Journal of Cytology
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Year : 2008  |  Volume : 25  |  Issue : 3  |  Page : 97-99
Cytology of soft tissue tumors: Miscellaneous soft tissue tumors


Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

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How to cite this article:
Gupta N. Cytology of soft tissue tumors: Miscellaneous soft tissue tumors. J Cytol 2008;25:97-9

How to cite this URL:
Gupta N. Cytology of soft tissue tumors: Miscellaneous soft tissue tumors. J Cytol [serial online] 2008 [cited 2020 Apr 6];25:97-9. Available from: http://www.jcytol.org/text.asp?2008/25/3/97/44042



   Miscellaneous Soft Tissue Tumors Top


Soft tissue tumors are a heterogeneous group of benign and malignant neoplasms. [1],[2],[3],[4] These tumors are histopathologically classified according to the types of adult tissue that the lesional cells resemble. Cytological classification is mainly based on the principal smear pattern. [3],[4]

However, there are a good number of tumors/lesions that are placed in the category of miscellaneous soft tissue tumors.


   Alveolar Soft-Part Sarcoma Top


Age affected: Adolescents and young adults

Sex-wise incidence: Slight female predominance

Common sites: Deep soft tissues of the lower extremities, particularly, the anterior thigh and buttocks, followed by the chest wall and abdominal wall.

Cytology: Smears show clusters as well as dissociated cells. Dissociated, large, neoplastic cells show prominent, nuclear pleomorphism with round to plasmacytoid morphology, cytoplasmic fragility, and granularity with abundant, atypical, naked nuclei. [5],[7]

PAS stain detects intracytoplasmic glycogen.


   Clear Cell Sarcoma Top


Age affected: Usually young adults aged 20-40 years.

Sex-wise incidence: Women more commonly affected.

Sites: Extremities, particularly, the foot, including the ankle and toe.

Cytology: Abundant cellularity consisting of single, oval, or spindle cells or both, resulting in a biphasic pattern. The cytoplasm can be clear/granular or both. The nuclei are variably pleomorphic and vesicular with large nucleoli and intranuclear invaginations. Multinucleated tumor giant cells may be present.

About 50% of the cases may show melanin pigment. [8]

S-100 and HMB-45 are positive.

Cytogenetics: t(12;22) (q13;q12).


   Epithelioid Sarcoma Top


Age affected: Adolescents and young adults

Sites: The arm including the hand and fingers, leg.

Cytology: Tumor cells with necrosis; may suggest granuloma. Single cells predominate but cells can be in cords, nests, or sheets. Most of the cells are epithelioid in appearance with moderate size and round to polygonal shape. The cytoplasm is dense and squamoid with distinct cell boundaries. The nuclei are round to oval and have large nucleoli. [9]

Cytokeratin: Positive


   Granulocytic Sarcoma/Chloroma Top


Age affected: Any age but common in children and young adults.

Sites: Any including lymph nodes.

Cytology: Myeloid cells in various stages of maturation including blasts, myleocytes, and polymorphs admixed with lymphocytes. [10]


   Extraskeletal Osteosarcoma Top


Age affected: Predominantly fifth- sixth decade of life.

Site: Proximal extremities

Cytology: Pleomorphic, spindle or round cells with tumor cells resembling osteoblasts; multinucleated tumor cells can be seen. Clumps of amorphous, faintly eosinophilic material in the background or in between the cell clusters can be seen. [11]


   Extraskeletal Myxoid Chondrosarcoma Top


Sites: Deep, soft tissue, particularly, muscle; two thirds arise in an extremity, thigh, or popliteal space.

