Cases Of Soft Tissue Tumors Research Articles

Peripheral Ameloblastoma: A rare case of soft tissue tumor (Case Study)

A rare case of Peripheral ameloblastoma (PA) is reported. This rare type of tumor, classified as benign, locally invasive odontogenic tumor which histologically resembles an intraosseous ameloblastoma but develops in the soft tissues of the gingiva and mucosa. The prevalence of PA ranging from 2-10% compared to the other types of ameloblastoma. A case of PA in a 56-years-old male with an exophytic painless mass in the gingiva of the anterior mandible provisionally diagnosed as irritation fibroma is reported. Histopathological result of surgical treatment was concluded as acanthomatous peripheral ameloblastoma. Based on this experience clinical manifestation of gingival tumor a careful diagnosis should be taken by included the PA in differential diagnosis, in order to manage an adequate treatment and to ovoid of tumor recurrent.

Detection of various fusion genes by one-step RT-PCR and the association with clinicopathological features in 242 cases of soft tissue tumor.

Introduction: Over the past decades, an increasing number of chromosomal translocations have been found in different STSs, which not only has value for clinical diagnosis but also suggests the pathogenesis of STS. Fusion genes can be detected by FISH, RT-PCR, and next-generation sequencing. One-step RT-PCR is a convenient method to detect fusion genes with higher sensitivity and lower cost. Method: In this study, 242 cases of soft tissue tumors were included, which were detected by one-step RT-PCR in multicenter with seven types of tumors: rhabdomyosarcoma (RMS), peripheral primitive neuroectodermal tumor (pPNET), synovial sarcoma (SS), myxoid liposarcomas (MLPS), alveolar soft part sarcoma (ASPS), dermatofibrosarcoma protuberans (DFSP), and soft tissue angiofibroma (AFST). 18 cases detected by one-step RT-PCR were further tested by FISH. One case with novel fusion gene detected by RNA-sequencing was further validated by one-step RT-PCR. Results: The total positive rate of fusion genes was 60% (133/213) in the 242 samples detected by one-step RT-PCR, in which 29 samples could not be evaluated because of poor RNA quality. The positive rate of PAX3-FOXO1 was 88.6% (31/35) in alveolar rhabdomyosarcoma, EWSR1-FLI1 was 63% (17/27) in pPNET, SYT-SSX was 95.4% in SS (62/65), ASPSCR1-TFE3 was 100% in ASPS (10/10), FUS-DDIT3 was 80% in MLPS (4/5), and COL1A1-PDGFB was 66.7% in DFSP (8/12). For clinicopathological parameters, fusion gene status was correlated with age and location in 213 cases. The PAX3-FOXO1 fusion gene status was correlated with lymph node metastasis and distant metastasis in RMS. Furthermore, RMS patients with positive PAX3-FOXO1 fusion gene had a significantly shorter overall survival time than those patients with the negative fusion gene. Among them, the FISH result of 18 cases was concordant with one-step RT-PCR. As detected as the most common fusion types of AHRR-NCOA2 in one case of AFST were detected as negative by one-step RT-PCR. RNA-sequencing was used to determine the fusion genes, and a novel fusion gene PTCH1-PLAG1 was found. Moreover, the fusion gene was confirmed by one-step RT-PCR. Conclusion: Our study indicates that one-step RT-PCR displays a reliable tool to detect fusion genes with the advantage of high accuracy and low cost. Moreover, it is a great tool to identify novel fusion genes. Overall, it provides useful information for molecular pathological diagnosis and improves the diagnosis rate of STSs.

THE NEED FOR MULTIPLE SURGERIES FOR FREQUENT DESMOID TUMOR RECURRENCE

Desmoid tumors are very rare mesenchymal neoplasms with an estimated incidence of 3 per 100 soft tissue tumor cases. They are locally invasive, aggressive and cause significant complications. The treatment modalities of desmoids include surgery, radiotherapy, chemotherapy, hormonal therapy. Currently there is no gold standard and neither therapy is effective for high recurrence (25‑77%) desmoid tumors. Desmoid tumors also have the capacity for self-limitation and, therefore, no treatment other than observation is possible expecting spontaneous regression. Treatment options for desmoid tumors are limited and as­sessment of treatment effects remains an unresolved issue due to no standard validated response criteria available.

