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MESENCHYMAL TUMORS 2

Lipoma

"Knapsack tumor: lipoma

Lipoma: encapsulated, lobular, and


homogenous

Lipoma

Well defined, lobulated

Lipoma

Normal mature fat cells

Lipoma

Myxoid changes: myxolpoma

Lipoma

Angiolipoma, capillary-sized vessels some with thrombi


surrounded by spindle cells

Liposarcoma

Liposarcoma (skin)

Tumor compression
(mesenterial liposarcoma)

Liposarcoma
Myxoid LS: intramuscular, gelatinous,
cystic, well defined

Lipoma-like liposarcoma (LS): fat with fibrous band, multiple lobules,


well defined.

Liposarcoma (skin)

Liposarcoma

Lipoma-like LS: fibrous band

Liposarcoma

Sclerosing LS: fibrous band and fat cells

Liposarcoma

Liposarcoma

Myxoid matrix with varying cellularity

Liposarcoma

Myxoid Liposarcoma: chicken wire vessels, myxoid matrix,


mini lipoblast and spindle cells

Liposarcoma

Round cells

Pleomorphic, large lipoblast

Pleomorphic

Lymphnode: metastatic signetring cell Ca of the breast

Leiomyoma
Leiomyosarcoma

Smooth muscle, relaxation

Smooth muscle, contraction

Benign vs Malignant Tumors

Leiomyoma (uterus)

Leiomyoma (uterus)

Leiomyoma

Moderate cellular lesion, composed of spindle cells with an elongated


nucleus with rounded ends (blunt-ended, cigar-shaped). Note the
Perinuclear vacuolization and perpendicular crossing

Leiomyoma

Leiomyosarcoma (uterus)

Leiomyosarcoma (uterus)

Leiomyosarcoma

Leiomyosarcoma

Similar cell shape and constellation with atypical cells, nuclear


pleomorphism, high mitotic activity and necrosis

Leiomyosarcoma

Leiomyosarcoma
skin, low grade

Leiomyosarcoma

partial epitheloid, high grade

Rhabdomyosarcoma

Rhabdomyosarcoma

Pleomorphic type, giant cells and tumor cells with bizarre nuclei

"Rotten Meat" appearance of


rhabdomyosarcoma

Rhabdomyosarcoma

Alveolar rhabdomyosarcoma with numerous spaces lined by


the tumor cells

Rhabdomyosarcoma

Malignant small round cells with abundant cytoplasm

"Small Round Blue Cell Tumor"


(Rhabdomyosarcoma)

Pleomorphic rhabdomyosarcoma
from adult extremity

Positive desmin immunostain =


skeletal muscle differentiation

Positive muscle specific actin


immunostain in same case

Hemangioma
Lymphangioma
Angiosarcoma

Hemangioma

Pyogenic granuloma

Capillary Hemangioma

Congenital capillary hemangioma at birth (A), and at 2 years


after spontaneous regression

Capillary hemangioma

Capillary hemangioma

Capillary hemangioma

Cavernous hemangioma

Cavernous hemangioma

Lymphangioma,
retropancreatic and intraabdominal

Lymphangioma

hygroma

hygroma

Angiosarcoma

Angiosarcoma in post-mastectomy arm edema (Stewart-Treves)

Angiosarcoma (liver)

Angiosarcoma

Angiosarcoma of the breast: intraparenchymatous, lobulated,


brown hemorrhage

Angiosarcoma

Well differentiated angiosarcoma with labyrinth of vessels,


infiltrating fat

Angiosarcoma

Poorly differentiated, epitheloid, solid pattern, with


irregular vessel structure

Angiosarcoma

A. Angiosarcoma of the heart (right ventricle)


B. Moderately differentiated, with dense clump of irregular,
moderate anaplastic cells and distinct vascular lumen
C. CD31 positive (endothelial marker)

Angiosarcoma
(HE) x 75

Angiosarcoma

FNA: plump spindle/hobnail cellsdissociating, large nuclei with irregular chromatin

Benign fibrous histiocytoma


Malignant fibrous histiocytoma

Benign fibrous histiocytoma

AJH pada MFH

"Fish Flesh" gross appearance of


sarcoma

MFH

MFH

MFH

Malignant fibrous histiocytoma revealing fascicles of plump


spindle cells in a swirling (storiform) pattern, typical but not
pathognomonic of this neoplasm.

Nuclear atypia in high grade


sarcoma (MFH)

MFH

MFH

MFH

Myxoid type, the same case

MFH, Myxoid type

MFH

Giant cell type