Grade Soft Tissue Sarcoma Research Articles

MIB-1 expression and iododeoxyuridine labelling in soft tissue sarcomas: an immunohistochemical study including correlations with p53, bcl-2 and histological characteristics.

We investigated the relationship between immunohistochemical estimates of proliferative activity and expression of bcl-2 protein and mutant p53 protein in 23 cases of soft tissue sarcoma. Furthermore, the reproducibility of estimates of proliferative activity was analysed and correlations between the variables and with mitotic score were investigated. Proliferative activity was assessed by use of monoclonal antibody MIB-1 and staining for iododeoxyuridine (IdUrd), and evaluated in multiple, random, systematically sampled fields of vision. MIB-1 indices were higher than those of IdUrd but for each case the two values were positively correlated (r = 0.78). The MIB-1 index correlated positively with mitotic score (2P < 0.001) and malignancy grade (2P = 0.001). The intraobserver reproducibility of the MIB-1 and IdUrd indices were excellent (r = 0.98 and r = 0.90, respectively). p53 expression was detected in 43% and strong bcl-2 expression was present in 57% of the studied cases. Expression of p53 and bcl-2 were not significantly correlated to proliferative activity or the histological features. We conclude, that the MIB-1 index is a reliable and reproducible estimate of proliferative activity and might improve the accuracy of conventional malignancy grading of soft tissue sarcomas. Furthermore, the results indicate that neither mutant p53 protein nor bcl-2 oncogene alone are sufficient to induce increased proliferation in these sarcomas.

Investigation of relationships between KI-67 score, DNA index, and histologic grade in soft tissue sarcomas

Proliferative activity of soft tissue sarcomas (STS) in 31 cases was estimated by histologic grading, mitotic count, DNA analysis by flow cytometry, and immuno-histochemical procedures with monoclonal antibody Ki-67. Aneuploid was found in 12 of 16 cases (75.0%) with Grade 3, and in 4 of 15 cases (26.7%) with Grade 1, 2 (P=0.0121). Tumors with more than 100 Ki-67 positive tumor cells per 10 high power fields (HPF) had a higher rate of aneuploid (81.3%) than those with less than 100 Ki-67 per 10 HPF (26.7%) (P=0.0038). There were significant correlations between Grade and DI (r=0.4901,P=0.0051), Grade and Ki-67 (r=0.4636,P=0.0086), Ki-67 and DI (r=0.6368,P=0.0001). The results indicate that DI and reactivity of tumor cells to Ki-67 may reflect proliferative activity and be helpful for clinicians to judge the biological behaviour of tumors more accurately and objectively. Supplementary to the grading of STS, DI and Ki-67 score could be useful as prognostic parameters for clinical investigation of multimodality therapy for individual patients.

Classification and Grading of Soft-Tissue Sarcomas

This article provides an overview of the classification of soft-tissue sarcomas as influenced by modern histopathologic techniques. The overview is followed by a practical grading system for these tumors based on a study of 282 eligible patients. The primary tumors of this trial were adequately treated. The quantitative data (mitotic count and size of the tumor) were based on the results of the statistical analysis.

Classification and Grading of Soft-Tissue Sarcomas: A Comment

A contrary viewpoint concerning certain issues in soft-tissue sarcoma pathology is presented. Three issues emphasized are (1) the role of immunocytochemistry and electron microscopy in diagnosis, (2) the classification of liposarcomas and atypical lipomatous tumors, and (3) the validity and usefulness of histologic grading.

A staging system for soft‐tissue sarcoma and its evaluation in relation to treatment

In order to define the significant factors for a staging system of soft-tissue sarcomas (STS), histologic and clinical findings in 190 adult patients with localized STS in the extremities and trunk were reviewed. The male-to-female ratio was 1.21. The histologic grading of tumors was defined according to the criteria recently proposed by us: tumors were low-grade in 65 cases, intermediate-grade in 57 cases and high-grade in 68 cases. The initial surgical procedure was as follows: intracapsular excision in 9 cases, marginal excision in 104 and wide local excision in 77, including 15 amputations. The mode of treatment was surgery alone (101 patients), surgery and chemotherapy (58), surgery and radiotherapy (22) and surgery and combined chemo- and radiotherapy (9). Univariate analysis revealed histologic grade, sex, tumor size and tumor depth to be significant prognostic factors. Multivariate analysis revealed histologic grade to be the only independent factor for prognosis. Significant clinical factors in each histologic grade were then evaluated. In the low-grade group, local recurrence significantly affected prognosis. Most of the patients with local recurrence had had marginal resection as the initial surgical procedure. No clinical factors affecting prognosis in the intermediate-grade group could be determined. In the high-grade group, patients with wide local excision and adjuvant chemotherapy had a better prognosis than those with marginal excision with or without adjuvant chemotherapy and wide local excision without chemotherapy (p = 0.09). In conclusion, histologic grade was the only significant factor for the staging of STS. On the basis of our staging system, different modalities of treatment for each grade of STS might be indicated; adequate surgery is essential for the prevention of local recurrence, which resulted in reduced mortality in patients with low-grade STS. For high-grade STS, the prevention of distant metastasis by combined extensive surgery and adjuvant chemotherapy may make long-term survival possible.

