Nita Khurana

Professor
Department of Pathology
Maulana Azad Medical College
New Delhi
How to read the slide
What is the cell type
What is the pattern
Are there any additional cells
Any clues to diagnosis
Cellularity
Uniformly hypocellular
Hypercellular & hypocellular areas
Uniformly normocellular /
hypercellular
Stroma
Fibrous
Myxoid
Storiform /cartwheel pattern
DFSP
MFH
LMS
Nerve sheath tumours
Liposarcoma
Fibromatosis
Nodular fasciitis
Cells arranged around vessels
Pericytoma like pattern with
staghorn like compressed vessels
Perivascularly arranged
cytologically bland cells
Glomus
Glomangiomyoma
Vascular leiomyoma
Peritheliomatous pattern
RCT- ES ,NB,PNET
Alternate fascicle /bundle pattern
Leiomyoma
Leiomyosarcoma
Fibromatosis
Fibrosarcoma
Cellular schwannoma
Synovial sarcoma
MPNST
Myxoma
Aggressive angiomyxoma
Myxoid neurofibroma
Myxoid chondroma
Myxoid lipoma
Ossifying fibromyxoid tumour of the soft parts
Myxoid liposarcoma
Myxoid chondrosarcoma
Myxoid MFH
Myxoid DFSP
Botyroid RMS
Myxoid LMS
15 year old girl ;
nodule on the ear lobe 3x2 cm
Keloid
Fibroepithelial polyp
Achrochordon, soft fibroma,squamous papilloma
40 + , face, neck, trunk, intertriginous
Non-neoplastic, common
Diabetes and intestinal polyposis
May have ischaemic necrosis due to torsion
Cutaneous leiomyoma
Lesions of nipple or scrotum
Pilar leiomyoma - piloleiomyoma
Angioleiomyoma subcutis
Usually superficial, small, multiple, painful
Familial cutaneous leiomyomatosis Reed Syndrome
mutation in fumarate hydratase
Associated with RCC
Symplastic leiomyoma
Schwannoma
Solitary encapsulated biphasic nerve sheath tumor
highly ordered cellular component (Antoni A) that
palisades Verocay bodies
plus myxoid component (Antoni B)
Clues large irregular vessels with hyalinisation and
thrombus formation
Variants
Glandular Melanotic
Epithelioid Plexiform
Cellular
Cystic
34/M progressively increasing
nodular mass on the shoulder 6x 8
cm with stretched skin
DFSP
Intermediate grade fibrohistiocytic tumour
Monomorphic population
Tight storiform pattern
Epidermis thinned
Subcutis infiltrated
Mitosis + , not atypical
Recurrences ++
Transformation to FS or MFH
CD 34 +
t(17,22)
Neurofibroma
Non-encapsulated proliferation of all elements of
peripheral nerves
Schwann cells with wire like collagen fibrils (wavy
serpentine nuclei, pointed ends)
stromal mucosubstances mast cells
Wagner-Meissner corpuscles
Pacinian corpuscles
axons (highlight with silver or acetylcholinesterase
stain, NSE, neurofilament),
fibroblasts and collagen;
perineurial cells in plexiform types
Traumatic neuroma
Benign, non neoplastic overgrowth
Tangled mass of axons, schwann cells and
perineuial fibroblasts
S-100 , neurofilament and EMA +
Cytologically malignant spindle cell
tumours
Fibrosarcoma
Leiomyosarcoma
Monophasic synovial sarcoma
Malignant peripheral nerve sheath
tumours
Malignant hemangiopericytoma
Screening panel for monomorphic
spindle cell tumours
MoAb SS MPNST FS LMS
CK + - - -
S-100 v + - -
CD34 - v - -
Desmin - - - +/-
SMA - - -/+ +
Screening panel for monomorphic
spindle cell tumours
MoAb SS MPNST FS LMS
CK + - - -
S-100 v + - -
CD34 - v - -
Desmin - - - +/-
SMA - - -/+ +
French federation of cancer center
sarcoma group
Grading parameters
Tumour differentiation
Mitosis count
Tumour necrosis (microscopic)
Histologic grade
Grading is based on the least differentiated area
of the tumour unless it forms a very minor area of
the tumour
Tumour differentiation
Score 1: Sarcoma closely resembling the adult
mesenchymal tissue
Score 2: Sarcoma for which histologic typing is certain
Score 3 : Embryonal and undifferentiated sarcomas
Tumour necrosis microscopic
Score 0 : no necrosis
Score 1: < 50% tumour necrosis
Score 2: >50% tumour necrosis
Mitosis count
Score 1: 0-9/10hpf
Score 2: 10-19/hpf
Score 3: > 20 /hpf
Histologic grade
Grade 1: total score : 2,3
Grade 2: total score : 4,5
Grade 3 : totoal score 6,7,8
Angiomyofibroblastoma
Circumscribed edematous lesion of external
genitalia and perineal soft tissue
Rare in males
Most < 5 cm
Well circumscribed with thin pseudocapsule
Edematous bgrd with prominent vascularity
Alternating hypo and hypercellular areas
Cells often aggregated around vessels
Angiomatoid fibrous
histiocytoma
Predominantly superficial tumour containing
cystic blood filled spaces and a prominent
peripheral lymphoid infiltrate
Previous name
Angiomatoid malignant fibrous histiocytoma
Diagnostic features
Circumscribed subcutaneous mass
May have a fibrous capsule
May involve skeletal muscle or periosteum
Rare cases in dermis
Large blood filled cystic spaces in most cases
lined by lesional round to spindled cells
Spaces may thrombose
ARMS
Solid and alveolar growth pattern
Partial skeletal muscle differentiation
Early to mid teens
Poor prognosis N-myc amplification , PAX3
fusion transcripts
Morphologic clues
Thin fibrous septae
Cross striations in 1/3
Deep eosinophilic cytoplasm, occ MNGC
IHC
Alveolar soft part sarcoma
Sarcoma with large poorly cohesive cells with
distinctly regular alveolar pattern
Granular cell tumour
Uncommon ;mostly benign ;any organ
First described by Abrikrossof in1926and
categorised as myoblastomas
Other names:
Granular cell myoblastoma
Uniform myoblastoma
Embryonal rhabdomyoblastoma
Fevter in 1935 - granular cell neuroma;confimed
byFust & Custler
1932-fischer and Welschler IHC & EM-Granular cell
schwannoma
Who -GCT
Adults >40;rare in children
H& N skin ;s/c tissue and mucosa
; rare at otolayngological sites
Multicentric in 10%
Tongue and larynx
Dyspnoea and stridor;
Even asymptomatic
Mostly posterior larynx;may be anterior
laryns and arytenoids and tonsils in children
Pleomorphic soft tissue
sarcoma
Look for morphological clues
IHC
Pleomorphic RMS
Pleomorphic LMS
Pleomorphic Myoid sarcoma
Pleomorphic liposarcoma
Pleomorphic Storiform MFH
Pleomorphic MPNST
Pleomorphic soft tissue osteosarcoma
Rule out Non Sarcomatous malignancies
carcinoma,lymphoma and melanoma