Surgical Pathology of Soft Tissue Neoplasms Ppt Powerpoint Presentation slides Keith J Kaplan MD Medical Slideshow Soft Tissue Neoplasms of the Lower Female Genital Tract

Surgical Pathology of Soft Tissue Neoplasms

Rating :

Rate It:

Send This

Download

Comment

Favourite

more

Post To:

Facebook

Twitter

Digg

Delicious

more share options

vidya on Sep 10, 2009 Says :

i want to download this

Anthony on Jul 07, 2009 Says :

very good

Post a comment

Post Comment on Twitter Post Comment on SlideWorld

Comments:

Subscribe to follow-up comments

3 Favorites

bizadi, favourited this 2 Months ago.

salha, favourited this 2 Months ago.

cletonogueira, favourited this 5 Months ago.

Notes

Show Notes

Slide 1 :

SURGICAL PATHOLOGY OF SOFT TISSUE NEOPLASMS Keith J. Kaplan, MD Mayo Clinic www.tissuepathology.com

Slide 2 :

www.tissuepathology.com

Slide 3 :

www.tissuepathology.com

Slide 4 :

OUTLINE TUMORS OF FIBROUS TISSUE FIBROHISTIOCYTIC TUMORS TUMORS OF ADIPOSE TISSUE TUMORS OF SMOOTH MUSCLE TUMORS OF SKELETAL MUSCLE TUMORS OF VASCULAR ORIGIN TUMORS OF PERIVASCULAR ORIGIN TUMORS OF SYNOVIAL TISSUE TUMORS OF PERIPHERAL NERVE TUMORS OF PARAGANGLIA EXTRASKELETAL CARTILAGINOUS & OSSEOUS NEOPLASMS TUMORS OF UNCERTAIN HISTOGENESIS www.tissuepathology.com

Slide 5 :

Slide 6 :

NODULAR FASCIITIS Reactive process Young adults (mean age 34 years; range 8-76) Short clinical history, rapid growth Most common in volar aspect of forearm, trunk, head and neck Superficial, usually in relationship with fascia Intramuscular, ossifying (parosteal) & IV forms Differential diagnosis with sarcomas Recurrence rate around 1% www.tissuepathology.com

Slide 7 :

NODULAR FASCIITIS Stellate to well circumscribed (Myo)fibroblastic cells in a haphazard, whorled to broad-storiform pattern Variable amount of myxoid matrix (feathery pattern/tissue culture) Cystic change Keloid-like collagen in older lesions Scattered lymphocytes, erythrocytes, and multinucleated giant cells www.tissuepathology.com

Slide 8 :

www.tissuepathology.com

Slide 9 :

www.tissuepathology.com

Slide 10 :

www.tissuepathology.com

Slide 11 :

PROLIFERATIVE FASCIITIS Reactive process less common than nodular fasciitis Short clinical history It affects adults between 40 and 70 years of age Usually in proximal extremities Irregular to stellate configuration Interlobular fibrous tissue in subcutaneous fat Ganglion cell-like and spindle myofibroblasts Myxoid to collagenized matrix www.tissuepathology.com

Slide 12 :

PROLIFERATIVE MYOSITIS IM counterpart of proliferative fasciitis Short clinical history Adults and children affected Usually in trunk and limb girdles Centered in epi-, peri-, and endomysium Checkerboard appearance Ganglion cell-like and spindled myofibroblasts Myxoid to collagenized matrix Atrophic skeletal muscle fibers www.tissuepathology.com

Slide 13 :

www.tissuepathology.com

Slide 14 :

SUPERFICIAL FIBROMATOSIS (fascial) Superficial; self-lmited Palmar fibromatosis (Dupuytren’s contracture) Plantar fibromatosis (Ledderhose’s disease) Penile fibromatosis (Peyronnie’s disease) www.tissuepathology.com

Slide 15 :

www.tissuepathology.com

Slide 16 :

DEEP FIBROMATOSIS (musculoaponeurotic) Deep in location; aggressive High incidence of local recurrence (up to 80%) Metastasis rare Mesenteric fibromatosis (Gardner’s syndrome) AD trait Osteomata, polyposis coli, cutaneous cyst Abdominal fibromatosis (s/p pregnancy) Vague fascicles of (myo)fibroblasts Infiltrative borders; no nuclear atypia or mitoses www.tissuepathology.com