Cytology: Moderately cellular; cells forming strands or dispersed are typically embedded in an abundant, brightly metachromatic, myxoid, ground substance. The cells are of small to medium size with moderate cytoplasm and round to ovoid nuclei with small distinct nucleoli. [12]


   Extrarenal Rhabdoid Tumor Top


Age affected: Infants and young children

Sites: Soft tissues of head and neck, paravertebral region, shoulder, trunk, extremities, mediastinum, and retroperitoneum

Cytology: Dyscohesive pattern of rhabdoid cells or cells are seen adhering to vessel walls or fibrous septae. The cells are round to polygonal in shape and have amphophilic to lightly basophilic cytoplasm that commonly has a weakly PAS-positive, paranuclear globoid inclusion with a pale eosinophilic, glassy appearance. A large eccentrically positioned nucleus with round to reniform configuration and prominent nucleoli can also be seen. [13]


   Granular Cell Tumor Top


Age affected: Usually between 30 and 50 years.

Sex-wise incidence: More common in females.

Common sites: Tongue, head and neck region, breast, and limbs.

Cytology: Smears are variably cellular, many neoplastic cells in syncytial clusters and single along with stripped nuclei. In clusters, nuclei are arranged vaguely in a follicular pattern; cells have abundant, dense, and eosinophilic cytoplasm. The nuclei are predominantly small, round to ovoid, uniform, have bland chromatin and small prominent nucleoli. Granules are PAS-positive and diastase-resistant. [14]

S-100-positive


   Adenomatoid Tumor Top


Sites: Paratesticular tissue (epididymis, tunica, spermatic cord), uterus,  Fallopian tube More Detailss, ovary, and paraovarian tissues.

Cytology: Sheets and multilayered or branching clusters of monotonous cells. The cells are round to oval with eccentric nuclei, fine chromatin, conspicuous nucleoli, and no significant atypia. Naked nuclei may be there. The cytoplasm is moderately abundant with indistinct cell borders. [15]


   Ossifying Fibromyxoid Tumor Top


Age affected: 14-79 years of age with peak incidence in the fifth decade.

Sites: Shoulder, upper arm, buttock, and thigh.

Cytology: Proliferating cells are small with lightly eosinophilic to clear cytoplasm and a cytologically bland-appearing, round- to spindle-shaped nucleus containing a small nucleolus. The stroma is composed of abundant myxocollagenous matrix material. [16]


   Solitary Fibrous Tumor Top


Sites: Pleura, pericardium, upper respiratory tract, liver, and rarely in the orbit.

Cytology: Variably cellular smears with scattered as well as clusters of spindle cells present within pinkish stroma-like material with few capillary channels in the background of abundant blood. [17]

The spindle cells stain strongly for CD34 and vimentin.


   Metastatic Tumors Top


Lung, renal carcinoma, and colon cancer are the common adenocarcinomas that metastasize to soft tissues. Squamous cell carcinoma with primary in lung, hypopharynx, esophagus, and cervix and renal cell carcinoma also metastasize to soft tissues. [18]

Multiple myeloma, lymphoma, melanoma, astrocytoma, chondroblastoma, and primary sarcoma have been reported to metastasize to soft tissue.

Angiosarcoma, chondrosarcoma, and synovial sarcoma are common among soft tissue sarcomas, others being osteogenic sarcoma, malignant fibrous histiocytoma, leiomyosarcoma, and dedifferentiated chondrosarcoma.

The thigh muscles, iliopsoas, and paraspinous muscles are the most frequent sites of reported clinical involvement. In recent series, thigh and arm muscles were equally involved, followed by the chest wall and paraspinous musculature.

