Myofibroblastic tumors

Nodular fasciitis
15-40 yo, rapidly growing, extremity, trauma
fascia at edge
tissue culture like myofibroblasts
extravasated RBC
no Necreosis

Proliferative fasciitis
Solitary lesion, 40-70 yo
Ganglion cell like myofibroblasts
eccentric nuclei w prominent basophilic nucleolus,
granular cytoplasm
Actin +

Fibrous Histiocytoma (dermatofibroma)

Storiform/short fascicular growth
Pushing stellate border
Collagen
Fibromatoses
Superficial (palmar/plantar) and Deep (abd/extraabd)
Elongate bld vessles

Parallel myofibroblasts
Beta catenin
Dermatofibrosarcoma protuberans
Lesion parallel to skin surface
Storiform
Entrapped fat
Elastofibroma
Scapula!!!!!!!!!!!
Abundant collagen, elastic fibers
Myxofibrosarcoma
Lobulated with nodules demonstrating hypocellular and
hypercellular areas
Curvilinear vessels
Pleomorphism, freq mitoses,

acral myxoinflamm fibroblastic sarcoma

40-50 yo
infiltrate subQ fat and involves jts and tendons
prominent dense, mixed acute and chronic inflamm infiltrate
alternating hyaline and myxoid zones
foci of hemosiderin deposition

malignant solitary fibrous tumor

patternless with alternating hypercell/hypocell areas
collagen bundles
hemangiopericytoma like vascular pattern

Desmoplastic fibroblastoma
50-70 yo, involves subq fat
Hypocellular with spindled/stellate shaped fibroblasts
Dense collagenous stroma
Well circum, not encapsulated

myofibroblastoma
older men and women
nodular well circum, unencapsulated
spindle cell, fascicles,
dense collagen
mammary type

cellular angiofibroma
vulva of middle aged women
uniform bland spindle cells
numerous thick walled hyalinized vessels
short bundles of wispy collagen

low grade fibromyxoid sarcoma

30-50 yo
limbs, girdles
well circums
swiriling fascicles of bland uniform spindles fibroblasts and
myofib
variable dense fibrous and myxoid hypovascular stroma
may have giant hyalinized rosettes
(SEE BELOW)

Benign fibrous histiocytoma

Deep-well circum

Storiform , polymorphus spindle cells with elongated or plmp

vesicular nuclei
Scattered foamy MO and giant cells
Myxoid, hemosiderin poss
Necrosis
Entrapped hyaline collagen at edge of lesion

Low cellularity
Myxofibrosarcoma
Multinodular
Myxoid
Elongated curvilinear capillariestumor cells align
themselves along vessel periphery
Atypia

Low grade myxofibrosarcoma (7,16) (11,16)

Bld vessels
Myxoid and collagenous background
Bland cells
Can have giant cell rosettes
Extraskeletal myxoid chondrosarcoma (9, 22) (9, 17)

Ugly MFH-like pattern

Pleomorphic sarcoma
Dediff sarcoma
Pseudosarcoma

Low grade fibromyxoid sarcoma

34 yo, very rare, prox ext or trunk, subfascia
Admixture of heavily collagenized and myxoid zones
Bland spindled cells
Whirling growth pattern
Arcades of curvilinear blood vessels
(vimentin)

Endometrial stromal sarcoma

42-58 yrs, t(7;17), CD10, ER/PR
into myometrium, like irregular tongues

hypercellular w uniform oval to spindle cells of endometrial

stromal type
small vessels, cells with foamy cytoplasm, invade lymphatic and
vascular channels

Fibromatosis
Palmar (>30 yr, men)
plantar (children and adolescents)
plump, immature spindle cells with similar size and shape
normochromatic nuclei and small pinpoint nucleoli
moderate amts of collagen and elongated vessels

Desmoid type-deep soft tissue, wont mets

Infiltration of surrounding soft tissue structures
Elongated, slender, spindle shaped cells of uniform
appearance
Collagenous stroma w variable prominent vessels
No atypia
Small pale staining nuclei with 1-3 minute nucleoli
Sweeping bundles
Keloid like collagen

Schwannoma
Epithelioid sarcoma
10-39 yo, male
flexor surface of fingers, hand, wrist, forearm, knee, lower leg,
ankle, fetet toes
firm slow growing, maybe ulceration
nodular pattern

mixed proliferation of esosinophilic epithelioid and spindle cells

with slight atypia, vesicular nuclei and small nucleoli
transition between epithelioid cells and spindle cells gradual and
intercellular collagen deposition marked
central necrosis

Clear cell sarcoma of soft tissue

10-50 yo, ft/ankle, ext
uniform nested to fascicular growth pattern
polygonal spindle shaped w abundant eosinophilic or clear
cytoplasm
Solitary Fibrous Tumor

Hemangiopericytoma like branching vascular pattern

20-70 yr
patternless with hypocellular and hypercellular
thick bands of hyalinized collagen
branching haemangiopericytoma like vessels
round to spindle
fibrosis and mast cells

Malignant Peripheral Nerve Sheath Tumors

Desmoplastic small round cell tumor
(11, 22), 10-50 yr
abd cavity
nests of small cells w desmoplastic stroma
central necrosis
uniform cells w small nuclei

Hemosiderotic fibrohistocytic lipomatosis

Tumoral calcinous
Cardiac angiosarcoma
Rudimentary vascular channels irregular in shape, freely
intercommunicate with one another in sinusoidal fashion
Infiltrate surrounding tissue in destructive fashion
Follicular dendritic cell sarcoma

Dediff liposarc
Extra skeletal myxoid chondrosarcoma
Multinodular defined by fibrous septa that divide the tumor into
circumscribed areas filled w pale blue myxoid stroma
Abundant myxoid matrix
Chondroblast like cells arranged in cords, clusers
60 yo, (9, 22)
prox extr, limb girdles

Intranodal palisaded myofibroblastoma

Inflammatory myofibroblastic tumor
Adolescent, children
Solitary well demarcated
Spindle cells w inflamm cells
Myxoid variant of spindle cell lipoma

MPNS with rhabdomyoblastic tumor

Giant cell fibroblastoma
Children, torso, ext

Local recurrence
Infiltrative dermal subq
Mildly pleomorphic spindle cells in myxoid stroma
*Pseudovascular spaces lined by pleomorphic, hyperchromatic
and multinucleated appearing cells

DFSP
Monotonous spindle cells in storiform pattern
Tumors infiltrate subQ