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seudosarcoma
It encompasses a large group
of diverse lesions that share
the ability to simulate a soft
tissue malignancy.
seudosarcoma
It |s a cha||eng|ng areas of
patho|ogy:
1. 1he|r morpho|og|c d|vers|ty.
2. 1he|r rar|ty.
seudo sarcomas Categor|es
1. Malignant non mesenchymal
tumors.
2. Benign mesenchymal tumors.
3. Benign reactive soft tissue lesions
that are neither neoplastic nor
malignant but have worrisome
clinical &/or morphologic pattern.
MALIGNAN1 NCN MLSLNCnMAL
1UMCkS.
seudosarcomas
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Me|anoma
Sp|nd|e ce|| me|anoma & desmop|ast|c
me|anoma may m|m|cs sarcomas as
LMS, MNS1, or p|eomorph|c
und|fferent|ated sarcoma.
Genera||y are ame|anot|c.
It can rare|y show hetero|ogous
e|ements as cart||age or bone.
Sp|nd|e ce|| me|anoma.
Desmop|ast|c Me|anoma
Me|anoma
Common|y present as p|aques on the sk|n.
Most often, an over|y|ng |n s|tu me|anoma
of the sk|n, (usua||y of the |ent|go ma||gna)
Nested pattern, no we||-formed fasc|c|es or
stor|form patterns typ|ca| of sarcomas.
Sp|nd|e ce|| me|anomas character|st|ca||y
d|sp|ay neurotrop|sm.
Me|anoma
Lymphocyt|c react|on to the tumor.
Cons|stent|y express strong d|ffuse S-100.
Cther me|anocyt|c markers, such as nM8-
4S, Me|an-A, and M|1I, are negat|ve.
1wo newer nuc|ear me|anocyt|c markers,
M|1I and SCk10, have shown prom|se |n
sta|n|ng desmop|ast|c me|anomas.
Sarcomato|d carc|nomas
1hey have, e|ther a sp|nd|ed or p|eomorph|c
]g|ant ce|| h|sto|og|c appearance.
rev|ous be||ef that they represented
co|||s|on tumors, but, recent ev|dence
strong|y supports that these are true
ep|the||a| neop|asms that have undergone
mesenchyma| metap|as|a.
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Sarcomato|d carc|nomas
Can occur |n v|rtua||y any organ,
(anap|ast|c carc|noma |n the thyro|d,
MMM1 |n the gyneco|og|c tract).
Most |mportant feature |s presence of a
convent|ona| carc|nomatous component,
present e|ther as nests w|th|n the tumor
or dysp|as|a of the over|y|ng ep|the||um.
Sarcomato|d carc|nomas
Desp|te |ts mesenchyma|
appearance, sarcomatous
arch|tecture |s not usua||y we||
deve|oped.
May exh|b|t hetero|ogous e|ements
(e.g, bone format|on).
Sarcomato|d carc|nomas
InC for cytokerat|ns and p63 may be
he|pfu| |n conf|rm|ng the ep|the||a|
nature of the ma||gnant sp|nd|ed
ce||s, but negat|ve resu|ts do not
ru|e |t out.
Sarcomato|d carc|noma, Sp|nd|e ce|| carc|noma shows
hetero|ogous osteo|d d|fferent|at|on, m|m|ck|ng an osteosarcoma.
8LNIGN MLSLNCnMAL 1UMCkS.
seudosarcomas
Schwannoma
It can have h|sto|og|c features that
are worr|some for ma||gnancy.
1hey are usua||y we||-c|rcumscr|bed,
encapsu|ated tumors, however, |n
the s|nonasa| tract, they are
unencapsu|ated & can erode bone.
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Schwannoma
D|agnost|c d|ff|cu|ty can ar|se when
Anton| 8 areas & Verocay bod|es are
rare or absent (ce||u|ar schwannoma).
Ce||u|ar schwannomas can have an
a|arm|ng|y hyperce||u|ar appearance
that may be coup|ed w|th occas|ona|
m|tot|c f|gures or, rare|y, foca| necros|s.
