Diagnosis Of Soft Tissue Tumors Research Articles

“Bone in the penis” or fasciitis ossificans of the penis – a first time description of a pseudo-tumor at an extraordinary site

BackgroundFasciitis ossificans is a rare subtype of nodular fasciitis, a benign soft tissue tumor with reactive characteristics. Due to its rapid growth, it is often misdiagnosed as a malignant tumor. While fasciitis ossificans commonly originates from the subcutaneous tissue and can appear throughout the body, it may also arise from extraordinary sites. Case presentationWe report the first-ever documented case of fasciitis ossificans arising from the penis in a male patient who presented with a tumor on the glans penis. The tumor was surgically resected due to suspicion of penile cancer. Initial histopathological analysis led to a misdiagnosis of squamous cell carcinoma. However, pathological consultation ultimately confirmed the diagnosis of fasciitis ossificans of the penis originating from the glans penis by demonstrating ossification.ConclusionThis case underscores the importance of considering fasciitis ossificans in the differential diagnosis of soft tissue tumors, even in unusual locations such as penile soft tissue.

A RARE CASE OF TENOSYNOVIAL GIANT CELL TUMOR IN PALMAR ASPECT OF RING FINGER OF LEFT HAND

Introduction: Giant cell tumor of the tendon sheath (GCTTS) is an uncommon benign soft tissue tumor of unknown etiology. It is seen more commonly in hand than ankle and foot. It presents as a painless and palpable swelling. Its diagnosis is mostly established by histopathology after surgical resection, although pre-operative imaging and fine-needle aspiration cytology (FNAC) support its suspicion. Herein, a case of GCT of flexor tendon sheath of the right ring finger is reported due to its rarity. Case Report: A 30-year-old female presented with complaints of swelling over the front of the right ring finger for 6months.. The swelling was spontaneous, painless, and very slowly progressive. Examination revealed a 2 cm * 1.5 cm firm swelling situated on the palmar aspect of the right ring finger over proximal inter phalangeal joint. Swelling was well defined, having smooth surface, uniformly firm consistency and could be moved sideways easily. X-ray of the hand showed localized soft tissue shadow in the involved area without any bony involvement. Ultrasonography of the finger showed soft tissue mass.MRI revealed Moderate to intense heterogeneous enhancement suggesting giant cell tumor.. Excisional biopsy was done. Histopathology showed typical features of GCTTS. Conclusion: GCTTS should be kept as a differential diagnosis in soft tissue tumors of hand in adults. FNAC followed by excisional biopsy is diagnostic and curative, but the patient should be followed up for detecting and managing recurrences.

A huge left buttock mass in an old female

IntroductionMyxofibrosarcoma also known as myxoid malignant fibrous histiocytoma is a rare soft tissue sarcoma that has a predilection for the elderly (beyond the 6th decade) Clinical observationWe report a case of a 64 years old patient that presented gradual appearance of huge tumor on her left buttock. Radiologic examination (MRI) concluded to MFS. There was no evidence of systemic involvement. The patient was directed in an oncology center, where the diagnostis of MFS was confirmed through surgical biopsy. DiscussionMFS is one of the most frequent sarcoma of soft tissue that occurs in elderly patients. This is an infiltrant tumor that is extending through muscular fascia. MRI is the gold standard in characterisation; it makes the positive diagnosis of MFS thanks to the myxoid signal, triple signal and the tail sign that is corresponding to the extension of the tumor into the muscular fascia and peri nervous spaces. ConclusionCross-sectionnal imaging in particular MRI plays a key role in the positive diagnosis of soft tissue tumors. It makes possible to approach with great precision the exact nature of the tumor thanks to specific radiological semiology without however claiming to replace histology.

