Difference between revisions of "Soft tissue lesions"

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Soft tissue lesions (view source)

Revision as of 18:06, 18 May 2011

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→‎Fibroblastic/myofibroblastic tumours: split-out
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=Fibroblastic/myofibroblastic tumours=
=Fibroblastic/myofibroblastic tumours=
{{Main|Fibroblastic/myofibroblastic tumours}}


==Inflammatory myofibroblastic tumour==
This is a very large and important group of soft tissue lesions. It is covered in a separate article.
*[[AKA]] inflammatory pseudotumour, AKA inflammatory fibrosarcoma.<ref name=Ref_WMSP610>{{Ref WMSP|610}}</ref>
===General===
*Mostly benign.
*Children & young adults.
*Classically located in mesentery of ileocolic region or small bowel.<ref name=Ref_WMSP610>{{Ref WMSP|610}}</ref>
 
===Microscopic===
Features:<ref name=Ref_WMSP610>{{Ref WMSP|610}}</ref>
*Inflammation:
**Plasma cells.
**Lymphocytes.
**Eosinophils.
*Spindle cells without atypia.
*+/-Fasciular architecture.
*Mitoses -- though none atypical.
*+/-Necrosis.
*+/-Hemorrhage.
*Calcifications.
 
DDx:
*Calcifying fibrous pseudotumour (has psammomatous calcifications).
*Inflammatory fibroid tumour.
*Nodular fasciitis.
 
Notes:
*Some consider this a wastebasket diagnosis... for benign appearing spindle cell lesions.<ref>URL: [http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970283-2 http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970283-2]. Accessed on: 10 May 2011.</ref>
 
==Nodular fasciitis==
===General===
*Benign.
*All age groups.
*Associated with trauma.
 
===Microscopic===
Features:<ref name=Ref_WMSP606>{{Ref WMSP|606}}</ref><ref>{{cite journal |author=de Feraudy S, Fletcher CD |title=Intradermal nodular fasciitis: a rare lesion analyzed in a series of 24 cases |journal=Am. J. Surg. Pathol. |volume=34 |issue=9 |pages=1377–81 |year=2010 |month=September |pmid=20716998 |doi=10.1097/PAS.0b013e3181ed7374 |url=}}</ref>
*Usu. well-circumscribed.
*Clusters of (non-pleomorphic) spindle cells.
*Inflammation (lymphocytes).
*Microcysts in cellular regions - uncommon - ''discriminatory''.
*Mitoses - common.
*Extravasated [[RBC]]s.
 
The BD feature list:<ref>BD. 26 April 2011.</ref>
*Tissue culture-like/CNS-like morphology.
*Thick (keloid-like) collagen bundles - '''key feature'''.
*Extravasated [[RBC]]s.
*Inflammation.
*+/-Giant cells.
 
Notes:
*No significant nuclear atypia.
*No atypical mitoses.
*May be cellular.
 
Images:
*[http://en.wikipedia.org/wiki/File:Nodular_fasciitis_%281%29.JPG NF - low mag. (WC)].
*[http://en.wikipedia.org/wiki/File:Nodular_fasciitis_%282%29.JPG NF - high mag. (WC)].
 
===IHC===
Routine spindle cell panel:
*CD34 -ve.
*Desmin -ve..
*SMA -ve.
*S100 -ve.
*AE1/AE3 -ve.
 
Others:
*H-caldesmon -ve.
*EMA -ve.
*Vimentin +ve.
 
===Molecular===
*Evolving - case reports.
**t(15;15)(q13;q25).<ref name=pmid12606136>{{cite journal |author=Velagaleti GV, Tapper JK, Panova NE, Miettinen M, Gatalica Z |title=Cytogenetic findings in a case of nodular fasciitis of subclavicular region |journal=Cancer Genet. Cytogenet. |volume=141 |issue=2 |pages=160–3 |year=2003 |month=March |pmid=12606136 |doi= |url=}}</ref>
 
==Desmoid-type fibromatosis==
*[[AKA]] desmoid tumour.
===General===
*Benign.
*Locally aggressive.<ref>URL: [http://www.dtrf.org/dtrf_aboutdesmoids.htm http://www.dtrf.org/dtrf_aboutdesmoids.htm]. Accessed on: 15 April 2011.</ref>
*May be seen in the context of [[familial adenomatous polyposis]].
 