Ce||u|ar schwannoma, In the s|nonasa| tract
Weiss & Goldblum: Enzinger and Weiss's Soft Tissue Tumors, 5th ed Ce||u|ar schwannoma Weiss & Goldblum: Enzinger and Weiss's Soft Tissue Tumors, 5th ed Ce||u|ar schwannoma
Schwannoma
In |ong stand|ng schwannomas,
"anc|ent change" degenerat|ve
changes |nc|ude nuc|ear atyp|a, cyst|c
change, hya||n|zat|on, hemorrhage &
ca|c|f|cat|on.
Schwannomas are strong|y & d|ffuse|y
|mmunoreact|ve for S-100.
Weiss & Goldblum: Enzinger and Weiss's Soft Tissue Tumors, 5th ed
Anc|ent Schwannoma
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Anc|ent Schwannoma Anc|ent Schwannoma
Weiss & Goldblum: Enzinger and Weiss's Soft Tissue Tumors, 5th ed
Anc|ent Schwannoma
Weiss & Goldblum: Enzinger and Weiss's Soft Tissue Tumors, 5th ed
Anc|ent Schwannoma
Weiss & Goldblum: Enzinger and Weiss's Soft Tissue Tumors, 5th ed
Anc|ent Schwannoma
Weiss & Goldblum: Enzinger and Weiss's Soft Tissue Tumors, 5th ed
Anc|ent Schwannoma
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Sp|nd|e Ce||]|eomorph|c L|poma
It |s c|ass|ca||y presented |n the S]C of
the poster|or neck, back, and shou|der.
Most are we|| c|rcumscr|bed, sma||, and
have the gross appearance of fat,
poss|b|y w|th myxo|d change.
1he amount of fat present |s var|ab|e
from abundant to not present at a||.
Sp|nd|e Ce||]|eomorph|c L|poma
Sp|nd|ed ce||s |n a myxo|d stroma, and
separated by bund|es of ropy co||agen
"f|oret||ke" g|ant ce||.
SCL |s strong|y CD34-pos|t|ve.
S-100 |s pos|t|ve |n the mature
ad|pocytes, but not the sp|nd|ed or
g|ant ce||s.
Sp|nd|e Ce||]|eomorph|c L|poma Sp|nd|e Ce||]|eomorph|c L|poma
Nodu|ar Iasc||t|s (NI)
It |s the most common soft t|ssue
pseudosarcoma.
It |s a ben|gn |es|on, thought to be a
react|ve pro||ferat|on of f|brob|asts
and myof|brob|asts.
Is most common|y encountered |n
the upper ||mbs, head & neck.
Nodu|ar Iasc||t|s (NI)
kap|d|y grow|ng so||tary mass, often
pa|nfu|.
It's we|| c|rcumscr|bed but
unencapsu|ated,
Usua||y s|tuated |n the f|brous septa
of S]C t|ssue.
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Nodu|ar Iasc||t|s (NI)
It d|sp|ays a haphazard, vague|y
stor|form, or "s-shaped" pattern.
Nf cons|sts of |rregu|ar, short
fasc|c|es of p|ump myof|brob|asts
s|m||ar to granu|at|on t|ssue ("t|ssue
cu|ture"-||ke).
Nodu|ar Iasc||t|s (NI)
Depend|ng on the age of the |es|on, NI
var|es from myxo|d to f|brot|c, the
stages of evo|ut|on often coex|st |n the
same |es|on "zoned pattern".
Myof|brob|asts are b|and & |ack
p|eomorph|sm. 1he nuc|e| are
hypochromat|c & ves|cu|ar, w|th smooth
nuc|ear contours and de||cate nuc|eo||.
Nodu|ar Iasc||t|s (NI)
Lymphocytes, g|ant ce||s & espec|a||y
extravasated k8C are often |nterm|xed
w|th the sp|nd|ed ce||s.
