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Questions and Answers
What type of adipose tissue is primarily responsible for heat production?
What type of adipose tissue is primarily responsible for heat production?
What are the two major types of adipose tissue?
What are the two major types of adipose tissue?
White fat and brown fat
Fibrous tissue consists mainly of adipocytes and extracellular matrix.
Fibrous tissue consists mainly of adipocytes and extracellular matrix.
False
What is the distinguishing feature of skeletal muscle fibers?
What is the distinguishing feature of skeletal muscle fibers?
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What type of soft tissue tumor is characterized by the presence of lipoblastic differentiation?
What type of soft tissue tumor is characterized by the presence of lipoblastic differentiation?
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Match the following tumor types with their respective characteristics:
Match the following tumor types with their respective characteristics:
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Most soft tissue sarcomas are multiple and synchronous.
Most soft tissue sarcomas are multiple and synchronous.
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The initial diagnostic procedure for large soft tissue tumors when malignancy is suspected is to perform a ______.
The initial diagnostic procedure for large soft tissue tumors when malignancy is suspected is to perform a ______.
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What is the most important organelle found in endothelial cells?
What is the most important organelle found in endothelial cells?
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What types of cell are blood vessels primarily composed of?
What types of cell are blood vessels primarily composed of?
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Which gene is particularly helpful in diagnosing various soft tissue tumor types?
Which gene is particularly helpful in diagnosing various soft tissue tumor types?
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Grading of soft tissue tumors is always objective and straightforward.
Grading of soft tissue tumors is always objective and straightforward.
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What is the relationship between tumor size and prognosis?
What is the relationship between tumor size and prognosis?
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The most widely used staging system for sarcomas is the __________.
The most widely used staging system for sarcomas is the __________.
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Match the following grading parameters with their definitions:
Match the following grading parameters with their definitions:
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Which type of sarcoma is classified as a high-grade tumor?
Which type of sarcoma is classified as a high-grade tumor?
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All tumor types are graded on a four-grade system.
All tumor types are graded on a four-grade system.
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Which grading system is most widely used to grade sarcomas?
Which grading system is most widely used to grade sarcomas?
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What is soft tissue defined as?
What is soft tissue defined as?
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A break-apart FISH probe for ______ is particularly helpful in diagnosing several soft tissue tumor types.
A break-apart FISH probe for ______ is particularly helpful in diagnosing several soft tissue tumor types.
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Which type of fat is primarily responsible for heat production?
Which type of fat is primarily responsible for heat production?
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What is the first parameter in the FNCLCC grading system?
What is the first parameter in the FNCLCC grading system?
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Poorly differentiated MPNST is a high-grade tumor.
Poorly differentiated MPNST is a high-grade tumor.
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Fibrous tissue consists primarily of fibrocytes.
Fibrous tissue consists primarily of fibrocytes.
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What aspect does the AJCC staging system evaluate?
What aspect does the AJCC staging system evaluate?
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What are the two major types of adipose tissue?
What are the two major types of adipose tissue?
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What does FISH stand for?
What does FISH stand for?
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What do soft tissue tumors include?
What do soft tissue tumors include?
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Tumor ______ has a definite relationship with the outcome.
Tumor ______ has a definite relationship with the outcome.
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Which cells line the lymph vessels?
Which cells line the lymph vessels?
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Most soft tissue sarcomas are solitary tumors.
Most soft tissue sarcomas are solitary tumors.
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Name one soft tissue tumor type that can be diagnosed using a break-apart FISH probe for FUS.
Name one soft tissue tumor type that can be diagnosed using a break-apart FISH probe for FUS.
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What is the initial diagnostic procedure for a large soft tissue tumor suspected of malignancy?
What is the initial diagnostic procedure for a large soft tissue tumor suspected of malignancy?
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Superficially located tumors have a worse prognosis than deep-seated tumors.
Superficially located tumors have a worse prognosis than deep-seated tumors.
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What is one common feature of necrotizing fasciitis?
What is one common feature of necrotizing fasciitis?
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Which gene is particularly helpful in diagnosing various soft tissue tumor types?
Which gene is particularly helpful in diagnosing various soft tissue tumor types?
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What type of tumors is the FNCLCC grading system primarily used for?
What type of tumors is the FNCLCC grading system primarily used for?
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All alveolar rhabdomyosarcomas are high-grade tumors.
