Difference between revisions of "Soft tissue lesions"

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Soft tissue lesions (view source)

Revision as of 15:26, 27 April 2011

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→‎Vascular lesions: split-out into separate article
(→‎Vascular lesions: split-out into separate article)
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=Vascular lesions=
=Vascular lesions=
{{Main|Vascular lesions}}
Vascular lesions are "too red"; they have too many RBCs.
Vascular lesions are "too red"; they have too many RBCs.


==Hemangioma==
They include:
===General===
*[[Hemangioma]].
Comes is various flavours:<ref name=pmid10410855>{{cite journal |author=Prieto VG, Shea CR |title=Selected cutaneous vascular neoplasms. A review |journal=Dermatol Clin |volume=17 |issue=3 |pages=507–20, viii |year=1999 |month=July |pmid=10410855 |doi= |url=}}</ref>
*[[Kaposi sarcoma]].
*Tufted.
*[[Masson hemangioma]].
**Small clusters of blood vessels.
*[[Angiosarcoma]]
*Microvenular hemangioma.
*[[Epithelioid hemangioendothelioma]].
*Glomeruloid hemangioma - associated with [[POEMS syndrome]].
*Epithelioid hemangioma.
*Targetoid hemosideric hemangioma.
 
===Microscopic===
Features:
*Abundance of benign small blood vessels. (???)
 
==Kaposi sarcoma==
===General===
*Not really a sarcoma.
*Caused by HHV-8.
*Associated with immunodeficiency, e.g. [[HIV]]/AIDS.
 
===Stages===
It is seen in different stages:<ref>URL: [http://www.histopathology-india.net/KS.htm http://www.histopathology-india.net/KS.htm]. Accessed on: 31 January 2010.</ref>
#Patch stage.
#Plaque stage.
#Nodular stage.
#Lymphangioma-like. (???)
 
===Microscopic===
Features:<ref name=Ref_Klatt23>{{Ref Klatt|23}}</ref>- '''key feature'''.
*+/-Nuclear atypia.
*Hyaline globules (intracytoplasmic)<ref name=pmid7528163>{{cite journal |author=del Rosario AD, Bui HX, Singh J, Ginsburg R, Ross JS |title=Intracytoplasmic eosinophilic hyaline globules in cartilaginous neoplasms: a surgical, pathological, ultrastructural, and electron probe x-ray microanalytic study |journal=Hum. Pathol. |volume=25 |issue=12 |pages=1283–9 |year=1994 |month=December |pmid=7528163 |doi= |url=}}</ref> - pale pink globs (that are paler than RBCs) - '''important feature'''.
*+/-Hemosiderin deposits.
 
DDx:
*Angiosarcoma (have many mitoses, nuclear atypia).
*Masson's hemangioma (Intravascular papillary endothelial hyperplasia).
 
Notes:
*Hyaline globules have a DDx ([[hepatocellular carcinoma]], lung adenocarcinoma, [[chondrosarcoma]]s + others).<ref name=pmid7528163/>
*Promontory sign - small vessel protruding into an abnormal vascular space.<ref name=pmid19318797>{{cite journal |author=Lazova R, McNiff JM, Glusac EJ, Godic A |title=Promontory sign--present in patch and plaque stage of angiosarcoma! |journal=Am J Dermatopathol |volume=31 |issue=2 |pages=132–6 |year=2009 |month=April |pmid=19318797 |doi=10.1097/DAD.0b013e3181951045 |url=}}</ref>
**Not pathognomonic for KS.<ref name=pmid20577080>{{cite journal |author=Fernandez-Flores A, Rodriguez R |title=Promontory Sign in a Reactive Benign Vascular Proliferation |journal=Am J Dermatopathol |volume= |issue= |pages= |year=2010 |month=June |pmid=20577080 |doi=10.1097/DAD.0b013e3181cf0ae5 |url=}}</ref>
**Image: [http://www.diagnosticpathology.org/content/3/1/31/figure/F1 Promontory sign (diagnosticpathology.org)].
 
Images:
*[http://commons.wikimedia.org/wiki/File:Kaposi_sarcoma_high_mag.jpg Kaposi sacoma - high mag. (WC)].
*[http://commons.wikimedia.org/wiki/File:Kaposi_sarcoma_low_intermed_mag.jpg Kaposi sarcoma - intermed. mag. (WC)].
 
===IHC===
*CD31 +ve.
*CD34 +ve.
*HHV-8 +ve.
 
==Masson hemangioma==
===General===
*Benign non-neoplastic lesion - a vessel that has thrombosed and recanalized.
*[[AKA]] ''intravascular papillary endothelial hyperplasia''.<ref name=pmid15865098>{{cite journal |author=Korkolis DP, Papaevangelou M, Koulaxouzidis G, Zirganos N, Psichogiou H, Vassilopoulos PP |title=Intravascular papillary endothelial hyperplasia (Masson's hemangioma) presenting as a soft-tissue sarcoma |journal=Anticancer Res. |volume=25 |issue=2B |pages=1409–12 |year=2005 |pmid=15865098 |doi= |url=}}</ref>
*Histomorphologically may be confused with low-grade angiosarcoma or other soft tissue sarcomas.<ref name=pmid15865098/>
===Microscopic===
Features:
*Well-circumscribed - '''key (low power) feature'''.
*Abundant small vascular channels with benign endothelium.
 
Notes:
*Looks like Kaposi sarcoma at high power.
 
==Angiosarcoma==
===General===
*Malignant tumour - with a horrible prognosis.<ref name=pmid20537949>{{cite journal |author=Young RJ, Brown NJ, Reed MW, Hughes D, Woll PJ |title=Angiosarcoma |journal=Lancet Oncol |volume= |issue= |pages= |year=2010 |month=May |pmid=20537949 |doi=10.1016/S1470-2045(10)70023-1 |url=}}</ref>
*Classically on the scalp or head & neck.
*May arise secondary to therapeutic radiation or chronic lymphoedema related to breast carcinoma.
 
===Microscopic===
Features:
*Very many small capillaries of irregular shape lined with:
**Pleomorphic nuclei.
***May have hobnail morphology.
*Mitoses.
*Cytoplasmic vacuoles.
**Cells trying to form lumina - embryologic.
 
Notes:
*Epithelioid variant (with abundant cytoplasm & sheeting architecture) may resemble ''[[melanoma]]'' or ''[[hepatocellular carcinoma]]''.
 
===IHC===
*CD34 +ve.
*D2-40 +ve. (???)
*CD31 +ve.
 
==Hemangioendothelioma==
===General===
*Usually benign.
 
===Microscopic===
Features:<ref name=Ref_Klatt23>{{Ref Klatt|23}}</ref>
*Well-formed thin vascular channels on a fibrous stroma - '''key feature'''.
*+/-Thrombosis.
*+/-Calcification.
*+/-Fibrosis.
*+/-Myxoid change.
 
===IHC===
*Factor VIII +ve.


=Skeletal muscle tumours=
=Skeletal muscle tumours=
Michael
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