Multidisciplinary Treatment of Soft Tissue Sarcomas

Foreword to the Series. Preface. List of Abbreviations. 1. Pathology and Grading of Soft Tissue Sarcomas J.M. Coindre. 2. Cytogenetics J.A. Fletcher. 3. Molecular-Biological Studies on Soft Tissue Sarcomas C. Cooper, J. Clark. 4. Diagnostic Imaging K. Herrlin, H. Petterson. 5. Surgical Wound Healing D.S. Springfield. 6. Preoperative Radiation Therapy for Patients with Sarcoma of the Soft Tissues H.D. Suit, I. Spiro. 7. Changing Concepts in the Systemic Treatment of Locally Advanced or Metastatic Soft Tissue Sarcomas J. Verweij, H.M. Pinedo. 8. Adjuvant Chemotherapy of Soft Tissue Sarcomas W.C. Mertens, V.H.C. Bramwell. 9. Preoperative Chemotherapy for Soft Tissue Sarcoma of the Extremities: The Experience at the University of California, Los Angeles C.J. Engel, F.R. Eilber, G. Rosen, M.T. Selch, Yao-Shi Fu. 10. Hyperthermia and Thermochemotherapy R. Issels. 11. Soft Tissue Sarcomas in Children C.B. Pratt, L.E. Kun. Index.

Usefulness of argyrophilic nucleolar organizer staining for histologic grading of soft-tissue sarcomas.

Accurate histologic grading is essential for making a proper therapy decision in soft-tissue sarcomas (STS). The usefulness of the argyrophilic stain for nucleolar organizer region (AgNOR) in assessing the histologic grade of STS has been examined. One hundred and forty-two patients with STS confined to the extremity and trunk were selected. Tumors were classified based on the criteria of Enzinger and Weiss ["Soft-Tissue Tumors." St. Louis: C. V. Mosby, 1983]. In addition, non-specific classification was made based on the shape of proliferating cells occupying more than 50% of the field in the sections such as pleomorphic cell, small round cell, spindle cell, epithelioid cell, myxoid, and unclassified tumors. The mean number of AgNOR dots per nucleus of tumor cells was calculated in 200 cells (AgNOR count). Each category of non-specific classification was divided into a high-count group (< 8 AgNOR count) and a low-count group (> 8 NOR). The low-count group showed a significantly better prognosis than the high-count group in small round cell and spindle cell tumors (P < 0.007 and P < 0.0005, respectively). Similar results were obtained in pleomorphic cell tumors, though they were statistically not significant because of the relatively small number of examined cases. Most patients with epithelioid cell and myxoid tumors were in the low-count group. These findings suggest that the assessment of histologic grading of STS could be made effectively by the non-specific classification and the aid of AgNOR staining.

The value of positron emission tomography (PET) in detection and grading of soft tissue sarcomas

The value of positron emission tomography (PET) in detection and grading of soft tissue sarcomas

Grading of soft tissue sarcomas: Experience of the EORTC soft tissue and bone sarcoma group

A practical grading system for soft tissue sarcomas was developed, based on 282 eligible patients entered in an EORTC adjuvant clinical trial. The primary tumours in this trial had to be adequately treated. Histopathological parameters, which appeared significant in two preceding studies, were tested. These parameters were differentiation of the tumour, presence and amount of necrosis, the presence and amount of myxoid areas and the number of mitoses. In addition, the size of the tumour was also analysed. The quantitative data (mitotic count and size of the tumour) were not a priori grouped, but were divided into categories based on the results of the statistical analysis. Based on a multivariate analysis only mitotic count, the presence or absence of necrosis and the size of the tumour were significantly correlated with the duration of survival or the time to distant metastases. Of these parameters, the mitotic count was the most important.

