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The principal management of primary soft tissue sarcoma is surgical resection. The clinical goal is resection with negative margins, preferably that extend 2 cm from the grossly determined border. This can be difficult to assess and is often limited by the presence of major neurovascular and bony structures. The majority of soft tissue sarcomas do not invade into bone unless there has been previous injury to bone or the lesion has an epithelioid component, such as synovial sarcoma.

One of the few known causes of sarcomas is therapeutic irradiation. Therapeutic radiation has also been associated with development of breast cancer, lung cancer, and accelerated coronary artery disease in patients receiving thoracic radiation [1–3]. With the increased recognition of second cancers as a long-term side effect of radiation therapy, attempts have been made to use radiation more sparingly. For example, there is a question as to whether surgery for ductal carcinoma in situ is necessary, whereas at least one present standard of care is lumpectomy and radiation therapy, despite the ability to obtain negative margins in at least 95 % of patients with surgery alone, and no difference in long-term breast cancer mortality with the addition of radiation therapy [4, 5]. The incidence of a sarcoma after radiation is not precisely known, and may vary from one part of the body to the next. In a series of patients treated for cancer of all sites in Finland, for example, the crude risk was of the order of 0.05 % [6].

Lipomas are the most common benign neoplasm and usually arise in subcutaneous tissue. The trunk and proximal limbs are the most frequent sites. Although deep-seated benign lipomas do occur in the mediastinum or retroperitoneum, seemingly mature fatty neoplasms in the retroperitoneum should be considered well-differentiated (WD) liposarcoma. Most lipomas are solitary, soft, and painless, and grow slowly; 2–3 % of patients have multiple lesions that are occasionally seen in a familial pattern.

Ossifying fibromyxoid tumor (OFMT) is a very uncommon soft tissue lesion that can occur anywhere in the body, but most commonly in the lower extremity. While most tumors are benign, malignant examples may metastasize in more than half of cases [1]. The largest series to date included only typical cases, excluding tumors with other morphologies, and in that series there were no patients who developed metastatic disease. In the few patients that we have observed recurrences, metastases are observed, typically to lung, and local–regional recurrence can be observed in a multifocal “shotgun” pattern around the area of the tumor, as has been observed in patients with epithelioid sarcoma.