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Section 9 Mesenchymal Tumors. 1. Benign (1) Fibroma Grossly: firm, encapsulated masses, whitish Histological: interlacing bundles of mature fibrocytes,

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Presentation on theme: "Section 9 Mesenchymal Tumors. 1. Benign (1) Fibroma Grossly: firm, encapsulated masses, whitish Histological: interlacing bundles of mature fibrocytes,"— Presentation transcript:

1 Section 9 Mesenchymal Tumors

2 1. Benign (1) Fibroma Grossly: firm, encapsulated masses, whitish Histological: interlacing bundles of mature fibrocytes, fibroblasts, and collagen fibers. Site: commonly in subcutaneous tissue, fascia periosteum ovary

3 Fibroma

4 * Formatives: tumor like growths of fibrous tissue in the soft tissue, e. g. dermatofibroma, nodular facilities, juvenile aponeurotic fibroma, desmoid fibromatosis, keloid, and palmar fibromatosis

5 (2) Lipoma Gross: lobulated mass with thin capsule, greasy on cut surface, yellowish in color. Histological: composed of mature fat cells. Site: Commonly in the subcutaneous tissue of arms, shoulder, and buttocks

6 Lipoma

7 (3) Hemangioma Usually congenital but may be acquired. Gross: Portwine colored, soft, poorly defined lesion Histological: Composed of blood vessels, invasive growth partner. Type: ① Capillary type commonly in skin or mucous membrane ② Cavernous type commonly in skin, spleen, liver.

8 Hemangioma (offered by Prof.Orr)

9 (4) Lymphangioma or cystic hygroma Usual congenital Gross: Pale, soft, poorly defined lesion Histological: Composed of lymphatic vessels.

10 右颈部囊状水瘤 (offered by Prof.Orr)

11 (5) Leiomyoma Gross: A single or multiple, firm, circumscribed Histological: Spindle shaped smooth muscle cells, interwoven fibers of fusiform, varying amounts of connective tissue. Site: Commonly in uterus, gastrointestinal tract tongue

12 Leiomyoma

13 (6) Osteoma Mainly found in skull and the long bones (7) Chondroma Gross: firm, bluish with fibrous capsule, sometimes central softening with brownish fluid.

14 2. Malignant (1) Fibrosarcoma The more the cellularity and the number of mitotic figures, the greater the malignancy

15 Fibrosarcoma

16 (2) Rhabdomyosarcoma Type: ① Embryonal rhabdomyosarcoma: Most common type occurs in children often arise in the nasal cavity, orbit, middle ear, prostate, and Para testicular region. Various stages of embryogenesis round and spindled cells in a variably myxoid stroma.

17 Fetal rhabdomyosarcoma ( 吴名耀提供 )

18 ② Alveolar rhabdomyosarcoma Occur in early to mid adolescence Commonly arise in the deep musculature of extremities pulmonary alveolae like. ③ Pleomorphic rhabdomyosarcoma Numerous large, multinucleated, bizarre eosinophilic tumor cells

19 Pleomorphic rhabdomyosarcoma

20 (3) Osteosarcoma A highly malignant tumor of bone Infiltrative growth manner both into the marrows and outwards into the surrounding soft tissue. Formatting tumor osteoid by the tumor cells. Some characteristics: “ sunburst ” appearance, codman ’ s triangle

21 Osteosarcoma (Quoted from Robbins 《 Pathology Basis of disease 》 )

22 (4) Liposarcoma Commonly occur in the buttocks, lower limbs, retroperitoneum. Composed of embryonic fat cells containing small fat globules in cytoplasm.

23 大腿脂肪肉瘤 A 手术前外观 B CT 影象 C 手术切除标本 D 镜下 ( 由宋建新主任医师提供 )

24 (5) 血管肉瘤 (angiosarcoma) 50 岁男性肩胛骨血管肉瘤, 左 1 为 X 线改变, 左 2 、 3 镜下改变 (offered by Prof.Orr) , 左 4 免疫组化上皮标记 CD31 呈阳性 ( quoted from Robbins Basic Pathology )

25 (6) Kaposi 肉瘤 可能来源于血管内皮或原始间叶 细胞的梭形细胞肉瘤。 Quoted form Robbins Basic Pathology, 2003

26 (6) Kaposi 肉瘤 Quoted from Robbins Basic Pathology, 2003

27 (7) Malignant fibrous histiocytoma Refer to a heterogeneous group of aggressive soft tissue tumors characterized by considerable cytologist plemorphism. Spindled cells in swirling (storiform) pattern. (8) Malignant lymphoma (9) Leukemia

28 3. Comparisons Between Carcinoma and Sarcoma CarcinomaSarcoma ① Histogenesis Epithelial tissuesMesenchymal tissues ② Morbidity High. In older ageLow. In children & young ③ Gross Hard, gray-white, drySoft, fleshy ④ Histologicaly Form carcinoma nests, so, there are clear line of demark- ation between nests & sup- ortive stroma. Tumor cells diffuse in supportive stroma, so, there are not marked boundary between parenchyma & supportive stroma.

29 CarcinomaSarcoma ⑤ Reticular fiber Staining: Around carcinoma nest,no around tumor cells. Around tumor cells ⑥ Metastasis: Most frequently via lymphatics. Most frequently via blood vessels.

30 1. The central nervous tumors (1) Glioma ① Astrocytoma ② Oligodendroglioma ③ Ependymoma (2) Medulloblastoma (3) Meningioma

31 2. Peripheral nervous tumors (1) Neurofibroma (2) Neurilemmoma

32 Neurilemmoma

33 (offered by Prof.Orr) 3. Retinoblastoma

34 4. Pigmented nevus and melanoma (1) Pigmented nevus Most authorities agree that the melanocytes are derived from neuro- ectoderm, and migrate to the basal layer of the skin in early intrauterine life A nevus or more implies a benign pigmented tumor containing nevus cells.

35

36 (2) Melanoma Malignant Gross: a variably pigmented, rapidly rowing, Ulcerated and bleeding lesion of the skin Histological: Pleomorphic, melanin- containing cellsinvading the underlying tissues. Amelanotic melanoma: Someone have no melaning pigment, but still DOPA positive.

37 melanoma


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