Atlas of Soft Tissue and Bone Pathology: With Histologic, Cytologic, and Radiologic Correlations

433 Pages·2014·89.19 MB·English

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Leslie G. Dodd, MD • Marilyn M. Bui, MD, PhD
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with histologic, cytologic, and
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This is an abundantly illustrated resource for diagnosis of bone and soft tissue lesions—a particular

radiologic correlations
challenge due to their rarity and complexity. In addition to carefully selected histologic photographs, A
this unique atlas enhances standard visual information with illustrations of imaging findings, n
cytology, and molecular and cytogenetic information. This vivid pictorial survey is arranged in a d

pattern-oriented approach based on the actual working method used in daily practice. B
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The authors are expert educators in surgical and cytopathology and experienced diagnosticians in n
the complexities of soft tissue and bone pathology. This richly illustrated and concise reference will e

be a practical and indispensible tool for general pathologists and pathologists in training, who are
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required to diagnose bone and soft tissue pathologies. It is also an excellent resource for physicians A
seeking a quick survey of sarcoma. T
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Key Features: O
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➤➤Offers a practical, pattern-oriented diagnostic approach that mirrors the working
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method used in daily practice
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and molecular and cytogenetic information o Leslie G. Dodd • Marilyn M. Bui
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➤➤Authored by recognized expert diagnosticians and teachers in the field d

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Recommended
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Shelving Category
Pathology i
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Atlas of Soft Tissue and
Bone Pathology

Atlas of Soft Tissue and
Bone Pathology
With Histologic, Cytologic, and
Radiologic Correlations
Leslie G. Dodd, MD
Professor
Department of Pathology
Section Chief, Cytopathology
University of North Carolina
Chapel Hill, North Carolina
Marilyn M. Bui, MD, PhD
Senior Member
Departments of Anatomic Pathology and Sarcoma
Moffi tt Cancer Center
Associate Professor
Department of Oncological Sciences
Director of Cytopathology Fellowship
University of South Florida Morsani College of Medicine
Tampa, Florida

NEW YORK
Visit our website at www.demosmedical.com
ISBN: 9781620700372
e-book ISBN: 9781617051999
Acquisitions Editor: Rich Winters
Compositor: Exeter Premedia Services Private Ltd.
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Medicine is an ever-changing science. Research and clinical experience are continually expanding our knowledge, in
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Library of Congress Cataloging-in-Publication Data
Dodd, Leslie G., author.
Atlas of soft tissue and bone pathology : with histologic, cytologic, and radiologic correlations / Leslie G. Dodd, Marilyn M. Bui.
p. ; cm.
Includes index.
ISBN 978-1-62070-037-2—ISBN 978-1-61705-199-9 (e-book)
I. Bui, Marilyn M., author. II. Title.
[DNLM: 1. Sarcoma—pathology—Atlases. 2. Biopsy, Fine-Needle—Atlases.
3. Bone Neoplasms—pathology—Atlases. 4. Soft Tissue Neoplasms—pathology—Atlases. QZ 17]
RC280.S66
616.99’471—dc23
2014027343
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14 15 16 17 / 5 4 3 2 1
To my mentors, teachers, colleagues, and trainees.
To my husband Cliff, for his patience and support. (LD)
To my late grandmother, my parents, brothers and their families for their love,
To my husband for his enduring and loving support,
To my daughter Katie whom is my pride, joy, and secret inspiration. (MB)