Slide 17 :

PELVIC AND MESENTERIC FIBROMATOSIS Half of mesenteric fibromatoses have a history of abdominal surgery or trauma Most cases sporadic, some associated with Gardner syndrome www.tissuepathology.com

Slide 18 :

EXTRA-ABDOMINAL FIBROMATOSIS Peak incidence between 25 and 35 years Trisomies of chromosomes 8 and 20 and loss of 5q Slow growing, deep, painless, firm, poorly circumscribed Nerve involvement possible Shoulder, chest wall, and thigh favored sites Uniform, elongated, slender spindle cells separated by abundant collagen Atypia and mitotic activity non-conspicuous Infiltrative margins, broad and sweeping fascicles Thin, elongated vessels www.tissuepathology.com

Slide 19 :

DESMOID www.tissuepathology.com

Slide 20 :

www.tissuepathology.com

Slide 21 :

www.tissuepathology.com

Slide 22 :

SOLITARY FIBROUS TUMOR First described on the pleura Majority behave in a benign fashion Metastasis rare Associated with hypoglycemia Composed of oval to spindled cells separated by discrete collagen bundles Patternless pattern or HPC-like pattern CD34 positive Worrisome features include ?cellularity, pleomorphism and ? mitotic activity www.tissuepathology.com

Slide 23 :

www.tissuepathology.com

Slide 24 :

www.tissuepathology.com

Slide 25 :

FIBROSARCOMA Uncommon tumor Herringbone growth pattern Compact fascicles of spindled cells with uniform cellular features Minimal intervening stroma SMA variable staining Differential includes monophasic SS, MPNST & leiomyosarcoma www.tissuepathology.com

Slide 26 :

www.tissuepathology.com

Slide 27 :

Slide 28 :

FIBROUS HISTIOCYTOMA Slow growing lesion of dermis and subcutis Occasionally intramuscular and visceral Adults are affected during 3rd to 5th decade of life Most lesions on the extremities Superficial lesions smaller and histologically more heterogeneous Deep lesions larger and predominantly myofibroblastic Factor XIIIa (+) & CD34 (-) www.tissuepathology.com

Slide 29 :

www.tissuepathology.com

Slide 30 :

www.tissuepathology.com

Slide 31 :

COLLAGEN ENTRAPMENT www.tissuepathology.com

Slide 32 :

FIBROUS HISTIOCYTOMA Deep FH are larger (up to 5 cm) than cutaneous FH They have a more prominent storiform pattern and fewer secondary elements HPC pattern may be focally present www.tissuepathology.com

Slide 33 :

DEEP FH SM MUSCLE www.tissuepathology.com

Slide 34 :

HPC PATTERN IN FH www.tissuepathology.com

Slide 35 :

FIBROUS HISTIOCYTOMA(Special Variants) 1. Cellular2. Aneurysmal3. Myxoid4. Epithelioid5. Clear cell6. Atypical (pseudosarcomatous)7. Lipidized (ankle-type)8. Palisading9. Granular10. Atrophic11. Ossified www.tissuepathology.com

Slide :

Slide 38 :

DERMATOFIBROSARCOMA PROTUBERANS (DFSP) Tumor of intermediate malignancy Dermis & SQ of yg-middle aged adults; M>F Most common sites are trunk & proximal extremity Locally aggressive; high local recurrence Metastases rare (<1%); usually to regional LNs Average size at surgery is 5 cm Ring chromosomes 17 and 22 www.tissuepathology.com

Slide 39 :

DERMATOFIBROSARCOMA PROTUBERANS (DFSP) Composed of spindled fibroblasts arranged in a monotonous storiform pattern Grossly circumscribed, but infiltrates diffusely into fat and adnexal structures CD34 positive (Factor XIIIa negative) It can be myxoid, with less defined storiform pattern A small subgroup contains dendritic cells laden with melanin (Bednar tumor) Wide local excision with negative margins www.tissuepathology.com

Slide 40 :

www.tissuepathology.com

Slide 41 :

DFSP www.tissuepathology.com

Slide 42 :

www.tissuepathology.com

Slide 43 :