Demographic and histopathologic study of soft tissue lesions in a tertiary care hospital in South India

The term soft tissue tumors (STT) encompass a wide range of tumors arising from the mesenchymal tissues. In this study, we have retrospectively analysed the various STTs occurring in the Department of Pathology and included all cases with a confirmed histopathological diagnosis of soft tissue lesions received during the study period of January 2018 – December 2019. These cases were further analysed for the site of the lesion, number of lesions, age and gender of the patients and the results tabulated. A total of 207 cases of soft tissue tumors with confirmed histopathological diagnosis were included in this study. The male: female ratio was 1.1:1. It was observed that most of the soft tissue tumors were seen in the 31-40 years age group (33%) followed by the 41-50 years age group (21%). The most common histopathologic subtype of tumors were of adipocytic origin (61%). Malignant morphology was observed in 2.4% of the cases. Soft tissue tumors are not uncommon tumors and account for 5.2% of cases among the routine histopathological specimens. This study is presented here to understand the demography and the spectrum of soft tissue tumors observed in a tertiary care centre.

Survival analyses of soft tissue pleomorphic sarcomas and a proposed leiomyosarcoma-specific dynamic nomogram: A large population-based study

BackgroundPleomorphic sarcoma of soft tissue11PSST: pleomorphic sarcoma of soft tissue (PSST) is a heterogeneous group of sarcomas with different prognoses. Survival patterns of this tumor group have not been thoroughly investigated. Prognostic models should be developed to support individualized evaluation of PSST patients. Materials and methodsWe collected cases of soft tissue tumors in the Surveillance, Epidemiology, and End Results22SEER: Surveillance, Epidemiology, and End Results (SEER) database, excluding tumors located in intra-abdominal and retroperitoneal regions. We included patients with histopathologic diagnoses of tumors in the PSST group (n = 14,685) and compared the survival patterns of the different histologic types. To develop a prognostic model of leiomyosarcoma, we divided leiomyosarcoma patients into two groups. The first group (n = 4136) was patients with missing values, which became our training cohort after imputation. The second group (n = 671) was the validation cohort. ResultsLeiomyosarcoma was the most common PSST (32.7 %). By pairwise comparison, we found that histologic types of PSST can be divided into 4 prognostic groups (p < 0.001). Regarding our model, the C-index, K statistic, and explained variation R2D were 0.84, 0.8, 0.52 (training cohort) and 0.76, 0.76, 0.4 (validation cohort), respectively. ConclusionsWe found that the survival patterns of PSST can be divided into four distinct groups of histology types. Our dynamic nomogram can individualize the management of leiomyosarcoma patients and, therefore, can be very helpful for clinician-patient communication due to its applicability of flexibility.

HISTOPATHOLOGICAL STUDY OF SOFT TISSUE TUMOURS AND CORRELATION OF HISTOLOGIC GRADE OF SARCOMAS WITH PROLIFERATIVE MARKER KI-67

INTRODUCTION:Soft tissue tumours have diagnostic and therapeutic challenge due to a wide variety of histomorphological patterns. Soft tissue sarcomas are relatively infrequent and constitute less than 1 % of all malignant neoplasms. Immunohistochemical evaluation of Ki-67 is a rapid prognostic tool to assess the cellular proliferation better than mitotic index. METHODS: A prospective study was conducted with a total of 100 cases of soft tissue tumors to analyze the frequency and histomorphology. Soft tissue sarcomas were graded by FNCLCC grading system and were subjected to Ki-67 evaluation. Spearman's Rho and Pearman's correlation coefcients were calculated to determine the correlation between the histologic grade and Ki-67 index. RESULTS: Soft tissue tumours constituted only about 1.3% of all neoplasms. Benign tumours (50%) outnumbered intermediate (11%) and malignant soft tissue tumours (39%). Soft tissue tumours were more common in males (52%) than females (48%) and frequently observed in the sixth decade. The sites of predilection were upper extremities for benign tumours and lower extremities for malignant tumours. Most common benign soft tissue tumour was Neurobroma (19%) followed by Schwannoma (14%). Undifferentiated pleomorphic sarcomas were the most common malignant soft tissue tumour (28%). In FNCLCC grading, most of the sarcomas were grade III (42%). Ki-67 index was low in grade I sarcomas, variable in grade II sarcomas and high in grade III sarcomas. Spearman's rho and Pearman's correlation R values were 0.77 and 0.75 respectively and p value is less than 0.05. CONCLUSION: There is positive correlation between the histologic grade and Ki-67 proliferative index in soft tissue sarcomas. Ki-67 index can be used as an independent prognostic factor to predict the risk of distant metastasis. Prospective evaluation of Ki-67 should be carried out in patients with soft tissue sarcomas for planning adjuvant treatment modalities

