BONE, JOINTS AND SOFT TISSUE TUMORS.pptx

This is about pathology

1. BONE, JOINTS AND SOFT TISSUE TUMORS DR ZORAN MUHIMBA

2. JOINT PATHOLOGY

3. Mesenchymal tumours

4. Soft tissue tumours and tumour like lesions (nomenclature) Tumours of adipose tissue Lipoma Liposarcoma Tumours and tumour like lesions of fibrous tissue Nodular fasciitis Fibromatoses Fibrosarcoma Fibrohistiocytic tumours Fibrous histiocytoma Dermatofibrosarcoma protuberans Malignant fibrous histiocytoma Tumours of skeletal muscle Rhabdomyoma Rhabdomyosarcoma Tumours of smooth muscle Leiomyoma Leiomyosarcoma

5. Soft tissue tumours and tumour like lesions (nomenclature) Vascular tumours Haemangioma Lymphangioma Haemangioendothelioma Haemangiopericytoma Angiosarcoma Peripheral nerve sheet tumours Neurofibroma Schwannoma Malignant peripheral nerve sheet tumour Tumours of uncertain histogenesis Granular cell tumour Synovial sarcoma Alveolar soft part sarcoma Epitheloid sarcoma

6. Morphology of cells in soft tissue tumours Cell type Features Tumour type Spindle cell Rod-shaped, long Fibrous, fibro-histiocytic, smooth muscle, Schwann cell Small round cell Size of lymphocyte with little cytoplasm Rhabdomyosarcoma, primitive neuroectodermal tumour Epithelioid cell polyhedral with abundant cytoplasm, nucleus is centrally located Smooth muscle, Schwann cell, endothelial, epithelioid sarcoma

7. Architectural patterns in soft tissue tumours Pattern Tumour type Fascicles of eosinophilic spindle cells intersecting at right angles Smooth muscle Short fascicles of spindle cells radiating from a central point – (spokes on a wheel) = storiform fibrohistiocytic Nuclei arranged in columns – palisading Schwann cell Herringbone Fibrosarcoma mixture of fascicles of spindle cells and groups of epithelioid cells = biphasic Synovial sarcoma

8. Prognosis dependant on: Exact histological diagnosis Grade Stage Superficial or deep location

9. Fatty tumours Lipomas benign tumor of fat, is the most common soft tissue tumor in adults. Conventional lipoma: sharply demarcated encapsulated mass of adipocytes Lipomatosis: occurs when multifocal lipomas involve a limb. Angiolipoma: are associated with pain

10. Fatty tumours Liposarcoma Malignant tumors of adipose tissue, Are the most common sarcomas of adulthood Prognosis dependant on histologic variant: Well differentiated tumour , Myxoid Pleomorphic Dedifferentiated

11. Fibrous tumours and tumour like lesions Nodular fasciitis Rapidly growing or sometimes painful mass on forearm, chest or back Morph.: cellular rich lesion with plump randomly orientated spindle cells, mitosis and lymphoid infiltrate

12. Fibrous tumours and tumour like lesions Myositis ossificans Frequently occuring after a trauma Morph: depending on the age of lesion typical central zone with fibroblast proliferation, intermediate zone with woven bone formation and outer zone with trabecular bone formation. Diff.: osteosarcoma

13. Fibrous tumours and tumour like lesions Keloid Fibromatoses Superficial fibromatosis (palmar, plantar, penile) Deep fibromatoses (desmoid tumour)

14. Fibrous tumours and tumour like lesions Dermatofibrosarcoma protuberans Grows in infiltrative fashion Frequent local recurrence Sites: Trunk and proximal extremities Uniform population of slender fibroblasts arranged in a storiform pattern CD 34 positive

15. Tumours of skeletal muscle Rhabdomyosarcoma Most common soft tissue sarcoma of childhood and adolescence mostly occur in head and neck or genitourinary tract. Morphology: Embryonal rhabdomyosarcoma (botryoid variant), alveolar and pleomorphic variants Prognosis dependant from histological subtype Prognosis: overall 65% of children are cured

16. Tumours of smooth muscle Leiomyomas Mostly in women Skin arising from arrector muscles

17. Tumours of smooth muscle Leiomyosarcoma 10 to 20% of soft tissue sarcomas Sites: skin, deep soft tissue, extremities and retroperitoneum Morph.: fascicles of malignant spindle cells with cigar shaped nuclei and perinuclear vacoules . Prognosis depends on size and location

18. Others Synovial sarcoma 10% of all soft tissue sarcomas Cell of origin unclear Most occur in the vicinity of large joints, medium age is 20 to 40. Histologically biphasic pattern with epitheloid and spindle cells Prognosis with aggressive treatment five year survival 25 to 62%

19. THE END