MYXOID DFSP www.tissuepathology.com

Slide 44 :

DFSP with fibrosarcomatous transformation Infrequently DFSP contains FS-like areas To be defined as such, the sarcomatous component should be at least 10% of the tumor and clearly demarcated Frequent loss of CD34 expression in FS areas Ring chromosomes of DFSP are preserved No increased risk of distant metastases if patients are treated with wide local excision with negative margins www.tissuepathology.com

Slide 45 :

www.tissuepathology.com

Slide 46 :

ATYPICAL FIBROXANTHOMA (AFX) Tumor of intermediate malignancy Cutaneous form of MFH Nodules or ulcers on skin of H&N in elderly Pleomorphic histiocytoid & spindled cells Despite pleomorphism, AFX is indolent in behavior Differential diagnosis includes melanoma & spindled squamous cell carcinoma www.tissuepathology.com

Slide 47 :

www.tissuepathology.com

Slide 48 :

Osteoclast-like giant cells Giant pleomorphic cells www.tissuepathology.com

Slide 49 :

MALIGNANT FIBROUS HISTIOCYTOMA (MFH) Most common soft tissue sarcoma of adults Present as deep soft tissue mass of lower extremity or retroperitoneum High grade malignancy Undifferentiated, pleomorphic spindled-cell sarcoma Several histologic subtypes www.tissuepathology.com

Slide 50 :

MALIGNANT FIBROUS HISTIOCYTOMA (MFH) There are several variants of MFH 1.Storiform-pleomorphic (66-77%) 2.Myxoid (15-17%) 3.Giant cell rich (3-15%) 4.Inflammatory (3-5%) 5.Angiomatoid (rare) www.tissuepathology.com

Slide 51 :

www.tissuepathology.com

Slide 52 :

www.tissuepathology.com

Slide 53 :

MALIGNANT FIBROUS HISTIOCYTOMA The storiform-pleomorphic most common variant Bizarre cells, fibroblast to histiocyte-like Variable storiform pattern Complex and heterogeneous cytogenetic rearrangements DDx with other pleomorphic neoplasms (MM, sarcomatoid Ca., K1 ML) &pleomorphic sarcomas (pleomorphic RMS, pleomorphic and dedifferentiated LS, MPNST, pleomorphic LMS) www.tissuepathology.com

Slide 54 :

www.tissuepathology.com

Slide 55 :

www.tissuepathology.com

Slide 56 :

www.tissuepathology.com

Slide 57 :

www.tissuepathology.com

Slide 58 :

MALIGNANT FIBROUS HISTIOCYTOMA Myxoid MFH is the second most common subtype of MFH At least 50% of the neoplasm must be myxoid Prominent vasculature with perivascular tumor cell growth Pseudolipoblasts present (Alcian blue, S-100) Better prognosis www.tissuepathology.com

Slide 59 :

www.tissuepathology.com

Slide 60 :

www.tissuepathology.com

Slide 61 :

MALIGNANT FIBROUS HISTIOCYTOMA The giant cell-rich MFH is a rare entity It is similar to the pleomorphic-storiform subtype, but it also contains osteoclast-like giant cells www.tissuepathology.com

Slide 62 :

www.tissuepathology.com

Slide 63 :

MALIGNANT FIBROUS HISTIOCYTOMA The inflammatory MFH is a rare entity It involves the retroperitoneum It looks like the pleomorphic-storiform MFH, but has abundant PMNs and foamy histiocytes admixed with it www.tissuepathology.com

Slide 64 :

www.tissuepathology.com

Slide 65 :

ANGIOMATOID MFH Benign tumor according to WHO Metastases in 1% of cases: low-grade sarcoma Children and young adults Mainly in extremities in areas of normal lymphoid tissue Resembles a LN, but no subcapsular sinus The histology is characterized by: 1.well-formed pseudocapsule 2.spindle to round myofibroblasts (50% desmin +) 3.pseudovascular spaces 4.dense lymphoplasmacytic infiltrate www.tissuepathology.com

Slide 66 :

www.tissuepathology.com

Slide 67 :

Slide 68 :

ANGIOLIPOMA Young adults Present as painful nodules (ANGEL) www.tissuepathology.com

