Cases Of Soft Tissue Tumors Research Articles

Cytogenetic Single-Institution Analysis: 101 Consecutive Cases of Soft-Tissue Tumors of the Extremities.

We summarize the results and clinical usefulness of cytogenetic analysis that is routinely performed for musculoskeletal tumors. We performed cytogenetic analysis and traditional histologic evaluation on 101 (51 malignant/ 50 benign) consecutive tumors that were surgically excised. The successful culture rate for cytogenetic analysis was 86% (87/101). Fifty-four percent (25/46) of clearly malignant tumors that were successfully cultured demonstrated significant clonal abnormalities. Fifty-one percent (21/41) of benign tumors that were cultured had significant cytogenetic clonal aberrations. Increased cellular ploidy (> 50 chromosomes/cell) was demonstrated in 14/46 malignant and 1/41 benign tumors that were successfully cultured. Hyperploidy was highly correlated with malignancy (p < 0.001); the only "benign" tumor was a multiply recurrent and giant cell, demonstrating histologic changes consistent with early sarcomatous transformation. As expected, cytogenetic abnormalities frequently occurred in malignant tumors. Surprisingly, almost half of the benign tumors had significant clonal cytogenetic aberrations. Consistent findings of extra chromosomes 5 and 7 in samples of pigmented villonodular synovitis strongly favored a neoplastic origin for this condition. Although the presence or absence of cytogenetic aberrations cannot be used to determine malignant potential, increased cellular ploidy is highly indicative of malignancy. Modern molecular genetics have become more popular, but cytogenetic analysis can be useful for classifying the malignant potential of recurrent and difficult to diagnose tumors of the musculoskeletal system.

Significance of Ki-67 in prognostication of soft tissue tumors

Background: Histological grading is the most important prognostic factors and the best indicator of metastatic risk in adult soft tissue sarcomas. It has been shown that Ki67 immunohistochemical (IHC) staining is an effective method of assessing the prognosis in a number of tumor types. Ki67 is a cell cycle antigen which is elevated in proliferation states. High level of Ki67 expression is an independent prognostic indicator that correlates with poor outcome in patients with sarcomas. Methods: In this study 53 cases of soft tissue tumor were selected and were classified according to FNCLCC system. IHC staining of Ki-67 was done in all the 53 samples. Diagnosis was made mainly based on histopathological pattern analysis and with the use of IHC. Results: By using FNCLCC grading soft tissue tumor cases were graded as grade I, II and III. The correlation between the FNCLCC grading and Ki67 was done and it was observed that there was statistically significant positive correlation between Ki67 and the grade of the tumor, as evidenced by P- values of 0.002, 0.005 and 0.004. The correlation between the 5 FNCLCC grading and Ki67 index was also assessed. Statistically significant positive correlation between Ki67 index and the grade of the tumor was observed. Conclusion: There was significant correlation noted between FNCLCC grading and Ki-67 index. Thus it can be recommended that Ki-67 IHC stain should be done on routine basis to accurately grade the sarcomas so that it will be beneficia l for the management of the patient. DOI:10.21276/APALM.1550

Evaluation of vascular invasion in patients with musculoskeletal tumors of lower extremities: use of time-resolved 3D MR angiography at 3-T.

Background Time-resolved angiography with stochastic trajectories (TWIST) sequence makes considerable progress in temporal and spatial resolution, which presents high potential in evaluation of vascular diseases. Purpose To assess magnetic resonance imaging (MRI) using TWIST MR angiography (MRA) sequence in the assessment of vascular invasion for bone and soft-tissue tumors in comparison to computed tomography angiography (CTA) as the reference standard. Material and Methods Thirty-three patients with lower extremity musculoskeletal tumors were imaged with conventional MR and TWIST MRA. CTA was performed 48 h later. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of the femoral artery were calculated. Vascular invasion as determined by MRA and CTA was separately analyzed. Vascular invasion by MRA and CTA were analyzed with kappa coefficients to determine agreement between the imaging methods. Results Seven cases of bone and 26 cases of soft tissue tumors were examined. SNR and CNR of the femoral artery were excellent for TWIST MRA (mean ± SD values of 317 ± 80 and 276 ± 76, respectively). Based on the TWIST sequence, the vessels were free of tumor in 16 cases. Vascular displacement was found in 11 cases and vascular stenosis in six cases. The MRA findings conflicted with CTA findings in only one case. The kappa value was 0.953 ( P < 0.01). In five cases, vascular malformations were found with TWIST MRA but not CTA. Conclusion TWIST MRA enables accurate delineation of anatomical structures and tumor arterial involvement, providing reliable preoperative imaging information with respect to lower extremity musculoskeletal tumors.

