SOFT TISSUE TUMORS  Pleomorphic – aggressive and metastatic

 Pathogenesis of Sarcomas FIBROUS TUMORS

- MC sporadic with no known predisposing  Nodular Fasciitis
cause; some are linked to germline o Self-limited fibroblastic and myofibroblastic
mutations in TSGs or environmental proliferation in young adults
exposures o MC on the forearm, chest, back
- Undefined precursors o Grow rapidly (weeks-months) but regresses
- Karyotypic complexity spontaneously; if excised rarely recurs
a. Simple (20%) – young patients, o Clonal proliferation harboring a t(17;22)
monomorphic; Ewing and synovial translocation that produces a MYH9-USP6
sarcoma fusion
b. Complex (80%) – leiomyosarcomas, o Morphology
undifferentiated pleomorphic sarcoma  Arises in the deep dermis, subcutis, fascia,
TUMORS OF ADIPOSE TISSUE or muscle
 Lipoma  Non-encapsulated – well-circumscribed or
o MC soft tissue tumor in adults slightly infiltrative, < 3 cm
o Morphology (conventional)  Plump immature-appearing fibroblasts an
 Well-encapsulated mass of mature myofibroblasts containing elongated
adipocytes nuclei with punctate nucleoli
 Arise in the subcutis of the proximal
extremities and trunk during middle
adulthood
 Lipomatosis – multiple multifocal lipomas
in a limb
 MC soft, mobile, painless, and cured with
simple excision
 Liposarcoma
o MC sarcomas of adulthood
o Develop in deep soft tissues of the proximal
extremities and retroperitoneum in the 6 th-7th
decade
o Genetic aberrations
 Well-differentiated: 12q13-q15 (includes
MDM2)
 Myxoid – 1(12;16) translocation
o Morphology
 Well-differentiated – mature adipocytes
with scattered atypical spindle cells
 Myxoid – abundant basophilic ECM,
arborizing capillaries, and primitive cells at
various differentiation stages (resemble
fetal fat)
 Pleomorphic – sheets of anaplastic cells
with bizarre nuclei admixed with variable
numbers of immature adipocytes
(lipoblasts)
o Clinical Features
 Recur locally unless adequately excised
 Well-differentiated – indolent