Slide 69 :

www.tissuepathology.com

Slide 70 :

SPINDLE CELL/PLEOMORPHIC LIPOMA Males, 45-60 SQ masses on posterior neck or shoulder Varying proportions of mature adipose tissue & spindled cells (seperated by collagen) & mast cells Positive for CD34 Pleomorphic contain floret-like MNGCs in an o/w spindle cell lipoma www.tissuepathology.com

Slide 71 :

www.tissuepathology.com

Slide 72 :

www.tissuepathology.com

Slide 73 :

www.tissuepathology.com

Slide 74 :

HIBERNOMA Most common in adults (mean age = 38 y) Extremities & trunk Three cell types resembling immature fat Univacuolar Multivacuolar Granular eosinophilic cells www.tissuepathology.com

Slide 75 :

www.tissuepathology.com

Slide 76 :

ATYPICAL LIPOMA Histologically similar to WD liposarcoma Occurs in superficial location Most common site is lower extremity www.tissuepathology.com

Slide 77 :

www.tissuepathology.com

Slide 78 :

ANGIOMYOLIPOMA (AML) F > M Composed of mature vessels, smooth muscle & fat to a varying degree Epithelioid variant thought to be more aggressive Perivascular epitheliod cells (PEC) HMB-45 and actin positive AML Lymphangioleiomyomatosis Sugar tumor of lung TS COMPLEX www.tissuepathology.com

Slide 79 :

www.tissuepathology.com

Slide 80 :

LIPOSARCOMA One of the most common sarcomas Lower extremities & retroperitoneum (like MFH) Most common site is lower extremity Several different subtypes Well-differentiated (low grade) Myxoid/round cell (low grade/high grade) Pleomorphic (high grade) Liposarcoma with dedifferentiation (MFH-like) www.tissuepathology.com

Slide 81 :

WD LIPOSARCOMA www.tissuepathology.com

Slide 82 :

www.tissuepathology.com

Slide 83 :

MYXOID LIPOSARCOMA www.tissuepathology.com

Slide 84 :

www.tissuepathology.com

Slide 85 :

PLEOMORPHIC LIPOSARCOMA www.tissuepathology.com

Slide 86 :

www.tissuepathology.com

Slide 87 :

Slide 88 :

LEIOMYOMA Superficial or deep No gender preferences except in retroperitoneum (females) Minimal nuclear atypia and mitoses No tumor necrosis www.tissuepathology.com

Slide 89 :

www.tissuepathology.com

Slide 90 :

LEIOMYOSARCOMA 10% of all soft tissue sarcomas Increased nuclear atypia & mitoses Tumoral necrosis Variants include epithelioid, myxoid and those with osteoclast-like giant cells www.tissuepathology.com

Slide 91 :

www.tissuepathology.com

Slide 92 :

www.tissuepathology.com

Slide 93 :

Slide 94 :

ADULT RHABDOMYOMA Seen in H&N of elderly; uncommon in extremities; M > F Polygonal cells with deeply eosinophilic cytoplasm Variable amounts of glycogen, imparting a partially vacuolated appearance (spider cells) Differential includes hibernoma www.tissuepathology.com

Slide 95 :

www.tissuepathology.com

Slide 96 :

FETAL RHABDOMYOMA Seen in H&N of young children (< 2) Mixed population of undifferentiated mesenchymal cells and muscle fibers of varying degree Muscle differentiation best seen at periphery Differential includes a spindle cell RMS www.tissuepathology.com

Slide 97 :

RHABDOMYOSARCOMA Most common in infants and yg children H&N, GU, extremities most common sites Classic SRBCT Diagnostic feature is rhabdomyoblasts Phosphotungstic acid-hematoxylin stain – enhances cross striations PAS – glycogen Desmin & MSA positive (sensitive) MyoD1 (specific) www.tissuepathology.com

Slide 98 :

RHABDOMYOSARCOMA www.tissuepathology.com

Slide 99 :

www.tissuepathology.com

Slide 100 :

www.tissuepathology.com

Slide 101 :

www.tissuepathology.com

Slide 102 :

