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Soft Tissue Pathology The Sort of Thing You Get in Exams!

Soft Tissue Pathology The Sort of Thing You Get in Exams!. Dr. Petra Dildey Royal Victoria Infirmary Newcastle upon Tyne. Case 38551/03:. 50y old male patient, soft tissue mass left popliteal fossa. Case 38551/03. Case 38551/03. Case 38551/03. Myxoid Liposarcoma.

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Soft Tissue Pathology The Sort of Thing You Get in Exams!

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  1. Soft Tissue PathologyThe Sort of Thing You Get in Exams! Dr. Petra Dildey Royal Victoria InfirmaryNewcastle upon Tyne

  2. Case 38551/03: 50y old male patient, soft tissue mass left popliteal fossa.

  3. Case 38551/03

  4. Case 38551/03

  5. Case 38551/03

  6. Myxoid Liposarcoma • Myxoid and round cell same category • Adults; deep-seated in extremities (thigh) • Histology: • multinodular with increased cellularity at periphery of nodules • myxoid matrix, occ. with mucin pools • typical delicate branching vessels • bland round to oval mesenchymal cells and univacuolated lipoblasts • progression to round cell LPS histological continuum • Genetics: t(12;16)(q13;p11), t(12;22)(q13;q12)

  7. Case 18319/05: 33y old male patient, 4cm deep soft tissue tumour right forearm.

  8. Case 18319/05

  9. Case 18319/05

  10. Case 18319/05

  11. Case 18319/05

  12. Low Grade Fibromyxoid Sarcoma • Rare soft tissue sarcoma • Young to middle-aged adults; extremities and trunk; deep • Histology: • circumscribed, low to moderate cellularity • alternating fibrous and myxoid stroma • bland spindle cells, whorled pattern • arcades of blood vessels • occ. giant collagen rosettes • Genetics: t(7;16)(q33;p11)

  13. Case 35841/03: 48y old female patient, 6.5cm intramuscular tumour left buttock.

  14. Case 35841/03

  15. Case 35841/03

  16. Intramuscular Myxoma • Important DD for myxoid soft tissue tumours • Middle-aged to older adults; large muscles of limb girdles • Histology: • macro circumscribed, but micro infiltrative • extensive myxoid matrix, hypocellular • bland stellate- and spindle-shaped cells • NO mitoses, pleomorphism, necrosis

  17. Case 34761/09: 77y old male patient, 4cm superficial mass right upper arm.

  18. Case 34761/09

  19. Case 34761/09

  20. Case 34761/09

  21. Myxofibrosarcoma • Rel. common fibroblastic sarcoma; myxoid MFH • Elderly patients; limbs and limb girdles; subcutaneous and deep • Histology: • multinodular with fibrous septa • myxoid stroma • atypical spindle-/stellate-shaped cells, occ. pseudolipoblasts • curvilinear vessels

  22. Case 19222/04: 66y old male patient, haemorrhagic soft tissue tumour right calf.

  23. Case 19222/04

  24. Case 19222/04

  25. Case 19222/04

  26. Extraskeletal Myxoid Chondrosarcoma • Rare soft tissue sarcoma • Middle-aged to older adults; extremities, limb girdles and other sites; often haemorrhagic • Histology: • multinodular • chondromyxoid matrix • cords and networks of cells • eosinophilic cytoplasm, uniform nuclei, few mitoses • focal S100, occ. cytokeratin and EMA • Genetics: t(9;22(q22;12), t(9;17)(q22;q11), t(9;15)(q22;q21)

  27. Case 30750/03: 15y old male patient, large pelvic mass and lymphadenopathy as well as mediastinal and lung lesions on CT. Groin node biopsied.

  28. Case 30750/03

  29. Case 30750/03

  30. Case 30750/03MyoD1

  31. Alveolar Rhabdomyosarcoma • Small round blue cell tumour • 10-25 years; often extremities, all other sites possible • Histology: • 3 subtypes: typical, solid, mixed • nests separated by fibrovascular septa • small round nuclei, scant cytoplasm • horse-shoe giant cells common • Myogenin, MyoD1, desmin positive • Genetics: t(1;13)(p36;q14), t(2;13)(q35;q14)

  32. Case 7739/06: 36y old female patient, large tumour tail of pancreas with liver metastases.

  33. Case 7739/06

  34. Case 7739/06

  35. Case 7739/06

  36. Case 7739/06

  37. Case 7739/06CK

  38. Case 7739/06 Desmin

  39. Desmoplastic Small Round Cell Tumour • Small round blue cell tumour showing divergent differentiation • Children and adolescents, esp. male; abdominal cavity, retroperitoneum, pelvis • Histology: • nests of variable size surrounded by desmoplastic stroma • small uniform cells with round nuclei, • occ. rhabdoid inclusions • epithelial, smooth muscle and neural markers positive, esp. CK, EMA and desmin (dot-like), WT1 • Genetics: t(11;22)(p13;q12)

  40. Case 24640/04: 42y old male patient, small nodule in the subcutis of the right buttock.

  41. Case 24640/04

  42. Case 24640/04

  43. Case 24640/04

  44. Nodular Fasciitis • Small fibroblastic proliferation • All age groups, mostly young adults; subcutis!, anywhere in body; rapid growth • Histology: • partly loose/feathery, partly cellular • tissue-culture fibroblasts • mitotically active • collagen bundles, hyalinisation, giant cells • SMA positive, desmin negative

  45. NEQAS Case 261: 50y old female patient, small subcutaneous tumour forearm.

  46. NEQAS Case 261

  47. NEQAS Case 261

  48. NEQAS Case 261

  49. Proliferative Fasciitis • A small fibroblastic proliferation similar to nodular fasciitis, but with large ganglion-like cells • Middle-aged and older adults; subcutis, esp. extremities; rapid growth • Histology: • ill-defined • tissue-culture fibroblasts • myxoid/collagenous stroma • large, ganglion-like cells with prominent nucleoli

  50. Case 3821/03: 18y old female patient, calcified soft tissue mass right thigh, recent increase in size, vague history of trauma.

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