EPIDEMIOLOGICAL DISTRIBUTION OF SOFT PART TUMORS IN A TERTIARY HOSPITAL.

To evaluate cases of soft tissue tumors at the Orthopedic Oncology service of the PUC-Campinas Hospital and determine the epidemiological profile in the period from February 2012 to November 2019, associating the participation of a non-reference hospital in the approach and treatment of the pathology. This study evaluated 72 patients aged 18 to 81 years, of both sexes and diagnosed with soft tissue tumor and divided into two groups: (I) primary etiology and (II) metastatic etiology. Of 146 patients admitted, 22 resulted in deaths, with 9 patients from Group I, and 13 from Group II. For all patients with soft tissue tumor, aged between 51 and 58 years, admitted in the period, the probability of survival after 46 months was 71.84%, Group I's was 22.7% and Group II's 91.43%. Despite the scarcity of epidemiological data related to soft tissue tumor, the data appreciated in the hospital's service, not a reference in treating this type of condition, are compatible with the data presented in specialized hospitals in Brazil, thus, in confluence with the literature. Level of Evidence III, Comparative, Prognostic and Retrospective Study.

Soft Tissue Tumor

Soft tissue tumors are a heterogeneous group of benign and malignant lesions that develop from a variety of nonepithelial, extraskeletal elements, including adipose tissue, smooth and skeletal muscle, tendons, cartilage, fibrous tissue, blood vessels, and lymphatic structures. The writing of this article includes various sources originating from scientific journals and government guidelines and related agencies. Source searches were carried out on online portals for journal publications such as Med Scape Google Scholar (scholar.google.com) and the National Centre for Biotechnology Information/NCBI (ncbi.nlm.nih.gov), with the keyword “Sensoric Nerve Trauma”. Soft tissue tumors (STT) can be benign or malignant, and benign soft tissue tumors are more common than malignant tumors with a ratio of 100: 1. In a study of 93 cases of soft tissue tumors, it was found that the incidence of benign tumors was 75.2% and malignant tumors were 24.8%. Soft tissue tumors are associated with genetic conditions, radiation, chronic lymphedema, environmental carcinogens, and infections.

Is immunohistochemistry always the panacea to morphologic mimics? Two, distinct soft tissue tumors exhibiting alveolar pattern and TFE3 immunoreactivity

Alveolar soft part sarcoma (ASPS) and certain perivascular epithelioid cell neoplasms (PEComas) exhibit overlapping histopathological features, including immunohistochemical expression of TFE3, as well as TFE3 gene rearrangement. PEComas with an epithelioid morphology are known to exhibit variable immunoexpression of muscle markers. At the same time, aberrant immunoreactivity of HMB45 immunostain, which is invariably, used to substantiate a diagnosis of a PEComa, has been reported in various other tumors. Herein, we discuss two rare cases of soft tissue tumors with overlapping morphological and immunohistochemical features. Case1: A 34-year-old male underwent a biopsy for a recurrent, right-sided nasal polyp. Biopsy showed polygonal tumor cells, containing prominent nucleoli, arranged in a "nesting-type"/alveolar growth pattern. Immunohistochemically, tumor cells displayed TFE3 positivity and an aberrant positivity for HMB45. Special stain (PAS-diastase) highlighted intracytoplasmic granules and crystals. Diagnosis of ASPS was offered. Furthermore, the tumor cells displayed TFE3 gene rearrangement. Case 2: A 29-year-old female underwent an aural polypectomy. Microscopic examination revealed a tumor with a "nesting-type"/alveolar arrangement of tumor cells with vacuolated cytoplasm, arranged around thin-walled blood vessels. Immunohistochemically, tumor cells were diffusely positive for HMB45 and TFE3 and focally for SMA. A diagnosis of a PEComa was offered. This report constitutes the first documentation of aberrant HMB45 immunoreactivity in case of ASPS, and one of the first reported cases of a PEComa in the ear. It emphasizes the value of integrating clinicopathological features with immunohistochemical and molecular results in differentiating two rare, but distinct soft tissue tumors with overlapping features. An exact diagnosis of both these tumor entities has therapeutic implications.

