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Soft Tissue Pathology 

Histopathological Grading of Soft Tissue Tumour

Dr Sampurna Roy MD    





Malignant soft tissue tumours constitute a heterogeneous group of tumours with a wide range of biological behaviour.

WHO Classification of Soft Tissue Tumours

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 


Mitotic activity


Tumour differentiation

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: 


Extraskeletal Ewing's sarcoma/PNET

Extraskeletal osteosarcoma

Myxoid / round cell liposarcoma

Mesenchymal chondrosarcoma

Pleomorphic liposarcoma


Low Grade Tumours:

Angiomatoid fibrous histiocytoma

Atypical fibroxanthoma

Atypical lipomatous tumour/well differentiated


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 Parameters                         Grade                                                                             

Histological Type / Subtype                                         1

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

Histological type, mitosis, differentiation         
- 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                     

- 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


Further reading:

Grading of soft tissue sarcomas: review and update

Grading of soft tissue sarcomas: review and update

Problems in grading soft tissue sarcomas.

Validity and reproducibility of histologic diagnosis and grading for adult soft-tissue sarcomas.

Prognostic significance of grading and staging systems using MIB-1 score in adult patients with soft tissue sarcoma of the extremities and trunk.





Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)








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