Soft Tissue Tumors

Front 1

liposarcoma

Back 1

le of adults, rare in children

Front 2

embryonal rhabdomyosarcoma

Back 2

head/neck of children, rare in adults

Front 3

sarcoma

Back 3

metastasize via bloodstream

Front 4

nodular fasciitis

Back 4

adults, volar forearm, chest, back

reactive pseudosarcomatous, solitary, rapid growth, sometimes painful w/in weeks, 10-15% previous trauma, plump (myo)fibroblasts randomly arranged, short fasicles (looks like tissue culture), myxoid bg (blue), extravasated rbc, lymphocytes, mitotic figures, scar-like collagenization over time (less cellular)

Front 5

grading criteria

Back 5

histological type, cellularity, pleomorphism, mitotic rate, extent of necrosis (<15% grade 2, 15%+ grade 3)

probability of metastasis, overall survival

does not predict recurrence

higher grade responds better to chemo

Front 6

myositis ossificans

Back 6

athletic adolescents, ya, 50% previous trauma, reactive pseudosarcomatous

early: swollen, painful, similar to nodular fasciitis
wks: less painful, firm, zonation
late: painless, hard, well circumscribed, complete bone metaplasia

Front 7

gardner syndrome

Back 7

fap, osteomas, dental anomalies, epidermal inclusion cysts, colorectal carcinoma, ***desmoid tumor

Front 8

turcot syndrome

Back 8

fap, medulloblastoma

Front 9

df

Back 9

dermatofibroma, benign, dermis/subcutis, slow growing, painless, mobile, small <1cm, well circumscribed, bland spindle cells w/ delicate cyt, ***storiform pattern (more pinwheel than whorl), collagen prod, no mitosis/necrosis/atypia

Front 10

dfsp

Back 10

ya, dermis/subcutis of trunk/extremities

dermatofibrosarcoma protuberans, modular polypoid lesion, malignant, low grade (<5% mets), slowly growing, 30% recur, ***storiform pattern, ***honeycomb infiltration (leaves some alone) into adipose

Front 11

fibrosarcoma

Back 11

adults 40-60 yo, deep soft tissue of upper/lower extremities, trunk, head/neck

subcutis if assoc w/ dfsp, scars, burns, rad therapy

dx of exclusion, solid growth of hyperchromatic malignant spindle cells, hypercellular, ***herringbone pattern

Front 12

mfh

Back 12

malignant fibrohistiocytoma, most common of adults, mm of prox extremities, retroperitoneum, cutaneous (atypical fibroxanthoma afx, rarely disseminates)

unknown origin, pleomorphic variant of otehr sarcoma?, aggressive, 30-50% recur (not cutaneous), angiomatoid subtype is indolent

Front 13

lipoma

Back 13

most common 1ary soft tissue tumor of adult, looks like nl tissue (adipocytes, thin strings of ct/capillaries), well encapsulated, lobulated, soft, solitary, freely movable, painless, benign

Front 14

spindle cell lipoma

Back 14

sc tissue of scapula (neck, upper back, shoulder) in middle age/elderly males, bipolar spindle cells, can be very cellular, some atypia (floret cells - multinuc giant cell)

Front 15

fibroma molle

Back 15

skin tag, very soft, pedunculated, mix of mature fibrous tissue and fat on surface

Front 16

angiolipoma

Back 16

***painful sc in forearm of ya, vascular channels w/ microthrombi

Front 17

intramuscular lipoma

Back 17

lipomatous growth w/in skeletal m fibers, doesn't destroy, ddx liposarcoma w/ skeletal m

Front 18

lipoblastoma

Back 18

children <3 yo, upper/lower limb, m2x>f, local sc

immature fat cells w/ less cyt, granular, clearer nuc, tend to mature into fat

Front 19

lipoblastomatosis

Back 19

diffuse lipoblastoma --> skeletal m

Front 20

hibernoma

Back 20

very rare, from brown fat (neck, axilla, mediastinum, perirenal), encapsulated, sc

Front 21

well-differentiated liposarcoma

Back 21

50-70 yo, 75% extremities

sclerosing-spindle cell more common than lipoma-like but w/ atypical cells, 5-15% dediff (look like fibrosarcoma/mfh, retroperitoneum, extremities, recurrances --> mets to lung), giant marker, ***ring chr, local recurrence high, no mets