===Microscopic===
Features:<ref name=Ref_WMSP609>{{Ref WMSP|609}}</ref>
*Abundant fibroblasts.
**Arranged in bundles or fascicles.
*+/-Collagen.
 
===IHC===
Features:<ref name=Ref_WMSP609>{{Ref WMSP|609}}</ref>
*Beta-catenin +ve.
*SMA +ve ~50% of lesions.
 
==Proliferative fasciitis==
*Need to write something here.
 
==Solitary fibrous tumour==
===General===
*Grouped with ''hemangiopericytoma'' in the WHO classification; possibly the same tumour (?).<ref name=Ref_WMSP609>{{Ref WMSP|609}}</ref>
*May be benign ''or'' malignant; more commonly benign.<ref>URL: [http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970528-9 http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970528-9]. Accessed on: 25 June 2010.</ref><ref>URL: [http://wjso.com/content/6/1/86 http://wjso.com/content/6/1/86]. Accessed on: 25 June 2010.</ref>
 
===Microscopic===
Features:
*Well-circumscribed.
*Fibroblast-like cells (spindle cells).
*Hemangiopericytoma-like area (staghorn vessels) - not seen on image.
*Keloid-like collagen bundles.
 
Images:
*[http://commons.wikimedia.org/wiki/File:Solitary_fibrous_tumour_low_mag.jpg SFT - low mag. (WC)].
*[http://commons.wikimedia.org/wiki/File:Solitary_fibrous_tumour_intermed_mag.jpg SFT - intermed. mag. (WC)].
*[http://commons.wikimedia.org/wiki/File:Solitary_fibrous_tumour_high_mag.jpg SFT - high mag. (WC)].
 
===IHC===
*CD34 ~90% +ve.
*CD99 ~70% +ve.
*BCL2 ~50% +ve.
 
==Hemangiopericytoma==
===General===
*Grouped with ''solitary fibrous tumour'' in the WHO classification; possibly the same tumour (?).<ref name=Ref_WMSP609>{{Ref WMSP|609}}</ref>
*Arises from the ''pericyte'', a connective tissue cell of small vessels that is thought to be involved in flow regulation.
*Hematologic spread most common - to lungs.<ref>URL: [http://emedicine.medscape.com/article/1255879-overview http://emedicine.medscape.com/article/1255879-overview]. Accessed on: 2 May 2010.</ref>
*Oncogenic osteomalacia - assoc. with hemangiopericytoma.<ref>URL: [http://emedicine.medscape.com/article/1255879-overview http://emedicine.medscape.com/article/1255879-overview]. Accessed on: 2 May 2010.</ref>
 
===Presentation===
*Usually painless mass, slow enlargement.
 
====Radiology====
*Intramedullary lytic mass.
*May be well-circumscribed.
*+/-Periosteal reaction.
*+/-Sclerotic border.
 
May be worked-up with angiography to distinguish from a [[vascular malformation]].<ref>URL: [http://emedicine.medscape.com/article/1255879-diagnosis http://emedicine.medscape.com/article/1255879-diagnosis]. Accessed on: 2 May 2010.</ref>
===Location===
*Usually extremities - femur or prox. tibial.<ref>URL: [http://emedicine.medscape.com/article/1255879-overview http://emedicine.medscape.com/article/1255879-overview]. Accessed on: 2 May 2010.</ref>
 
===Histology===
Features:<ref>URL: [http://emedicine.medscape.com/article/1255879-diagnosis http://emedicine.medscape.com/article/1255879-diagnosis]. Accessed on: 2 May 2010.</ref>
*Hypervascular lesion - '''key diagnostic feature'''.<ref name=enzinger>Enzinger & Weiss's Soft Tissue Tumors. 4th Ed. PP.1007-13. ISBN 0-323-01200-0.</ref>
**Abundant thin-walled branching small vessels of variable size.
***May be described as "staghorn vessels" or "antler-like" vasculature.
***Cells may "onion-skin" around thin blood vessels.
*Spindle or ovoid shaped cells in nests or sheets.
 