Striking Multinucleated Giant Cells in FNA Specimens and Their Values in Diagnosis of Soft Tissue Tumors

Striking Multinucleated Giant Cells in FNA Specimens and Their Values in Diagnosis of Soft Tissue Tumors

Intraarticular Lipoma of the Pisotriquetral Joint: A Rare Case Report

AbstractIntraarticular lipomas are infrequently reported, with most reported cases occurring in the knee joint. A case of intraarticular lipoma in the small joints of the hand, specifically in the pisotriquetral joint, has been documented for the first time. A 24-year-old male visited the emergency department after a road traffic accident with a painful and swollen wrist. Radiographic examination revealed fractures of the distal radius and triquetrum. A subsequent wrist computed tomography scan identified an intraarticular lipoma within the pisotriquetral joint, further confirmed by ultrasonography. This article underscores the importance of recognizing that, though exceedingly rare, intraarticular lipomas should be considered in the differential diagnosis of soft-tissue tumors affecting the hand and wrist.

Possibility of contrast-free MR-perfusion using in differential diagnosis of soft tissue tumor

Contrast-free MR-perfusion of "labeled arterial blood spins" ("ASL-perfusion") is an MR-technology for qualitative and quantitative assessment of tissue perfusion properties based on of arterial blood proton spins labeling by radiofrequency pulses and their subsequent measurement when passing through the area of interest. The most of ASL-perfusion application clinical data referred to central nervous system diseases diagnostics, but some works showing the effectiveness of this technique in assessment of skeletal muscle perfusion and diagnostics of soft tissue tumors appeared recently.Two presented clinical cases (soft tissue tumor and post-traumatic benign changes) demonstrate the possibility of this technique usage to assess vascularization of pathological changes in hip soft tissues.

Role of diffusion-weighted MR imaging in the initial diagnosis of soft tissue tumours

BackgroundSoft tissue tumours (STT) constitute a heterogeneous group of lesions frequently studied by Magnetic Resonance Imaging (MRI). It has not yet been clearly established whether the inclusion of apparent diffusion coefficient (ADC) diffusion-weighted imaging (DWI) maps would better determine tumour aggressiveness. PurposeTo assess the diagnostic value of quantitative ADC DWI maps in the initial diagnosis of STT; and to determine whether the inclusion of DWI provides more valuable information than conventional sequences alone. Material and methodsRetrospective study of patients with histologically proven STT. Conventional morphological MRI sequences and the DWI sequence were analysed. The ADC was quantified using a region of interest (ROI) that covered the largest sectional area (global ADC) and another that selected the area of ​​greatest restriction (selected ADC). Differences in ADC values ​​were analysed between both benign and malignant lesions and high and low-grade sarcomas. A multivariate analysis was performed to determine the ability of ADC ​​to adequately diagnose the nature of STTs when associated with other morphological characteristics. Results84 patients with STT, of which 40 were benign and 44 malignant. The malignant group included 10 low-grade sarcomas, 23 high-grade sarcomas, 4 non-sarcomatous neoplasms and 7 sarcomas with no histological grading. The ADC values ​​were significantly higher in benign lesions for the selected ADC. Significantly higher selected ADC values ​​were also obtained in low-grade sarcomas. In the multivariate analysis, the highest diagnostic precision values were obtained when morphological features and ADC were included, with a sensitivity, specificity, and area under the curve (AUC) of 84, 75 and 91%, respectively. ConclusionThe inclusion of ADC DWI values ​​improves the diagnostic accuracy of MRI for STTs, especially when used in combination with conventional MRI sequences.

LARGE PERIPHERAL ODONTOGENIC FIBROMA: CLINICAL AND HISTOLOGICAL ASPECTS: A CASE REPORT

Peripheral odontogenic fibroma (POdF) is an odontogenic neoplasm of connective tissue. Due to the rarity of POdF, the lesion is not commonly reported in the literature. POdF is a benign, slow-growing, asymptomatic, non-ulcerated gingival mass seen mainly in the anterior mandible. It is designated as the extraosseous counterpart of the central odontogenic fibroma (COF). POdF mainly consists of connective tissue with various amounts of epithelial nests. This entity should be added to armamentarium of the differential diagnosis of soft tissue tumors like peripheral ossifying fibroma, peripheral ameloblastoma, pyogenic granuloma, and giant cell granuloma. Surgical excision is the treatment of choice. Recurrence was reported in the literature. Thus, the patient should be followed up regularly after the surgery.

Fusion genes aiding the diagnosis of soft tissue tumours of the oral cavity: from bench to bedside.

