Clinicopathological Assessment of Soft Tissue Sarcoma in a Sample of Adult and Elderly Iraqi Patients

Introduction: Although soft tissue sarcomas are rare, they represent a clinically important group of malignant tumors because of their aggressive potential and wide histological diversity. Their tendency for local recurrence, distant metastasis, and variable response to therapy makes accurate pathological classification essential, often requiring integration of histological features with immunohistochemical and molecular findings. Method: This was a retrospective study conducted over the period from January 2025 to December 2025, including 100 samples of soft tissue sarcoma collected from different pathology centers around Iraq. Histopathological reports and slides were reviewed, and clinical parameters were recorded from patient records. Results: In this cohort of 100 soft tissue sarcoma cases, the mean patient age was 46.5 years, with a nearly equal sex distribution (55% males, 45% females). The lower extremities were the most frequent tumor site, followed by the upper extremities and head and neck region. The mean tumor size was 8.4 cm. 58% were primary tumors, 34% were recurrences, and 8% had metastases. Histologically, Grade 3 tumors predominated (65%), followed by Grade 2 (30%) and Grade 1 (5%). Synovial sarcoma was the most common subtype (31%), followed by liposarcoma (18%) and undifferentiated pleomorphic sarcoma (13%), with other subtypes being less frequent. Conclusion: Soft tissue sarcoma in Iraqi adults mainly affected middle-aged and older patients, with a slightly younger mean age compared to international reports. The lower extremities were the most common tumor site, and most cases presented with large tumor size, suggesting delayed diagnosis and limited early referral. A high proportion of tumors were high grade (Grade 3). Synovial sarcoma was the most frequent subtype. Larger tumor size was associated with higher histologic grade, and the lungs were the most common site of metastasis.