Difference between revisions of "Spindle cell lesions"
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Revision as of 22:55, 6 October 2013
Spindle cell lesions are seen frequent enough that one ought to have a solid approach to 'em.
General DDx
Spindle cells should make think:
- Nerve.
- Muscle.
- Smooth.
- Skeletal.
- Other.
- Carcinoma, e.g. metaplastic carcinoma.
A long DDx of spindle cell tumour
Microscopic
Grouping by pleomorphism
- Monomorphic - small variation of tumour cell size.
- Pleomorphic - large variation of tumour cell size.
DDx - monomorphic:
- Synovial sarcoma.
- Fibrosarcoma.
- MPNST.
- Metaplastic carcinoma, e.g. metaplastic breast carcinoma.
DDx - pleomorphic:
- Pleomorphic undifferentiated sarcoma.
- Pleomorphic liposarcoma.
- Pleomorphic rhabdomyosarcoma.
- Pleomorphic leiomyosarcoma.
- Metaplastic carcinoma.
- Malignant melanoma.
Grouping by pattern
IHC
Basic panel
Dixon panel:[8]
- CD34.
- Desmin.
- SMA.
- S100.
- AE1/AE3 (pankeratin).
Memory device SCADS or CAD SS = S100, CD34, AE1/AE3, Desmin, SMA.
Big panels
A MSH MFH panel
- CD34 - GIST, angiosarcoma, solitary fibrous tumour/hemangiopericytoma, Kaposi sarcoma, DFSP, PASH.
- S100 - neural marker, sensitive for malignant melanoma, Langerhans cells, clear cell sarcoma.
- Desmin - smooth muscle.
- MIB1 - proliferation.
- CD99 - immature T cells (thymus), small round cell tumours, synovial sarcoma, Merkel cell carcinoma, osteosarcoma.[9]
- Considered "slutty", i.e. non-specific, by Dr. Fletcher; useful if membranous stain pattern = Ewing sarcoma/PNET.
- BCL2 - synovial sarcoma, small cell lymphomas, spindle cell lipoma,[10][11] solitary fibrous tumour.
- PGP 9.5.
- SMMS - smooth muscle.
- Caldesmon - muscle.
- PDGFR - GIST
- DOG-1 - GIST (membranous, cytoplasmic),[12] normal pancreas (islets),[12] associated with BRCA1.
Others:
- Beta-catenin - a small subset of soft tissue lesions:
- Desmoid-type fibromatosis (~70%), solitary fibrous tumour & endometrial stromal sarcoma (~40%), synovial sarcoma (~30%).[13]
DJH panels
MFH
- Vimentin.
- Keratin 5D3 - carcinomas.
- Keratin LP34 - carcinomas.
- EMA.
- CD99.
- MSA.
- SMA.
- Caldesmon.
- CD34.
- S-100 - neural tumours.
- HMB45 - melanoma
- Mart-1 - melanoma.
- Tyrosinase.
- MYF-4 - RMS.
- Alpha-1-antichymotrypsin.
SRCT
Same as MFH panel plus the following:
- CD45.
- CD30.
- CD3.
- CD20.
- Desmin.
- CD31 - angiosarcoma.
- Factor VIII - angiosarcoma.
See also
- Bone.
- Dermatopathology.
- Hematopathology.
- Soft tissue lesions.
- Immunohistochemistry.
- Spindle cell.
- Epithelioid cell lesions.
Treatment
- It depends on the subtype.
- Malignant lesions are usually sarcomas and treated with radiation and surgery.[14]
References
- ↑ Remstein, ED.; Kurtin, PJ.; Nascimento, AG. (Jan 2000). "Sclerosing extramedullary hematopoietic tumor in chronic myeloproliferative disorders.". Am J Surg Pathol 24 (1): 51-5. PMID 10632487.
- ↑ Dei Tos, AP.; Mentzel, T.; Newman, PL.; Fletcher, CD. (Sep 1994). "Spindle cell liposarcoma, a hitherto unrecognized variant of liposarcoma. Analysis of six cases.". Am J Surg Pathol 18 (9): 913-21. PMID 8067512.
- ↑ Folpe, AL.; Weiss, SW. (Jun 2002). "Lipoleiomyosarcoma (well-differentiated liposarcoma with leiomyosarcomatous differentiation): a clinicopathologic study of nine cases including one with dedifferentiation.". Am J Surg Pathol 26 (6): 742-9. PMID 12023578.
- ↑ Montgomery, E.; Goldblum, JR.; Fisher, C. (Feb 2001). "Myofibrosarcoma: a clinicopathologic study.". Am J Surg Pathol 25 (2): 219-28. PMID 11176071.
- ↑ Iwasa, Y.; Fletcher, CD. (Nov 2004). "Cellular angiofibroma: clinicopathologic and immunohistochemical analysis of 51 cases.". Am J Surg Pathol 28 (11): 1426-35. PMID 15489646.
- ↑ Oliva, E.; Clement, PB.; Young, RH.; Scully, RE. (Aug 1998). "Mixed endometrial stromal and smooth muscle tumors of the uterus: a clinicopathologic study of 15 cases.". Am J Surg Pathol 22 (8): 997-1005. PMID 9706980.
- ↑ Ulbright, TM.; Srigley, JR.; Hatzianastassiou, DK.; Young, RH. (Nov 2002). "Leydig cell tumors of the testis with unusual features: adipose differentiation, calcification with ossification, and spindle-shaped tumor cells.". Am J Surg Pathol 26 (11): 1424-33. PMID 12409718.
- ↑ BD. 1 April 2011.
- ↑ Tadrous, Paul.J. Diagnostic Criteria Handbook in Histopathology: A Surgical Pathology Vade Mecum (1st ed.). Wiley. pp. 108. ISBN 978-0470519035.
- ↑ Tadrous, Paul.J. Diagnostic Criteria Handbook in Histopathology: A Surgical Pathology Vade Mecum (1st ed.). Wiley. pp. 107. ISBN 978-0470519035.
- ↑ URL: http://ajp.amjpathol.org/cgi/content/full/160/3/759. Accessed on: 3 August 2010.
- ↑ 12.0 12.1 Ardeleanu C, Arsene D, Hinescu M, et al. (October 2009). "Pancreatic expression of DOG1: a novel gastrointestinal stromal tumor (GIST) biomarker". Appl. Immunohistochem. Mol. Morphol. 17 (5): 413–8. doi:10.1097/PAI.0b013e31819e4dc5. PMID 19417627.
- ↑ Ng TL, Gown AM, Barry TS, et al. (January 2005). "Nuclear beta-catenin in mesenchymal tumors". Mod. Pathol. 18 (1): 68–74. doi:10.1038/modpathol.3800272. PMID 15375433.
- ↑ Collini P, Sorensen PH, Patel S, et al. (August 2009). "Sarcomas with spindle cell morphology". Semin. Oncol. 36 (4): 324–37. doi:10.1053/j.seminoncol.2009.06.007. PMID 19664493.