Soft tissue tumor: Difference between revisions

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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]]''', 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> as well as '''desmin''' and '''SMA''' for '''[[Leiomyosarcoma]]'''.<ref name=PathOutlinesLeiomyosarcoma/>
<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===
<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.
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>
{{Further|Evaluation of suspected malignancies}}
{{Further|Evaluation of suspected malignancies}}
{{Bottom}}
{{Bottom}}

Latest revision as of 15:43, 25 October 2023

Author: Mikael Häggström [note 1]

Gross processing

Generally sample one slice per centimeter.

Evaluation

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/nerve sheath tumors (see section below)
  • 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 or nerve sheath tumor (see section below)
  • Desmin, indicating a muscular tumor (skeletal muscle or Smooth muscle tumor, latter also positive on SMA)[1]
  • 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 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,[2] as well as desmin and SMA for Leiomyosarcoma.[1]

  • Main features of liposarcoma:[3] - Spindle cells with enlarged, hyperchromatic nuclei. - Apparently univacuolated adipocytes (may look normal). - Lipoblasts (multivacuolated), but neither necessary nor sufficient for diagnosis.
    Main features of liposarcoma:[3]
    - Spindle cells with enlarged, hyperchromatic nuclei.
    - Apparently univacuolated adipocytes (may look normal).
    - Lipoblasts (multivacuolated), but neither necessary nor sufficient for diagnosis.
  • Leiomyosarcoma: Variable atypia, often with cytoplasmic vacuoles at both ends of nuclei, and frequent mitoses.[4]
    Leiomyosarcoma: Variable atypia, often with cytoplasmic vacuoles at both ends of nuclei, and frequent mitoses.[4]

Neural or nerve sheath tumors

  • Schwannoma, characterized by cellular Antoni A areas (top) and a loose paucicellular Antoni B areas (bottom).
    Schwannoma, characterized by cellular Antoni A areas (top) and a loose paucicellular Antoni B areas (bottom).
  • Schwannoma is also characterized by Verocay bodies (one encircled), which are stripes of anuclear zones, separated by cellular palisades.
    Schwannoma is also characterized by Verocay bodies (one encircled), which are stripes of anuclear zones, separated by cellular palisades.
  • Neurofibroma: A spindle cell lesion composed of slender fibroblast-like cells with storiform pattern and very low amount of stroma.
    Neurofibroma: A spindle cell lesion composed of slender fibroblast-like cells with storiform pattern and very low amount of stroma.
  • In case of atypia, keep in mind that metastatic melanoma is generally also positive for S100.[2]
    In case of atypia, keep in mind that metastatic melanoma is generally also positive for S100.[2]

Further information: Evaluation of suspected malignancies

Notes

  1. ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.

Main page

References

  1. ↑ 1.0 1.1 Borislav A. Alexiev, M.D.. Soft tissue - Leiomyosarcoma-general. Pathology Outlines. Last author update: 29 September 2023
  2. ↑ 2.0 2.1 Susan Potterveld, D.O., M.P.H., Michael R. Clay, M.D.. Dedifferentiated liposarcoma. Pathology Outlines. Last author update: 14 June 2023
  3. ↑ Michael R. Clay, M.D.. Liposarcoma. PathologyOutlines. Topic Completed: 1 November 2017. Minor changes: 11 May 2021
  4. ↑ Vijay Shankar, M.D.. Soft tissue - Smooth muscle - Leiomyosarcoma - general. Pathology Outlines. Topic Completed: 1 November 2012. Revised: 11 September 2019

Image sources


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