Soft tissue sarcomas in Mosul: a pathologic evaluation

Ahmad F Lazim ,Bedoor Ak Al-Irhayim

doi:10.33899/mmed.2008.32311

Abstract

Objective: Histochemical and immunohistochemical examination of soft tissue sarcomas(STS) in Mosul to assess the value of these techniques in verifying the primary diagnosis. Methods: Paraffin embedded tissue blocks of 35 cases of soft tissue sarcomas collected over a period of 20 months in Mosul, were utilized. H&E, reticulin ,and Van Gieson's staining techniques and immunohistochemical marker for S-100 protein were applied to all the cases. Results: Soft tissue sarcoma accounts for 16.4%of the total of 213 cases of benign and malignant soft tissue neoplasms,with a mean age of 30.5 years ,and a male preponderance( Male: Female ratio of1.7:1). The most common histologic subtypes are extraskeletal Ewing’s sarcoma(ES), dermatofibrosarcoma protuberans(DFSP) ,and spindle cell sarcoma, not other wise specified (NOS). The extremities are affected in 51.4% of all cases, particularly the lower limbs. The majority of soft tissue sarcomas belong to the high grade category by applying French Federation of Cancers Centers Sarcoma Group ( FFCCSG) and American Joint Cancer Committee (AJCC) grading schemes .Both reticulin and Van Gieson's stains have been successfully depicting the growth patterns of different subtypes. Immunoreactivity for S-100 protein was positive in two cases. Conclusions: High quality H&E stained sections remain the best method for establishing the diagnosis of sarcomas .Reticulin stain proved extremely helpful in subclassifying sarcomas and S-100 protein was instrumental in changing the diagnosis of sarcoma in one case.

Highlights

The main objectives of this study are subtyping of already diagnosed sarcomas by applying reticulin stain, Van Gieson stain, and immunohistochemical marker S-100 protein, assess histologic grading by reevaluation of H&E stained sections,as well as finding out the relative frequency of soft tissue sarcomas in Mosul, age and gender distribution
According to standard knowledge, soft tissue sarcomas account for 1-2% of all malignant neoplasms[3,4,16,17,18,19]
In this study they represented 16.4% of soft tissue neoplasms [Benign: Malignant ratio of 100:18], and this is not much different from that recognized in a previous study from Mosul in

Summary

Introduction

Soft tissue sarcomas usually afflict old persons, with a median age of 56 years, and a male; female ratio of 1:1(9). The main objectives of this study are subtyping of already diagnosed sarcomas by applying reticulin stain, Van Gieson stain, and immunohistochemical marker S-100 protein, assess histologic grading by reevaluation of H&E stained sections,as well as finding out the relative frequency of soft tissue sarcomas in Mosul, age and gender distribution. Peripheral neuroblastoma has the characteristic of well circumscribed masses of small round cells in a fibrillary stroma .Kaposi's sarcoma shows fascicles of plumpy spindle cells, recognized by H&E stain.Spindle cell sarcoma (NOS) case is depicting a marked nuclear hyperchromasia and intense S-100 protein immunoreactivity(figures 6&7).

Results

Conclusion