm with extremes of 1.2 cm and 19.1 cm. The tumour size was less than 5 cm in 40 cases (72.7 %) and greater than 5 cm in 15 cases (27.3 %). Tumours were ulcerated in 8 cases (14.5 %). There were 5 tumours over 5 cm and 3 tumours under 5 cm. As imaging, standard radiography was performed in 36 cases (65.4 %), ultrasound was performed in 14 cases (25.4 %), CT scan was performed in 4 cases (7.3 %) and magnetic resonance imaging was performed in 2 cases (3.7 %) There were 51 cases (92.7 %) of benign tumours and 4 cases of malignant tumours (7.3 %). Benign tumors were dominated by lipomas (24 cases or 43.6 %) and cysts (15 cases or 27.3 %). Table 2 shows the distribution of the different tumor types. The malignant tumors were all ulcerated.
Table 1: Distribution according to the location of the tumor.
|
|
Number
|
Percentage
|
|
Upper limb (21 cases)
|
Arm
|
3
|
5,45
|
|
Elbow
|
1
|
1,82
|
|
Forearm
|
3
|
5,45
|
|
Wrist
|
8
|
14,55
|
|
Hand
|
6
|
10,91
|
|
Lower limb (19 cases)
|
Thigh
|
4
|
7,27
|
|
Knee
|
6
|
10,91
|
|
Leg
|
2
|
3,64
|
|
Foot
|
7
|
12,73
|
|
Head – Trunk (15 cases)
|
Head
|
8
|
14,55
|
|
Neck
|
3
|
5,45
|
|
Chest
|
3
|
5,45
|
|
Lumbar
|
1
|
1,82
|
|
Total
|
|
55
|
100,00
|
Table 2: Distribution by type of tumor.
|
|
|
Number
|
Parentage
|
|
Benign tumors (51 cases)
|
Lipoma
|
24
|
43,64
|
|
Synovial Cyst
|
7
|
12,73
|
|
Dermoid Cyst
|
6
|
10,91
|
|
Mucoid Cyst
|
2
|
3,64
|
|
Fibromatosis
|
1
|
1,82
|
|
Hemangioma
|
1
|
1,82
|
|
Lymphangioma
|
2
|
3,64
|
|
Neurofibroma
|
2
|
3,64
|
|
Tuberculous Nodule
|
1
|
1,82
|
|
Schwannoma
|
2
|
3,64
|
|
Giant Cell Tumor
|
1
|
1,82
|
|
Botryomycoma
|
2
|
3,64
|
|
Malignant tumors (04 cases)
|
Rhabdomyosarcoma
|
1
|
1,82
|
|
Liposarcoma
|
1
|
1,82
|
|
Melanoma
|
1
|
1,82
|
|
Squamous Cell Carcinoma
|
1
|
1,82
|
|
Total
|
|
55
|
100,00
|
DISCUSSION
For 55 patients selected, the mean age was 39.7 years and the sex - ratio 1.2. Dabak in Turkey found an average age of 40.3 years and a sex ratio of 0.8, while Resit in the same country observed an average age of 45.5 years and a sex - ratio of 0.5 [4,12]. Gogi in India found an average age of 37.9 years and a sex ratio of one [7]. Closer to us in Nigeria, Babatundé obtained, in his study on anatomopathological analyses, an average age of 33.5 years and a sex - ratio of 0.8 [1]. It appears from all these studies that soft tissue tumors concern young subjects with an average age in the range of 30 to 45 years and a relatively variable sex - ratio [13]. Clinically, swelling and pain were the main reasons for consulting soft tissue tumours. They were found respectively in 94.5 % and 32.7 % in our series. In India, they were found respectively in 100 % and 33.3 % [7]. In Morocco, they represented respectively 95 % and 21 % of cases [14]. In addition, aesthetic discomfort was noted in 4 % in India against 14.5 % in our series.
Our patients were all in good general condition and fever was found in only one case, one that was ulcerated. Squalli Houssaini in Marocco found 13 % weight loss in his study [14]. This nevertheless allows us to say that tumors of the soft tissues of the musculoskeletal system, generally benign, have very little effect on the general condition of patients. The size of the tumors in our patients was greater than 5 cm in 15 cases. According to Grimer in United Kingdom, any tumor larger than a golf ball (4.27 cm), should be given special attention because of the relatively high potential risk of malignancy [8]. For Johnson in United Kingdom, any mass of soft tissue with any of these four clinical features should be considered to be malignant until proved otherwise: rapid growth in size; size larger than 5 cm; pain; or deep to the deep fascia [9]. Ulceration was observed in 5/15 cases of tumors larger than 5 cm and in 3/40 cases of tumors smaller than 5 cm in size; moreover, all the malignant tumors in our series (3 cases) were ulcerated. Ulceration can therefore be considered a presumptive clinical feature of malignancy of a soft tissue tumour.
Tumors predominated in the upper limb with 38.2 % in our series, while for Gogi in India and Squalli Houssaini in Morocco, tumors predominated on the head - trunk with respectively 47.8% and 37.6%; these authors observed localization in the thoracic part in 27.5 % and 31.6 % respectively [7,14]. The preferred location of these tumors was the wrist and hand in our series as well as in that of Dabak and that of Resit in Turkey [4,12]. As for malignant tumors of the soft tissues, according to Reshadi in Syria, Solooki in Iran, the thigh and the leg are the preferred sites; the wrist and hand being less affected by malignant tumors [10,13]. The imaging assessment included very few CT (7.3 %) and MRI (3.6 %) in our series. Squalli Houssaini and Belaabidia had found CT in 10% and MRI in 19 % in Morocco [14]. In Cameroon, Farikou obtained 9.3 % for ultrasound, 4.6% for CT, 2.3 % for scintigraphy, 0 % for MRI [5].
The limited financial conditions of patients and the lack of administrative support in sub-Saharan Africa constitute obstacles to access to CT and MRI, the latter being the examination of choice in soft tissue tumors. Moreover, MRI is only available in Benin very recently in 2018. Benign tumors largely predominated in our series than in the various series in the literature [1,4,7,12] they were mainly lipomas (43.64 %) and cysts (27.27 %) in our series. In the literature, lipoma often came first [1,7,12] or ranked 2nd [4,12]. It was followed by fibrous tumors [1,7,12] or was preceded, depending on the case, by cysts [4] or lymph nodes [12]. Malignant tumors were very rares in our series; there were one liposarcoma, one rhabdomyosarcoma, one melanoma and one squamous cell carcinoma. These malignant tumors were also found in Resit and Dabak in Turkey, in Duduyemi in Nigeria [1,4,12]. These authors have found other types of malignant tumors, including, among others, fibrosarcomas, basal cell carcinomas, synovial sarcomas, malignant schwanoma [1,4,12].
Figure 3: Ulcerative-budding tumor of the elbow (Squamous cell carcinoma).
CONCLUSION
Soft tissue tumors of the musculoskeletal system in Cotonou are uncommon. They present a varied epidemiological profile and clinical aspects. They are largely dominated by benign tumours, but the severity of malignant tumours justifies a biopsy before excision at the slightest doubt. The low rate of use of MRI in the imaging assessment remains a real difficulty in our working conditions. Ulcerated tumors are potentially malignant tumors.
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