EMBRYONAL RHABDOMYOSARCOMA Most common of the RMSs GU & H&N most common sites Botyroid (hollow viscus) Spindled-cell type (excellent prognosis) www.tissuepathology.com

Slide 103 :

www.tissuepathology.com

Slide 104 :

BOTYROID SPINDLE www.tissuepathology.com

Slide 105 :

ALVEOLAR RHABDOMYOSARCOMA More commonly seen in the extremities Classic alveolar growth pattern and wreath-like tumor giant cells t(2;13)(q37;q14) Poor prognosis www.tissuepathology.com

Slide 106 :

www.tissuepathology.com

Slide 107 :

PLEOMORPHIC RHABDOMYOSARCOMA More commonly seen in adults Represents a pleomorphic sarcoma with RMS differentiation Rare; most commonly extremity or trunk www.tissuepathology.com

Slide 108 :

www.tissuepathology.com

Slide 109 :

Slide 110 :

HEMANGIOMA One of the most common benign soft tissue tumors Most common sites are H&N Intramuscular hemangiomas associated with mature adipose tissue Associated syndromes include Kassabach-Merritt (thrombocytopenic purpura), blue rubber bleb nevus (skin & GI angiomas), Mafucci’s (multiple enchondromas & cutaneous angiomas) www.tissuepathology.com

Slide 111 :

www.tissuepathology.com

Slide 112 :

www.tissuepathology.com

Slide 113 :

EPITHELIOID HEMANGIOENDOTHELIOMA Intermediate-grade malignancy Soft tissue, bone, lung (IVBAT) & liver Angiocentric, epithelioid cells within a fibromyxoid stroma Presence of intracytoplasmic vascular lumina (blister cells) CD31 & CD34 positive Differential diagnosis includes epithelioid sarcoma www.tissuepathology.com

Slide 114 :

www.tissuepathology.com

Slide 115 :

www.tissuepathology.com

Slide 116 :

www.tissuepathology.com

Slide 117 :

ANGIOSARCOMA Most common form is cutaneous involvement in H&N of the elderly Other sites include breast Poor prognosis Vasoformative architecture with varying degrees of nuclear atypia CD31 & CD34 positive; may be CK positive (epithelioid angiosarcoma) www.tissuepathology.com

Slide 118 :

www.tissuepathology.com

Slide 119 :

KAPOSI’S SARCOMA Prior to AIDS, most commonly seen in elderly males (E. European Jews) Most commonly cutaneous nodules on distal LEs In AIDS, cutaneous & visceral forms Patch, plaque & nodular Slit-like vascular spaces, extravasation of RBCs PAS (+), diastase-resistant hyaline globules CD31 & CD34 positive www.tissuepathology.com

Slide 120 :

www.tissuepathology.com

Slide 121 :

www.tissuepathology.com

Slide 122 :

LYMPHANGIOMA Rare compared to hemangiomas Usually children in H&N, axilla Fetal/neonatal associated with Turner’s syndrome & hydrops fetalis Arborizing lymphatic spaces with lymphoid aggregates www.tissuepathology.com

Slide 123 :

www.tissuepathology.com

Slide 124 :

www.tissuepathology.com

Slide 125 :

LYMPHANGIOSARCOMA Rare Seen in setting of postsurgical lymphadema (historically after radical mastectomies) Stewart-Treves syndrome www.tissuepathology.com

Slide 126 :

www.tissuepathology.com

Slide 127 :

Slide 128 :

GLOMUS TUMOR Presents as painful blue-red nodules Subungul location most common Thin-walled vessels with collars of epithelioid cells Stroma may be hyalinized or myxoid Glomangioma (gaping vessels) Glomangiomyoma (smooth muscle differentiation) Actin positive DDx includes adnexal tumors of the skin www.tissuepathology.com

Slide 129 :

PAINFUL DERMAL TUMORS ANGEL Blue rubber bleb nevus Angiolipoma Angioleimyoma Neuroma Glomus tumor Eccrine spiradenoma Leiomyoma www.tissuepathology.com

Slide 130 :

www.tissuepathology.com

Slide 131 :

www.tissuepathology.com

Slide 132 :

