Tumors of Adipose Tissue Tumors Epidemiology Clinical Features. Morphology. Mature Adipocytes Separated by delicate fibrous septa

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1 Tumors of Adipose Tissue Lipoma Liposarcoma Most commonly happens in female The most common soft tissue tumor o Originates from matured Adipocytes Most commonly happes at the 4 th and 5 th decade of life Most common in adult above the age of 40 o Very rare occurs in children Arise from Lipoblast o Primitive Mesenchymal Cells Benign o 1-4% reccur after recovery o Common Trunk Back Neck Shoulder Proximal extremities o Rare Hands Lower legs Face Retroperitoneum Deep seated mass in the Adipose tissue Symptoms o When the tumor is very large Painful Functional disturbances o If happens Retroperitoneally Weight loss Emaciation Abdominal pain May cause kidney failure Due to compression Prognosis o Prognostic factors Tumor size Histologic classification o Post-operative radiation may reduce recurrence o Well-differentiated Liposarcoma has a good prognosis Soft Yellow in color Wellcircumscribed Encapsulated o Nodular mass o Large in diameter o Wellcircumscribed o Not encapsulated o Grey-white to yellowish mass o Myxoid o Gelatinous Mature Adipocytes Separated by delicate fibrous septa Low Grade Well-differentiated Liposarcoma o Resembles Lipoma o Contains vacoulated Lipoblasts Myxoid Liposarcoma o Mesemchymal resembelence Monomorphic Fusiform Stellate cells o Dispersed in Mucopolysaccaride ground substance High Grade Round Cell Liposarcoma o Cells are Uniform Round to oval Multivacoulated cytoplasm Hyperchromatic nuclei Pleomorphic Liposarcoma o Highly undifferentiated o The most Anaplastic o Numerous Tumor Giant Cells o Bizzare Lipoblasts

2 Tumors and Tumor-like Lesions of Fibrous Tissue Fibromas Fibrosarcoma True Fibromas are uncommon Represent as hyperplastic fibrous tissue Combination o Neurofibroma o Fibromyoma Occurs in adult at the age of 40 to 70 o 10% happen in children Can be surgically removed Can virtually affect any organ Rare Slowly growing tumor o Upper extremity o Trunk o Head o Neck o Retroperitoneum Prognosis o 50% recur o 25% metastasize Bone Lungs o Survival rate 5 years 41% 10 years 29% o Better prognosis if tumor is Well-differentiated Superficial Low mitotic rate No necrosis Fibromatous Can be either o Hard o Grey to white o Firm o Lobulated o Deceptively circumscribed mass o Fish-flesh like o Foci of necosis o Heamorrhagic Fibroma Durum Often pedunculated Well-circumscribed Sites o Body surface o Mucous membrane Fibroma Molle/ Fibrolipoma Mixture of o Matured fibrous tissue o Matured Adipocytes Elastofibroma Located at Subscapular region Association of o Collagenous bundles o Branching of Elastin fibers Uniform Spindle-shaped fibroblast o Arranged in intersecting fascicles o Herring bone pattern in welldifferentiated tumor Poorly differentiated tumor o Atypical cells o Pleomorphism o Multinucleated giant cells o Reduced number of collagen Evidence of angiogenesis

3 Tumors and Tumor-like Lesions of Fibrous Tissue Nodular Fascitis Palmar/Plantar Desmoid / Musculo-Aponeurotic Happens usually in young adults Commonly occurs in adults Variance o Palmar o Plantar o Penile o Knuckles pad Can be divided into o Abdominal o Extra-abdominal Benign Reactive fibroblastic growth can extend to o Superficial fascia o Subcutaneous fat o Subjacent muscles o Upper extremity o Trunk o Neck Palmar o Commonly in elderly males o Located at the fascia of the palmar o Manifested as flexion contractures Plantar o Happen at the medial aspect of plantar arch Penile o Shaft of penis Knuckle pad FIbromatoses tissues of knuckles Locally aggressive tumors Rarely metastasize Well-circumscribed nodule Located at the superficial fascia Small nodular mass Associated with o Aponeurosis o Subcutaneous fat is grey to yellow color o Large o Firm o Infiltrative border o Often located in muscular fascia o Gritty sensation during cutting o White surface Whorled/ S-shaped pattern of Fibroblasts Edematous background The cells are o Spindled in shape o Plump o Mild nuclear atypia Fibrovascular tissue Plump of tightlypacked Fibroblasts o With high mitotic rate Fibroblasts are o Banal o Tame-looking The Fibroblasts arranged in broad sweeping fascicles o Infiltrate neighbouring tissue