Contents
Preface ix 6. Benign and Low-Grade Spindle Cell Tumors 73
Acknowledgments xi 6.1 Fibromas 74
Share Atlas of Soft Tissue and Bone Pathology: With 6.2 Elastofi broma 81
Histologic, Cytologic, and Radiologic Correlations 6.3 Fibromatosis 83
6.4 Neurofi broma 89
PART I: OVERVIEW 6.5 Schwannoma 93
6.6 Perineurioma 98
1. Introduction 1 6.7 Nodular Fasciitis 100
6.8 Additional Variants of Fasciitis 102
2. Principles of Diagnosis 9
6.9 Angiomyofi broblastoma 104
2.1 Specimen Type and Procurement 10
6.10 Cellular Angiofi broma 107
2.2 Ancillary Testing 13
6.11 Myofi broblastoma 109
2.3 Tumor Grading and Staging 20
6.12 Gastrointestinal Stromal Tumor 112
3. Clinical and Radiographic Features 25 6.13 Leiomyoma 117
3.1 Clinical Information 26 6.14 Myofi broma and Myofi bromatosis 120
3.2 Imaging of Soft Tissue and 6.15 Solitary Fibrous Tumor 122
Bone Tumors 28 6.16 Low-Grade Fibromyxoid Sarcoma 125
Jamie T. Caracciolo
7. Intermediate- to High-Grade Spindle Cell
Tumors 129
PART II: TUMORS OF SOFT TISSUE
7.1 Leiomyosarcoma 130
7.2 Dermatofi brosarcoma Protuberans 133
4. Tumors With Adipose Differentiation 35
7.3 Infantile Fibrosarcoma 136
4.1 Lipoma With Variants 36
7.4 Adult Fibrosarcoma 139
4.2 Spindle Cell/Pleomorphic Lipoma 40
7.5 Malignant Peripheral Nerve Sheath
4.3 Hibernoma 42
Tumor 143
4.4 Lipoblastoma 44
7.6 Spindle Cell/Sclerosing
4.5 Atypical Lipomatous Tumor/Well-
Rhabdomyosarcoma 146
Differentiated Liposarcoma 46
7.7 Synovial Sarcoma 149
4.6 Dedifferentiated Liposarcoma 50
5. Tumors With Myxoid Stroma 53 8. Epithelioid Soft Tissue Tumors 155
5.1 Ganglion Cyst 54 8.1 Rhabdomyoma 156
5.2 Myxoma 56 8.2 Granular Cell Tumor 159
5.3 Aggressive Angiomyxoma 58 8.3 Glomus Tumor 162
5.4 Myxoid Liposarcoma 61 8.4 Neoplasms With Perivascular Epithelioid
5.5 Extraskeletal Myxoid Cell Differentiation (PEComa) 164
Chondrosarcoma 66 8.5 Myoepithelial Tumors of Soft
5.6 Myxofi brosarcoma (High Grade) 68 Tissue 167
viii ■ CONTENTS
8.6 Clear Cell Sarcoma 169 PART III. TUMORS OF BONE
8.7 Epithelioid Sarcoma 172
15. Osseous Lesions 273
8.8 Alveolar Soft Part Sarcoma 177
15.1 Osteoma 274
9. Small Round Blue Cell Tumors 181 15.2 Osteoid Osteoma 277
9.1 Embryonal Rhabdomyosarcoma 182 15.3 Osteoblastoma 280
9.2 Alveolar Rhabdomyosarcoma 187 15.4 Osteosarcoma 283
9.3 Desmoplastic Small Round Cell 15.5 Major Histologic Variants of
Tumor 192 Osteosarcoma 288
9.4 Extrarenal Rhabdoid Tumor 195 15.6 Parosteal Osteosarcoma 293
9.5 Melanotic Neuroectodermal Tumor of 15.7 Periosteal Osteosarcoma 297
Infancy 197
16. Cartilaginous Lesions 301
10. Giant Cell-Rich Tumors 199
16.1 Enchondroma 302
10.1 Plexiform Fibrohistiocytic Tumor 200
16.2 Osteochondroma and Bizarre Parosteal
10.2 Tenosynovial Giant Cell Tumors 203
Osteochondromatous Proliferation
10.3 Giant Cell Tumor of Soft Tissue 208
(Nora’s Lesion) 306
11. Soft Tissue Tumors With Infl ammation 211 16.3 Chondroblastoma 310
11.1 A ngiomatoid Fibrous 16.4 Chondromyxoid Fibroma 313
Histiocytoma 212 16.5 Chordoma 317
11.2 Myxoinfl ammatory Fibroblastic 16.6 Chondrosarcoma 322
Sarcoma 214 16.7 Clear Cell Chondrosarcoma 327
11.3 Infl ammatory Myofi broblastic
Tumor 218 17. Giant Cell-Rich Lesions 331
11.4 IgG4-Related Diseases 221 17.1 Langerhans Cell Histiocytosis
(Eosinophilic Granuloma) 332
12. Vascular Tumors 225 17.2 Giant Cell Lesion of Small Bones (Giant
12.1 Hemangiomas 226 Cell Reparative Granuloma) 336
12.2 Hemangioendothelioma 231 17.3 Giant Cell Tumor of Bone 339
12.3 Kaposi Sarcoma 234
12.4 Angiosarcoma 237
18. Spindle Cell Tumors 343
18.1 Fibrous Dysplasia 344
13. Pleomorphic Soft Tissue Tumors 241
18.2 Nonossifying Fibroma 348
13.1 P leomorphic Hyalinizing Angiectatic
18.3 Osteofi brous Dysplasia 351
Tumor of Soft Parts 242
18.4 Adamantinoma 355
13.2 Pleomorphic Liposarcoma 244
18.5 Desmoplastic Fibroma of Bone 359
13.3 P leomorphic Myogenic Sarcomas
18.6 Undifferentiated High-Grade Sarcoma of
(Rhabdomyosarcoma and
Bone 362
Leiomyosarcoma) 247
13.4 Intimal Sarcoma 249
19. Small Round Blue Cell Tumors 365
13.5 U ndifferentiated/Pleomorphic
19.1 Ewing Sarcoma and Primitive
Sarcoma 251
Neuroectodermal Tumor 366
14. Soft Tissue Tumors With Osseous or 19.2 Lymphoma of Bone 371
Cartilaginous Matrix 255 19.3 Plasmacytoma 374
14.1 Myositis Ossifi cans 256 19.4 Mesenchymal Chondrosarcoma 378
