Soft tissue tumor - Revision history

Mikael Häggström: /* Evaluation */ Expanded

2023-10-25T19:43:40Z

Evaluation: Expanded

← Older revision		Revision as of 15:43, 25 October 2023
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	*'''CD34''', indicating a solitary fibrous tumor		*'''CD34''', indicating a solitary fibrous tumor
	*'''S100''', indicating a neural or nerve sheath tumor (see section below)		*'''S100''', indicating a neural or nerve sheath tumor (see section below)
	*'''Desmin''', indicating a muscular tumor (skeletal muscle or '''[[Smooth muscle tumor]]''')		*'''Desmin''', indicating a muscular tumor (skeletal muscle or '''[[Smooth muscle tumor]]''', latter also positive on '''SMA''')<ref name=PathOutlinesLeiomyosarcoma>{{cite web\|url=https://www.pathologyoutlines.com/topic/softtissueleiomyosarcoma.html\|title=Soft tissue - Leiomyosarcoma-general\|author=Borislav A. Alexiev, M.D.\|website=Pathology Outlines}} Last author update: 29 September 2023</ref>
	*'''Beta catenin''', indicating fibromatosis		*'''Beta catenin''', indicating fibromatosis
	At least in case of enlarged atypical nuclei, consider '''sarcoma''' as a differential diagnosis, and if unsure, have a low threshold for '''[[Consultation\|consulting]]''' with people with expertise in the matter, as the visual difference between benign and malignant spindle cells is relatively subtle. Relevant stains may include '''MDM2''' and '''CDK4''' for '''[[liposarcoma]]'''.<ref name=PathOutlinesDediffLipo>{{cite web\|url=https://www.pathologyoutlines.com/topic/softtissuededifflipo.html\|title=Dedifferentiated liposarcoma\|website=Pathology Outlines\|author=Susan Potterveld, D.O., M.P.H., Michael R. Clay, M.D.}} Last author update: 14 June 2023</ref>		At least in case of enlarged atypical nuclei, consider '''sarcoma''' as a differential diagnosis, and if unsure, have a low threshold for '''[[Consultation\|consulting]]''' with people with expertise in the matter, as the visual difference between benign and malignant spindle cells is relatively subtle. Relevant stains may include '''MDM2''' and '''CDK4''' for '''[[liposarcoma]]''',<ref name=PathOutlinesDediffLipo>{{cite web\|url=https://www.pathologyoutlines.com/topic/softtissuededifflipo.html\|title=Dedifferentiated liposarcoma\|website=Pathology Outlines\|author=Susan Potterveld, D.O., M.P.H., Michael R. Clay, M.D.}} Last author update: 14 June 2023</ref> as well as '''desmin''' and '''SMA''' for '''[[Leiomyosarcoma]]'''.<ref name=PathOutlinesLeiomyosarcoma/>
	<gallery mode=packed heights=210px>		<gallery mode=packed heights=210px>
	File:Histopathology of liposarcoma, annotated.jpg\|Main features of '''[[liposarcoma]]''':<ref name=PathologyOutlines-Liposarcoma>{{cite web\|url=https://www.pathologyoutlines.com/topic/softtissuewdliposarcoma.html%7Ctitle=Liposarcoma\|author=Michael R. Clay, M.D.\|website=PathologyOutlines\|title=Liposarcoma}} Topic Completed: 1 November 2017. Minor changes: 11 May 2021</ref><br>- Spindle cells with enlarged, hyperchromatic nuclei.<br>- Apparently univacuolated adipocytes (may look normal).<br>- [[Lipoblast]]s (multivacuolated), but neither necessary nor sufficient for diagnosis.		File:Histopathology of liposarcoma, annotated.jpg\|Main features of '''[[liposarcoma]]''':<ref name=PathologyOutlines-Liposarcoma>{{cite web\|url=https://www.pathologyoutlines.com/topic/softtissuewdliposarcoma.html%7Ctitle=Liposarcoma\|author=Michael R. Clay, M.D.\|website=PathologyOutlines\|title=Liposarcoma}} Topic Completed: 1 November 2017. Minor changes: 11 May 2021</ref><br>- Spindle cells with enlarged, hyperchromatic nuclei.<br>- Apparently univacuolated adipocytes (may look normal).<br>- [[Lipoblast]]s (multivacuolated), but neither necessary nor sufficient for diagnosis.
	File:Histopathology of leiomyosarcoma.jpg\|'''Leiomyosarcoma''': Variable atypia, often with cytoplasmic vacuoles at both ends of nuclei, and frequent mitoses.<ref>{{cite web\|url=http://www.pathologyoutlines.com/topic/softtissueleiomyosarcoma.html\|title=Soft tissue - Smooth muscle - Leiomyosarcoma - general\|author=Vijay Shankar, M.D.\|website=Pathology Outlines}} Topic Completed: 1 November 2012. Revised: 11 September 2019</ref>		File:Histopathology of leiomyosarcoma.jpg\|'''[[Leiomyosarcoma]]''': Variable atypia, often with cytoplasmic vacuoles at both ends of nuclei, and frequent mitoses.<ref>{{cite web\|url=http://www.pathologyoutlines.com/topic/softtissueleiomyosarcoma.html\|title=Soft tissue - Smooth muscle - Leiomyosarcoma - general\|author=Vijay Shankar, M.D.\|website=Pathology Outlines}} Topic Completed: 1 November 2012. Revised: 11 September 2019</ref>
	</gallery>		</gallery>
	===Neural or nerve sheath tumors===		===Neural or nerve sheath tumors===