All alveolar rhabdomyosarcomas are high-grade tumors.
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What does the 'T' in the AJCC staging system stand for?
What does the 'T' in the AJCC staging system stand for?
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Superficially located tumors have a much better prognosis than _____ ones.
Superficially located tumors have a much better prognosis than _____ ones.
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What is the primary parameter associated with tumor prognosis?
What is the primary parameter associated with tumor prognosis?
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Which of the following parameters is NOT used in the FNCLCC grading system?
Which of the following parameters is NOT used in the FNCLCC grading system?
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Grading of tumors has no prognostic value.
Grading of tumors has no prognostic value.
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Match the following tumors with their characteristics:
Match the following tumors with their characteristics:
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What is the grading criterion for mitotic count with a score of 2?
What is the grading criterion for mitotic count with a score of 2?
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What are the two major types of adipose tissue?
What are the two major types of adipose tissue?
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What is the primary function of brown fat?
What is the primary function of brown fat?
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White fat cells are smaller than brown fat cells.
White fat cells are smaller than brown fat cells.
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What are fibroblasts responsible for?
What are fibroblasts responsible for?
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Which types of tumors are primarily addressed in this chapter?
Which types of tumors are primarily addressed in this chapter?
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What is the distinguishing feature of skeletal muscle fibers?
What is the distinguishing feature of skeletal muscle fibers?
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The main components of soft tissue include fibrous tissue, __________, skeletal muscle, blood vessels, and peripheral nerves.
The main components of soft tissue include fibrous tissue, __________, skeletal muscle, blood vessels, and peripheral nerves.
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Match the following cell types with their characteristics:
Match the following cell types with their characteristics:
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Fibromatosis is solely associated with benign tumors.
Fibromatosis is solely associated with benign tumors.
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Which condition is characterized by a severe reaction to infectious processes in soft tissues?
Which condition is characterized by a severe reaction to infectious processes in soft tissues?
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What is angiosarcoma?
What is angiosarcoma?
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Angiosarcoma can only occur in adults.
Angiosarcoma can only occur in adults.
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Which of the following are common locations for angiosarcoma? (Select all that apply)
Which of the following are common locations for angiosarcoma? (Select all that apply)
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What microscopic features are diagnostic of angiosarcoma?
What microscopic features are diagnostic of angiosarcoma?
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Angiosarcomas can arise in which of the following conditions? (Select all that apply)
Angiosarcomas can arise in which of the following conditions? (Select all that apply)
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Study Notes
Normal Anatomy of Soft Tissues
- Soft tissues include non-epithelial structures, excluding supportive and hematopoietic tissues.
- Composed of fibrous tissue, adipose tissue, skeletal muscle, blood/lymph vessels, and peripheral nervous system.
- Fibrous tissue is made up of fibroblasts and extracellular matrix (collagen and elastin).
- Fibroblasts are responsible for extracellular material production, existing in spindle and stellate shapes.
- Myofibroblasts show characteristics between fibroblasts and smooth muscle cells.
- Adipose tissue categorized into white fat (energy storage) and brown fat (heat production).
- White fat cells have large lipid droplets; brown fat cells are smaller with multiple vacuoles.
- Skeletal muscle forms from myoblasts, differentiating into muscle fibers with unique microfilament arrangements.
Vascular Structures
- Blood vessels comprise endothelial cells, pericytes, smooth muscle, and glomus cells.
- Blood vessels sub classified into arterial, venous, and capillary components.
- Endothelial cells express specific antigens (CD34, CD31) aiding in tissue analysis.
- Lymph vessels lined by endothelial cells with weaker staining characteristics.
Tumors and Tumor-like Conditions
- Soft tissue tumors are challenging diagnostic issues for pathologists.
- Tumor classification includes diverse neoplastic lesions and their molecular genetic changes.
- Proliferation of soft tissue tumors results from primitive multipotential mesenchymal cells.
- Lymphomas and tumors arising from blood and lymph vessels are excluded from certain classifications.
Clinical Features
- Tumor types correlate with patient age at presentation; e.g., embryonal rhabdomyosarcoma in infants versus liposarcomas in older adults.
- Most soft tissue sarcomas are solitary, with multiple occurrences being rare.
Diagnosis and Techniques
- Initial diagnosis involves excisional, incisional, core needle biopsies, or fine-needle aspirations.
