Part 1 book “Biopsy interpretation series biopsy interpretation of soft tissue tumors” has contents: Biopsy techniques, diagnostic methods, and reporting, benign and intermediate fibrosing lesions, cutaneous spindle cell lesions, intra-abdominal spindle cell lesions, smooth muscle tumors, benign peripheral nerve sheath tumors,… and other contents.
B I O P S Y I N T E R P R E TAT I O N S E R I E S BIOPSY INTERPRETATION OF SOFT TISSUE TUMORS BIOPSY INTERPRETATION SERIES Series Editor: Jonathan I Epstein, MD Interpretation of Breast Biopsies, 4/e Darryl Carter, 2002 Prostate Biopsy Interpretation, 3/e Jonathan I Epstein, Ximing J Yang, 2002 Bladder Biopsy Interpretation Jonathan I Epstein, Mahul B Amin, and Victor E Reuter, 2004 Biopsy Interpretation of the Gastrointestinal Tract Mucosa Elizabeth A Montgomery, 2005 Biopsy Interpretation of the Upper Aerodigestive Tract and Ear Edward B Stelow and Stacey E Mills, 2007 Biopsy Interpretation of the Prostate, 4/e Jonathan I Epstein and George Netto, 2007 Biopsy Interpretation of the Breast Stuart J Schnitt and Laura C Collins, 2008 Biopsy Interpretation of the Liver, 2/e Stephen A Geller and Lydia M Petrovic, 2009 Biopsy Interpretation of the Uterine Cervix and Corpus Anais Malpica, Michael T Deavers and, Elizabeth D Euscher, 2009 Biopsy Interpretation: The Frozen Section Jerome B Taxy, Aliya N Hussain, and Anthony G Montag, 2009 Biopsy Interpretation of the Skin A Neil Crowson, Cynthia M Magro, and Martin C Mihm, 2009 Biopsy Interpretation of the Thyroid Scott L Boerner and Sylvia L Asa, 2009 Biopsy Interpretation of Soft Tissue Tumors Cyril Fisher, Elizabeth A Montgomery, and Khin Thway 2010 Biopsy Interpretation of the Bladder, 2/e Jonathan I Epstein, Mahul B Amin, and Victor E Reuter, 2010 Biopsy Interpretation of the Lung Saul Suster and Cesar Moran, 2011 Biopsy Interpretation of the Central Nervous System Daniel J Brat and Matthew J Schniederjan, 2011 B I O P S Y I N T E R P R E TAT I O N S E R I E S BIOPSY INTERPRETATION OF SOFT TISSUE TUMORS Cyril Fisher, MD, DSc, FRCPath Department of Histopathology Royal Marsden Hospital London, United Kingdom Elizabeth A Montgomery, MD Department of Pathology Johns Hopkins Hospital Baltimore, Maryland Khin Thway, BSc, MBBS, FRCPath Department of Histopathology Royal Marsden Hospital London, United Kingdom Senior Executive Editor: Jonathan W Pine, Jr Product Manager: Marian A Bellus Vendor manager: Bridgett Dougherty Senior Marketing Manager: Angela Panetta Senior Manufacturing Manager: Benjamin Rivera Creative Director: Doug Smock Production Service: SPi Technologies © 2011 by LIPPINCOTT WILLIAMS & WILKINS, a WOLTERS KLUWER business 530 Walnut Street Philadelphia, PA 19106 USA LWW.com All rights reserved This book is protected by copyright No part of this book may be reproduced in any form by any means, including photocopying, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews Materials appearing in this book prepared by individuals as part of their official duties as U.S government employees are not covered by the above-mentioned copyright Printed in the People’s Republic of China Library of Congress Cataloging-in-Publication Data Fisher, Cyril Biopsy interpretation of soft tissue tumors / Cyril Fisher, Elizabeth A Montgomery.—1st ed p ; cm.—(Biopsy interpretation series) Includes bibliographical references and index ISBN 978-0-7817-9559-3 (alk paper) Soft tissue tumors—Pathophysiology Soft tissue tumors—Diagnosis Biopsy I Montgomery, Elizabeth (Elizabeth A.), 1958- II Title III Series: Biopsy interpretation series [DNLM: Soft Tissue Neoplasms—diagnosis Soft Tissue Neoplasms—pathology Biopsy—methods Diagnosis, Differential WD 375 F533b 2011] RC280.S66F57 616.99'4—dc22 2011 2010025303 Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication Application of the information in a particular situation remains the professional responsibility of the practitioner The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance with current recommendations and practice at the time of publication However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions This is particularly important when the recommended agent is a new or infrequently employed drug Some drugs and medical devices presented in the publication have Food and Drug Administration (FDA) clearance for limited use in restricted research settings It is the responsibility of the health care provider to ascertain the FDA status of each drug or device planned for use in their clinical practice To purchase additional copies of this book, call our customer service department at (800) 638-3030 or fax orders to (301) 223-2320 International customers should call (301) 223-2300 Visit Lippincott Williams & Wilkins on the Internet: at LWW.com Lippincott Williams & Wilkins customer service representatives are available from 8:30 am to pm, EST 10 CONTENTS Preface vii Biopsy Techniques, Diagnostic Methods, and Reporting Benign and Intermediate Fibrosing Lesions 20 Cellular Benign and Intermediate Lesions of Fibroblasts and Myofibroblasts 44 Cutaneous Spindle Cell Lesions 67 Intra-Abdominal Spindle Cell