M|crocysts & m|croscop|c areas of
hemorrhage are common.
1he m|tot|c rate |s typ|ca||y h|gh, a
potent|a||y a|arm|ng feature, but
atyp|ca| m|toses are not seen.
Nodu|ar Iasc||t|s (NI)
Var|ants |nc|ude:
Css|fy|ng fasc||t|s, |n wh|ch metap|ast|c
bone |s seen.
Intravascu|ar fasc||t|s, |n wh|ch the
pro||ferat|on |s |n sma|| to med|um-
s|zed vesse|s.
Cran|a| fasc||t|s, wh|ch |nvo|ves the
sca|p and sku|| of |nfants.
Nodu|ar Iasc||t|s (NI)
InC resu|ts are typ|ca| for a
myof|brob|ast|c pro||ferat|on:
os|t|ve for smooth musc|e act|n
and ca|pon|n,
Negat|ve for desm|n or ca|desmon.
Nodu|ar Iasc||t|s
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Nodu|ar Iasc||t|s Nodu|ar Iasc||t|s
lrom Lhe web
Nodu|ar Iasc||t|s Nodu|ar Iasc||t|s
Nodu|ar Iasc||t|s
ro||ferat|ve Iasc||t|s (I) ]
ro||ferat|ve Myos|t|s (M)
I & M are ben|gn f|brob|ast|c
pro||ferat|ons of the S]C fasc|a & musc|e,
respect|ve|y.
1hey're |ess common than NI & affect
s||ght|y o|der pt., w|th an average age of
about S0 years.
1hey present as rap|d|y grow|ng, so||tary &
S.t pa|nfu| & mob||e masses.
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ro||ferat|ve Iasc||t|s (I) ]
ro||ferat|ve Myos|t|s (M)
D.Dk:
? Nodu|ar fasc||t|s
? Gang||oneurob|astoma
? Und|fferent|ated p|eomorph|c sarcoma
? khabdomyosarcoma
ro||ferat|ve Iasc||t|s (I) ]
ro||ferat|ve Myos|t|s (M)
I occurs most often |n the upper ||mbs
& trunk, whereas M affects the
musc|es of the trunk and ||mb g|rd|es.
I |s a poor|y c|rcumscr|bed, e|ongated
mass that extends a|ong preex|st|ng
f|brous septa of the subcut|s.
M |s an |nf||trat|ve, scar||ke process of
the musc|e and over|y|ng fasc|a.
ro||ferat|ve Iasc||t|s (I) ]
ro||ferat|ve Myos|t|s (M)
1he h|sto|og|c features of I and M
are s|m||ar to those of NI.
In M, the f|brob|ast|c pro||ferat|on
may a|ternate w|th atroph|c ske|eta|
musc|e f|bers, |mpart|ng a "checker
board ||ke" pattern.
ro||ferat|ve Iasc||t|s (I) ]
ro||ferat|ve Myos|t|s (M)
1he un|que feature of I]M |s c|usters
of ce||s that resemb|e gang||on ce||s
wh|ch are rounded to po|ygona|
mod|f|ed f|brob|asts w|th abundant
amphoph|||c to basoph|||c cytop|asm, 1-
2 nuc|e| w|th ves|cu|ar chromat|n &
prom|nent nuc|eo|| & occas|ona|
cytop|asm|c |nc|us|ons.
ro||ferat|ve Iasc||t|s (I) ]
ro||ferat|ve Myos|t|s (M)
ed|atr|c cases are rare, but tend to be more
a|arm|ng because of |ncreased ce||u|ar|ty,
h|gh m|tot|c rate & even necros|s.
