Clinical manifestations Fibrosarcoma is more common in men than in women, and the most common age is 30-55 years old. Fibrosarcoma can occur in all parts of the body, but it is more common in the limbs, with 45% in the lower limbs and 28% in the upper limbs, followed by 17% in the trunk, and less frequently in the retroperitoneum, head and neck, and also in the nasal cavity, sinuses, thyroid, and breast. Fibrosarcoma grows slowly and the duration of the disease varies from weeks to decades, with an average of more than 3 years. The main symptom is a solitary mass that can be a dozen centimeters in diameter or larger. Sometimes huge fibrosarcoma often involves one side of the gluteal muscle and even extends into the foramen ovale, causing lower limb pain and difficulty in walking due to compression of the sciatic nerve, and edema in the affected limb in severe cases. The pain of superficial masses is often not obvious. Pathologic grading revealed that pain was associated with pathologic grading, and the higher the degree of malignancy, the higher the incidence of pain. Moreover, the local recurrence rate of painful masses is twice as high as that of painless masses. It may be related to the deep location of painful masses, which are difficult to eradicate. Some fast-growing superficial tumors grow outwardly to a large size, forming skin ulcers, sometimes with a foul odor, and forming “mushroom-like” masses. The tumor may also invade deeper tissues. Deeper tumors that originate from intramuscular and intermuscular fibrous tissues, fascial envelope, and tendon tendons may also grow around the bone and appear on X-ray as thickening of periosteum and bone cortex, as well as foci of calcification and ossification, which are hard and tough. MRI is the best imaging method for soft tissue tumors, with high sensitivity but not high specificity, and has certain limitations for differentiation and qualitative diagnosis of benign and malignant soft tissue tumors. The lesion is similar to muscle signal on T1-weighted image and may have peripheral enhancement; T2-weighted image shows low signal area on equal or high signal background, bone invasion is less common, and necrotic changes within the tumor rarely occur. Ultrasound shows a well-defined hypoechoic mass, and CT shows substantial occupancy at different sites, sometimes more extensive and surrounded by occasional ring-like irregular changes. Treatment The first choice of treatment for fibrosarcoma is surgical resection. Once proven to be fibrosarcoma by pathological biopsy, extensive resection including normal tissue should be performed immediately. The extent of surgical resection depends on: 1) the location and size of the tumor; 2) whether nerves and blood vessels are involved; 3) whether bones and joints are involved; 4) whether the lesion is of multicentric origin; 5) histological grading. In most cases, the radical surgery can be completed by wide excision. If the tumor is located in the extremities, the important nerves and blood vessels should be separated as much as possible during the surgery to preserve the limbs; in more advanced cases and those with tumor ulceration, amputation is feasible. For those located in the chest wall, it is often necessary to remove the ribs and repair the chest wall, and adopt free muscle flap for repair. For those located in the abdomen, flaps or medical polyester repair materials can be used to repair the defect after removal of a large portion of the abdominal wall. In retroperitoneal fibrosarcoma, because of the toughness of the mass, it is not necessary to take into account the tumor rupture, and it is appropriate to remove it after blunt separation of the tumor, and the tumor invading the lumbar muscle should be removed together. Fibrosarcoma is considered to be of low malignancy due to its slow growth, and lymph node metastasis rarely occurs, and even multiple local recurrences do not occur lymphatic and hematologic metastasis, so it is not necessary to routinely cleanse the lymph nodes in the region to which it belongs. Adjuvant therapy There is no consensus on whether radiotherapy is beneficial for fibrosarcoma. Chemotherapy is often considered insensitive and is less commonly used clinically. However, in poorly differentiated cases, chemotherapy can be tried with uncertain efficacy. Clinical use is often in the form of multi-drug combinations, including vincristine, cyclophosphamide, vincristine, and adriamycin. Some scholars also believe that postoperative chemotherapy is not necessary, but it can still be considered when distant metastases appear. Metastases are most commonly found in the lung, liver, and bone.