- Light microscopic evaluation remains the standard technique for diagnosing soft tissue lesions.
- Ancillary techniques like immunohistochemistry and molecular methods become important if initial evaluations are inconclusive.
- Cytogenetic studies reveal chromosomal alterations in numerous soft tissue tumors, crucial for classification and diagnosis.
Grading and Staging
- Grading of soft tissue tumors is integrated into conventional microscopic classifications, aiding prognosis and treatment strategies.
- Differentiation scores in sarcomas can range based on histologic type and determine treatment approaches.
Infections and Hematomas
- Soft tissue infections often arise from direct sources or complications from trauma/surgery.
- Necrotizing fasciitis, characterized by severe systemic toxicity, is usually caused by group A streptococci.
- Hematomas can mimic sarcomas, highlighting the need for careful clinical assessment.
Key Terms
- Soft tissue tumors: diverse neoplasms including lipomas, schwannomas, fibrosarcomas, and various sarcomas.
- Ancillary techniques: methods beyond initial biopsy/imaging to enhance diagnosis accuracy.
- Differentiation score: a tool to evaluate the degree of malignancy in sarcomas.### Soft Tissue Sarcomas Overview
- Clear cell sarcoma and epithelioid sarcoma are significant types of soft tissue sarcomas, with differing grades and prognostic implications.
- Alveolar rhabdomyosarcoma is classified as a high-grade tumor, whereas dermatofibrosarcoma protuberans (DFSP) is a low-grade neoplasm.
- Grading systems for soft tissue sarcomas may consist of two, three, or four distinct grades, focusing on the tumor's biological behavior.
Grading Criteria for Sarcomas
- Grading involves evaluating cellularity, pleomorphism, mitotic activity, and necrosis, all of which have prognostic significance.
- Subjective evaluation and limited biopsy sampling can pose challenges in accurate grading.
- FNCLCC (French Federation of Cancer Centers Sarcoma Groups) is a widely accepted three-grade grading system, assessing differentiation, mitotic rate, and necrosis.
Prognostic Factors for Soft Tissue Tumors
- The prognosis is influenced by multiple interrelated parameters, including:
- Tumor Size: Larger tumors generally correlate with poorer outcomes across various tumor types.
- Tumor Depth: Superficial tumors have a better prognosis compared to deep-seated tumors due to easier excision opportunities.
- Tumor Location: Retroperitoneal tumors show worse outcomes compared to similar tumors located in the extremities; upper extremity lesions are associated with a higher local recurrence rate.
Staging Systems
- The American Joint Committee on Cancer (AJCC) staging system is commonly utilized, based on the TNM classification:
- T (Primary Tumor): Size is categorized from TX (not assessable) to T4 (greater than 15 cm).
- N (Regional Lymph Nodes): N0 indicates no lymph node involvement, while N1 indicates positive regional lymph node metastasis.
- Histologic grading is integral to the AJCC system, aiding in comprehensive tumor evaluation and prognosis assessment.
Normal Anatomy
- Soft tissue refers to extraskeletal structures excluding epithelial support and hematopoietic/lymphoid tissue.
- Composed of fibrous tissue, adipose tissue, skeletal muscle, blood and lymph vessels, and peripheral nervous system components.
- Fibrous tissue has fibroblasts and an extracellular matrix, classified as loose or dense.
- Adipose tissue consists of white fat (larger cells, lipid-filled) and brown fat (smaller, heat-producing cells).
Tumors Overview
- Soft tissue tumors are complex for pathologists, categorizing reactive and neoplastic lesions.
- Recent developments in tumor classifications include molecular genetic alterations.
- Key tumor types include lipomas, sarcomas, fibromas, and neuromas.
Classification of Soft Tissue Tumors
- Tumors are traditionally classified based on histogenesis, e.g., fibrosarcoma from fibroblasts.
- Soft tissue sarcomas arise from multipotential mesenchymal cells rather than specific precursors.
Clinical Features
- The presentation of soft tissue tumors relates to patient age; for example:
- Embryonal rhabdomyosarcoma typically in infants.
- Synovial sarcoma in adolescents and young adults.
- Liposarcomas mostly in middle-aged and elderly patients.
Diagnosis and Special Techniques
- Initial tumor diagnosis involves biopsy techniques such as excisional, incisional, or fine-needle aspiration.
