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| Year : 2008 | Volume
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| Issue : 3 | Page : 97-99 |
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| Cytology of soft tissue tumors: Miscellaneous soft tissue tumors |
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Nalini Gupta
Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Click here for correspondence address and email
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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 |
 Miscellaneous Soft Tissue Tumors | |  |
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 | | |
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 | | |
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 | | |
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 | | |
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 | | |
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 | | |
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 | | |
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 | | |
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 | | |
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 | | |
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 | | |
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 | | |
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 | | |
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| 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. |
| 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. |
| 4. | DeMay RM. Soft-tissue tumors. In: DeMay RM. The art and science of cytopathology. 1st ed. Chicago: ASCP Press; 1996. p. 559-642. |
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| 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. |
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Correspondence Address:
Nalini Gupta
Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0970-9371.44042
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