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Histopathological Study of Soft Tissue Tumours (Three Years Study) International Journal of Science and Research (IJSR) ISSN (Online): 2319-7064 Index Copernicus Value (2013): 6.14 | Impact Factor (2013): 4.438 Histopathological Study of Soft Tissue Tumours (Three Years Study) Mirza Asif Baig MD (Pathology) Former Asst. professor BLDUs Shri B.M.Patil medical college, Hospital and Research centre Bijapure, Karnataka, India Abstract: Background: Soft tissue tumors are defined as mesenchymal proliferations which occur in the extraskeletal non-epithelial tissues of the body, excluding the viscera, coverings of brain and lymphoreticular system. The main objective of this study was to study the histopathological features of soft tissue tumors and to study the occurrence of soft tissue tumors in relation to age, sex and anatomical site. Methodology & Results: This study comprised a period of 3 years from September 2004 to August 2007. Soft tissue tumors accounted for 1.65% of all surgical specimens and 9.64% of all tumors received in our Department. In this study a total of 137 cases of soft tissue tumors were studied. There were 113 benign soft tissue tumors (82.48%) and 24 malignant soft tissue tumors (17.52%). The benign to malignant ratio was 4.70:1. The soft tissue tumors were more common in males comprising 72 cases (52.55%) as compared to females 65 cases (47.44%) with a male-female ratio of 1.10:1.Majority of benign tumors were located in head and neck region (34 cases, 30%), and soft tissue sarcomas showed a predilection for lower extremities (18 cases – 75%). The benign soft tissue tumors occurred over a wide range of distribution with peak incidence in the fourth decade of life (27 cases – 23.89%) & were more common in males – 60 cases (53.09%). Malignant soft tissue tumors occurred with an equal frequency in both male and female patients accounting for 12 cases each. The most common benign soft tissue tumors was adipose tissue tumor (52 cases – 46.01%) followed by vascular tumors (20 cases – 17.69%), fibrous tumors (18 cases – 15.92%), peripheral nerve sheath tumors (8 cases – 7.%), synovial tumors (5 cases – 4.4%), fibrohistiocytic tumors (4 cases – 3.5%), smooth muscle tumors (3 cases – 2.65%). In soft tissue sarcomas, malignant fibrous histiocytic tumors were the commonest tumors (5 cases – 20.83%), followed by PNET and related lesions (4 cases – 16.66%). These were followed by adipose tissue and perivascular tumors (3 cases each – 12.5%), and fibrous and vascular tumours (2cases– 8.3%).Majority of soft tissue sarcomas were grade-2 accounting for 10 cases (43.47%) Conclusion: A good clinical acumen, thorough description and grossing of specimens, and light microscopic evaluation of hematoxylin and eosin stained sections are fundamental aspects in the diagnosis of soft tissue tumors. Majority of soft tissue tumors can be diagnosed by hematoxylin and eosin stained sections, supplemented by special stains and immunohistochemistry, yet the foundation of these newer techniques rests upon the diagnosis made on light microscopic evaluation of hematoxylin and eosin stained sections. Keywords: Soft tissue tumors; Benign tumors; Malignant tumors; Enzinger & Weiss; FNCLCC, AFIP, MPNST, PNET, MFH, Grading, Staging 1. Introduction prognostic factor for all soft tissue sarcomas, strongly associated with the advent of metastasis and patients 2, 6 Soft tissue can be defined as non-epithelial, extraskeletal survival . tissues of the body exclusive of reticulo-endothelial system, glia and supporting tissues of various parenchymal The use of ancillary techniques like organs. It is represented by voluntary muscles, fat and immunohistochemistry, electron microscopy flow fibrous tissue, along with the vessels serving these tissues. cytometry and cytogenetics, has increased insight into the By convention, it also includes peripheral nervous system1. tumor biology and has provided tools for greater diagnostic accuracy. Yet the foundation of these newer Soft tissue tumors are defined as mesenchymal techniques rests upon the histologic diagnosis made on proliferations which occur in the extraskeletal non- light microscopic evaluation of hematoxylin and eosin epithelial tissues of the body, excluding the viscera, stained sections and use of special stains. It is critical to coverings of brain and lymphoreticular system2. The recognize immunohistochemistry as an adjunctive annual incidence of soft tissue tumor is 1.4 per 100000 technique, which does not supercede or replace the 7 population3. Soft tissue tumors are the fourth most traditional morphologic diagnosis . Soft tissue masses common malignancy in children, after hematopoietic present a challenge to the pathologist because of their 8 neoplasm, neural tumor and Wilms tumor2. Soft tissue extremely varied morphology and biologic behaviour . sarcomas account for 15% of all childhood cancers2. Benign tumors outnumber malignant ones by margin of Need for the Study 100:11. It is difficult to study the occurrence of soft tissue tumors The degree of differentiation is a reliable indicator of in relation to age, sex, site and