- Light microscopy remains standard, with certain cases requiring immunohistochemistry and molecular genetics for accurate diagnosis.
- Cytogenetics reveal nonrandom chromosomal alterations aiding in tumor classification.
Tumors and Tumor-like Conditions
- Tumors can occur in various soft tissue types, including adipose, fibrous, hematopoietic, and vascular tissues.
- Specific tumor types such as hemangiomas and schwannomas have unique immunohistochemical markers.
Infections and Hematomas
- Infections in soft tissues typically arise from direct extension from other sites or trauma.
- Hematomas can mimic sarcomas in appearance, especially when deep and encapsulated.
- Necrotizing fasciitis is a severe infection, often caused by group A streptococci, and presents with systemic toxicity.
Grading and Staging of Tumors
- Microscopic grading is integrated into the classification of soft tissue tumors.
- Different sarcoma tissues have unique differentiation scores that guide prognosis and treatment strategies.### Soft Tissue Sarcoma Grading
-
Grading Systems: Various grading systems for soft tissue sarcomas exist, including:
- Two grades (low and high)
- Three grades (I, II, III)
- Four grades (I, II, III, IV)
- Prognostic Features: Key criteria for grading include cellularity, pleomorphism, mitotic activity, and necrosis, which are important for prognostication in both adult and pediatric tumors.
FNCLCC Grading System
-
Three-Grade System: The FNCLCC grading system evaluates:
- Tumor differentiation
- Mitotic rate
- Extent of tumor necrosis
- Relevance: This system is widely accepted due to its clarity and applicability in grading sarcomas.
American Joint Committee on Cancer (AJCC) Staging
-
Staging Basis: AJCC staging follows a TNM format involving:
- T (size of primary tumor)
- N (nodal involvement)
- M (metastasis)
- G (histologic grade)
- Professional Utilization: This system serves as a standard framework for assessing sarcoma status and prognosis.
Prognostic Factors
- Tumor Size: Larger tumors are consistently linked to worse outcomes across various cancer types.
- Tumor Depth: Superficial tumors located in the dermis/subcutaneous tissue have a better prognosis compared to deeper lesions (intermuscular or retroperitoneal).
- Tumor Location: Tumors in the retroperitoneum have poorer outcomes than similar ones in extremities, particularly noting higher local recurrence in upper extremity tumors compared to those in the lower extremity.
Limitations of Grading
- Subjectivity: Grading can be subjective due to evaluator bias.
- Sampling Issues: Limited biopsy sampling can affect the accuracy of grading assessments.
- Impact of Preoperative Therapy: Preoperative treatments can complicate grading evaluations.
Historical Context
- Definitional Changes: Terms like "low-grade" and "high-grade" are historically rooted in classifications for various sarcoma types, influencing treatment decisions and patient prognosis.
Normal Anatomy
- Soft tissue refers to extraskeletal structures excluding epithelial support and hematopoietic/lymphoid tissue.
- Composed of fibrous tissue, adipose tissue, skeletal muscle, blood and lymph vessels, and peripheral nervous system components.
- Fibrous tissue has fibroblasts and an extracellular matrix, classified as loose or dense.
- Adipose tissue consists of white fat (larger cells, lipid-filled) and brown fat (smaller, heat-producing cells).
Tumors Overview
- Soft tissue tumors are complex for pathologists, categorizing reactive and neoplastic lesions.
- Recent developments in tumor classifications include molecular genetic alterations.
- Key tumor types include lipomas, sarcomas, fibromas, and neuromas.
Classification of Soft Tissue Tumors
- Tumors are traditionally classified based on histogenesis, e.g., fibrosarcoma from fibroblasts.
- Soft tissue sarcomas arise from multipotential mesenchymal cells rather than specific precursors.
Clinical Features
- The presentation of soft tissue tumors relates to patient age; for example:
- Embryonal rhabdomyosarcoma typically in infants.
- Synovial sarcoma in adolescents and young adults.
- Liposarcomas mostly in middle-aged and elderly patients.
Diagnosis and Special Techniques
- Initial tumor diagnosis involves biopsy techniques such as excisional, incisional, or fine-needle aspiration.
- Light microscopy remains standard, with certain cases requiring immunohistochemistry and molecular genetics for accurate diagnosis.
- Cytogenetics reveal nonrandom chromosomal alterations aiding in tumor classification.