Prognostic significance of Ki-67 reactivity in soft tissue sarcomas.

Proliferative activity of soft tissue sarcomas (STS) in 34 cases was estimated by immunohistochemical procedures (avidin-biotin complex [ABC] method) with monoclonal antibody Ki-67 which reacts with a nuclear antigen expressed in all phases of cell cycle except G0. In 20 of 34 cases (59%), varying numbers of Ki-67-positive tumor cells were detected with a range from 5 to 382 per 10 high power fields (HPF) (mean 57.2/10 HPF). Ki-67 index (the number of Ki-67-positive tumor cells/10 HPF) positively correlated with mitotic count (r = 0.428, P less than 0.02), cellularity (r = 0.447, P less than 0.01), and histologic grade (r = 0.473, P less than 0.01). The Ki-67 low index group (less than 50/10 HPF) showed more favorable prognosis than the high index group (more than 50/10 HPF) (P less than 0.005). Three cases with low mitotic count and unfavorable prognosis were proved to be the Ki-67 high index group (142-382/10 HPF). These results indicated that reactivity of tumor cells for Ki-67 is a useful prognostic marker in the patients with STS, and might be used as one of the histologic factors for the grading of STS.

Pathology of soft tissue sarcomas.

Soft tissue sarcomas are a relatively rare type of primary malignant neoplasm, comprising <1% of all malignant tumors. They are a heterogeneous group of tumors with a wide range of biological behavior. They are grouped together on an anatomical basis and present common clinical problems that, together with the rarity of many of the subtypes, dictate a uniform clinicopathological approach. Nonetheless, accurate histopathological diagnosis is essential for management because the grading of soft tissue sarcomas is an integral part of most current staging systems and may be the most important single prognostic factor. Several studies [1–3] have emphasized that, for many sarcomas, prognosis is related directly to the diagnosis, i.e., the precise histological subtype. Thus, synovial sarcoma, epithelioid sarcoma, and rhabdomyosarcoma generally have a poor outlook. Other sarcomas, including many liposarcomas, leiomyosarcomas, nerve sheath tumors, and malignant fibrous histiocytomas have a wider spectrum of behavior and, in grading each case, microscopic details such as cellularity, pleomorphism, amount of necrosis, and mitotic count must be considered.KeywordsSoft Tissue SarcomaAcquire Immune Deficiency SyndromeSynovial SarcomaMalignant Fibrous HistiocytomaEpithelioid SarcomaThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Histological Diagnosis and Grading of Soft-Tissue Sarcomas

No AccessJournal of Urology1 Oct 1988Histological Diagnosis and Grading of Soft-Tissue Sarcomas Robert C. Newman Robert C. NewmanRobert C. Newman More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)41867-2AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Histological Diagnosis and Grading of Soft-Tissue Sarcomas." The Journal of Urology, 140(4), p. 902 © 1988 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 140Issue 4October 1988Page: 902 Advertisement Copyright & Permissions© 1988 by The American Urological Association Education and Research, Inc.MetricsAuthor Information Robert C. Newman More articles by this author Expand All Advertisement PDF DownloadLoading ...

Histological diagnosis and grading of soft-tissue sarcomas.

Grading methodology for soft-tissue tumors is not yet unequivocally established. The authors use a system that is an elaboration upon that of the National Cancer Institute: grade 1 or low-grade lesions are malignant lesions with minimal risk of metastases with a tendency for local recurrence if not totally excised, and with a capability for progression to a higher grade with recurrence; grades 2 and 3 are high-grade lesions with a significant risk of metastases; grade 2 are lesions with intermediate aggressiveness, and grade 3 are highly malignant lesions with dissemination early in the course of the disease. Whereas the great majority of grade 3 lesions recur within 24 months of the initial diagnosis, patients with grade 2 lesions may go recurrence-free beyond 36 months. Although more experience is needed in grading soft-tissue sarcomas, it is hoped that grading will continue to contribute to the management of patients with malignant tumors of the soft tissue. It represents an adjunct to histological typing, which is useful in conveying the degree of biological aggressiveness as judged by histological features. Histologically 80% of the lesions can be classified on the basis of hematoxylin and eosin-stained sections and other conventional special stains. In some instances electron microscopy and immunohistochemistry are necessary for histotyping. The most challenging area for histopathological differential diagnosis remains the distinction of tumor-like reactive conditions, and pleomorphic benign tumors from sarcomas.