14.2 P hosphaturic Mesenchymal Tumor 260
14.3 Tumoral Calcinosis 262 20. Cystic Lesions 381
14.4 Synovial Chondromatosis 265 20.1 Aneurysmal Bone Cyst 382
14.5 O ssifying Fibromyxoid Tumor of 20.2 Simple Bone Cyst 386
Soft Parts 267
14.6 Extraskeletal Osteosarcoma and Selected Readings 389
Chondrosarcoma 270 Index 413
Preface
Why another tome on bone and soft tissue sarcoma? for several reasons. Needle core biopsy now
There are already a number of excellent and compre- represents the fi rst-line diagnostic procedure of choice
hensive works on this topic by numerous authors, some in most sarcoma centers. When cores are obtained
with multiple editions to their credit. The authors of under image guidance, there are frequently requests
this volume undertook the task of compiling this Atlas for “rapid on site evaluation” (ROSE) for an assort-
of Soft Tissue and Bone Pathology with the goal to ment of reasons. Many will use ROSE as a tool to
present to potential readers a very unique type of work. ensure that any given specimen is “adequate” and
One challenge for the authors was to present this representative of the lesion. But immediate study of
material in a manner that is simultaneously practi- the cytologic fi ndings also represents an additional
cal and logical. We have chosen to arrange this mate- opportunity to identify features that may be help-
rial in a more or less “pattern-based” scheme. This ful in formulating a fi nal diagnosis. In addition, a
approach to diagnosing lesions of soft tissue and cytologic “snapshot” of the tumor can help facilitate
bone differs from the standard classifi cation scheme an appropriate “triage” of material for appropriate
in that it emphasizes morphologic features instead of ancillary study. The latter is crucial, as the “do more
a presumed tissue of origin. While this approach has with less” challenge requires that tissue be utilized in
its relative merits and drawbacks, we feel it is particu- the most effi cient manner possible.
larly well suited to diagnosis on small tissue samples. Readers of this Atlas will also note that there are
Those of us who have been in practice for a number a number of radiographic illustrations. These were
of years have seen a dramatic decrease in the quantity included for several reasons. First, imaging studies
of specimen available for examination. At the same provide extremely valuable information about the
time, we are being asked to provide more informa- nature of any given tumor. While pathologists are not
tion to guide and facilitate appropriate treatment. expected to be experts at interpreting various imag-
In some instances, this may include neoadjuvant ther- ing modalities, it is essential that those working in the
apy that will hopefully obliterate the tumor before it fi eld of “sarcoma” have some knowledge of the basic
is removed for fi nal pathologic examination. features of tumors on imaging. In addition, we feel
The authors of this book fully embrace the move that it is important that pathologists be active partici-
to small needle biopsy specimens, both core biopsy pants in the multidisciplinary approach to sarcoma
and fi ne needle aspiration. Even on a quick perusal diagnosis and treatment. Examination of imaging,
through this work, it will become obvious that we commonly in a tumor board setting, is becoming a
are enthusiastic about the role of fi ne needle aspira- routine part of the day for those of us who attempt to
tion in the diagnosis of sarcoma. Wherever possible become profi cient in the diagnosis of sarcoma.
we have tried to provide high quality examples of the In summary, we have attempted to provide a fairly
representative cytologic features of many of the enti- comprehensive yet concise guide to most of the more
ties discussed and illustrated. We acknowledge that common soft tissue and bone lesions. We have pur-
the diagnosis of sarcoma primarily by fi ne needle posely strived to keep the text at a minimum but have
aspiration is controversial and practiced at only a raided our collective image fi les and exhibited these with
handful of centers. Nevertheless, we feel that illus- abandon. We sincerely hope that the users of this Atlas
tration of these fi ndings in this volume is i mportant will fi nd this is a valuable “scope side” reference source.