Mikael Häggström: /* Evaluation */ Expanded

2023-10-25T19:39:40Z

Evaluation: Expanded

← Older revision		Revision as of 15:39, 25 October 2023
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	*'''Desmin''', indicating a muscular tumor (skeletal muscle or '''[[Smooth muscle tumor]]''')		*'''Desmin''', indicating a muscular tumor (skeletal muscle or '''[[Smooth muscle tumor]]''')
	*'''Beta catenin''', indicating fibromatosis		*'''Beta catenin''', indicating fibromatosis
	~~Also~~ consider a '''sarcoma''' as a differential diagnosis, and if unsure, have a low threshold for '''[[Consultation\|consulting]]''' with people with expertise in the matter, as the visual difference between benign and malignant spindle cells is relatively subtle.		At least in case of enlarged atypical nuclei, consider '''sarcoma''' as a differential diagnosis, and if unsure, have a low threshold for '''[[Consultation\|consulting]]''' with people with expertise in the matter, as the visual difference between benign and malignant spindle cells is relatively subtle. Relevant stains may include '''MDM2''' and '''CDK4''' for '''[[liposarcoma]]'''.<ref name=PathOutlinesDediffLipo>{{cite web\|url=https://www.pathologyoutlines.com/topic/softtissuededifflipo.html\|title=Dedifferentiated liposarcoma\|website=Pathology Outlines\|author=Susan Potterveld, D.O., M.P.H., Michael R. Clay, M.D.}} Last author update: 14 June 2023</ref>
			<gallery mode=packed heights=210px>
			File:Histopathology of liposarcoma, annotated.jpg\|Main features of '''[[liposarcoma]]''':<ref name=PathologyOutlines-Liposarcoma>{{cite web\|url=https://www.pathologyoutlines.com/topic/softtissuewdliposarcoma.html%7Ctitle=Liposarcoma\|author=Michael R. Clay, M.D.\|website=PathologyOutlines\|title=Liposarcoma}} Topic Completed: 1 November 2017. Minor changes: 11 May 2021</ref><br>- Spindle cells with enlarged, hyperchromatic nuclei.<br>- Apparently univacuolated adipocytes (may look normal).<br>- [[Lipoblast]]s (multivacuolated), but neither necessary nor sufficient for diagnosis.
			File:Histopathology of leiomyosarcoma.jpg\|'''Leiomyosarcoma''': Variable atypia, often with cytoplasmic vacuoles at both ends of nuclei, and frequent mitoses.<ref>{{cite web\|url=http://www.pathologyoutlines.com/topic/softtissueleiomyosarcoma.html\|title=Soft tissue - Smooth muscle - Leiomyosarcoma - general\|author=Vijay Shankar, M.D.\|website=Pathology Outlines}} Topic Completed: 1 November 2012. Revised: 11 September 2019</ref>
			</gallery>
	===Neural or nerve sheath tumors===		===Neural or nerve sheath tumors===
	<gallery mode=packed heights=210px>		<gallery mode=packed heights=210px>
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	File:Antoni A area of schwannoma with Verocay bodies - annotated.png\|'''Schwannoma''' is also characterized by Verocay bodies (one encircled), which are stripes of anuclear zones, separated by cellular palisades.		File:Antoni A area of schwannoma with Verocay bodies - annotated.png\|'''Schwannoma''' is also characterized by Verocay bodies (one encircled), which are stripes of anuclear zones, separated by cellular palisades.
	File:Histopathology of neurofibroma.jpg\|'''Neurofibroma''': A spindle cell lesion composed of slender fibroblast-like cells with storiform pattern and very low amount of stroma.		File:Histopathology of neurofibroma.jpg\|'''Neurofibroma''': A spindle cell lesion composed of slender fibroblast-like cells with storiform pattern and very low amount of stroma.
			File:Histopathology of invasive melanoma, high magnification.jpg\|In case of atypia, keep in mind that metastatic '''[[Invasive melanoma of the skin\|melanoma]]''' is generally also positive for S100.<ref name=PathOutlinesDediffLipo/>
	</gallery>		</gallery>
	{{Further\|Evaluation of suspected malignancies}}		{{Further\|Evaluation of suspected malignancies}}
	{{Bottom}}		{{Bottom}}