4 Fibrohistiocytic Tumors Benign Fibrous Dermatofibrosarcoma Protuberans Malignant Fibrous Indolent tumors of the female adults o 20 years old o 50 years old Very common benign tumor Also called Intermediate Fibrous Common in males Very rare in children Age o 50 years old o 70 years old Sometimes it is associated with TRAUMA Roughly aggressive and metastatic Low grade malignant tumor o Located at the Dermis o Histiocytic in origin o Trunk o Will not happen at Leg Feet Arm Recurs locally Seldom metastasize May progress into o Malignant Fibrous o Fibrosarcoma Highly aggressive tumors o Recur locally o 50% metastasize o Upper extremity o Retroperitoneum Wellcircumscribed Mobile nodule in the o Dermis o Subcutaneous fat Firm Solitary Multiple sattelite nodules extending into subcutaneous Thin and ulcerated skin o Multilobulated o Deceptively wellcircumscribed o Firm and fleshy mass o Grey white o Myxoid Dominated by proliferation of cells that are o Spindle in shape o Bland o Interlacing Th elesion rich in foam cells Borders seem infiltrative, but no local invasion Can be simply removed through incision Hypercellularism Fibroblasts arranged in Cart-wheel (Storiform pattern) o Radial whorls of spindle cells Mixture of spindle shape Fibroblasts o Arranged in Cart-wheel pattern Round Histiocytes Varying degree of o Pleomorphism o Hyperchromatism o Mitotic activity Presence of Multinucleated Bizzare Tumor Giant Cells

5 Tumors of Skeletal Muscle Embryonal Botryoid The most common type Occurs in children below than the age of 12 Variant of Embroyonal Happens in children below the age of 10 Head Neck Orbital area Urogenital tract Retroperitoneum Vagina Urinary bladder Nose Gelatinous mass Grow between muscle in subcutaneous tissue Distinctive GRAPE-like appearance Gelatinous mass Protruding into hollow cavity Mixture between small and round to oval cells Spindle shape cells Bipolar cytoplasmic processes Cross striations are evident Mitoses are frequent Grow underneath the mucosal layer Forming Cambium layer of tumor cells Alveolar Pleomorphic Rhadomyosarcoma Age o Older children o Young adults below 20 s Adults more the age of 40 years old Upper extremity Lower extremity Less frequent Site of occurrence Arise from skeletal muscle Grows very rapidly into mass that is o Gelatinous Well-circumscribed Soft Whitish mass Area of o Haemorrhage o Necrosis Resembles pulmonary alveolar o Formed by Fibrocollagenous septa The cells are o Small o Lymphocyte like o Frequent mitoses o Cross striation is evident Highly anaplastic cells Bizzare appearance Numerous multinucelated giant cells Cross striations sometimes evident

6 Tumors of Uncertain Histogenesis Malignant Synovioma Age o Children o Adult 2 nd most common after Arise from o Synovial tissue of large joints o Tendon sheaths o Bursae o Joint capsule o Joint cavities o Upper extrimity Grow slowly Painful mass Metastasize to lungs through blood o Variable in size o Grey to white o Round to multilobulated o Encapsulated o Fish flesh sarcomatous like appearance o Foci of calcification o Cystic spaces o Areas of Heamorrhage Necrosis Biphasic cellular pattern Composed of gland like structures o Lined by cuboidal/ columnar cells Plump to oval cells