Accuration of Fine Needle Aspiration Biopsy in Musculoskeletal Tumour

Fine needle aspiration biopsy (FNAB) has been reported to be the preferable choice of biopsy for musculoskeletal tumour. While FNAB appears to have advantages to core biopsy in the aspect of simplicity and cost, the diagnostic accuracy should be the most critical parameter in determining the choice of biopsy. This research was designed to evaluate the diagnostic accuracy of fine needle aspiration in musculoskeletal tumour in Sardjito Hospital from 2010 until 2014. This was a descriptive study from medical record in Sardjito Hospital from 2010 until 2014. The inclusion criteria are musculoskeletal tumours in all age level that has been performed FNAB with subsequent operative treatment and confirmation of histopathology examination in Sardjito Hospital. There were 41 elligible subjects in this study. Concordance diagnosis of FNAB and histopathological examination in all musculoskeletal tumor cases was found to be 86%. In addition, the concordance in soft tissue tumor cases was 94% with the detail as follows: giant cell tumor was 86%, synovial sarcoma was 50% and liposarcoma was 50%. In bone tumours, the accuracy was found to be 60% with the detail as follows: distribute osteosarcoma was 60%, osteochondroma was 50% and chondrosarcoma was 50%. Our data showed that accuracy of FNAB for diagnosis of musculoskeletal tumours was 86% with soft tissue tumour 94%, bone tumour 60% and others 93%. Therefore, Fine needle aspiration biopsy is still important diagnosis tool in musculoskeletal tumours.

Accuration of Fine Needle Aspiration Biopsy in Musculoskeletal Tumour

Fine needle aspiration biopsy (FNAB) has been reported to be the preferable choice of biopsy for musculoskeletal tumour. While FNAB appears to have advantages to core biopsy in the aspect of simplicity and cost, the diagnostic accuracy should be the most critical parameter in determining the choice of biopsy. This research was designed to evaluate the diagnostic accuracy of fine needle aspiration in musculoskeletal tumour in Sardjito Hospital from 2010 until 2014. This was a descriptive study from medical record in Sardjito Hospital from 2010 until 2014. The inclusion criteria are musculoskeletal tumours in all age level that has been performed FNAB with subsequent operative treatment and confirmation of histopathology examination in Sardjito Hospital. There were 41 elligible subjects in this study. Concordance diagnosis of FNAB and histopathological examination in all musculoskeletal tumor cases was found to be 86%. In addition, the concordance in soft tissue tumor cases was 94% with the detail as follows: giant cell tumor was 86%, synovial sarcoma was 50% and liposarcoma was 50%. In bone tumours, the accuracy was found to be 60% with the detail as follows: distribute osteosarcoma was 60%, osteochondroma was 50% and chondrosarcoma was 50%. Our data showed that accuracy of FNAB for diagnosis of musculoskeletal tumours was 86% with soft tissue tumour 94%, bone tumour 60% and others 93%. Therefore, Fine needle aspiration biopsy is still important diagnosis tool in musculoskeletal tumours.