Mikael Häggström: /* Evaluation */ visual

2022-12-10T19:43:56Z

Evaluation: visual

← Older revision		Revision as of 15:43, 10 December 2022
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	*'''Desmin''', indicating a muscular tumor (skeletal muscle or '''[[Smooth muscle tumor]]''')		*'''Desmin''', indicating a muscular tumor (skeletal muscle or '''[[Smooth muscle tumor]]''')
	*'''Beta catenin''', indicating fibromatosis		*'''Beta catenin''', indicating fibromatosis
	Also consider a '''sarcoma''' as a differential diagnosis, and if unsure, have a low threshold for '''[[Consultation\|consulting]]''' with people with expertise in the matter, as the difference between benign and malignant spindle cells is relatively subtle.		Also consider a '''sarcoma''' as a differential diagnosis, and if unsure, have a low threshold for '''[[Consultation\|consulting]]''' with people with expertise in the matter, as the visual difference between benign and malignant spindle cells is relatively subtle.

	===Neural or nerve sheath tumors===		===Neural or nerve sheath tumors===

Mikael Häggström: /* Evaluation */ Consultation

2022-12-09T20:58:36Z

Evaluation: Consultation

← Older revision		Revision as of 16:58, 9 December 2022
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	*'''Desmin''', indicating a muscular tumor (skeletal muscle or '''[[Smooth muscle tumor]]''')		*'''Desmin''', indicating a muscular tumor (skeletal muscle or '''[[Smooth muscle tumor]]''')
	*'''Beta catenin''', indicating fibromatosis		*'''Beta catenin''', indicating fibromatosis
			Also consider a '''sarcoma''' as a differential diagnosis, and if unsure, have a low threshold for '''[[Consultation\|consulting]]''' with people with expertise in the matter, as the difference between benign and malignant spindle cells is relatively subtle.

