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Soft Tissue Tumors Lucy H. Liu, M.D. Department of Pathology University of Illinois at Chicago

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Presentation on theme: "Soft Tissue Tumors Lucy H. Liu, M.D. Department of Pathology University of Illinois at Chicago"— Presentation transcript:

1 Soft Tissue Tumors Lucy H. Liu, M.D. Department of Pathology University of Illinois at Chicago

2 Soft Tissue Tumors UIC College of Medicine M2 Pathology Course, Lecture # 63 Tuesday, January 28, :30 am

3 Soft Tissue Tumors Lecture Goals: 1. Nomenclature & classification system of tumors 2. Differences between benign and malignant tumors 3. Clinical & morphologic features of common tumors 4. Approach to diagnosis of soft tissue tumors

4 Soft Tissue Tumor  Neoplastic conditions arising in extraskeletal mesodermal tissues -- Skeletal muscle -- Fibrous tissue -- Smooth muscle -- Blood & lymphatic vessels -- Peripheral nerves - neuroectoderm -- Adipose tissue

5 Soft Tissue Tumor General principles for diagnosis: -- Deep lesions tend to be malignant -- Larger tumors tend to be malignant  Location  Size -- Superficial lesions - benign -- Rapidly growing - malignant  Growth pattern -- Infiltrating - malignant  Metastasis -- Malignant

6 Soft Tissue Tumors  Histological morphology  Immunohistochemistry  Cytogenetic study  Molecular analysis  Ultrastructure Approach to Diagnosis

7 Soft Tissue Tumors  Cytokeratin  Vimentin  Smooth muscle actin  Desmin  S-100  CD 31  CD 34 Immunohistochemistry

8 Soft Tissue Tumors  t( 2:13) Alveolar rhabdomyosarcoma  t( 11;22) Ewing’s sarcoma/PNET  t( 11;22) Desmoplastic small round cell tumor  t( 12;16) Myxoid liposarcoma  t( 9;22) Myxoid chondrosarcoma  t(12;22) Clear cell sarcoma  t( X;18) Synovial sarcoma Cytogenetic Changes

9 Nodular Fasciitis  Benign reactive soft tissue lesion  Probably secondary to trauma  On forearm, trunk, back- well circumscribed  Spindle cells ( fibroblasts & myofibroblasts) in loose matrix -“fibroblasts in tissue culture”  Rapid growth, frequent mitotic figures  Self-limited, cured by excision  Must differentiate from a sarcoma

10 Nodular Fasciitis

11 Fibromatosis  Fibroproliferative lesions  Desmoid - Infiltrative masses in abdominal, extra-abdominal & intra-abdominal  Fibroblasts & Myofibroblasts  Palmar, plantar fibromatosis  Surgical excision  Infiltrative growth pattern  Tendency to recur

12 Fibromatosis

13 Fibrosarcoma  Malignant tumor of fibroblast origin  In adults, in lower extremities, upper extremities, trunk  Increased cellularity, high nuclear-cytoplasmic ratios  Spindle cells in a herringbone pattern  Must exclude other tumors which resemble fibrosarcoma - Peripheral nerve sheath tumor - Synovial sarcoma

14 Fibrosarcoma

15 Dermatofibroma  Benign fibrous histiocytoma  Usually in skin  Mixture of fibroblasts, myofibroblasts, histiocytes  Surgical excision

16 Dermatofibroma

17 Dermatofibrosarcoma Protuberans (DFSP)  Fibrohistiocytic tumor  Intermediate malignant potential  In skin & subcutis  Spindle cells in storiform pattern  Local recurrence  CD 34  Transformation to fibrosarcoma  Surgical excision

18 Dermatofibrosarcoma Protuberans ( DFSP )

19 Malignant Fibrous Histiocytoma  Malignant soft tissue tumor with histocytic differentiation  Most common type of soft-tissue sarcoma  Most frequently encountered sarcoma post radiation therapy  In adults, in deep soft tissue - extremities & retroperitoneum  Marked pleomorphism, spindle cells, storiform, myxoid

20 MFH

21 Leiomyoma  Benign soft tissue tumor  Arising in subcutaneous tissue or blood vessel wall  Usually painful  Fascicles of regular smooth muscle cells

22 Leiomyoma

23 Leiomyosarcoma  Malignant soft tissue tumor  Arising in extremities of blood vessel wall  Necrosis, hemorrhage  Fascicles, nuclear atypia  High mitotic activity

24 Leiomyosarcoma

25 Rhabdomyosarcoma  Malignant tumor of striated muscle differentiation  In children & young adults  Several subtype - Embryonal - Alveolar - Botryoid - Pleomorphic

26

27 Embryonal Rhabdomyosarcoma  Most common in children, in head & neck  Most common subtype  Rhabdomyoblasts with cytoplasmic cross-striation

28 Embryonal rhabdomyosarcoma

29 Botryoid Rhabdomyosarcoma  Most common in hollow visceral organs - genitourinary tract  Polypoid, grape-like tumor masses  Scattered malignant cells in myxoid stroma

30 Botryoid rhabdomyosarcoma

31 Alveolar Rhabdomyosarcoma  In extremities  Fibrous septa with loose clusters of rounded cells in center - alveolar pattern

32 Alveolar rhabdomyosarcoma

33 Pleomorphic Rhabdomyosarcoma  In skeletal muscles of older persons, in thigh  Marked pleomorphism  Irregularly arranged cells  Multinucleated giant cells

34 Pleomorphic Sarcoma

35 Lipoma  Benign, well-circumscribed tumor of well-differentiated adipocytes  Usually subcutaneous, any site of adipose tissue  Most common type of benign soft tissue tumor  In adult, upper back, neck, shoulder  Resemble normal adipose tissue  Subtypes:angiolipoma, spindle cell lipoma

36 Lipoma

37 Liposarcoma  Second most common sarcoma in adults  In deep compartments of extremities & retroperitoneum  Lipoblasts  Several subtypes - Well differentiated/atypical lipoma - Myxoid / Round cell - Pleomorphic

38 Liposarcoma

39 Hemangioma  Benign lesion  Resemble normal blood vessels  Congenital or non-congenital  Most common in infants & children  Head & neck, internal organs - liver

40

41 Angiosarcoma  Malignant vascular tumor  Many locations: skin, soft tissue, breast, live, spleen  Irregular channels & atypical endothelial cells  CD31- endothelial cell marker

42 Angiosarcoma

43 Schwannoma  Benign tumor of neural differentiation - Schwann cells  Antoni A  Antoni B  In association with large nerve trunks  Head & neck, extremities -- Cellular area, palisaded nuclei -- Less cellular area, myxoid background  S-100

44 Schwannoma

45 Synovial sarcoma  Malignant soft tissue tumor  Arising in region of a joint & other sites of deep soft tissue  Unknown origin- misnomer  Multilobular  Biphasic pattern - spindle cells - epithelial - like cells  t( X;18 )

46 Synovial sarcoma


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