HISTOPATHOLOGICAL PATTERN OF SOFT TISSUE TUMORS IN A TERTIARY CARE CENTRE IN NORTH INDIA: A RETROSPECTIVE STUDY

Background: Soft tissue tumors are a diverse group of lesions arising from the supporting soft tissue of the body. Though pathologically diverse, they frequently exhibit similar clinical presentations and radiological features. Correct histopathological diagnosis is therefore crucial for further management. &#x0D; Aim/Objectives: To evaluate the spectrum of benign as well as malignant soft tissue tumors in a tertiary care centre in North India.&#x0D; Material and Methods: This retrospective study was carried out in the Department of Pathology from April 2017 to March 2018. All cases of soft tissue tumors in this period were included in the study. Gross findings were recorded from Histopathology request forms. Histology slides stained with haematoxylin and eosin stain were reviewed and findings recorded. &#x0D; Results: Majority of patients were males with maximum cases in the 4th decade. Of all soft tissue tumors, 90.4% were benign, 4.0 % intermediate and 5.6% were malignant. Benign Adipocytic tumors (48.0%) were the commonest soft tissue tumors, followed by benign vascular tumors (24.0%). Malignant Fibrous Histiocytoma was the commonest malignant neoplasm in our study (42.8 %).&#x0D; Conclusions: Soft tumors pose diagnostic challenges because of confounding morphological characteristics. The incidence of benign tumors (90.4%) was much higher than malignant tumors in our study with benign lipomatous tumors (48.0%) being most common tumors.&#x0D; Keywords: Histopathology; Tumors; Lipomatous; Malignant

Vulvovaginal fibroepithelial stromal polyp with myxoid stroma: A diagnostic dilemma on histology – Report of two cases

Genital stromal tumors are a rare and unique subset of soft-tissue tumors encountered in the vulvovaginal and inguinoscrotal region and this group includes fibroepithelial stromal polyp, superficial (cervicovaginal) myofibroblastoma, cellular angiofibroma, mammary-type myofibroblastoma, angiomyofibroblastoma, superficial angiomyxoma, and deep/aggressive angiomyxoma. The relative rarity and overlapping histomorphological and immunohistochemical features result in a diagnostic difficulty for the pathologists. Herein, we describe two cases of soft-tissue tumors in the vulvovaginal region presenting as polypoidal mass with detailed histopathology and immunohistochemical workup.

Spectrum of soft tissue tumors: A two year clinicopathological study at tertiary level hospital

Introduction: Soft tissue sarcomas account for less than 1% of overall human burden of malignant tumors. Our study was conducted in a tertiary care hospital in konaseema region to identify various histological patterns of the soft tissue tumors along with their relation to age, sex and site. Materials and Methods: 215 cases of soft tissue tumors were analysed both retrospectively and prospectively for two years during January 2015 to January 2017. A careful histopathological examination was done with clinical correlation. Results: In a span of two years, we received 215 soft tissue tumors, 179 cases (83.2%) were benign in nature, 18 (8.3%) cases were of intermediate grade malignancy and 18 (8.3%) were malignant. Males were affected more than females. The most common site was lower extremities. Conclusion: A vigilant Histopathological examination using Hematoxylin and Eosin stain (H&E) with clinical correlation is still an important tool and gold standard in diagnosing various patterns of soft tissue tumors. Keywords: Soft tissue sarcoma, Benign, Malignant, Hematoxylin and Eosin stain.

