Practical Soft Tissue Tumor Lecture Notes

my lecture notes on practical abt soft tissue tumor

1. Practical: Soft Tissue Tumors
AP Dr Nornazirah Azizan
FMHS, UMS
I
mesenchymal

2. Architectural patterns
Tumor Pattern
Smooth muscle Interlacing fascicles of pink color spindle cells
Fibrocystic Storiform pattern: Short fascicles of spindle cells
radiating from a central point
Schwann cell Palisaded arrangement: tumor cells are piled upon
each other
Fibrosarcoma Herringbone pattern
Synovial Sarcoma Biphasic pattern: Mixture of fascicles of spindle cells
and groups of epitheloid cells
legimyometrium)
Ceg
:
dermis)
ceg
:
peripheral
nerves
Ceg
:
joints)
brain
:
glial
,
oligo
PNS
:
schwann

3. InterlacingSpindle-shaped·
crossing
over
eachother
·
anyamtikar
·
leiomyoma
F

4. Storiform
·
whorling

5. Pallisading
-
>
Schwanoma
Cl
Ctngok
area
ada117
-peratur
eg
:
BCC

6. Herring bone pattern
·
similarto
fishbone

7. Soft Tissue Tumors
Origin Tumor
Fat/adipose tissue Lipoma
Smooth muscle Leiomyoma
Schwan cell/neuron Schwannoma/neurofibroma
Blood vessel Hemangioma
C-oma
,
benign)
liposarcoma
leiomyosarcoma
Cnomalignant
?
angiosarcoma

8. Lipoma
•Conventional Lipoma ?
the most common
•Arises in subcutaneous
level
•Proximal extremities &
trunk
•Round to oval, or
lobulated
•Soft
•Well demarcated
•Curable by simple
excision
(fats)

9. Gross morphology: Lipoma
•Well-encapsulated mass of mature
adipocytes
•Varies in size
•Sometimes very large, intra-
muscular & poorly circumscribed
•The cut surface is soft, lobulated,
yellowish & greasy
·
soft
,
mobile
,
painless
globules
*

10. Lipoma: Microscopic
•Tumor composed of lobules of mature adipose cells,
separated by delicate fibrous septa
•A thin fibrous capsule surrounds the tumor
-
cytoplasmclear
nucles&periphery
fat
cells
spindle-celllipoma

11. Leiomyoma: Gross
•Single or multiple
•Subserosa, submucosa,
intramural or pedunculated
•Nodular
•Well circumscribed
•Firm
•Grey white in colour
•Various sizes
•No capsule
•Cut surface exhibit
characteristic whorled pattern
•Mainly in the myometrium of
the corpus:
-Submucosal : just beneath
the endometrium
-Intramural/Interstitial: within
the myometrium
-Subserosal : beneath the
serosa
•Rarely:
-Lower uterine segment
-Cervix
-Uterine ligament
Mutipleleiomyoma/leiomyomata
EXAM
!!
(smooth
muscles
Cmutiple:
mentioneer
(
·
Whouledpattern

12. Submucosa Leiomyoma
①
beneath
mucosa
-~
origin
:
myometrium
14
&
etri

13. Pedundulated Submucous Leiomyoma
②
Ctergantung
?
ragina

14. Intramural Leiomyoma
③
withinthewall
wellcirumsa
six-
withinmyometrium
whorling
whitish
~
endometrium
cavity

15. Intramural Leiomyoma

16. Multiple Leiomyoma/Leiomyomata
I-Tem
in
size

17. Multiple Leiomyoma
wellcirum
Scribe
Twhorling

18. Leiomyoma: Microscopic
•The tumour composed of 2 tissue elements:
?Whorled bundles of smooth muscle cells
admixed with variable amount of fibrous
tissue
•The smooth muscle cells are uniform in size &
shape with abundant cytoplasm & central
oval nuclei
•Mitotic figures are scarce
•Well demarcated & pushing the surrounding
tissue
•No capsule
•Low power can see the characteristic whorled
pattern
Microscopically
:
Cno
mitosish
I
-
-
no
necrosis
-
formal
myometrium
Humor

19. Leiomyoma
interlacing

20. Leiomyoma
-
spindle
shaped
higher
power
-
nucleus
in
ova
I
inShape

21. Schwannoma: Gross
•Round or oval in shape
•Well circumscribed covered by thin capsule
•Firm
•Grey white in colour
•Solid sometimes cystic
•Cut surface exhibit smooth surface, sometimes slimy
•Attached to the nerve but can be separated from it

22. Schwannoma: Microscopic
•Tumor is composed of elongated cells, arranged in fascicles/bundles.
•Sometimes forming whorled arrangement
•There are areas of dense & compact cellularity (Antoni A pattern) alternating
with areas of less densely cellular loose meshwork of cells along with
microcysts & myxoid changes (Antoni B pattern)
•Areas of Antoni A show palisaded nuclei with free zone in between called
Verocay bodies
•Degeneration area in areas of Antoni B contain haemosiderin & lipid-laden
macrophages
identify
,*
*
C
3

23. Schwannoma: Microscopy
EXAM

24. Schwannoma

25. Schwannoma/Pallisading

26. Neurofibroma
X

27. Hemangioma: Gross
•Varying in size (few mm to few cm)
•Flat or slightly elevated
•Red to purple
•Soft & lobulated
•Intact covering epithelium
•Occasionally: Pedunculated with broad-to
slender stalk.
Hemangioma
:
proliferationofredbloodcells
linedbyendo
minm
call
Cendothelium)

28. Hemangioma

29. Hemangioma

30. Cavernous hemangioma

31. Heangioma

32. Hemangioma: Microscopic
•Well define
•Un-encapsulated
•Thin wall capillary-sized blood vessels
•Lined by single layer endothelial cells
•The vessels are separated by scant connected
tissue stroma

33. Capillary hemangioma
~endothelium
-RBC

34. Cavernous hemangioma
~
Glarger
sizeVessels
plasmasbbbloodturn
buh
↑

35. Thank you.