Histopathological study of soft tissue tumors: A three year experience in tertiary care centre

Background: Soft tissue sarcomas compared with carcinomas and other neoplasms are relatively rare and constitute less than 1% of all the cancer. Soft tissue sarcomas may occur anywhere in the body but most arise from large muscle of extremeties, the chest wall, the mediastinum and the retroperitoneum. Aims and objectives: To study the macroscopic and microscopic pathology of benign and malignant soft tissue tumour and there clinicopathological correlation. Materials and methods: The study was conducted in Dr .D .Y Patil School of Medicine, Navi Mumbai, from 1st of January 2008 to December 2010. A Cross sectional study of 150 cases of soft tissue tumors were carried out in details. A pretested proforma was used to classify each tumor and details like age, sex, clinical features, gross and microscopic findings were noted. Results: The most common soft tissue tumor in the study were benign tumors (140 cases), followed by malignant (9 cases) and one case was reported as borderline. Lipomas were the most common benign tumors accounting for 49 out of 140 cases. Benign smooth muscle tumors were the next most common tumor accounting for 44 cases.Benign vascular and benign peripheral nerve sheath tumor accounted for 19 cases in each category. Of 19 cases of benign vascular tumor, 16 cases were of haemangioma, 3 cases were of angiofibroma. Of 19 benign peripheral nerve sheethtumor, 12 cases were reported as neurofibroma and 7 schwannomas. Of 5 cases of fibrohistiocytictumor, 3 cases were benign, 1 case of borderline (Dermatofibrosarcoma protuberance) and 1 case of malignant fibrous histiocytoma (MFH). Of 7 cases of Fibrous tumor, 6 cases were of Benign and 1 cases of malignant variant (Fibrosarcoma). Out of 6 cases which were reported as benign, comprised of 2 cases each of fibroma, fibromxyoma, and palmar fibromatosis. 9 out of 150 cases were malignant tumors,3 cases were malignant peripheral nerve sheath tumor(MPNST) ,whearas Gastrointestinal stromal tumor(GIST),leiomyos

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OBJECTIVE: Soft tissue' is a non-epithelial extra skeletal tissue of the body exclusive of the reticuloendothelial system, glia and supporting tissue of the various parenchymal organs.(1) Though they can occur anywhere in the body, most commonly they involve upper and lower extremities, trunk, retro-peritoneum and head and neck. (1) Biological activity of these tumors varies from benign localized tumors, to benign locally aggressive, to malignant metastatic types. (2) Diagnosis of soft tissue tumors are done by standard methods like Light microscopy, special stains and immunohistochemistry.(3,4,5) This study was conducted with the aim of studying gross and microscopic features of various malignant soft tissue tumors and also to correlate them clinically. MATERIALS AND METHODS: The incisional and excisional specimens of various soft tissue tumors were fixed in 10% neutral formalin for 24 hrs and they were subjected for routine processing and reporting. Both gross and light microscopy of the tumors was studied that included the clinicopathological features of 109 cases of soft tissue tumors between the period of May 2008 to May 2012. RESULTS: A total number of 109 cases of soft tissue tumors were studied. Malignant soft tissue tumors constituted 14.6% of all soft tissue tumors with a peak age occurrence in the sixth decade and the most common malignant soft tissue tumor was malignant fibrous histiocytoma. CONCLUSION: Malignant soft tissue tumors occur less frequently and it is very important to make accurate diagnosis since it has a variable prognosis.

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INTRODUCTION: Tissue diagnosis is essential for effective management of bone and soft tissue lesions. In this regard pathologist plays a crucial role in patient management by giving appropriate diagnosis. AIMS AND OBJECTIVES: The aim of the present study was to evaluate the diagnostic accuracy of core needle biopsies (CNB) by comparing with excised specimens, and to calculate the specificity (sp), sensitivity (sn), positive predictive value (ppv) and negative predictive value (npv) of CNB, and to study the complications. MATERIALS AND METHODS: We retrospectively reviewed all the bone and soft tissue tumor cases (60 cases, 50 bone and 10 soft tissue cases). Core needle biopsies (CNB) were performed in all cases at our institute, using a Jamshidi needle for bone lesions and tru-cut needle for soft tissue lesions between March 2010 and February 2014. Biopsy accuracy and errors were determined on the basis of histopathological examination of the excised specimens. RESULTS: Of the sixty CNBs done at our institute, we had 32 benign (30 bone & 2 soft tissue) and 28 malignant (20 bone & 8 soft tissue) cases. On correlating with excised specimens CNB reports were diagnostic and accurate in 58 cases (96%). Two false negative cases (major errors, 8% and 0% minor errors) reported. The sp, sn, ppv, and npv were calculated for benign and malignant lesions. No complications were seen with CNB. CONCLUSION: The present study indicates that core needle biopsy is safe and reliable for diagnosing the bone and soft tissue lesions.