Soft tissue tumours (STT) are a heterogeneous group of benign, malignant, and intermediate/borderline mesenchymal tumours. In the oral and maxillofacial region, less than 3% of all lesions correspond to benign STT and <1% are sarcomas. Overlapping microscopic features may lead to quite challenging diagnostic processes. Translocations and fusion genes are frequent, and type-specific genetic alterations are detected in these tumours. The detection of such alterations by classic cytogenetic, FISH, RT-PCR or NGS can help to define the diagnosis. This narrative review aims to review fusion genes reported for STT that affect the oral cavity and their use in diagnostic molecular pathology. Basic concepts regarding mechanisms of fusion genes formation are presented to clarify this information for surgical pathologists. The chromosomal rearrangements and fusion genes of adipocytic, fibroblastic and myofibroblastic, vascular, pericytic, smooth muscle, skeletal muscle, chondro-osseous, and uncertain origin STT are summarised. The advance in molecular pathology techniques has led not only to a better understanding of the molecular pathogenesis of STT, but also to the development of helpful diagnostic tools. Therefore, it is important for the oral and head and neck pathologists to familiarise with the signature rearrangements and fusion genes for each tumour.

A Deep Learning–Based System Trained for Gastrointestinal Stromal Tumor Screening Can Identify Multiple Types of Soft Tissue Tumors

The accuracy and timeliness of the pathologic diagnosis of soft tissue tumors (STTs) critically affect treatment decision and patient prognosis. Thus, it is crucial to make a preliminary judgement on whether the tumor is benign or malignant with hematoxylin-and-eosin-stained images. Here, we present a deep learning-based system, STT-BOX, with only hematoxylin-and-eosin images for malignant STT identification from benign STTs with histopathologic similarity. STT-BOX assumed gastrointestinal stromal tumor as a baseline for malignant STT evaluation, and distinguished gastrointestinal stromal tumor from leiomyoma and schwannoma with 100% area under the curve in patients from three hospitals, which achieved higher accuracy than the interpretation of experienced pathologists. Particularly, this system performed well on six common types of malignant STTs from The Cancer Genome Atlas data set, accurately highlighting the malignant mass lesion. Moreover, without any fine-tuning, STT-BOX was capable of distinguishing ovarian malignant sex-cord stromal tumors. Our study includes mesenchymal tumors that originated from the digestive system, bone and soft tissues, and reproductive system, where the high accuracy of migration verification may reveal the morphologic similarity of the nine types of malignant tumors. Further evaluation in a pan-STT setting would be potential and prospective, obviating the overuse of immunohistochemistry and molecular tests, and providing a practical basis for clinical treatment selection in a timely manner.

The Recent Advances in Molecular Diagnosis of Soft Tissue Tumors

Soft tissue tumors are rare mesenchymal tumors with divergent differentiation. The diagnosis of soft tissue tumors is challenging for pathologists owing to the diversity of tumor types and histological overlap among the tumor entities. Present-day understanding of the molecular pathogenesis of soft tissue tumors has rapidly increased with the development of molecular genetic techniques (e.g., next-generation sequencing). Additionally, immunohistochemical markers that serve as surrogate markers for recurrent translocations in soft tissue tumors have been developed. This review aims to provide an update on recently described molecular findings and relevant novel immunohistochemical markers in selected soft tissue tumors.

Giant cell tumour of the extensor tendon sheath of the ankle: A rare case report with review of literature

Giant cell tumour of the tendon sheath is also termed as tenosynovial giant cell tumour. It is relatively a rare tumour comprising only about 1.6% of all the soft tissue tumours. Giant cell tumour of the tendon sheath of the foot and ankle is much less reported as compared to giant cell tumour of the tendon sheath of the hand and knee. However giant cell tumor of the tendon sheath should be considered as a differential diagnosis of soft tissue tumours of the foot and ankle.We here present a rare case of giant cell tumour of the extensor tendons heath of the ankle in a young female which presented with chief complaint of a painless swelling of size about 3.5×3.5cm over her right ankle from one year. The diagnosis was made initially by using ultrasonography which was supported by MRI and confirmed after the histopathological examination of the excisional biopsy. The giant cell tumour was found arising from the tendon sheath of extensor tendons - tibialis anterior and extensor hallucis longus. In our case the patient showed complete resolution of the symptom with no sign of recurrence at final follow-up after 1 year.

