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Flashcards in Soft tissue tumors Deck (65):
1

____ is a benign tumor of adipose tissue.

lipoma

2

What is needed to really the difference between lipoma and liposarcoma?

Histology

3

What is the characteristic cell of liposarcoma?

lipoblast- bizarre nucleus and vesicles of lipid in cytoplasm

4

____ is the most common benign soft tissue tumor in adults.

lipoma

5

_____ is the most common malignant soft tissue tumor in adults.

liposarcoma

6

What are the 2 types of reactive proliferations

nodular fasciitis and myositis ossificans

7

____ is a rapidly growing, small benign fibrous proliferation on the subcutis, usually encountered as a small mass.

nodular fasciitis

8

Who is nodular fasciitis most prevalent in? What is characteristic about the history?

Young adults-- rapid growth

9

Where does nodular fasciitis commonly appear?

arms, esp flexor aspects of forearms, subdermal fat

10

Where and when does mysotitis ossificans occur?

lower limb, blunt trauma

11

_____ is reactive bone formation in muscle as a result of injury.

myositis ossificans

12

What is seen with mysositis ossificans histologically? How is it differentiated from malignancy?

woven bone in granulation tissue. Bone will be well formed at periphery but immature at center. Malignancy will lack this maturation

13

What is encompassed in superficial fibromatoses?

small lesions of the hand (palmar, Dupuytren contraction, knuckle pads, infantile digital fibromatoses)
Feet (planter/Ledderhose)
Penis (penile/ Peyronie)

14

What is the most common superficial fibromatoses?

palmar

15

Age group, uni or bilateral, and sex of palmar fibromatoses

increases over 40, men (until over 80), frequently bilateral

16

Age group, and uni or bilateral of plantar fibromatosis

younger age group, bilateral

17

What characterizes infantile digital fibromatosis?

peculiar inclusion like condensations of cytoplasmic actin

18

Penile fibromatoses are often associated with what?

other superifcial fibromatoses

19

What fingers are most commonly afftected by Dupuytrens?

ring and pinky

20

T of F Dupuytrens progresses slowly and is usually painless.

T

21

What happens to the palmar aponeurosis in Dupuytrens contracture

becomes hyperplastic and undergoes contracture

22

What is encompassed in deep fibromatosis?

aggressive fibromatosis, musculoaponeurotic fibromatosis, desmoid tumors

23

Describe the deep fibromatosis seen in the pediatric population.

female, most are extra-abdominal

24

Describe the deep fibromatosis in pt in late 20s.

female, most are of abdominal wall

25

Describe deep fibromatosis of later adult years

no sex presdis., fewer abdominal tumors

26

T of F Deep fibromatosis tumors are large and local control can prove difficult, but despite their capacity for local aggression, deep fibromatosis do not metastasize.

T

27

What is seen with deep fibromatosis histologically?

bland fibroblast prolif, NOT monoclonal

28

____ is a tumor of mesenchymal cell origin that is composed of malignant fibroblasts in a collagen background

fibrosarcoma

29

Where does fibrosacroma of bone usually happen?

metaphysis of long bones in lower extremities like femur and tibia and pelvis.

30

Age and sex of fibrosarcoma of bone

men, 4th decade painful

31

Where and when do fibrosarcoma on soft tissue occur

wider age spectrum 35-55; thigh and posterior knee with ill defined margins, painless

32

Describe the infantile form of fibrosarcoma

excellent prognosis

33

Appearance of fibrosarcoma histologically

herringbone pattern, nuclei have spindle shaped nucleus

34

____ is a noncancerous growth of dermal dendritic histiocytic cells.

dermatofibroma

35

Dermatofibromas can arise at the site of ____

injury like inject bite or thorn prick. most often legs and arms.