A prospective study of soft tissue tumors histocytopathology correlation.

Background. Soft tissue tumors are defined as nonepithelial extraskeletal tissue of the body exclusive of the reticuloendothelial system, glia, and supporting tissue of various parenchymal organs. The absence of recognizable tissue architectural patterns in cytological preparation makes diagnosis by FNAC more difficult. Aims. To assess the utility of FNAC in diagnosing soft tissue tumors and to determine their patterns compared with with the respective histopathology results. Materials and Methods. 150 cases of soft tissue tumors were included in this study for cytologic and histologic correlation. FNAC air dried smears were stained with Giemsa stain and 95% ethanol fixed smears were stained with Papanicolaou stain. The smears were studied for cytological diagnosis and were categorized as benign, suspicious of malignancy, and malignant along with specific subtyping of the lesion. All diagnostic FNAC results were compared for diagnostic concordance using histology results as the “gold standard.” Results. The sensitivity, specificity, positive predictive value, negative predictive value, and efficiency were 70%, 100%, 97.90%, 100%, and 98%, respectively. P value was <0.0001 which shows statistically extreme significant correlation. Conclusion. FNAC is a very important preliminary diagnostic tool in palpable soft tissue lumps with high degree of correlation with the final histopathology report.

116 cases of soft tissue tumor in the hand

116 cases of soft tissue tumor in the hand

A Study of Soft Tissue Tumors in Reference to Cytopathologic and Histopathologic Changes in Chidambaram of Cuddalore District, Tamil Nadu

Background: Tumors of the supporting tissues of the body constitute a heterogeneous group in terms of clinical presentation, morphological features and clinical behavior. The biological spectrum of these lesions is so vast and diverse, that they continue to be an enigma to both clinicians & pathologists. Method: The material for this study was obtained from 153 patients who presented with a mass to Rajah Muthiah Medical College Hospital and private laboratories in Chidambaram of Cuddalore district, Tamil Nadu, around July, 2000 to July, 2005. Results & Conclusion: A total of 151 cases of Soft tissue tumors were studied of which: 90.73% were benign tumors, Benign tumors occurred more commonly in the 3rd to 4th decade while malignant tumors occurred in the 5th and 6th decade, Majority of the Soft tissue tumors occurred in the extremities (54.31%).

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Fine needle aspiration biopsy is a useful tool in the pre-operative evaluation and grading of soft tissue tumors, and offer patients the advantage of neo-adjuvant/ adjuvant chemotherapy or radiotherapy. Our study aimed at correlating the clinical, radiological and cytological findings of benign and malignant tumors of soft tissues and evaluating the usefulness of percutaneous needle biopsy as a diagnostic tool. Out of a total of 136 cases of soft tissue tumors aspirated, 110 were benign and 26 malignant. Upper extremity including axilla was the most frequently involved site of benign soft tissue tumors with 37 cases, while the lower extremity including inguinal area was the most common site of malignant soft tissue tumors with 10 cases. Sensitivity and specificity of cytological diagnosis was 77.8 and 92.3%, respectively, while the positive and negative predictive value was 87.5 and 86.7%, respectively, with the diagnostic accuracy being 86.9%. &nbsp; Key words:&nbsp;Fine needle aspiration biopsy, soft tissue tumors, immunohistochemistry.

Application of time intensity curve of contrast enhanced ultrasound in the discrimination of benign and malignant soft tissue tumors