Differential diagnosis of myxoid soft tissue tumors. Experience in the Clinical University Hospital of Valencia

Soft tissue tumors with myxoid components are often a diagnostic challenge for the pathologist. We retrospectively reviewed 41 cases of soft tissue tumors with myxoid components diagnosed in our center over a five-year period. The most frequent diagnoses were myxofibrosarcoma and myxoid liposarcoma, followed by low-grade fibromyxoid sarcoma, low-grade fibromyxoid tumor and myxoid neurofibroma. Other diagnoses included were extraskeletal myxoid chondrosarcoma, myxoinflammatory fibroblastic sarcoma, low-grade myxoliposarcoma, myofibrosarcoma, fibromatosis, solitary fibrous tumor, non-ossifying variant of ossifying fibromyxoid tumor and ancient neurinoma with myxoid degeneration. Immunohistochemical and molecular biology studies contributed significantly to the diagnosis. We highlight the importance of immunohistochemistry for MUC4 in the diagnosis of low-grade fibromyxoid sarcoma, and underscore the need for molecular studies in selected cases. Furthermore, several myxoid neoplasms present specific chromosomal translocations, therefore molecular biology studies to detect fusion genes are usually essential for the diagnosis. When the characteristics of the sample are not adequate for molecular biology, or no specific alterations are described, an in-depth knowledge of the histology of these lesions is still necessary to decide the most accurate diagnosis.

Morphological spectrum of soft tissue tumors in a tertiary care hospital affiliated with a teaching institute: A 4 years retrospective study

Aims and Objectives: 1) To study the morphological spectrum of soft tissue tumors in detail on the basis of both histopathological features and recent WHO classification and 2) To study the relative frequencies of Benign, Intermediate and Malignant tumors along with their locations, age groups of presentation and gender ratio. Materials and Methods: The present 4 years retrospective study was conducted at the department of Pathology, GMERS Medical College-Junagadh from January 2015 to December 2018. It includes 105 cases of soft tissue tumors that presented and diagnosed at our institute on both clinical and pathological basis. Results: Out of 105 cases, 101 (96.19%) were benign, only one (0.95%) was intermediate & 3 (2.86%) were malignant in nature. The commonest age group was 41-50 years & M: F ratio was 1.56:1. Among benign tumors, adipocytic tumors constituted majority of the cases (78.22%) followed by vascular tumors (7.92%). Both upper & lower extremities were found to be the commonest location for such tumors. Conclusion: Soft tissue tumors are diagnosed on the basis of gross & light microscopic features in majority of the cases. However, in certain cases of malignancies or sarcomas, ancillary techniques like special histochemical staining & IHC become quite helpful in diagnosis. Keywords: Peripheral Neuroblastic tumors, Neuroblastoma, Ganglioneuroblastoma, Ganglioneuroma, Immunohistochemistry.

Study of histopathological pattern of soft tissue tumours in tertiary care centre of Gandhi Nagar, Gujarat

Background: Soft tissue tumours are a diverse and fascinating group of lesions that arise from the supporting soft tissue of the body. Although pathologically diverse, they frequently exhibit similar clinical presentations and radiological features. Correct histopathological diagnosis is therefore crucial. Aims and objectives: This study aims to analyze the histopathological patterns of soft tissue tumours and their distribution according to age, sex and site of occurrence in patients. Methods: This study comprised of 170 cases of soft tissue tumours received in the Department of Pathology, GMERS Medical College, Gandhinagar were analysed. Their gross features, microscopic findings were analysed in detail. Soft tissue tumours were divided into benign and malignant categories and their further sub typing were done according to WHO Classification. The distribution of soft tissue tumours according to the age, sex and site of occurrence was studied. Results: Out of 170 cases of soft tissue tumours, 158 cases (92.4%) were benign, 2 cases (1.18%) were malignant and 10 cases (5.88%) were classified under intermediate category. Adipocytic tumors formed the largest group constituting 92 cases (46%). Vascular tumors were the second commonest (7%) followed by peripheral nerve sheath tumours (10.5%). The benign tumours were seen in younger age as compared to malignant tumours. Conclusion: Benign tumours were more common than malignant. The most common benign tumours were lipoma followed by hemangioma (14.0%) and schwannoma (5.5%). There is wide range of their distribution according to age, sex and site. The benign tumours were seen in younger age as compared to malignant tumours.