===IHC===
Features:<ref name=Ref_WMSP609>{{Ref WMSP|609}}</ref><ref name=enzinger/>
*Vimentin +ve (usually).
*Desmin -ve (typical).
*Factor VIII -ve (marks endothelium).
*CD34 +ve.
**CD34 usu. -ve in synovial sarcoma.
*CD31 -ve (marks benign endothelium).
*vWF (von Willebrand factor) -ve.
 
May be in the DDx for [[meningioma]]:<ref>Croul, SE. 8 November 2010.</ref>
*EMA -ve.
*S100 -ve.
 
===DDx===
*Other vascular tumours.
*Vascular malformations.
*Synovial sarcoma.
 
==Desmoplastic fibroblastoma==
*AKA ''collagenous fibroma''.<ref name=pmid18271804>{{Cite journal  | last1 = Watanabe | first1 = H. | last2 = Ishida | first2 = Y. | last3 = Nagashima | first3 = K. | last4 = Makino | first4 = T. | last5 = Norisugi | first5 = O. | last6 = Shimizu | first6 = T. | title = Desmoplastic fibroblastoma (collagenous fibroma). | journal = J Dermatol | volume = 35 | issue = 2 | pages = 93-7 | month = Feb | year = 2008 | doi = 10.1111/j.1346-8138.2008.00421.x | PMID = 18271804 }}</ref>
*Benign lesion.
*Classically found in shoulder region.
 
===IHC===
*Beta-catenin -ve.<ref name=pmid18544056>{{Cite journal  | last1 = Takahara | first1 = M. | last2 = Ichikawa | first2 = R. | last3 = Oda | first3 = Y. | last4 = Uchi | first4 = H. | last5 = Takeuchi | first5 = S. | last6 = Moroi | first6 = Y. | last7 = Kiryu | first7 = H. | last8 = Furue | first8 = M. | title = Desmoplastic fibroblastoma: a case presenting as a protruding nodule in the dermis. | journal = J Cutan Pathol | volume = 35 Suppl 1 | issue =  | pages = 70-3 | month = Oct | year = 2008 | doi = 10.1111/j.1600-0560.2007.00964.x | PMID = 18544056 }}
</ref>
**Significance ???
 
==Low-grade fibromyxoid sarcoma==
*[[AKA]] ''hyalinizing spindle cell tumour''.
===General===
*Deep soft tissue.
 
===Microscopic===
Features:<ref>{{cite journal |author=Vernon SE, Bejarano PA |title=Low-grade fibromyxoid sarcoma: a brief review |journal=Arch. Pathol. Lab. Med. |volume=130 |issue=9 |pages=1358–60 |year=2006 |month=September |pmid=16948525 |doi= |url=}}</ref>
*Myoid stroma - '''key feature'''.
*Low cellularity.
*Spindle cells.
 
Notes:
*Few/absent mitoses.
 
===Molecular pathology===
t(7;16)(q33;p11)<ref>{{cite journal |author=Panagopoulos I, Storlazzi CT, Fletcher CD, ''et al.'' |title=The chimeric FUS/CREB3l2 gene is specific for low-grade fibromyxoid sarcoma |journal=Genes Chromosomes Cancer |volume=40 |issue=3 |pages=218–28 |year=2004 |month=July |pmid=15139001 |doi=10.1002/gcc.20037 |url=}}</ref>


=Perivascular tumours=
=Perivascular tumours=
Michael
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