The diagnosis, classification and grading of soft tissue tumors

Abstract

An accurate diagnosis of soft tissue tumors is dependent on a thorough history and clinical examination, adequate organ imaging, and subsequent core needle biopsy under organ imaging control. Portions of the cores should be submitted for histology, cytogenetics, electron microscopy, microbiology, and any research requirements. Two recent, cautionary cases of Madelung's disease that were initially misdiagnosed because the history, clinical examination, and organ imaging were circumvented are documented. Single examples of malignant fibrous histiocytoma, Ewing's sarcoma, synovial sarcoma, and intramuscular myxoma, in which appropriate treatment was based on the histories, examination, organ imaging, and core needle biopsies are described. The most reliable classification applicable to the diagnosis and management of soft tissue tumors is found in Enzinger and Weiss' classic textbook, Soft Tissue Tumors' (3rd ed. St Louis; CV Mosby, 1995). Provided that the pathologist is trained and experienced in the histological diagnosis of soft tissue tumors, that histological classification provides more accurate prognostic indicators for the established but rare clinico-pathological entities than the crude histological grade. The latter finds its greatest prognostic application with so-called malignant fibrous histiocytomas of adults.