Management of these cases should preferably be done in centers with expertise in both colorectal and soft tissue surgery. The rarity of these diseases warrants full imaging, pathological review (Table 2) and discussion at multidisciplinary tumor board. Some cases may require consideration of neoaduvant radio and chemotherapy, however, the literature is scant on high quality evidence

to support Inhibitors,research,lifescience,medical this. Most reviews agree that post operative radiation is a relevant if margins are positive and margin re-resections are not possible or if margins are less than 1cm, although there are no clinical trials to support this clinical trial approach and the use of post-operative radiation therapy should not justify poor surgery or predictable positive margins. If neoadjuvant therapy is chosen then a positron emission tomography (PET) scan would be useful in monitoring

the response to chemotherapy in these patients (151). Inhibitors,research,lifescience,medical Table 2 Soft tissue tumors and commonly associated immunohistochemical (IHC) markers The standard curative approach for ARSTs is surgical excision, with wide local excision (WLE) and APR being the most frequently performed interventions. Inhibitors,research,lifescience,medical Endoscopic and transanal excision should be reserved for the tumors with benign features and low local recurrence rates but are expected to play an increasing role in the future management Inhibitors,research,lifescience,medical of ARST as they become widely available and more refined. Curative resection remains the major

determinant of recurrence and survival. Follow up of ARST patients should be similar to that of sarcomas of other sites with physical exam and CT imaging every 3-6 months for the first 2-3 years then every 6 months for 2 years then annually (152). Because this is a rare disease we do not expect large scale multicentre studies in the near future therefore it is advisable these patients be treated in multidisciplinary fashion in centers with colorectal Inhibitors,research,lifescience,medical and surgical oncology expertise. Acknowledgements Dr Meguerditchian is supported by research grants from the Cedars Cancer Institute and the Fonds de la Recherche en Santé du Québec. Disclosure: The authors declare no conflict of interest.
Fine needle aspiration biopsy (FNAB) of the liver with 20-23 G needles under radiologic guidance has only been shown to be a safe and efficacious tool for procuring small tissue samples from liver mass lesions (1-3). The advantages of percutaneous (transabdominal) FNAB are well documented. However, as with all small samples, there are limitations of sampling error and insufficient material for ancillary tests. Part of this shortfall can be overcome by multiple sampling (up to 4 passes) of different parts of large lesions.