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Section 9Section 9 Mesenchymal Mesenchymal TumorsTumors
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1. Benign (1) Fibroma Grossly: firm, encapsulated masses,
whitish
Histological: interlacing bundles of mature fibrocytes, fibroblasts, and collagen fibers.
Site: commonly in subcutaneous tissue, fascia periosteum ovary
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Fibroma
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* Formatives: tumor like growths of fibrous tissue in the soft tissue, e. g. dermatofibroma, nodular facilities, juvenile aponeurotic fibroma, desmoid fibromatosis, keloid, and palmar fibromatosis
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(2) LipomaGross: lobulated mass with thin
capsule, greasy on cut surface, yellowish in color.
Histological: composed of mature fat cells.
Site: Commonly in the subcutaneous tissue of arms, shoulder, and buttocks
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Lipoma
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(3) HemangiomaUsually congenital but may be acquired. Gross: Portwine colored, soft, poorly
defined lesion Histological: Composed of blood
vessels, invasive growth partner.Type: ① Capillary type commonly in skin or
mucous membrane② Cavernous type commonly in skin,
spleen, liver.
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HemangiomHemangiomaa
(offered by Prof.Orr)
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(4) Lymphangioma or cystic hygroma
Usual congenital
Gross: Pale, soft, poorly defined lesion
Histological: Composed of lymphatic vessels.
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右颈部囊状水瘤(offered by Prof.Orr)
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(5) Leiomyoma Gross: A single or multiple, firm,
circumscribed Histological: Spindle shaped smooth
muscle cells, interwoven fibers of fusiform, varying amounts of connective tissue.
Site: Commonly in uterus, gastrointestinal tract tongue
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Leiomyoma
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(6) Osteoma Mainly found in skull and the long
bones
(7) Chondroma Gross: firm, bluish with fibrous
capsule, sometimes central softening with brownish fluid.
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2. Malignant
(1) Fibrosarcoma
The more the cellularity and the number of mitotic figures, the greater the malignancy
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Fibrosarcoma
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(2) Rhabdomyosarcoma
Type: ① Embryonal rhabdomyosarcoma: Most common type occurs in children
often arise in the nasal cavity, orbit, middle ear, prostate, and Para testicular region.
Various stages of embryogenesis round and spindled cells in a variably myxoid stroma.
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Fetal rhabdomyosarcoma (吴名耀提供)
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② Alveolar rhabdomyosarcoma Occur in early to mid adolescence Commonly arise in the deep
musculature of extremities pulmonary alveolae like.
③ Pleomorphic rhabdomyosarcoma Numerous large, multinucleated,
bizarre eosinophilic tumor cells
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Pleomorphic rhabdomyosarcomaPleomorphic rhabdomyosarcoma
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(3) Osteosarcoma A highly malignant tumor of bone Infiltrative growth manner both
into the marrows and outwards into the surrounding soft tissue. Formatting tumor osteoid by the tumor cells. Some characteristics: “sunburst” appearance, codman’s triangle
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Osteosarcoma (Quoted from Robbins 《 Pathology Basis of disease 》 )
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(4) Liposarcoma
Commonly occur in the buttocks, lower limbs, retroperitoneum. Composed of embryonic fat cells containing small fat globules in cytoplasm.
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大腿脂肪肉瘤 A 手术前外观 B CT 影象 C 手术切除标本 D 镜下 ( 由宋建新主任医师提供 )
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(5) 血管肉瘤 (angiosarcoma)
50 岁男性肩胛骨血管肉瘤, 左 1 为 X 线改变, 左 2 、 3 镜下改变 (offered by Prof.Orr) ,左 4 免疫组化上皮标记 CD31 呈阳性( quoted from Robbins Basic Pathology)
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(6) Kaposi 肉瘤 可能来源于血管内皮或原始间叶细胞的梭形细胞肉瘤。
Quoted form Robbins Basic Pathology, 2003
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(6) Kaposi 肉瘤
Quoted from Robbins Basic Pathology, 2003
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(7) Malignant fibrous histiocytoma
Refer to a heterogeneous group of aggressive soft tissue tumors characterized by considerable cytologist plemorphism. Spindled cells in swirling (storiform) pattern.
(8) Malignant lymphoma
(9) Leukemia
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3. Comparisons Between Carcinoma and
Sarcoma
Carcinoma Sarcoma① Histogenesis Epithelial tissues Mesenchymal
tissues
② Morbidity High. In older age Low. In children & young
③ Gross Hard, gray-white, dry
Soft, fleshy
④ Histologicaly Form carcinoma nests, so, there are clear line of demark- ation between nests & sup-ortive stroma.
Tumor cells diffuse in supportive stroma, so, there are not marked boundary between parenchyma & supportive stroma.
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Carcinoma Sarcoma
⑤ Reticular fiberStaining:
Around carcinoma nest,no around tumor cells.
Around tumor cells
⑥ Metastasis: Most frequently via lymphatics.
Most frequently via blood vessels.
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1. The central nervous tumors
(1) Glioma ① Astrocytoma ② Oligodendroglioma ③ Ependymoma
(2) Medulloblastoma
(3) Meningioma
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2. Peripheral nervous tumors
(1) Neurofibroma
(2) Neurilemmoma
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NeurilemmoNeurilemmomama
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(offered by Prof.Orr)
3. Retinoblastoma
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4. Pigmented nevus and melanoma
(1) Pigmented nevus Most authorities agree that the
melanocytes are derived from neuro-ectoderm, and migrate to the basal layer of the skin in early intrauterine life
A nevus or more implies a benign pigmented tumor containing nevus cells.
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(2) Melanoma Malignant Gross: a variably pigmented, rapidly
rowing, Ulcerated and bleeding lesion of the skin
Histological: Pleomorphic, melanin- containing cellsinvading the underlying tissues.
Amelanotic melanoma: Someone have no melaning pigment, but still DOPA positive.
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melanoma