Lesions 91 Smooth Muscle Tumors 119 Myofibroma, Myopericytic Tumors, Myoepithelioma, and Myofibroblastoma 138 Tumors of Specialized Lower Genital Tract Mesenchyme 159 Benign Peripheral Nerve Sheath Tumors 171 10 Spindle Cell Sarcomas 195 11 Epithelioid Tumors of Soft Tissue 230 12 Soft Tissue Lesions with Clear or Granular Cells 256 13 Pleomorphic Soft Tissue Tumors 282 14 Small Round Cell Tumors 304 15 Benign Adipose Tissue Tumors 335 16 Liposarcoma 363 17 Superficial Vascular Lesions and Mimics 381 18 Deep Vascular Tumors 430 19 Osteochondroid Lesions of Soft Tissue 447 20 Myxoid Tumors of Superficial Soft Tissue 468 21 Myxoid Tumors of Deep Soft Tissue 484 22 Plexiform Soft Tissue Tumors 511 23 Soft Tissue Tumors with Giant Cells 524 Index 545 v PREFACE There are more than two hundred types of soft tissue tumors, including many variant patterns In most textbooks, they are organized by differentiation or diagnostic subtype in line with the World Health Organization classification scheme Detailed information is available – for those who already know the approximate diagnosis However, in limited material, especially core needle biopsy, soft tissue tumors first appear to the pathologist as one of a number of microscopic patterns in which the line of differentiation is not always obvious or in which there is a wide differential diagnosis This book, intended as a practical guide for the diagnostic surgical pathologist, additionally approaches diagnosis by cytomorphologic pattern – spindle, epithelioid, pleomorphic, small round cell, or plexiform Other chapters deal with those in which the line of differentiation is apparent (adipose, vascular, nerve sheath, smooth muscle) but which in core biopsies are sometimes hard to categorize or evaluate for malignant potential; tumors that favor specific anatomical locations such as skin and retroperitoneum; and those in which stromal changes are the predominant feature The latter, such as myxoid lesions, are relatively common and often difficult to distinguish Some tumor types are discussed in more than one chapter, but this is essential as they are approached from different angles The key features of specific tumors and tumor-like lesions are detailed within each category, using morphologic, immunohistochemical, ultrastructural, and genetic data This parallels and complements the normal diagnostic process In addition to color photomicrographs, the book includes numerous tables for differential diagnosis within each category Relevant clinical data that inform the pathologic diagnosis, and subsequent implications for therapy, are included Sampling techniques, specimen handling, application of ancillary diagnostic modalities, sarcoma grading and staging, and reporting are discussed in the introductory chapter Sarcomas and many benign soft tissue tumors are rare and present a real challenge to those who encounter them infrequently We hope this book will be of value to all pathologists faced with diagnosis and assessment of likely behavior in a soft tissue tumor biopsy Cyril Fisher Elizabeth A Montgomery Khin Thway vii BIOPSY TECHNIQUES, DIAGNOSTIC METHODS, AND REPORTING INTRODUCTION Soft tissue tumors comprise a group of entities showing mesenchymal differentiation which can be located in skin, subcutis, or deep soft tissue The latter includes subfascial limb and limb girdle tumors, and those located in head and neck, abdomen, retroperitoneum (including paratestis), pelvis, and thoracic and intracranial cavities Similar lesions can also involve viscera Typically, soft tissue tumors are classified by the type of differentiation which they display,1 and the principal objectives of the surgical pathologist are to identify the lineage of the lesional cells and assess their malignant potential Nonmesenchymal lesions such as carcinoma or melanoma can also present as soft tissue neoplasms In many cases, the tumor is seen initially as a spindle cell, epithelioid cell, small round cell, or pleomorphic lesion which needs to be characterized further with the aid of ancillary techniques including immunohistochemistry, electron microscopy, and genetic analysis Lesions with adipose, osteochondroid, or vascular space formation can readily be identified morphologically but often present difficulties in precise subcategorization and in assessment of malignancy This book is, therefore, organized into chapters representing the main morphologic categories as they present to the surgical pathologist Each entry includes relevant clinical data, morphologic features, and information from ancillary techniques wherever appropriate The differential diagnosis within each category is presented in detailed tabular form It is hoped that this approach will reflect the diagnostic process as practiced by the pathologist and will facilitate diagnosis and provision of relevant information to the clinician in this rare and difficult group of neoplasms Necessarily, some entities appear in more than one category with the main entry corresponding to the most common pattern or location in each case BIOPSY Most superficial tumors and those