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Bone & Soft Tissue Pathology
Wednesday, March 28, 2007, 7:30 PM
Convention Center 5 A/B
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Moderator:
BRIAN P. RUBIN
Cleveland Clinic
Cleveland, OH
Disclosure: The speakers have indicated they have nothing to disclose.
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Clinical histories and Virtual Slides as well as Still Images are displayed below.
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for Text and References
Submitted by: Andre M. Oliveira - Mayo Clinic, Rochester, MN
65 year-old male with a 22 x 14 x 5 cm mass in the retroperitoneum and symptoms of urinary retention.
Case 1 - Slide 1
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Case 1 - Figure 1 - Adipose tissue neoplasm with scattered medium size vessels (HE, 40X).
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Case 1 - Figure 2 - Adipose tissue neoplasm showing scattered areas of perivascular fibrosis (HE, 40X).
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Case 1 - Figure 3 - No apparent cytologic atypia is seen at medium magnification (HE, 100X).
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Case 1 - Figure 4 - Thin fibrous septa show bland spindle cells with no apparent cytologic atypia (HE, 100X).
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Case 1 - Figure 5 - Thin fibrous septa show bland spindle cells with no apparent cytologic atypia (HE, 100X).
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for Text and References
Submitted by: Anthony Montag - University of Chicago, Chicago, IL
52 year old with right lower arm mass for four years, slowly growing. Previous history of lesion in same arm 25 years ago, but no records available.
Case 2 - Slide 1
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Case 2 - Figure 1 - Clinical appearance of right lower arm prior to surgery
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Case 2 - Figure 2 - Radiograph of right arm prior to surgery. Note expanded metaphysis/diaphysis and periosteal reaction in the distal ulna.
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Case 2 - Figure 3 - Low power of biopsy from lesion. Note well formed spicules of bone and intervening fibrous matrix.
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Case 2 - Figure 4 - Intermediate power of biopsy. Note focal osteoblastic and osteoclastic activity and relative paucicellularity of the stroma.
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Case 2 - Figure 5 - High power of biopsy. Note the mixed lamellar and woven bone comprising the trabeculae
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for Text and References
Submitted by: Carrie Y. Inwards - Mayo Clinic, Rochester, MN
A mass involving the distal ring finger of a 35 year old male who states that it has been there for several years.
Case 3 - Slide 1
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Case 3 - Figure 1 - Low power view of a cellular hyaline cartilaginous neoplasm with a nodular growth pattern. The nodules are closely associated with spicules of bone.
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Case 3 - Figure 2 - The tumor nodules tend to pull away from the bone. Loose fibrous connective tissue also surrounds some of the bone.
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Case 3 - Figure 3 - Low power view of a cellular hyaline cartilaginous neoplasm with a nodular growth pattern. The nodules are closely associated with spicules of bone.
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Case 3 - Figure 4 - The tumor nodules tend to pull away from the bone. Loose fibrous connective tissue also surrounds some of the bone.
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Case 3 - Figure 5 - Calcification diffusely involving some of the cartilage nodules.
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Case 3 - Figure 6 - Some of the chondrocytes contain abundant eosinophilic cytoplasm.
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for Text and References
Submitted by: Gene P. Siegal - University of Alabama, Birmingham, AL
A 15 year old young woman first came to our attention because of an apparent "re-growth" of a tumor mass immediately adjacent to the site of a previous surface lesion removed at age 11.
Radiologic images (Case - 4 Figs. 1-2) revealed an abnormal lesion adjacent to the lateral aspect of the distal fibula with some mixed elements including bone and cartilage but without continuity to the fibula marrow. The consulting radiologist felt an organizing hematoma would need to be excluded but a neoplastic proliferation could not be completely eliminated. Representative images of the histology are provided for your review (Case 4 - Figs. 3-4).
The intra-operative radiograph (Case 4 - Fig 5) and original slide from three years earlier were subsequently obtained and additional images are provided (Case 4 - Figs. 6-7).
The patient was not treated beyond simple excision and now at age 17 has developed a second recurrence. A representative radiologic (Case 4 - Fig 8) and two histopathologic (Case 4 - Figs. 9-10) images are similarly provided.
Case 4 - Slide 1
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Case 4 - Slide 2
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Case 4 - Figure 1 - Radiologic images revealed an abnormal lesion adjacent to the lateral aspect of the distal fibula with some mixed elements including bone and cartilage but without continuity to the fibula marrow.
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Case 4 - Figure 2 - Radiologic images revealed an abnormal lesion adjacent to the lateral aspect of the distal fibula with some mixed elements including bone and cartilage but without continuity to the fibula marrow.
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Case 4 - Figure 3 - Representative images of histology. Note the varying proportions of atypical cartilage, bone and spindles fibroblast cell population. Note that some of the bone is "blue".
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Case 4 - Figure 4 - Representative images of histology. Note the varying proportions of atypical cartilage, bone and spindles fibroblast cell population. Note that some of the bone is "blue".
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Case 4 - Figure 5 - The intraoperative radiograph demonstrates an expansile mass with lesional contents suggesting both bone and cartilaginous element.
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Case 4 - Figure 6 - Representative images of original slide. There does appear to be a thin cartilage cap overlying atypical fibroblastic cells and bony spicules. The lesion is very vascular which is better appreciated at higher power.
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Case 4 - Figure 7 - Representative images of original slide. There does appear to be a thin cartilage cap overlying atypical fibroblastic cells and bony spicules. The lesion is very vascular which is better appreciated at higher power.
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Case 4 - Figure 8 - Representative radiologic image of recurrence. A surgical defect is noted both in the bone and soft tissues along with a sclerotic proliferation adjacent to the previous site of surgery.
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Case 4 - Figure 9 - Representative histologic images of the recurrence which are very similar to the previous sections. This time the cartilage is however more hypercellular and the nuclei have increased pleomorphism
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Case 4 - Figure 10 - Representative histologic images of the recurrence which are very similar to the previous sections. This time the cartilage is however more hypercellular and the nuclei have increased pleomorphism
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for Text and References
Submitted by: Jean-Michel Coindre - Institut Bergonie, Bordeaux, France
A 62-year-old man presented with a 15 cm tumor developed in the retroperitoneum with involvement of the small intestine.
Case 5 - Slide 1
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Case 5 - Figure 1 - The tumor seemed to be well demarcated but with adhesion to the deep part of the small intestine.
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Case 5 - Figure 2 - The adjacent tissue was composed of mature adipocytes arranged in lobules separated by thick fibrous septa.
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Case 5 - Figure 3 - The tumor was composed of spindle and pleomorphic eosinophilic cells arranged in fascicles.
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Case 5 - Figure 4 - The tumor cells tended to have an abundant eosinophilic cytoplasm with racket-like contours.
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Case 5 - Figure 5 - These tumor cells showed a wide range of cell shapes from globular to tadpole-like, with atypical nuclei and mitoses.
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Case 5 - Figure 6 - These tumor cells showed a wide range of cell shapes from globular to tadpole-like, with atypical nuclei and mitoses.
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Case 5 - Figure 7 - A few atypical, hyperchromatic cells were visible in the fibrous septa separating adjacent adipocytic tissue.
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Case 5 - Figure 8 - A few atypical, hyperchromatic cells were visible in the fibrous septa separating adjacent adipocytic tissue.
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Case 5 - Figure 9 - The tumor cells were diffusely and strongly positive for desmin. At that time, the diagnosis was pleomorphic rhabdomyosarcoma.
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