HEMANGIOPERICYTOMA Primarily adults LE, pelvis & retroperitoneum Associated with hypoglycemia (SFT & HPC) Staghorn vessels & variable storiform growth pattern CD34 positive DDx includes synovial sarcoma, mesenchymal chondrosarcoma & SFT www.tissuepathology.com

Slide 133 :

www.tissuepathology.com

Slide 134 :

www.tissuepathology.com

Slide 135 :

Slide 136 :

GIANT CELL TUMOR OF TENDON SHEATH Adults, more commonly women Most common site are hand & wrist Polymorphous population of histiocytoid cells, multinucleated giant cells & inflammatory cells Variable amounts of hemosiderin Fibrous bands within the tumor www.tissuepathology.com

Slide 137 :

www.tissuepathology.com

Slide 138 :

PIGMENTED VILLONODULAR TENOSYNOVITIS Intra-articular giant cell tumor of tendon sheath Young adults Large joints (knee, hip, ankle) Local recurrence uncommon Histology similar to GCT of tendon sheath DDx with hyperplastic synovitis (hemophiliacs) www.tissuepathology.com

Slide 139 :

www.tissuepathology.com

Slide 140 :

www.tissuepathology.com

Slide 141 :

SYNOVIAL SARCOMA Despite its name, only rarely found within joints “Great masquerader” or carcinoma of soft parts 15 – 40 years; M > F Deep, slow growing mass near a large joint May present with LN involvement Circumscribed, often multinodular, with pseudocapsule 4 Types Biphasic – Monophasic epithelial Monophasic fibrous – Poorly differentiated www.tissuepathology.com

Slide 142 :

SYNOVIAL SARCOMA The biphasic SS is composed of uniform spindle cells and epithelial areas The spindle cells have a high N/C ratio The epithelial cells form glands, papillae and squamous nests Fibrosis, calcification, and mast cells are seen www.tissuepathology.com

Slide 143 :

BIPHASIC SYNOVIAL SARCOMA www.tissuepathology.com www.tissuepathology.com

Slide 144 :

www.tissuepathology.com

Slide 145 :

SS WITH CALCIFICATION www.tissuepathology.com

Slide 146 :

SYNOVIAL SARCOMA The monophasic SS, fibrous type, has spindle cells similar to the biphasic subtype The cells are arranged in interweaving fascicles Fibrosis, calcification, and mast cells are seen Cystic degeneration, metaplastic bone and cartilage may be seen www.tissuepathology.com

Slide 147 :

MONOPHASIC FIBROUS SS www.tissuepathology.com

Slide 148 :

SYNOVIAL SARCOMA The epithelial predominant SS is a rare variant in which the glandular or epithelial components predominate. Only rare examples have been described DDx include metastatic CA www.tissuepathology.com

Slide 149 :

SYNOVIAL SARCOMA The poorly differentiated variant of SS consists of closely packed small oval or spindle cells, which are intermediate in appearance between spindle and epithelial cells HPC pattern may be seen Diagnosis based on the focal presence of a biphasic pattern or cytogenetic findings www.tissuepathology.com

Slide 150 :

POORLY DIFFERENTIATED SS www.tissuepathology.com

Slide 151 :

SYNOVIAL SARCOMA The epithelial component stains for keratin and EMA The spindle cells may focally express keratin and EMA S-100 protein may be focally seen CD99 may be present in the poorly differentiated variant www.tissuepathology.com

Slide 152 :

www.tissuepathology.com

Slide 153 :

SYNOVIAL SARCOMA Characterized by t(x;18)(p11.2;q11.2) There is fusion of SYT gene on chrom 18 and SSX1 or SSX2 genes on chrom X, with formation of chimeric genes SYT-SSX1 or SYT-SSX2. The type of translocation determines the proliferation rate of the tumor and the prognosis: SYT-SSX1 patients have a 5 year metastasis-free survival of 42% SYT-SSX2 patients have a 5 year metastasis-free survival of 89% www.tissuepathology.com

Slide 154 :

Slide 155 :

SCHWANNOMA Biphasic tumor with Antoni A (cellular) & Antoni B (hypocellular) areas Variable pallisading (Verrocay bodies) Degenerative changes (so-called ancient schwannoma) include cysts, perivascular hyalinization & nuclear atypia Strong S100 positivity Malignant transformation rare www.tissuepathology.com