Objective To study the value of time intensity curve of contrast enhanced ultrasound in the discrimination of benign and malignant soft tissue tumors. Methods Thirty-seven cases of soft tissue tumors were carried out contrast-enhanced ultrasound examination. The region of interest in the dynamic images were chosen to carry out Gamma-Variate curve fitting through Q-LAB software and made a quantitative analysis. Then they were compared with pathological diagnosis to analyze the ultrasound imaging performance of benign and malignant tumors and their characteristics of micro-irrigation. Results Thirty-seven cases of soft tissue tumors were pathologically diagnosed 21 cases of benign and malignant in 16 cases. The perfusion of benign tumors were mainly uniformity (19/21) or potentialization (2/21). The perfusion of malignant tumors were mainly uniformity (10/16) or nonuniformity (6/16). There were no significant differences in time to peak(TTP) and arrival time of contrast agent(AT) between benign and malignant tumors( P ＞0.05). The upslope rate(A) and the derived peak intensity(DPI) in benign group were significantly less than malignant group ( P ＜0.05). Conclusions Time-intensity curve analysis of contrast-enhanced ultrasound showed that benign and malignant soft tissue tumors were different in perfusion,and it will be of a certain value for the clinical differential diagnosis. Key words: Ultrasonography; Microbubbles; Soft tissue neoplasms

Prospective Evaluation of TLE1 as a Diagnostic Immunohistochemical Marker in Synovial Sarcoma

Synovial sarcoma is a high-grade soft tissue sarcoma that can be challenging to diagnose on the basis of histology alone. It is defined by a characteristic translocation t(X;18) that produces the fusion oncogene SYT-SSX. The current diagnostic gold standard for synovial sarcoma is the demonstration of the translocation by fluorescence in situ hybridization, reverse transcriptase polymerase chain reaction, or cytogenetics, in an appropriate histologic context. TLE1 encodes a transcriptional corepressor that is overexpressed in synovial sarcomas. Gene and tissue microarray studies have identified TLE1 as an excellent bio-marker for distinguishing the synovial sarcoma from other soft tissue malignancies. We prospectively evaluated incoming soft tissue tumor cases where the histology and clinical setting made synovial sarcoma a real consideration in the differential diagnosis. TLE1, Bcl2, epithelial membrane antigen, and cytokeratin expression were assessed using commercially available antibodies. TLE1 gave intense, diffuse nuclear staining in 35 of 35 molecularly confirmed synovial sarcoma cases, and was rare to absent in the 73 other soft tissue tumors examined (positive staining was found only in 1 of 43 malignant peripheral nerve sheath tumors, the 1 tested fibrosarcoma, and 1 pleomorphic sarcoma). TLE1 was more sensitive and specific for synovial sarcoma than other currently available immunohistochemical markers including Bcl2, epithelial membrane antigen and cytokeratins, and had a positive predictive value of 92% and a negative predictive value of 100% in this clinical setting. Our findings confirm, in a prospective diagnostic context, that TLE1 is more sensitive and specific for synovial sarcoma than any other currently available immunohistochemical stains, and in some cases may preclude the need for molecular testing.

Lipoma of unusual sites diagnosed by fine needle aspiration biopsy cytology (FNABC): a case report

<h3>Aim</h3> The role of the fine needle aspiration (FNA) technique in the diagnosis of common tumours in an uncommon location was emphasised. <h3>Methods</h3> Pathological files of 67 cases of soft tissue tumours diagnosed by FNABC and confirmed by histopathological technique from Governor Celestino Gallares Memorial Hospital, Bohol, Philippines, were reviewed. <h3>Results</h3> A 12-year-old male had a slow growing 8.0×6.5cm mass on the left knee. Leg X-ray revealed an eccentric medullary expansile mass involving the fibula. A 52-year-old female had a slow growing 3.0×1.5cm mass on the left side of the tongue. FNAs of the two cases showed cellular findings consistent with lipoma. Definitive diagnoses of lipoma of the leg and tongue were made with histopathological examination. <h3>Discussion</h3> Lipoma is the most common benign tumour of the body occurring in sites where fat is present. Intraosseous and tongue lipomas where fat is absent are rare. Of thirty-one of the 67 soft tissue tumours diagnosed as lipomas, only two were found in the aforementioned unusual sites, thus were the first cases diagnosed by FNABC in this medical center.