the frequency of benign to future behaviour but sometimes differentiation is malignant tumor is nearly impossible to determine 1 misleading, certain leomyosarcomas may metastasize accurately . This has promoted me to undertake the present widely despite of their relative high degree of study. differentiation, fibrosarcomas on the other hand tends to persue a less aggressive clinical course that one would 2. Objectives expect from their immature histological appearance and sarcomas arising in DFSP has increased metastases risk 3, 4, 1. To study the occurrence of soft tissue tumors in relation 5. Histologic grade represents the most important to age, sex and anatomical site. Volume 4 Issue 6, June 2015 www.ijsr.net Paper ID: SUB155485 Licensed Under Creative Commons Attribution CC BY 1039 International Journal of Science and Research (IJSR) ISSN (Online): 2319-7064 Index Copernicus Value (2013): 6.14 | Impact Factor (2013): 4.438 2. To study histopathological features of soft tissue tumors. Definitions of Grading Parameters for FNCLCC 3. To study frequency of occurrence of benign and System1, 15 malignant soft tissue tumors. 4. To study soft tissue sarcomas based on degree of Parameter Criterion Tumor cellularity, cellular pleomorphism, mitotic activity, 1. degree of necrosis, invasive growth, hemorrhage, differentiation inflammatory infiltrate (Broder et al, 1939). To grade Sarcoma closely resembling normal soft tissue sarcomas by Federation Nationale des Centres Score-1 adult mesenchymal tissue (e.g., well differentiated liposarcoma) de Lutte Contre Le Cancer (FNC LCC) System (Trojani Sarcoma for which the histologic et al, 1984). Score-2 typing is certain (e.g., alveolar soft part sarcoma) Embryonal and undifferentiated 3. Review of Literature Score-3 sarcomas. Virchow proposed connective tissue as the origin of all 2. Mitosis Count soft tissue tumors in 18581. Score-1 0-9/ 10 HPF Stout was the first investigator to provide a detailed Score-2 10-19 / 10 HPF description of tumors of soft tissues9. Score-3 20/10 HPF Tumor necrosis Systemic clinical study of soft tissue tumors were 3. 10 (microscopic) primarily initiated by Pack and his colleagues . Score-0 No necrosis Score-1 50% tumor necrosis The annual incidence of benign soft tissue tumors is 300 Score_2 >50% tumor necrosis per 100000 and that of sarcoma is 1.4 per 100000 4. Histologic grade 1 population . Incidence of soft tissue tumors varies Grade-1 Total score 2, 3 depending on age and sex of patient. Soft tissue Sarcoma Grade-2 Total score 4, 5 is more common in men11 Grade-3 Total score 6, 7, 8 Classification of Soft Tissue Tumors: The first classification of soft tissue tumors was given by 4. Methodology and Results Rokitansky in 18421. Wilkis in 1859, proposed a classification based on cellular and fibrous components of The present study is done by examining surgically tumors1. Brost in 1902 classified soft tissue tumors based removed soft tissue specimens submitted in the on histogenesis and structure2. Stout in 1953 proposed Department of Pathology, M.R. Medical College, classification of tumors based on histogenesis, morphology Gulbarga from Basaveshwar Teaching & General and behavior9. Hospital, Government General Hospital, Gulbarga and from referred cases of private hospitals. Classification of soft tissue tumors by Armed Forces Institute of Pathology Inclusion criteria: In this study soft tissue tumors and tumor like lesions were studied as per the Histologic (AFIP) 12 in 1957, 1967 and 1983. WHO in 1969 proposed classification given in Enzinger & Weiss’s 4th Edition, classification of soft tissue tumors based on review of 2001.Histopathological study of soft tissue tumors was more than 500 soft tissue tumors, which was later on done in relation to age, sex, anatomical site and both revised in 199413. benign and malignant tumors were studied. The gross morphological features were recorded as detailed in the The classification followed in this study is “Histologic proformaThe malignant soft tissue tumors were classification of soft tissue tumors” given in Enzinger and histologically graded by FNCLCC system (Trojani et al, Weiss’s soft tissue tumor, 4th Edition, Chapter-1, page No. 1984). Special stains like PAS, Masson’s trichrome, 7. This classification is similar but not identical to the PTAH, iron hematoxylin, reticulin were employed 1994 WHO classification1. whenever necessary for diagnosis Federation Nationale des Centres de Lutte Contre le Table 1: Percentage of soft tissue tumors Cancer (FNCLCC) System13, 14: Total No. of biopsy specimens received 8277 Total No. of soft tissue tumors 137 In 1984 Trojani et al15 presented FNCLCC system of Percentage of tissue tumors 1.65 grading soft tissue sarcoma based on analysis of 155 adult patients. So far FNCLCC system is the best documented During the study period, soft tissue tumors accounted for and tested system1. So this FNCLCC system of grading 1.65% of the total surgical specimens received in the soft tissue sarcomas is being followed in this present study. Department. Table 2: Percentage of soft tissue tumors among all tumors Total No.
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