Developing Surgical Oncology Services in Resource Constrained Settings: Results of a Systematic and Motivated Approach

Background: General surgeons trained in surgical oncology and working in a general service hospital can offer and provide a wide variety of oncological services although significant limitations exist compared with a true tertiary cancer care center in developed high income countries. Providing optimal and standard of care surgical oncology services is truly demanding and limitations in ancillary and support services can potentially limit the quality of care provided in resource constrained settings like ours. Aim: The aim of this study was to analyze the patterns of care, surgical outcomes in terms of morbidity and mortality, quality of resection in terms of margins and nodal yield over a period of 08 weeks in a general service hospital with resource constrained setting and with two trained and motivated surgical oncologists. Methods: Data of 22 patients with solid organ cancers who underwent major operative treatment both curative and palliative under the surgical oncology services were analyzed retrospectively. All patients were evaluated clinically, imaging as required and pathologic tissue diagnosis of cancer obtained as was possible and after adequate preoperative preparation were operated upon. Results: Four patients of carcinoma rectum underwent low anterior resection with diverting ileostomy, one patient with rectal cancer had APR with permanent end colostomy, two patients underwent total thyroidectomy for papillary thyroid cancer, eight patients underwent modified radical mastectomy for carcinoma breast, two patients had optimal cytoreductive surgery for carcinoma ovary -one patient upfront and another as interval cytoreduction, two cases of soft tissue tumor underwent limb salvage surgery, one case of carcinoma stomach underwent subtotal gastrectomy, one case of carcinoma cecum underwent classic right radical hemicolectomy. Two patients underwent emergency exploration for acute abdomen who were otherwise metastatic for palliation. All but one case received neoadjuvant therapy prior to surgery in carcinoma rectum, one case of carcinoma ovary and carcinoma breast were operated after neoadjuvant chemotherapy. Overall there was only one margin positive resection after low anterior resection who was operated upfront due to impending obstruction. The average nodal yield in all cases of colorectal carcinomas and breast cancer cases were as per current NCCN standards. Morbidities included seroma collection in 3 patients, minor surgical site infection in 2 patients, peristomal allergy in two patients, there were no deaths in elective cases. Conclusion: Providing quality surgical oncology services in a resource constrained general service hospital is challenging. Through an aggressive, well planned and motivated approach with a good surgical oncology training background and with available resources it is possible to achieve a varied spectrum, quality care and an improved and sustainable healthcare oncology systems for better outcomes even in these settings.

Therapeutic Conduct in Soft-Tissue Tumors Diagnosed in the Pregnant Patient

Abstract Introduction. Soft tissue tumors are a rare pathology encountered in the pregnant patient. Considering the patient’s potential vital risk, the concomitant evolution of pregnancy and the possible infertility acquired after treatment, the therapeutic conduct of these tumors is a challenge to current medical practice. Material and method. The paper aims to present certain cases of soft-tissue tumors diagnosed in pregnant women as well as a retrospective analysis of literature. Results. The diagnosis of certainty was significantly delayed in the case of pregnant patients. The treatment plan was complex and had to take into account the type and the location of the primary tumor, growth rate, associated symptom, age of pregnancy, as well as minimize the fetal toxic effects. Conclusions. The identification of a soft-tissue tumor during pregnancy is associated with limited diagnostic methods. A multidisciplinary team should establish the therapeutic approach for softtissue tumors diagnosed in the pregnant patient. The therapeutic approach should be individualized in each case in order to achieve a balance between tumor treatment, pregnancy outcome, and subsequent reproductive capacity of the patient.