	===Neural or nerve sheath tumors===		===Neural or nerve sheath tumors===

Mikael Häggström: /* Evaluation */ Merged

2022-09-29T21:33:14Z

Evaluation: Merged

← Older revision		Revision as of 17:33, 29 September 2022
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	[[File:Histopathology of solitary fibrous tumor.png\|thumb\|A '''solitary fibrous tumor''', an example of spindle cell tumor.]]		[[File:Histopathology of solitary fibrous tumor.png\|thumb\|A '''solitary fibrous tumor''', an example of spindle cell tumor.]]
	In case of '''spindle cell tumors''' (having elongated nuclei), the following features may help to roughly classify the tumor:		In case of '''spindle cell tumors''' (having elongated nuclei), the following features may help to roughly classify the tumor:
	*Pointed on both ends: True fibroblastic tumors		*Pointed on both ends: '''True fibroblastic tumors'''
	*Pointed on one end and blunted on the other ("bullet-shaped"): Neural		*Pointed on one end and blunted on the other ("bullet-shaped"): '''Neural'''/'''nerve sheath''' tumors (see section below)
	*Blunted on both ends ("cigar-shaped"): '''[[Smooth muscle tumor]]'''		*Blunted on both ends ("cigar-shaped"): '''[[Smooth muscle tumor]]'''
	*Triangular: Myofibroblastic		*Triangular: Myofibroblastic
	In uncertain cases, the following [[immunohistochemistry]] markers are usually helpful:		In uncertain cases, the following [[immunohistochemistry]] markers are usually helpful:
	*'''CD34''', indicating a solitary fibrous tumor		*'''CD34''', indicating a solitary fibrous tumor
	*'''S100''', indicating a neural tumor		*'''S100''', indicating a neural or nerve sheath tumor (see section below)
	*'''Desmin''', indicating a muscular tumor (skeletal muscle or '''[[Smooth muscle tumor]]''')		*'''Desmin''', indicating a muscular tumor (skeletal muscle or '''[[Smooth muscle tumor]]''')
	*'''Beta catenin''', indicating fibromatosis		*'''Beta catenin''', indicating fibromatosis

			===Neural or nerve sheath tumors===
			<gallery mode=packed heights=210px>
			File:Schwannoma with Antoni A and Antoni B areas.jpg\|'''Schwannoma''', characterized by cellular Antoni A areas (top) and a loose paucicellular Antoni B areas (bottom).
			File:Antoni A area of schwannoma with Verocay bodies - annotated.png\|'''Schwannoma''' is also characterized by Verocay bodies (one encircled), which are stripes of anuclear zones, separated by cellular palisades.
			File:Histopathology of neurofibroma.jpg\|'''Neurofibroma''': A spindle cell lesion composed of slender fibroblast-like cells with storiform pattern and very low amount of stroma.
			</gallery>
	{{Further\|Evaluation of suspected malignancies}}		{{Further\|Evaluation of suspected malignancies}}
	{{Bottom}}		{{Bottom}}

Mikael Häggström: Started

2022-09-29T20:36:17Z

Started

New page

{{Top
|author1=[[User:Mikael Häggström|Mikael Häggström]]
|author2=
}}
==Gross processing==
<gallery>
File:Lipoma 06.jpg|link=Lipomatous tumor|If it appears fatty, gross and evaluate as a '''[[lipomatous tumor]]'''.
</gallery>
Generally sample one slice per centimeter.

==Evaluation==
[[File:Histopathology of solitary fibrous tumor.png|thumb|A '''solitary fibrous tumor''', an example of spindle cell tumor.]]
In case of '''spindle cell tumors''' (having elongated nuclei), the following features may help to roughly classify the tumor:
*Pointed on both ends: True fibroblastic tumors
*Pointed on one end and blunted on the other ("bullet-shaped"): Neural
*Blunted on both ends ("cigar-shaped"): '''[[Smooth muscle tumor]]'''
*Triangular: Myofibroblastic
In uncertain cases, the following [[immunohistochemistry]] markers are usually helpful:
*'''CD34''', indicating a solitary fibrous tumor
*'''S100''', indicating a neural tumor
*'''Desmin''', indicating a muscular tumor (skeletal muscle or '''[[Smooth muscle tumor]]''')
*'''Beta catenin''', indicating fibromatosis
{{Further|Evaluation of suspected malignancies}}
{{Bottom}}