Front 22

myxoid liposarcoma

Back 22

25-45 yo, 75% extremities

low grade: lipoblasts, chicken-wire/net vessels, myxoid bg
high grade: same as low but w/ solid areas of round cells w/o cyt, chr t(12;16), recurrence, metastasis, 40% of liposarcoma

Front 23

pleomorphic liposarcoma

Back 23

deep soft tissue of limb/limb girdle

looks like pleomorphic mfh, high grade w/ high metastatic potential, very aggressive, very poor prognosis, 20% of liposarcoma, abundant giant cells

Front 24

round cell liposarcoma

Back 24

round-oval cells, multivacuole cyt, central hyperchromatic nuc, signet ring lipoblasts

Front 25

lipomatosis

Back 25

multiple lipomas

Front 26

rhabdomyoma

Back 26

heart, children, benign

Front 27

rhabdomyosarcoma

Back 27

malignant, most common soft tissue sarcoma <20 yo, head/nec, gu, extremities

aggressive, tx surg/chemo/rads, 65% children cured, adults less successful, immounohisto (desmin, myoglobin, myogenin pos)

Front 28

embryonal rms

Back 28

60% of rms, <10 yo, nasal cavitis, orbit, mid ear, prostate, paratesticular

botrioid better prognosis, clusters of grapes, pedunculated nodules, hypercelular, rhabdoid cells w/ eosinophilic cyt, eccentric/round nuc but not signet ring, can see tadpole cells w/ striations, **hollow organs like vag, nasopharynx, biliary tract, bladder of babies

Front 29

alveolar rms

Back 29

10-25 yo, deep mm of extremities

worse prognosis, small cells w/ high n/c ratio, psuedoalveolar pattern, chr t(2;13), t (1;13)

Front 30

pleomorphic rms

Back 30

thigh, adults, grows rapidly

Front 31

leiomyoma

Back 31

skin/sc: erectores pilorum, erector m of nipple, tunica media of bv
deep soft tissue: retroperitoneum, omentum, mesentary, broad ligament
can also be iv

benign, fascicles of spindle cells 90 deg, ***cigar shaped nuc, fibrillary cyt, no mitosis/atypia/necrosis, immunohisto (desmin, actin, vimentin pos), can be vascular (painful if skin/sc), epithelioid

Front 32

leiomyosarcoma

Back 32

malignant, extremities, retroperitoneum, cutaneous, female genital, deep soft tissue, f>m

10-20% all sarcoma, death by local extension or mets (lung), short fascicles, 90 deg interweaving, ***atypical cigar-shaped nuc, atypical mitosis, fibrillar cyt (trichrome), immunohisto (desmin, actin, vimentin pos), cyt/nuc vacuolated

Front 33

synovial sarcoma

Back 33

20-40 yo, lower extremities, deep seated (parapharyngeal, abd wall)

unclear cell of origin, recapitulate synovium, 10% of all sarcoma, only 10% intraarticular, mets to lung, ***chr t(x;18) syt-ssx gene fusion

biphasic: spindle, epithelial (glands)
monophasic: spindle (like fibrosarcoma), epithelial (glands, rare)

Front 34

benign synovioma

Back 34

gct of tendon sheath

Front 35

most common soft tissue tumor

Back 35

lipoma

Front 36

liposarcoma in retroperitoneum fatal how?

Back 36

local aggressiveness to bv, ureter, other vital organs

Front 37

most common soft tissue tumor in children

Back 37

rhabdomyosarcoma

Front 38

most common malignant soft tissue tumor in general

Back 38

metastatic cancer

Front 39

hemangioma

Back 39

benign, bv, head/neck, many hamartomas, capillary and cavernous subtypes

Front 40

angiosarcoma

Back 40

head/neck skin of elderly

malignant, anastomosing vascular channels w/ malignant endothelial cells

Front 41

stewart-treves syndrome

Back 41

lymphangiosarcoma, extremities w/ longstanding lymphedema (postmastectomy)

Front 42

kaposi's sarcoma

Back 42

middle age/older intially cutaneous nodules of distal leg

bland plum spindle cells w/ slit-like vascular spaces w/ rbc/hemosiderin

Front 43

extraskeletal ewing's sarcoma

Back 43

lower extremity, paravertebral