Cell types for soft tissue tumors Epithelioid: Pleomorphic: Round cell: Spindle cell:

Fibromas is benign

fibroblastic proliferation. the term fibroma-benign the term fibrosarcomamalignant tumors Eg includes fibroma of tendon

Gross Firm fibrous mass. lobular in appearance Microscopic

More or less mature

sheath, fibroma of ovary,

fibrous tissue consisting of interlacing bundles of mature fibroblasts, collagen fibres and few blood capillaries

Fibroma

More or less mature fibrous tissue consisting of interlacing bundles of mature fibroblasts, collagen fibers and few blood capillaries

FIBROSARCOMA
Malignant tumor of

fibroblasts. Rare, lower extremities Young adults. M>F Large deep seated slow growing solitary May occur at the site of prior injury, irradiation or burn

Gross Well defined solitary mass,38 cms Whitish or fleshy, may contain necrosis / haemorrhage Microscopic Monotonous ,uniform, spindle shaped cells with scant cytoplasm & tapered nuclei. Pleomorphism- variable. Herringbone pattern Collagenous stroma Mitosis+ Giant cells +

FIBROSARCOMA

Highly cellular, plumped spindle shaped cells, architecture disarray, cellular and nuclear pleomorphism, frequent and abnormal mitotic figures & necrosis

Lipoma
A benign uniform

proliferation of mature adipocytes trunks & limbs 4th-5thdecade , m>f Slow growing painless mass

Gross Well circumscribed, capsulated mass with yellow cut surface Microscopy Lobules of uniform mature adipocytes

Lobules of mature clear fat cells resembling normal cells with no pleomorphism separated by thin fibro-vascular septa

 Proliferation of mature

Gross
Well circumscribed, cut

adipocytes exhibiting marked variation in cell size with focal nuclear atypia Retroperitonium , limbs , spermatic cord , mediastinum. 6th decade, M >F Slow growing painless mass

surface- yellow (lipoma like) with white grey areas(fibrous tissue). Microscopy Mature adipose tissue proliferation with variation in size & shape, associated with nuclear atypia in fat &/or stromal cells. Hyperchromatic bizzare stromal cells Lipoblast +

Liposarcoma is composed of large bizarre lipoblasts (primitive nucleated fat cells with clear vacuolated cytoplasm ) with mitoses and pleomorphism

Fibrohistiocytic tumors
Tumors that are composed of fibroblasts, myofibroblasts,

and tumor cells (including multinucleated giant cells) showing some evidence of phagocytic activity.

Benign fibrous histiocytoma

A benign fibrohistiocytic

proliferation of dermis or superficial sub cutis, or both. extremities Benign, non-recurring Early to middle aged adults, F>m c/f elevated or flat, well delineated, painless, often indurated, red to brown skin lesion.

Pathologic features Gross

Small< 2 cm, plaque or nodular well delineated lesion.

Microscopy dermal lesion Storiform /cartwheel pattern growth pattern Foamy macrophages, tuton giant cells & sideroblasts + Areas of increased cellularity, atypia & mitotic figures may be present. Accompanying epidermal hyperplasia.

Hemosiderin deposits

FIBROUS HISTIOCYTOMA
Giant cell

Benign fibrous histiocytoma : proliferating spindle shaped cells arranged in storiform pattern, foam cells, hemosidrin deposits & multinucleated giant cells

RHABDOMYOSARCOMA
Primitive malignant soft tissue Gross
Fleshy tumor

sarcoma with skeletal muscle Subtypes: alveolar, anaplastic, embryonal, pleomorphic, sclerosing although mixtures are common Most common soft tissue sarcoma of childhood/adolescence rare in adults

MicroscopyEccentric eosinophilic granular cytoplasm rich in thick and thin filaments If round and elongate, are

called strap cells or tadpole cells / rhamdomyoblast.

RHABDOMYO SARCOMA
Sheets of both oval & spindle shaped malignant cells showing all malignant criteria

Rhabdomyoblast is the diagnostic cell in all types (oval or elongated) (tadpole or strap cells ) with eosinophilic eccentric granular cytoplasm containing cross striations

Alveolar soft part sarcoma

Malignant mesenchymal tumor

characterized by large eosinophilic cells with an alveolar growth pattern Rare, deep soft tissue of extremities 60% cases female Painless soft tissue mass

Gross
Large haemorrhagic soft

tissue mass

Microscopy
Uniform,organoid nests of

large dyshesive,eosinophilis tumor cells with prominent nucleoli Mitosis & necrosis-rare

d/d-Ca, melanoma.

-Dense fibrous trabeculae divide the tumor into compartments - Nests or islands of tumour cells are separated by thin walled vascular septa - Tumor cells are large, round to oval, with eosinophilic granular cytoplasm, eccentric rounded nuclei and prominent nucleoli. - Central degeneration and loss of cohesion, result in pseudo alveolar pattern.

Alveolar soft part sarcoma