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Pathology of the Soft Tissues & Nerves

Pathology of the Soft Tissues & Nerves. Arlene L. Santos, M.D. SY 10-11. Pathology of the Soft Tissues. I. Fatty Tumors II. Fibrous Tumors & Tumor -like Lesions III. Fibrohistiocytic Tumors IV. Tumors of the Skeletal Muscle. V. Tumors of the Smooth Muscle

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Pathology of the Soft Tissues & Nerves

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  1. Pathology of the Soft Tissues & Nerves Arlene L. Santos, M.D. SY 10-11

  2. Pathology of the Soft Tissues

  3. I. Fatty Tumors • II. Fibrous Tumors & Tumor-like Lesions • III. FibrohistiocyticTumors • IV. Tumors of the Skeletal Muscle

  4. V. Tumors of the Smooth Muscle • VI. Tumors of the Skeletal Muscle

  5. I. Fatty Tumors

  6. A. Lipoma

  7. A benign tumor of fat • The most common soft tissue tumor of adulthood • Age group commonly affected: middle adulthood

  8. Pathologic Findings- Conventional Lipoma • Single or multiple subcutaneous growths that are soft, rounded or lobulated & movable against overlying skin • A well-encapsulated mass composed of sheets of mature fat cells • Arises in subcutis of proximal extremities & trunk

  9. Lipoma

  10. Angiolipoma

  11. B. Liposarcoma

  12. A malignant tumor of fat • Age group commonly affected: 40-60 y/o • Usually arises in the deep soft tissues of the proximal extremities & retroperitonemum

  13. Liposarcoma

  14. Histopathology • Variants depending on morphologic features: • 1) Well-differentiated • 2) Myxoid/Round cell • 3) Pleomorphic

  15. Histopathology-Well differentiated Liposarcoma • Tumor cells are recognized as lipocytes • Tumor cells contain supernumerary rings & giant rod chromosomes

  16. Histopathology-Myxoid & Pleomorphic Variants • Tumor contains lipoblasts (mimic fetal fat cells)

  17. Liposarcoma

  18. MyxoidLiposarcoma

  19. II. Fibrous Tumors & Tumor-like Lesions

  20. A. Fibromatoses

  21. 1) Superficial Fibromatoses (Palmar, Plantar & Penile Fibromatoses) • 2) Deep-seated Fibromatoses (Desmoid Tumors)

  22. A1. Superficial Fibromatosis (Palmar, Plantar & Penile Fibromatoses)

  23. Characterized by nodular or poorly defined broad fascicles of fibroblasts surrounded by abundant dense collagen • Male predominance

  24. Fibromatosis

  25. Variants of Superficial Fibromatoses • 1. Palmarfibromatosis • 2. Plantar fibromatosis • 3. Penile fibromatosis

  26. Palmarfibromatosis • Also known as Dupuytren contracture

  27. PalmarFibromatosis • Irregular thickening of palmar fascia ↓ W/ attachment to overlying skin ↓ • Puckering & dimpling of skin ↓ After some time • Progressive flexion contracture of 4th & 5th fingers of hand

  28. Plantar Fibromatosis • Irregular or nodular thickening of plantar fascia • Flexion contractures are uncommon

  29. Penile Fibromatoses • Also known as Peyronie disease • Presents as a palpable induration or mass on dorsolateral aspect of the penis

  30. Penile Fibromatosis • May cause: 1) Abnormal curvature of the shaft 2) Constriction of the urethra 3) Both

  31. A2. Deep-seated Fibromatosis (DesmoidTumors)

  32. Present as large, infiltrative masses that frequently recur after incomplete excision • Composed of well-differentiated fibroblasts • Age predilection: At any age but commonly in the teens-30 y/o

  33. Types of Deep-setaedFibromatosis • 1) Extra-abdominal • 2) Abdominal • 3) Intra-abdominal • W/ similar gross & histologic features

  34. Gross Pathology • Gray-white, firm, poorly demarcated masses • Rubbery & tough • Infiltrative

  35. Extra-abdominal Fibromatosis-Gross Pathology • Sites of Origin: Musculature of: 1) Shoulder 2) Chest wall 3) Back 4) Thigh

  36. Abdominal Fibromatosis-Gross Pathology • Site of Origin: Musculoaponeurotic structures of anterior abdominal wall in ♀ during or after pregnancy

  37. Intra-abdominal Fibromatosis • Site: Mesentery or pelvic walls in individuals w/ familial adenomatouspolyposis (Gardner syndrome) • Mutations in APC or β-catenin genes

  38. Histopathology • Plump fibroblasts arranged in broad sweeping fascicles w/c infiltrate the surrounding tissue

  39. B. Fibrosarcoma

  40. Gross Pathology • Site: deep soft tissues of extremities • Unencapsulated, infiltrative, soft, fish-flesh masses • (+) hemorrhage & necrosis

  41. Histopathology • All degrees of differentiation • Resemble cellular fibromatosis • MTC arranged in a herringbone pattern • Tumors w/ architectural disarray, pleomorphism, mitotic figures & necrosis

  42. Fibrosarcoma

  43. PleomorphicFibrosarcoma

  44. III. FibrohistiocyticTumors

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