Background: Unplanned excisions (UEs) of soft-tissue sarcoma are resections performed without appropriate preoperative imaging or biopsy confirmation. These procedures represent a large proportion of referrals to sarcoma centers and can negatively influence oncologic outcomes. Limited evidence exists regarding the impact of consultation timing after UE. This study aimed to compare oncologic outcomes of patients evaluated early versus late at a sarcoma center following UE. Methods: Of 397 patients treated for soft-tissue sarcoma from 2012 to 2020 at 2 tertiary centers, 117 underwent UE followed by later tumor bed excision and were analyzed. Consultation with a sarcoma specialist was defined as the patient’s first visit with a multidisciplinary sarcoma team member, marking entry into the coordinated cancer center. Patients were stratified into early (≤2 months) and late (>2 months) consultation groups. Demographic, clinical, and tumor characteristics were collected. Primary outcomes included local recurrence-free survival (LRFS), metastasis-free survival (MFS), and overall survival (OS). Chi-square and t tests were used for univariate comparisons, and Kaplan-Meier analyses were performed. Multivariable Cox regression and logistic regression analyses were performed, adjusting for patient age, sex, and comorbidities; tumor size, depth, grade, stage, and margin status; and/or follow-up duration. Results: Among the 117 patients (mean age, 56 years; 55% female; 84% White; 65% non-Hispanic), 26 were seen early and 91 late. The rate of metastasis was significantly higher in the late cohort (48.4% versus 11.5%, p = 0.0016), as was mortality (30.8% versus 3.8%, p = 0.0109). Five-year Kaplan-Meier survival outcomes favored early consultation, including LRFS (84.6% versus 63.7%, p = 0.041), MFS (88.5% versus 50.5%, p = 0.003), and OS (96.2% versus 64.8%, p = 0.005). On multivariable analysis, late consultation was independently associated with inferior LRFS (hazard ratio [HR] = 1.95, p = 0.046), MFS (HR = 2.76, p = 0.004), and OS (HR = 2.53, p = 0.022). Logistic regression showed increased odds of metastasis (odds ratio [OR] = 7.11, p = 0.0027) and mortality (OR = 11.29, p = 0.021) at 5 years in the late group. Conclusions: Delayed consultation after UE was associated with significantly worse outcomes, including higher rates of metastasis and mortality and lower LRFS, MFS, and OS. These results emphasize the importance of timely referral to sarcoma centers for early multidisciplinary management. Level of Evidence: Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.

Background: Diffuse tenosynovial giant cell tumor (DTGCT) is a locally aggressive benign tumor of the synovium. Patients often initially present with pain, stiffness, and swelling of the affected joint with varying levels of severity. Treatment traditionally involved surgical resection exclusively; however, this could be complicated by high disease recurrence rates. New research has introduced several targeted systemic therapies onto the market changing the treatment paradigm and necessitating a multidisciplinary treatment approach in specialized centers to optimize patient outcomes. Methods: This review synthesizes the current literature on DTGCT including its pathophysiology, classification, diagnosis, and available treatment options. There is a particular focus on the newer systemic therapies available and how these medications may be used in conjunction with surgery to enhance disease control. Results: DTGCT most commonly affects young to middle-aged adults, with a slight female predominance, and is most frequently found in the knee. Arthroscopic and even open synovectomy can have disease recurrence rates exceeding 50%. Colony stimulating factor 1 (CSF1) receptor inhibitors have proven effective at symptom palliation and reducing tumor burden in approximately 40% of patients. While these medications improve the quality of life for patients with unresectable disease, they may also be effective in the neoadjuvant setting to downstage surgical approaches and possibly improve disease control in otherwise highly morbid cases. Conclusions: Surgery alone, the traditional standard for DTGCT, is often insufficient due to high recurrence rates. Systemic therapies can restore function and improve quality of life in patients with advanced disease with rare—but potentially serious—adverse effects. Combining surgical resection with neoadjuvant CSF1R inhibition may provide superior outcomes. Further research is needed to refine the role of systemic agents and develop multidisciplinary protocols. Although initial symptoms often lead patients to community providers, optimal care for patients with DTGCT is best delivered at referral centers with dedicated musculoskeletal oncology programs. Level of Evidence: Level V . See Instructions for Authors for a complete description of levels of evidence.

» Pelvic Ewing sarcoma presents unique challenges as pelvic tumors can grow to large sizes before detection and can require complex reconstructionsaffecting long-term functional outcomes. » This review highlights a case of a 10-year-old boy with iliosacral Ewing sarcoma. Throughout, the review details the collaborative approach integrating orthopaedic oncology, radiation oncology, medical oncology, pathology, radiology, and rehabilitation staff that is critical to successful treatment. » Important considerations for therapeutic combinations, timing, and duration are explored for each specialty across a typical treatment timeline.

Case: A 64-year-old man developed a rapidly enlarging, painless exophytic mass on the plantar medial aspect of the right foot following a traumatic laceration. Magnetic resonance imaging revealed a 5.5-cm soft-tissue lesion. Core biopsy revealed a hemangioma with papillary endothelial hyperplasia. The lesion was treated with wide excision followed by acellular dermal matrix reconstruction. At 1-year follow-up, the wound was fully healed with no recurrence. Conclusion: This represents the first reported plantar hemangioma with temporal association to trauma. The exact mechanism remains uncertain, but this case emphasizes considering vascular lesions in the differential diagnosis of rapidly growing plantar masses post-trauma.

Case: A patient 90 years or older presented with progressive ankle pain and a mass arising from the distal fibula. Imaging revealed an expansile, radiolucent lytic lesion with cortical expansion. Biopsy confirmed chordoma. He underwent wide resection without reconstruction; histopathology confirmed a chondroid-type chordoma with negative margins. Wound dehiscence at 7 weeks required 4 months of wound care. At a 24-month follow-up, he has a stable ankle, ambulates without pain, and has no evidence of local recurrence or metastasis. Conclusion: Brachyury immunostaining distinguished this lesion from chondrosarcoma. Wide resection without osseous reconstruction preserved functional ambulation in this elderly, low-demand patient.