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Dr. Rajasekhar A. National Pathology Laboratory Hyderabad

This document defines sarcomas as malignant tumors arising from mesenchymal tissues like bone, cartilage, fat, muscle, blood or lymph vessels. Sarcomas of the jaw bone are rare, accounting for 1% of malignant tumors in that area, with most patients between 1-80 years old presenting with pain, swelling, ulceration or hemorrhaging. Accurate diagnosis requires histopathological confirmation and possibly immunohistochemistry. Diagnostic workup involves imaging like x-rays, CT or MRI as well as biopsy. Histological examination identifies subtypes like osteosarcoma. Immunohistochemistry aids in distinguishing sarcomas from carcinomas and identifying the tissue of origin. Grading systems evaluate the malignancy level,

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Amit Kumar
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138 views

Dr. Rajasekhar A. National Pathology Laboratory Hyderabad

This document defines sarcomas as malignant tumors arising from mesenchymal tissues like bone, cartilage, fat, muscle, blood or lymph vessels. Sarcomas of the jaw bone are rare, accounting for 1% of malignant tumors in that area, with most patients between 1-80 years old presenting with pain, swelling, ulceration or hemorrhaging. Accurate diagnosis requires histopathological confirmation and possibly immunohistochemistry. Diagnostic workup involves imaging like x-rays, CT or MRI as well as biopsy. Histological examination identifies subtypes like osteosarcoma. Immunohistochemistry aids in distinguishing sarcomas from carcinomas and identifying the tissue of origin. Grading systems evaluate the malignancy level,

Uploaded by

Amit Kumar
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Dr. Rajasekhar A.

National Pathology Laboratory


HYDERABAD.
Definition of Sarcoma
 Malignant tumor arising from the mesenchymal
tissues – Malignant Mesenchymal Tumor (MMT)

 Malignant tumor s of bone, cartilage, fat, muscle,


vascular or haematopoetic tissues.

 Greek σάρξ sarx meaning "flesh“.


Sarcomas - Overview

Sarcomas of Jaw bones are rare – 1 % of all the


malignant tumors.
Age group : 1 to 80 years : Bimodal distribution.
 Pain and swelling are common symptoms.
 Ulceration and hemorrhage.
 Skin/Mucosa – red, inflamn, vascular prominence.
 Short duration indicating rapid growth rate
Sarcomas - Overview
 Highly aggressive in behaviour.

 Accurate diagnosis is necessary .

 Histopathological confirmation +/-


Immunohistochemistry are helpful.
Diagnostic work-up
 Routine clinical and biochemical investigations.
 Radiological work-up – X-ray/OPG.
 Cytology – Fine Needle Sampling or Aspiration.
 Biopsy – Trucut or Punch or Open
 Immunohistochemistry
Radiological features :
 X-rays (Orthopantomogram)

 Computerized Tomography

 Magnetic Resonance Imaging.

 Angiography
Radiological features :
 Diffuse radiolucent lesion.
 Ill-defined borders.

 Wide bone destruction.

 New bone formation.


 High vascularity.
Osteosarcoma of mandible.
FNS/AC in Sarcomas: Advantages.
 Rapid preliminary diagnosis – few hours-one day.

 No need of hospitalization or anesthesia.

 Excellent patient compliance – minimal pain

 Minimal complications – local hematoma.


FNS or FNAC – Material & Methods
 23-25 G Needles.
 10 ml Syringe.
 8-10 Glass slides.
 95% Alcohol solution.
 Couplin Jar with label.
 Wait for 10 minutes.
 Stain with Papanicolou’s, H & E and MGGiemsa.
Fine Needle Aspiration Cytology
FNS/AC in Sarcomas: Disadvantages

 Experienced Cytologist is needed.

 Inability to hit deeper regions or penetrate bone.

 ? Tumor spread along the needle tract.

 Tissue architecture is difficult to ascertain.


Histology techniques :
 Biopsy tissue fixed in 10% Neutral Buffered Formalin.

 Processed routinely to Paraffin wax.

 Sectioned in 3-4 micron slices.

 Routine Haematoxylin and Eosin staining.


Histological types of sarcomas
 Osteosarcomas.
 Osteogenic or Chondroid types.
 Rhabdomyosarcoma.
 Ewing’s sarcoma.
 Lymphoma – Burkitt’s type.
 Granular sarcomas (Myeloid leukemia)
 Kaposi’s sarcoma.
Histological patterns :
 Spindle cell sarcomas
 Fibrosa, Neurofibrosa.
 Pleomorphic sarcomas.
 Osteosa, Rhabdomyosa.

 Round cell sarcomas


 Lymphoma, leukemia, Ewings
 Vascular sarcomas
 Kaposi sa. or rare Osteosa.
Sarcoma : Spindle cell pattern
Sarcoma : Pleomorphic pattern
Sarcomas : Round cell pattern
Grading of Sarcomas (NCI):
 Grade I :
 Fibrosa., Liposa., Leiomyosa., Chondrosa.,
Hemangipericytoma.

 Grade II :

 Grade III :
 Osteosa., Rhabdosa., Ewing’s, Lymph./Leukemia,
Kaposi’s types.
Immunohistochemistry of Sarcomas
 Cytokeratin+EMA – Sarcoma vs. Carcinoma
 Desmin + SMA – Myogenic / Myofibroblastic origin.
 S100 protein – Neurogenic / Melanocytic origin.
 CD99 antigen – Ewing’s sarcoma.
 Leucocyte Common Antigen – Burkitt’s+Granulocytic
 HMB45 antigen – Melanoma.
 Vimentin – Not an useful marker.
 Ki67 antigen – Proliferative index – malignant/benign
Spindle cell sa… S100 antigen
Pleomorphic sa… Cytokeratin
Round cell tumor : CD99 antigen
IHC : Vascular pattern: CD31
IHC : Ki antigen staining

Benign tumor Malignant tumor


Dr. Rajasekhar A.
National Pathology Laboratory

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