A hospital based clinico-pathological study of soft tissue tumors

Background: Soft tissue sarcomas can develop from soft tissues like fat, muscle, nerves, fibrous tissues, blood vessels, or deep skin tissues. They can be found in any part of the body, commonly seen in the trunk, head and neck area, internal organs, and the area in back of the abdominal cavity (known as the retroperitoneum). Most of them develop in the arms or legs. Aim: The study was conducted to know the incidence, location of soft tissue tumors at different age group individuals and to analyze the various types and subtypes of soft tissue tumors. Materials &amp; Methods: Total of 124 cases of soft tissue lesions were analyzed retrospectively and prospectively in a period of 1.5 years. The prospective study was conducted in the department of surgery and Institutional ethical committee approval was obtained. A detailed clinical data was collected by using the standard data sheet and biopsy specimens were sent to pathology department for histopathological evaluation. Results: The present clinicopathological study included 124 soft tissue tumor cases in different age groups. The occurrence of age wise soft tissue tumors has been depicted in table 1. Out of 124 soft tissue tumors, 97 were benign type, 27 were malignant variety. Conclusion: The present hospital-based study reports data of various types of benign and malignant soft tissue tumors, their relative incidence in male and female and their distribution with respect to the anatomical location of human body. Benign tumors required simple excision, but aggressive benign myxoid tumors and malignant soft tissue tumors require wide surgical excision and close follow up.

Hemangioma Pedis and Tuberculoma Pedis Sinistra in Children

HISTORY : The girl 15 years old, had main complaint, there was a mass in her pedis since she got 2 years old, look red, no pain although in walk, size equal with the skin. The mass got bigger and pain in walk. The mass get bleedy after had crushed by stone, after that bleedy always happen when there was a contact, although soft touch. Patient had history contact with tuberculosis patient. INTERESTING POINTS FOR DISCUSSION : Tuberculoma is a mass that happened because infected bacil mycobacterium tuberculosis, hemangioma is a soft tissue mass that formed by vascular. hemangioma commonly happened in children about 4-10% in children’s tumor. It happened in a girl 3-5 more times than in a boy. Both of them are rare happen in the same time, especially in pedis. From this case, we can found both type in the same patient. SOLUTION AND RATIONALE : For this case of soft tissue tumor,we use open biopsy. After we found the result , the best treatment for hemangioma and tuberculoma of the pedis for this case is below knee amputation. FINAL OUTCOME : For this case, the best treatment is amputation, and after amputation, the patient never complain about pain anymore, she feel satisfied and overall her quality of life is improving.

Loss of Expression of a Novel Chromatin Remodeler SMARCA1 in Soft Tissue Sarcoma.

Introduction:Vital cellular processes such as proliferation and differentiation are regulated by chromatin remodeling complexes. A variety of neoplasms have been discovered to have genomic alterations (GAs) and loss of immunohistochemical (IHC) expression of chromatin remodelers ARID1A (BAF250A), SMARCA2 (BRM), SMARCA4 (BRG1), and SMARCB1 (INI1). SMARCA1 (SNF2L) is another member of the chromatin remodelers, and has not yet been studied in neoplasia. As SMARCA1 is located on chromosome X, could be potentially inactivated by a single hit. We aimed to evaluate GAs and protein expression of SMARCA1 in soft tissue tumors.Method:The publically available cBioPortal.32e34 platform was queried to analyze data on soft tissue tumors from The Cancer Genome Atlas project (TCGA) related to SMARCA1 GAs. Our institutional archives were queried to collect 26 cases of soft tissue tumors including 10 undifferentiated sarcomas, 5 leiomyosarcomas, 6 liposarcomas, and 5 malignant peripheral sheath tumors (MPNST). IHC for SMARCA1 with an SNF 2C4 monoclonal antibody was performed on whole tissue sections.Results:SMARCA1 GAs were present in 8/261 soft tissue sarcomas (3%) in the TCGA dataset. Leiomyosarcomas had most common SMARCA1 GAs in 6/99 cases. SMARCA1 deletions existed in 1/56 dedifferentiated liposarcomas and 1/48 undifferentiated sarcomas. No SMARCA1 GAs occurred in other sarcoma subtypes. SMARCA1 IHC was studied in the sarcoma subtypes with potential SMARCA1 alterations in our institutional cases. SMARCA1 nuclear expression was lost in 3/10 cases (30%) of undifferentiated sarcoma, and 2/5 cases of MPNST (40%). SMARCA1 expression was intact in all cases of leiomyosarcoma and liposarcoma.Conclusion:This is the first study to demonstrate loss of expression of SMARCA1 in soft tissue sarcomas subtypes, including undifferentiated sarcoma. Our study highlights merit for further investigation on the role of SMARCA1 in the differentiation process and molecular mechanisms of SMARCA1 inactivation.