8oth the background sp|nd|ed ce||s and
gang||on||ke ce||s |abe| as myof|brob|ast|c,
a|though act|n exp. |n the gang||on||ke ce||s |s
often weak & can be absent.
ro||ferat|ve myos|t|s. 1he presence of a sp|nd|ed pro||ferat|on m|ng||ng
between atroph|c ske|eta| musc|e f|bers |mparts a "checkerboard" ||ke pattern
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ro||ferat|ve myos|t|s ro||ferat|ve myos|t|s
ro||ferat|ve fasc||t|s
ro||ferat|ve fasc||t|s. Large gang||on||ke ce||s |n c|usters are seen
|n a background that otherw|se resemb|es nodu|ar fasc||t|s
Atyp|ca| Decub|ta| I|brop|as|a
(Ischem|c Iasc||t|s)
ADI, |s a ben|gn degenerat|ve ] reparat|ve
soft t|ssue pro||ferat|on that resu|ts from
chron|c pressure-|nduced |schem|a.
ADI typ|ca||y presents as a pa|n|ess mass
over|y|ng a bony protuberance,
C|ass|ca||y, but not a|ways, |n e|der|y pt.
who are deb|||tated or whee|cha|r bound.
Atyp|ca| Decub|ta| I|brop|as|a
(Ischem|c Iasc||t|s)
ADI |s poor|y c|rcumscr|bed & |nvo|ves
the S]C t|ssue, usua||y 3-4 cm, and |ts
C]S often has a myxo|d qua||ty.
ADI |s character|zed by a |obu|ar & zona|
pattern.
In the center of the zones |s an area of
f|br|no|d fat necros|s & myxo|d stroma,
surrounded by a r|m of pro||ferat|ng,
ectat|c, granu|at|on t|ssue-||ke vesse|s.
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Atyp|ca| Decub|ta| I|brop|as|a
(Ischem|c Iasc||t|s)
1he vesse|s conta|n p|ump endothe||a| ce||s,
many have f|br|n thromb|. Around wh|ch
pro||ferat|on of f|brob|asts, some of wh|ch
are g|ant ce||s w|th abundant basoph|||c
cytop|asm, |arge nuc|e| & prom|nent nuc|eo||.
1hese |arge ce||s are hyperchromat|c, but
have a smudgy chromat|n pattern typ|ca| of
degenerat|ve processes.
1he f|brob|ast|c ce||s may have an e|evated
m|tot|c rate, but atyp|ca| forms are absent.
Atyp|ca| decub|ta| f|brop|as|a
Atyp|ca| decub|ta| f|brop|as|a, there are atyp|ca| f|brob|asts
w|th hyperchromat|c, smudgy nuc|e|
Mass|ve Loca||zed Lymphedema
MLL |s a ben|gn, mass ||ke process that |s thought
to ar|se from the obstruct|on of |ymphat|c
channe|s by fo|ds of fat.
MLL typ|ca||y |nvo|ves pat|ents who are morb|d|y
obese. It presents as a un||atera| med|a| ||mb
mass, most common|y |nvo|v|ng the th|gh.
1he |es|ons are pendu|ous & very |arge & the
over|y|ng sk|n |s th|ckened w|th a "cobb|estone"
or "peau d'orange" appearance.
D. Dk:
Sc|eros|ng we|| d|fferent|ated
||posarcoma
Mass|ve Loca||zed Lymphedema
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MLL |s character|zed by marked
derma| f|bros|s, d||ated |ymphat|c
channe|s & expans|on of the f|brous
septae that separate S]C fat by
edema, co||agen & |ncreased
numbers of stroma| f|brob|asts that
are m||d|y atyp|ca|.
Mass|ve Loca||zed Lymphedema
1he over|y|ng ep|derm|s may d|sp|ay
acanthos|s and hyperkeratos|s.
ro||ferat|ve cap|||ar|es are
occas|ona||y seen at the |nterface of
the fat and the f|brous septae.
Mass|ve Loca||zed Lymphedema
Mass|ve |oca||zed |ymphedema.
1he septa between fat |obu|es are expanded and f|brot|c, w|th m||d|y atyp|ca|
stroma| ce||s (|nset)
Mass|ve |oca||zed |ymphedema.
1he over|y|ng sk|n shows acanthos|s, hyperkeratos|s, and d||ated |ymphat|c channe|s
LND