Slide 156 :

www.tissuepathology.com

Slide 157 :

www.tissuepathology.com

Slide 158 :

www.tissuepathology.com

Slide 159 :

NEUROFIBROMA Monophasic growth pattern Variable amount of collagen & stromal mucin S100 positive Malignant transformation common in NF Plexiform neurofibroma virtually pathognomonic for NF www.tissuepathology.com

Slide 160 :

www.tissuepathology.com

Slide 161 :

www.tissuepathology.com

Slide 162 :

www.tissuepathology.com

Slide 163 :

www.tissuepathology.com

Slide 164 :

www.tissuepathology.com

Slide 165 :

www.tissuepathology.com

Slide 166 :

www.tissuepathology.com

Slide 167 :

GRANULAR CELL TUMOR Schwann cell origin Solitary or multiple Most common site is tongue, chest wall, UE Malignant transformation rare EM – abundant membrane-bound lysosomes www.tissuepathology.com

Slide 168 :

www.tissuepathology.com

Slide 169 :

OSSIFYING FIBROMYXOID TUMOR Most common in 5th decade of life M > F; low grade (can metastasize) Subcutaneous tissues of extremities Composed of round to oval cells with intervening fibromyxoid stroma Rim of mature bone S100 positive www.tissuepathology.com

Slide 170 :

www.tissuepathology.com

Slide 171 :

www.tissuepathology.com

Slide 172 :

MALIGNANT PERIPHERAL NERVE SHEATH TUMOR (MPNST) Histologically similar to other spindled cell tumors such as SS and fibrosarcoma S100 may be negative Reserve dx outside setting of NF or if able to identify nerve trunk or areas of neurofibroma or schwannoma Several variants Triton tumor – MPNST w/rhabdo differentiation www.tissuepathology.com

Slide 173 :

www.tissuepathology.com

Slide 174 :

Slide 175 :

PARAGANGLIOMA Organoid growth pattern (zellballen) S100 (+) sustentacular cells and NE (+) tumor cells Carotid body (chemodectoma) Jugulotympanic (glomus jugulare) – females Retroperitoneal (organ of Zuckerhandl) www.tissuepathology.com

Slide 176 :

www.tissuepathology.com

Slide 177 :

Slide 178 :

MYOSITIS OSSIFICANS Reactive process in young persons Trauma history Solitary & well circumscribed Zonation phenomenon – cellular fibroblastic proliferation with gradual osseous metaplasia towards periphery www.tissuepathology.com

Slide 179 :

www.tissuepathology.com

Slide 180 :

EXTRASKELETAL OSTEOSARCOMA Rare Many soft tissue sarcomas may undergo osseous metaplasia www.tissuepathology.com

Slide 181 :

EXTRASKELETAL MYXOID CHONDROSARCOMA Most common sites are deep tissues of extremities Multinodular growth pattern with malignant cells in mucin; no hyaline cartilage Associated with t(9;22) S100 positive (variable); CK & EMA negative DDx includes chordoma & metastatic adenocarcinoma www.tissuepathology.com

Slide 182 :

DIFFERENTIAL www.tissuepathology.com

Slide 183 :

www.tissuepathology.com

Slide 184 :

MESENCHYMAL CHONDROSARCOMA Biphasic tumor composed of undifferentiated SRBCs within islands of hyaline cartilage Cellular areas with prominent HPC-like pattern SRBCs are CD99 positive Cartilaginous component is S100 positive www.tissuepathology.com

Slide 185 :

www.tissuepathology.com

Slide 186 :

Slide 187 :

TUMORAL CALCINOSIS Adolescents & young adults Periarticular calcium deposits usually near large joints No association with hypercalcemia Calcium with histiocytes & foreign body giant cell reaction www.tissuepathology.com

Slide 188 :

INTRAMUSCULAR MYXOMA Reactive process; not a true neoplasm Seen mostly in extremities Pauicellular with abundant mucin www.tissuepathology.com

Slide 189 :

Less than 1% of soft tissue sarcomas Bimodal age distribution: 1. adolescents and young adults - LE 2. Children – H&N Specific chromosomal abnormalities: 1. trisomy of chromosomes 8 and 12 2. deletions in chromosome 17 ALVEOLAR SOFT PART SARCOMA www.tissuepathology.com