Histopathological Diagnostic Discrepancies in Soft Tissue Tumours Referred to a Specialist Centre

Aims. A study was performed to determine areas of diagnostic discrepancy in the reporting of cases of soft tissue tumours referred to a specialist sarcoma unit. This was to pinpoint common discrepancies and to determine their causes. Methods and Results. We compared the sarcoma unit's histopathology reports with referring reports on 349 specimens from 277 patients with suspected or proven soft tissue tumours in a one-year period. Conclusions. Diagnostic agreement was found in 256 of 349 cases (73.4%), with minor diagnostic discrepancy in 55 cases (15.7%) and major discrepancy in 38 cases (10.9%). Benign/malignant discordances accounted for only 5% of all discrepancies (5 cases). The most common discrepancies occurred in tumour classification, including diagnosis of gastrointestinal stromal tumour and leiomyosarcoma and the subtyping of spindle cell sarcomas, as well as in tumour grading that could conceivably lead to changes in clinical management. Major diagnostic discrepancies leading to management change occurred in a relatively select range of tumour groups, and almost all discrepancies occurred due to differences in tumour interpretation between general or nonsoft tissue pathologists, and pathologists at the specialist unit. The findings support guidelines by the National Institute for Health and Clinical Excellence that diagnostic review of soft tissue tumours should be performed by specialist soft tissue pathologists.

A case of soft tissue tumor in infantile from birth

A case of soft tissue tumor in infantile from birth

深頸部領域に発生した軟部組織腫瘍２例

We encountered two rare cases of soft tissue tumor arising in the deep neck. The first case was a 29-year-old woman diagnosed as having pseudomalignant osseous tumor. At surgery, a circumscribed, hard mass was found in the deep portion and adhered to the cervical vertebra. The mass was extirpated together with a layer of the surrounding macroscopically intact tissue. The post-operative course was uneventful. The second case was a 59-year-old man diagnosed as having epithelioid sarcoma. At surgery, a circumscribed, invasive mass was found in the deep portion and adhered to the cervical vertebra. The mass was excised together with adjacent muscle tissue and fat tissue. The post-operative course was uneventful. Immunohistochemical evidence in these cases are also presented.

Evaluation of fine needle aspiration cytology and its correlation with histopathological findings in soft tissue tumours

A total of 105 cases of soft tissue tumours were studied by fine needle aspiration cytology (FNAC). All the cases were corroborated by histological examination. Sixty five were benign, 33 were malignant and 7 cases were inconclusive. On histopathological examination, accuracy rate of benign tumours was found to be 90.6% and that of malignant tumours was 91.3%. The overall accuracy rate was 90.8%. So FNAC is to be considered as an useful cost effective procedure for the diagnosis of soft tissue tumours.

Cytomorphological study of soft tissue neoplasms: role of fluorescent immunocytochemistry in diagnosis

Exact categorization of soft tissue tumours (STTs) on smears requires application of various ancillary techniques. This study was aimed at evaluating the role of fluorescent immunocytochemistry (FICC) in cyto-diagnosis of 30 STT cases. Thirty cases of soft tissue tumours were included in the present study. All cases were subjected to routine Giemsa and Papanicolaou stain. Extra smears were made and kept for fluorescent immunostaining. A panel of cytoskeletal antibodies, tagged with FITC (Fluorescein isothyocynate), was employed in all these cases. Fluorescent immunostained smears were examined under Zeiss Confocal Laser scanning microscope, using double immunofluorescence (red-green). Finally, all cases were subjected to biopsy and again immunoperoxidase staining. Among the 30 cases in the present study, unaided cytological diagnoses ranged from 'spindle cell' tumour in four (13.3%) cases, benign and malignant spindle cell tumour in 17 (56.6%) cases, to malignant mesenchymal tumour in nine (30%) cases. FICC helped in further correct categorization of 25/30 (83.3%) cases viz. leiomyoma (three), benign neurogenic tumour (six), schwannoma (one), dermatofibrosarcoma protuberans (three), synovial sarcoma (two), rhabdomyosarcoma (two), malignant fibrous histiocytoma (five) and malignant peripheral nerve sheath tumour (three). Aggressive fibromatosis was found to be a missed diagnosis in two cases. Overall concordance between cyto-diagnosis with FICC, and histopathology results was 83.3% (P < 0.05). Fluorescent immunocytochemistry is a significant ancillary technique for making a rapid and specific diagnosis of STT, as required for their timely management. Incorporation of a wide panel of antibody markers with clinico-cytological correlation is recommended in forming an exact diagnosis in these cases.