 
   References Top

1.Rosai J. Soft tissues. In: Rosai J. Rosai and Ackerman's surgical pathology. 9th ed. Missouri: Mosby; 2004. p. 2237-372.  Back to cited text no. 1    
2.Montgomery E. Soft tissue tumors. In: Silverberg SG, DeLellis RA, Frable WJ, LiVolsi VA, Wick MR, editors. Principles and practice of surgical pathology and cytopathology. 4th ed. New York: Churchill Livingstone; 2006. p. 307-418.  Back to cited text no. 2    
3.Akerman M. Skin, subcutis and soft tissues. In: Orell SR, Sterrett GF, Walters MN, Whitaker D. Manual and atlas of fine needle aspiration cytology. 3rd ed. New York: Churchill Livingstone; 1999. p. 371-400.   Back to cited text no. 3    
4.DeMay RM. Soft-tissue tumors. In: DeMay RM. The art and science of cytopathology. 1st ed. Chicago: ASCP Press; 1996. p. 559-642.  Back to cited text no. 4    
5.Zarrin-Khameh N, Kaye KS. Alveolar soft part sarcoma. Arch Pathol Lab Med 2007;131:488-91.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]
6.López-Ferrer P, Jimιnez-Heffernan JA, Vicandi B, Gonzαlez-Permato P, Viguer JM. Cytologic features of alveolar soft part sarcoma: Report of three cases. Diagn Cytopathol 2002;27:115-9.  Back to cited text no. 6    
7.Kapila K, Chopra P, Verma K. Fine needle aspiration cytology of alveolar soft-part sarcoma: A case report. Acta Cytol 1985;29:559-61.  Back to cited text no. 7  [PUBMED]  
8.Murugan P, Basu D, Kumar S, Jagadish S. Clear cell sarcoma of the soft parts arising in the rectus abdominis in a child - aspiration cytology of a rare case. Cytojournal 2007;15:4-15.  Back to cited text no. 8    
9.Jogai S, Gupta SK, Goel A, Ahluwalia J, Joshi K. Epithelioid sarcoma: Report of a case with fine needle aspiration diagnosis. Acta Cytol 2001;45:271-3.  Back to cited text no. 9  [PUBMED]  
10.Kumar PV. Soft tissue chloroma diagnosed by fine needle aspiration cytology: A case report. Acta Cytol 1994;38:83-6.  Back to cited text no. 10  [PUBMED]  
11.Nicol KK, Ward WG, Savage PD, Kilpatrick SE. Fine-needle aspiration biopsy of skeletal versus extraskeletal osteosarcoma. Cancer 1998;84:176-85.  Back to cited text no. 11  [PUBMED]  [FULLTEXT]
12.Jakowski JD, Wakely PE Jr. Cytopathology of extraskeletal myxoid chondrosarcoma: Report of 8 cases. Cancer 2007;111:298-305.  Back to cited text no. 12  [PUBMED]  [FULLTEXT]
13.Akhtar M, Kfoury H, Haider A, Sackey K, Ali MA. Fine-needle aspiration biopsy diagnosis of extrarenal malignant rhabdoid tumor. Diagn Cytopathol 1994;11:271-6.  Back to cited text no. 13  [PUBMED]  
14.Wieczorek TJ, Krane JF, Domanski HA, Akerman M, Carlιn B, Misdraji J, et al . Cytologic findings in granular cell tumors, with emphasis on the diagnosis of malignant granular cell tumor by fine-needle aspiration biopsy. Cancer 2001;93:398-408.  Back to cited text no. 14    
15.Gupta N, Rajwanshi A, Srinivasan R, Nijhawan R. Fine needle aspiration of epididymal nodules in Chandigarh, north India: An audit of 228 cases. Cytopathology 2006;17:195-8.  Back to cited text no. 15  [PUBMED]  [FULLTEXT]
16.Mohanty SK, Srinivasan R, Rajwanshi A, Vasishta RK, Vignesh PS. Cytologic diagnosis of ossifying fibromyxoid tumor of soft tissue: A case report. Diagn Cytopathol 2004;30:41-5.  Back to cited text no. 16  [PUBMED]  [FULLTEXT]
17.Clayton AC, Salmγo DR, Keeney GL, Nascimento AG. Solitary fibrous tumor: A study of cytologic features of six cases diagnosed by fine-needle aspiration. Diagn Cytopathol 2001;25:172-6.  Back to cited text no. 17    
18.Damron TA, Heiner J. Distant soft tissue metastases: A series of 30 new patients and 91 cases from the literature. Ann Surg Oncol 2000;7:526-34.   Back to cited text no. 18  [PUBMED]  [FULLTEXT]

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Correspondence Address:
Nalini Gupta
Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9371.44042

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    Miscellaneous So...
    Alveolar Soft-Pa...
    Clear Cell Sarcoma
    Epithelioid Sarcoma
    Granulocytic Sar...
    Extraskeletal Os...
    Extraskeletal My...
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