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Soft Tissue Tumors Lucy H. Liu, M.D. Department of Pathology

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

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

2 UIC College of Medicine M2 Pathology Course, Lecture # 63
Soft Tissue Tumors UIC College of Medicine M2 Pathology Course, Lecture # 63 Tuesday, January 28, 2003 11:30 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 -- Fibrous tissue -- Smooth muscle -- Skeletal muscle -- Adipose tissue -- Blood & lymphatic vessels -- Peripheral nerves - neuroectoderm

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

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

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

8 Soft Tissue Tumors Cytogenetic Changes
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

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

12 Fibromatosis

13 Fibrosarcoma Malignant tumor of fibroblast origin
In adults, in lower extremities, upper extremities, trunk Spindle cells in a herringbone pattern Increased cellularity, high nuclear-cytoplasmic ratios 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


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 In adult, upper back, neck, shoulder Usually subcutaneous, any site of adipose tissue Most common type of benign soft tissue tumor 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


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
In association with large nerve trunks Head & neck, extremities Antoni A Antoni B -- Cellular area, palisaded nuclei -- Less cellular area, myxoid background S-100

44 Schwannoma

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

46 Synovial sarcoma

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