Multipametric Ultrasonographic Diagnostics of Extraorganic Soft Tissue Tumors Containing Adipose Tissue

Purpose : To develop algorithms for echographic differential diagnosis of soft tissue tumors containing fat tissue, the data of the complex examination were analyzed, including using various ultrasound techniques, including different types of dopplerography and compression elastography. Material and methods : Echographic studies of verified histologically 221 (63 %) lipomas, 87 (24.8 %) liposarcoma, 43 (12.2 %) hemangioma and lymphangosis of different superficial localizations were performed on Hitachi HI Vision 900, Logiq-400, Aloka-650, Aloka-2000 with 5–13 MHz sensors. Results : It has been established that ultrasonic elastography in a number of clinical situations can be a significant addition in the differentiation of lipomas and highly differentiated liposarcoma, as well as in determining the boundaries of diffuse tumors from adipose tissue. Diagnostic algorithms for differentiating tumors have been proposed. Conclusions : Differential diagnosis of fat-containing soft tissue formations is very complex and requires a multiparametric approach in ultrasound diagnostics.

Multiparametric MRI diagnosis of soft tissue tumors.

Multiparametric MRI diagnosis of soft tissue tumors.

Role of Histopathology in diagnosis of Soft Tissue Tumors at Tertiary Care Center

Introduction: Soft tissue tumors (STTs) are a diverse group of neoplasms. It varies from the most common benign tumors to some self-limited lesions and rare malignant soft tissue tumors. Because of the overlap in their clinical and radiological characteristics, histopathology is crucial in determining their diagnosis.&#x0D; Objectives: To study the relative frequencies of types of soft tissue tumors (benign, intermediate and malignant) as well as their histological pattern in relation to age, gender and site of distribution.&#x0D; Methodology: This was a retrospective study conducted over a period of three years from January 2018 to December 2020 in the Department of Pathology, Dhulikhel Hospital, Kavre Nepal. This study included STTs of all the anatomical sites excluding STTs of the female reproductive system. The tumors were classified as benign, intermediate, or malignant using the WHO 2013 classification of soft tissue and bone tumors. The sarcomas were further graded into grades 1, 2, and 3 using the FNCLCC (French Federation Nationale des Centres de Lutte Contre le Cancer) grading system. Immunohistochemistry (IHC) and special staining procedures were also performed as and when required. &#x0D; Result: A total of 198 STTs were studied, of which benign cases were 191 (96.45%), intermediate 03 (1.52%) and malignant 04 (2.03%) in number. The most common type of STTs was vascular tumors 77(38.89%) followed by adipocytic tumors 52(26.26%) and nerve sheath tumors 13(6.56%). STTs were most common in the third decade of life, with the head and neck region       being the commonest site.  All four malignant tumors were categorized using the FNCLCC grading system. There were three cases of Grade 2 sarcoma and one case of Grade 3 sarcoma.&#x0D; Conclusion: The most common benign tumors were vascular tumors followed by adipocytic tumors and nerve sheath tumors. STTs were most common in the third decade of life. Benign tumors were more common than malignant tumors.  In comparison to malignant tumors, benign tumors were found at a younger age group. STTs were found mainly in the head and neck region followed by upper and lower limbs. Despite the fact that molecular diagnostics is gaining popularity in the field of soft tissue tumors, histopathology still remains the gold standard.

Epithelioid and Clear Cell Solitary Fibrous Tumors: Clinicopathologic, Immunohistochemical, and Molecular Genetic Study of 13 Cases.