Tumors and Tumor-like Conditions
- Tumors can occur in various soft tissue types, including adipose, fibrous, hematopoietic, and vascular tissues.
- Specific tumor types such as hemangiomas and schwannomas have unique immunohistochemical markers.
Infections and Hematomas
- Infections in soft tissues typically arise from direct extension from other sites or trauma.
- Hematomas can mimic sarcomas in appearance, especially when deep and encapsulated.
- Necrotizing fasciitis is a severe infection, often caused by group A streptococci, and presents with systemic toxicity.
Grading and Staging of Tumors
- Microscopic grading is integrated into the classification of soft tissue tumors.
- Different sarcoma tissues have unique differentiation scores that guide prognosis and treatment strategies.### Soft Tissue Sarcoma Grading
-
Grading Systems: Various grading systems for soft tissue sarcomas exist, including:
- Two grades (low and high)
- Three grades (I, II, III)
- Four grades (I, II, III, IV)
- Prognostic Features: Key criteria for grading include cellularity, pleomorphism, mitotic activity, and necrosis, which are important for prognostication in both adult and pediatric tumors.
FNCLCC Grading System
-
Three-Grade System: The FNCLCC grading system evaluates:
- Tumor differentiation
- Mitotic rate
- Extent of tumor necrosis
- Relevance: This system is widely accepted due to its clarity and applicability in grading sarcomas.
American Joint Committee on Cancer (AJCC) Staging
-
Staging Basis: AJCC staging follows a TNM format involving:
- T (size of primary tumor)
- N (nodal involvement)
- M (metastasis)
- G (histologic grade)
- Professional Utilization: This system serves as a standard framework for assessing sarcoma status and prognosis.
Prognostic Factors
- Tumor Size: Larger tumors are consistently linked to worse outcomes across various cancer types.
- Tumor Depth: Superficial tumors located in the dermis/subcutaneous tissue have a better prognosis compared to deeper lesions (intermuscular or retroperitoneal).
- Tumor Location: Tumors in the retroperitoneum have poorer outcomes than similar ones in extremities, particularly noting higher local recurrence in upper extremity tumors compared to those in the lower extremity.
Limitations of Grading
- Subjectivity: Grading can be subjective due to evaluator bias.
- Sampling Issues: Limited biopsy sampling can affect the accuracy of grading assessments.
- Impact of Preoperative Therapy: Preoperative treatments can complicate grading evaluations.
Historical Context
- Definitional Changes: Terms like "low-grade" and "high-grade" are historically rooted in classifications for various sarcoma types, influencing treatment decisions and patient prognosis.
Overview of Angiosarcoma
- Angiosarcoma primarily affects adults and the elderly but can infrequently occur in children.
- Common locations include skin, soft tissue, breast, bone, liver, and spleen.
Characteristics and Types
- Soft tissue angiosarcomas can arise from major blood vessels like:
- Inferior vena cava
- Pulmonary artery
- Aorta
- These vascular tumors often appear undifferentiated and display a solid growth pattern.
- They may be labeled with terms such as:
- Intimal sarcoma
- Luminal sarcoma
- Arterial/venous trunk sarcoma
Associations and Risk Factors
- Angiosarcomas can develop in previously irradiated areas or around long-term foreign bodies.
- Observed in arteriovenous fistulas, including surgically constructed ones.
- They can occur as secondary tumors in mediastinal or retroperitoneal germ cell tumors or arise within existing benign tumors (e.g., schwannoma, neurofibroma).
Gross and Microscopic Findings
- Grossly, angiosarcomas are distinguished by a highly hemorrhagic nature and deep invasiveness.
- Microscopic examination shows a spectrum of appearances:
- Well-differentiated forms resembling benign hemangiomas.
- Poorly differentiated types mimicking carcinoma, malignant melanoma, or other sarcomas.
- Diagnostic features include:
- Anastomosing vascular channels lined with atypical endothelial cells.
- Clusters of reactive lymphocytes and hemosiderin deposits.
Variability in Cell Appearance
- Neoplastic endothelial cells exhibit significant variability:
- Shapes vary from elongated to plump and epithelioid.
- Sizes range from small to giant, with some forming multinucleated variants.
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Description
This quiz covers the anatomy and pathology of soft tissues, including normal anatomical structures, infections, hematomas, and tumors of adipose tissue. Perfect for students of pathology looking to test their knowledge on these critical topics.