36

What do the dermatofibromas look like?

firm nodules that are often yellow-brown, sometimes pink, sometimes dark. A dimple forms if squeezed indicating tethering
histo: bland histocyte type cells interdigitate between normal collagen bundles

37

What is dermatofibrosarcoma protuberans?

relatively uncommon soft tissue neoplasm with intermediate- to low-grade malignancy. Although metastasis rarely occurs, DFSP is a locally aggressive tumor with a high recurrence rate; it is a cutaneous malignancy that arises from the dermis and invades deeper subcutaneous tissue

38

What is the cellular origin of dermatofibrosarcoma protuberans

The cellular origin of DFSP is not clear. Evidence exists that supports the cellular origin being fibroblastic, histiocytic, or neuroectodermal. DFSP manifests partial features of each. Therefore, many authorities suggest pluripotential progenitor cells, such as undifferentiated mesenchymal cells, may be the origin of DFSP, because DFSP has a capacity to differentiate into all 3 cell types.

39

What does dermatofibrosarcoma tumor look like (grossly and histo)

Grossly: umbilicated, somewhat irregular neoplasm; Histo: greater cellularity than dermatofibroma with greater cellular atypia, though without mitotic figures or necrosis

40

_____ is the most common soft-tissue sarcoma occurring in late adult life.

malignant fibrous histiocytoma

41

____ tumor contains both fibroblastlike and histiocytelike cells in varying proportions, with spindled and rounded cells exhibiting a storiform (Latin, storea, “woven mat”) arrangement

malignant fibrous histiocytoma

42

What is the most important prognostic factor with malignant fibrous histiocytoma

The clinical stage of the tumor, which is defined by tumor grade, size, and presence of distant metastases

43

What is the most common location of metastasis for malignant fibrous histiocytoma?

lung (90%), bone (8%), and liver (1%).

44

The rate of metastasis for MFH varies with what?

the histologic subtype from 23% (myxoid) to 50% (giant cell).

45

What is associated with decreased incidence of local recurrence of MFH?

resection with negative microscopic margins decreases

46

T or F Retroperitoneal MFH have better prognosis.

F

47

Histological appearance MFH

Storiform, or can be typical bizarre giant cells

48

What is involved in the transition from benign to malignant FH?

Dermatofibroma to dermatofibrosarcoma protuberans to malignant fibrous histiocytoma
*increased cellularity, storiform

49

____ have a white fish flesh appearance

rhabdomyosarcomas

50

Rhabdomyosarcoma is a tumor made up of cancerous muscle cells called _____.

rhadomyoblasts

51

Age group associated with RMS

less then 15, 2/3 are younger than 10

52

RMS may arise in any muscle in the body, but the most common sites for this tumor are:

Adjacent to the base of the skull (parameningeal)
Around the eye (orbital)
Other sites in the head and neck, such as the nose and throat (nasopharngeal)
Arms and legs (extremities)
Urinary system and reproductive sexual organs (GU, or genitourinary: includes bladder, vagina, prostate and paratesticular sites

53

Histo appearance of RMS

bizarre cells; elongated “strap” cells may recapitulate skeletal muscle cells. Some may even have cross striations like muscle or bizarre cells with abundant pink cytoplasm.

54

______is the most common place to find leiomyomas.

uterus

55

Why might there be necrosis and cysts with leimyomas?

. Not infrequently these tumors reach quite a large size; in doing so they outgrow their blood supply and may undergo areas of necrosis with ultimate formation of one or more cysts

56

Describe the cells in LM

Cells are clonal and are estrogen sensitive

57

Who does LM affect most?

Affect 25-40% of reproductive age women

58

What happens to LM after menopause?

regress

59

Are LM solitary or multiple?

either

60

The typical LM has what kind of cells?

spindle shaped nuclei with blunt ends—they are said to be “cigar” shaped. There will be no mitotic figures and no nuclear atypia. As said before, there may be large zones of ischemic necrosis or other degenerative change

61

Leiomyosarcoma can arise anywhere in the body, but is more common in the _____.

uterus, abdomen, pelvis

62

Survival with LMS depends on what?

tumor size and invasiveness into other structures which affects ability to completely resect the neoplasm. Other important survival indicators include histological grade of the tumor

63

T or F It is not clear whether LMS arise de novo or whether they arise in preexisiting leiomyomas.

T

64

What would a low grade LMS look like histo? High grade?

low: cigar cells with mitotic figures
high: bizarre, unrecognizable smooth muscle origin

65

How do sarcomas tend to spread

hematgenously-->lungs