Solitary fibrous tumors (SFTs) are ubiquitous soft tissue neoplasms known for their protean histology and potentially aggressive behavior. Although most cases are composed of a monotonous proliferation of spindle cells, some tumors show unusual cytologic features. We have studied 13 SFTs that were characterized by a predominant population of round epithelioid cells with abundant eosinophilic cytoplasm and clear cell changes. The tumors occurred in 8 women and 5 men, aged 36 to 80 years (mean=63y), and were located within the orbit (3), lower extremity (3), retroperitoneum (2), abdominal cavity (2), and superficial soft tissues of the neck, pelvis, and pubis (1 each). The tumors measured from 3.5 to 24.5cm. Using a risk assessment system, 6 cases were stratified as low-risk tumors; 3 of these showed no evidence of recurrence or metastases from 6 to 18 years, and 1 tumor in the orbit recurred and led to the patient's demise. Five cases were of intermediate risk; clinical follow-up showed no evidence of recurrence or metastases from 3 to 4 years in 3 patients, and 1 patient suffered a recurrence 4 years after diagnosis. Two cases were high risk; 1 patient died after 1 year and the second patient experienced local recurrence at 4 years. Immunohistochemical studies showed nuclear positivity for STAT6 in 10 cases. CD34 immunohistochemistry was positive in 11 cases. A NAB2::STAT6 rearrangement was present in all cases. Epithelioid and clear cell SFT should be considered in the differential diagnosis of soft tissue neoplasms with epithelioid and clear cell morphology.

Tenosynovial Giant Cell Tumor of the Ankle: A Case Report with an Unusual Location

Tenosynovial giant cell tumor (TSGCT), is a slow-growing benign tumor that originates from the tendon sheath or bursae. TSGCT of the foot and ankle has been reported much less frequently compared to the reported cases in hand and knee. Morphologically it is classified as the localized form which often seen in the hand and the diffuse form seen in large joints. TSGCT should be considered in the differential diagnosis of soft tissue tumors of the foot and ankle. Clinical and radiological findings of intra-articular localized form of TSGCT in the ankle were presented in this study.

Atypical Sites of the Lipoma on the Hand and Fingers: Clinical and Imaging Features and Surgical Outcomes.

Background: Lipomas are the most frequent benign soft tissue tumor that are rarely found in the hand and are exceptionally rare on the fingers. The aim of this study was to investigate lipomas of atypical locations, so that they can be taken into account when making a differential diagnosis of a tumor of the hand or fingers. Methods: We studied a group of 27 patients diagnosed with lipoma of the wrist, palm, and fingers. The diagnosis was made by clinical and imaging examinations. Surgical treatment was established based on symptoms of pain, paresthesias, functional impairment, or aesthetic concerns. Treatment outcomes were assessed clinically at 1.5 years post-intervention. Results: Sizes over 5 cm were recorded in five cases, with the largest lipoma being 8 by 5 by 3.5 cm in size and weighing 125 g, located in the palm. There was one case of spontaneous tendon rupture and one case of carpal tunnel syndrome. There was no recurrence recorded at 1.5-year follow-up. Conclusions: Lipomas in the palm and fingers are rare entities (with more men affected), and surgical treatment consists of complete removal of the tumor and providing definitive healing. Despite their rarity, clinicians should consider lipomas when making differential diagnoses of soft tissue tumors of the hand.

Orofacial intramuscular lymphoma: first presentation.

The term lymphoma includes a wide variety of different clinical entities including diffuse large B-cell lymphomas (DLBCL). Skeletal muscle or intramuscular lymphomas represent less than 2% of B-cell Lymphoma, they are quite rare, even more in the orofacial area. We present the case of a painless growing mass of the right cheek mimicking a chronic oral cellulitis in a 34-year-old man. Magnetic resonance imaging (MRI) of the mandible revealed a well-defined 7x3cm mass around the core of the mandible that invades the buccal floor and the subcutaneous planes. A whole-body 18F-FDG PET/CT for the initial diagnosis revealed an intensely isolated hypermetabolic band corresponding to a voluminous tumoral permeation. The diagnosis of a skeletal muscle diffuse large B-cell lymphoma was established after an intraoral biopsy. It was treated with 4 chemotherapy cures and showed complete remission at one year of follow-up. This atypical form of lymphoma should be integrated into the differential diagnosis of soft tissue tumors in the oral cavity.

The Role of Magnetic Resonance Imaging in the Diagnosis of Soft Tissue Tumors and Tumor Mimics Arising Within Skeletal Muscle.

The Role of Magnetic Resonance Imaging in the Diagnosis of Soft Tissue Tumors and Tumor Mimics Arising Within Skeletal Muscle.