The differential diagnosis of a presacral soft tissue mass includes a heterogeneous list of benign and malignant tumors. Preoperative imaging is helpful in judging resectability, but core-needle biopsy is generally recommended for tissue diagnosis and to facilitate decision-making about neoadjuvant therapy. Malignant tumors (sarcomas) frequently require resection of involved adjacent structures to achieve a complete gross resection. Data for extremity and retroperitoneal sarcoma suggest that radiation therapy - pre-, intra-, or postoperative - improves local control and that postoperative chemotherapy may improve survival for high-risk tumors. Pelvic sarcomas are uncommon but challenging tumors to treat and require a multidisciplinary and individualized approach.
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