Gastrointestinal Stromal Tumour

          

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                           Histopathological grading of 
Soft Tissue Tumour

             Dr Sampurna Roy  MD 

 
Web www.histopathology-india.net
May 2007

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Myxoid Tumours of Soft Tissue

Classification of Soft Tissue Tumour

Gross examination of soft tissue specimen          

A practical approach to histopathological reporting of soft tissue tumours

Grading of soft tissue tumours

Lipomatous tumours

Neural tumours

Myogenic tumours

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Fibrohistiocytic tumours

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Soft TissueTumours of UncertainDifferentiation               

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Visit related websites:

- An approach to histopathological reporting of soft tissue tumour: click

-Gross examination  of soft tissue specimens: click

                    

Malignant soft tissue tumours constitute a heterogeneous group of tumours with a wide range of biological behaviour. Histopathological grading is essential for separating tumours with favourable prognosis to those with poor prognosis and determines overall survival of the patient. Pathologists are required to indicate biological potential of the tumour, so that appropriate treatment regimen may be selected by the clinician. The criteria used in the grading scheme do not equally apply for all tumour types . Treating clinician should  be aware of  the limitations of the grading scheme, as there are frequent failures in the prediction of clinical outcome.

Note: Needle biopsies are not ideal for preoperative grading purposes.

 PARAMETERS USED IN GRADING:

Histological type
Necrosis
Mitotic activity
Cellularity
Tumour differeniation
Nuclear pleomorphism
Vascular invasion

Accurate histological typing of the tumour plays an  important role in determining tumour prognosis in the following cases:
 
                      HIGH  GRADE  TUMOURS

       Angiosarcoma
       Extraskeletal Ewing's sarcoma/PNET
       Extraskeletal osteosarcoma
       Myxoid / round cell liposarcoma
       Mesenchymal chondrosarcoma
       Pleomorphic liposarcoma
       Rhabdomyosarcoma
       

                              
                        LOW  GRADE  TUMOURS

        Angiomatoid 'malignant fibrous histiocytoma
        Atypical fibroxanthoma
        Atypical lipomatous tumour/well differentiated
        liposarcoma
        Dermatofibrosarcoma protuberans
        Desmoid tumour
        Myxoid liposarcoma

 
 NATIONAL  CANCER  INSTITUTE  GRADING SYSTEM:

Grading in this system is based on histological type of tumour and tumour necrosis where histological type does not define grade.


HISTOLOGICAL PARAMETER                                          GRADE

HISTOLOGICAL TYPE/SUBTYPE                                                      1

- Epithelioid haemangioendothelioma
- Well differentiated liposarcoma
- Myxoid liposarcoma
- Infantile fibrosarcoma


HISTOLOGICAL TYPE, MITOSIS, DIFFERENTIATION      
1                                                                                  
- Well-differentiated leiomyosarcoma
  (< 6 mitosis /10HPF)
- Well- differentiated fibrosarcoma
   (< 6 mitosis / 10HPF)
- Malignant peripheral nerve sheath tumour (< 6 mitosis/ 10HPF)
- Extraskeletal myxoid chondrosarcoma (no mitoses)


HISTOLOGICAL TYPE, NECROSIS                                                  2

- Any sarcoma not compulsorily grade 3 and less than 15% necrosis                                                     



HISTOLOGICAL TYPE / SUBTYPE                                                   3

- Any sarcoma with more than 15% necrosis
- Rhabdomyosarcoma (all subtypes)
- Extraskeletal osteosarcoma
- Ewing's sarcoma /primitive neuroectodermal tumour
- Mesenchymal chondrosarcoma
- Pleomorphic liposarcoma
- Alveolar soft part sarcoma

                  

Abstract:

Problems in grading soft tissue sarcomas.Am J Clin Pathol. 2000 Nov;114 Suppl:S82-9.

Validity and reproducibility of histologic diagnosis and grading for adult soft-tissue sarcomas.Hum Pathol. 2002 Jan;33(1):111-5.

Prognostic significance of grading and staging systems using MIB-1 score in adult patients with soft tissue sarcoma of the extremities and trunk.Cancer. 2002 Aug 15;95(4):843 51

 
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