Slide 190 :

ALVEOLAR SOFT PART SARCOMA Well circumscribed Fibrous septa and delicate vessels separate nests of cells Polygonal, uniform cells, abundant pink to clear cytoplasm Cytoplasmic PAS +, diastase resistant crystals and glycogen Rare mitoses and pleomorphism Vascular invasion frequent www.tissuepathology.com

Slide 191 :

ALVEOLAR SOFT PART SARCOMA Vimentin, MSA, desmin, and cytoplasmic MyoD1 pos Occasionally S-100 and NSE positive DDx: RCC, MM, clear cell sarcoma, granular cell tumor, paraganglioma, and alveolar RMS Rhomboid crystals on EM www.tissuepathology.com

Slide 192 :

www.tissuepathology.com

Slide 193 :

PAS CRYSTALS www.tissuepathology.com

Slide 194 :

EPITHELIOID SARCOMA Adolescents and young adults between (10-35 yrs) M > F (2:1) Fingers, hands, and forearm are the favorite sites Slow course; tendency to recur and metastasize (45%) Superficial (dermis and subcutis) or deep (fascia) Superficial ES firm, painless nodules that can ulcerate Deep ES poorly defined, often multinodular areas of induration, firmly attached to fascia or tendon www.tissuepathology.com

Slide 195 :

EPITHELIOID SARCOMA www.tissuepathology.com

Slide 196 :

DEEP ES www.tissuepathology.com

Slide 197 :

EPITHELIOID SARCOMA Multiple nodules, festoon or garland-like growth Central necrosis, epithelioid cells The surrounding stroma is fibrous or desmoplastic The tumor cells are epithelioid to spindled with a brightly eosinophilic cytoplasm The transition between the two cell types is gradual The tumor extent may be underestimated due to insidious growth along fascial planes CD34 & CK positive DDx includes rheumatoid nodule, met CA or epithelioid hemangioendothelioma www.tissuepathology.com

Slide 198 :

www.tissuepathology.com

Slide 199 :

www.tissuepathology.com

Slide 200 :

RHABDOID ES www.tissuepathology.com

Slide 201 :

CAM 5.2 CD 34 www.tissuepathology.com

Slide 202 :

CLEAR CELL SARCOMA (MELANOMA OF SOFT PARTS) Young adults on foot & ankle most common Epithelioid & spindled cells with organoid growth pattern Multinucleated giant cells with uniform nuclear features S100 & HMB45 positive Pre-melanosomes on EM DDx with MPNST www.tissuepathology.com

Slide 203 :

www.tissuepathology.com

Slide 204 :

EWING’S SARCOMA/PNET Adolescents & young adults (10-20) Classic SRBCT CD99 & Fli-1 positive t(11;22)(q24;q12) EWS/FLI1 fusion product DDx with other SRBCTs www.tissuepathology.com

Slide 205 :

www.tissuepathology.com

Slide 206 :

DESMOPLASTIC SMALL ROUND CELL TUMOR (DSRCT) Originally described in peritoneum or pelvic sites Nests of SRBCs within a fibrous stroma DDx with other SRBCTs Diagnosis with IHC Positive for keratin, desmin & NSE May be positive for CD99 www.tissuepathology.com

Slide 207 :

www.tissuepathology.com

Slide 208 :

CK DESMIN www.tissuepathology.com

Slide 209 :

www.tissuepathology.com

	tissuepathology 1 Years ago. Category: Pathology

Tags:	Pathology

Embed:
1631 Views, 4 favourite
PowerPoint Presentation on Surgical Pathology of Soft Tissue Neoplasms or PowerPoint Presentation o more PowerPoint Presentation on Surgical Pathology of Soft Tissue Neoplasms or PowerPoint Presentation on Surgical Pathology of Soft Tissue Neoplasms less

SWINE Flu

Why do women live longer then men? Humor

History of Medicine

Yoga and Medicine

How to be a Successful Interventional Fellow size 50 MB

Cardiac Pathology

Hypertension: New Concepts, Guidelines, and Clinical Management

Diabetes Pathology

Medical Powerpoint Templates
(20% Dicsount For Student/Faculty)