Tumors of the Soft Tissues, by Arthur Purdy Stout and Raffaele Lattes (1967) / Chapter Skim
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BENIGN TUMORS AND TUMOR-LIKE PROLIFERATIONS
BENIGN TUMORS AND TUMOR-LIKE PROLIFERATIONS
Pages 15-68
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vascular leiomyomas, which apparently arise from the smooth muscle of blood vessels. The latter are very vascular.
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Granular Cell Myoblastoma SYNONYMS AND RELATED TERMS: AbrikossoH's tumor; embryonal rhabdomyoblastoma; epulis of newborn; "granular cell neurofibroma"; granular myoblastoma; myoblastic myoma; myoblastoma; "pleomorphic-cell sarcoma." It is probable that no tumor at the present time has aroused more interest and greater differences of opinion than the mysterious granular cell tumor which is most frequently called granular cell myoblastoma. Although sporadic cases have been recorded under various names at least since 1854, it was first described as an entity by Abrikossoff in 1926.
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The tumor is composed of blood vessels with smooth muscle in their coats, and there is additional unrelated smooth muscle in the stroma shown at lower left.
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Tumors of the Soft Tissues Fig.
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Malignant granular cell myoblastoma of thigh (organoid type)
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Tumors of the Soft Tissues Fig.
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However, it must be noted that four tumors in the Columbia series with this relatively benign appearance have behaved like malignant tumors and metastasized, so that one cannot make the sweeping statement that tumors with the classic morphology of the common accepted form of granular cell myoblastomas are always harmless. The specialized tumor variously called organoid granular cell myoblastoma and paraganglioma will be described later in the section on Malignant Granular Cell Myoblastoma, since it is a malignant tumor.
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. If the vascular tumor has vessels with thicker walls containing smooth muscle cells, it is called a venous hemangioma (pl.
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The photomicrograph shows scattered muscle fibers separated by blood vessels, some of which have smooth muscle in their walls.
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Tumors of the Soft Tissues Fig.
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A: This shows the capillaries lined with normal endothelial cells with the tumor cells packed in tightly about them. B: In a Laidlaw silver reticulin impregnation the capillary sheaths are clearly defined.
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Tumors of the Soft Tissues «'*
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Subungual glomus tumor. Cajal impregnation, showing the rich plexus of delicate axis cylinders, which occupies the loose-textured spaces found between the masses of pericytes.
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Tumors of the Soft Tissues Fig.
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It has a muscular coat with pericytes surrounding it and intermingled with the smooth muscle cells. (Figure 6 from Stout.
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Tumors of the Soft Tissues .''•-::^ V;;n j .
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Some hemangiopericytomas approximate the appearance of venous hemangiomas, except that the spindle-shaped cells oriented around vascular lumens have no myofibrils. Others with rounded cells oriented outside the reticulin sheaths of capillaries somewhat resemble glomus tumors, but differ because they are not organoid and grow progressively by infiltration.
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OTHER BENIGN TUMORS Benign Tumors Composed of Cartilage or Bone It seems to be well established that the extraskeletal formation of bone can take place about almost any group of mesenchymal cells, provided there can be mobilized at the site the proper concentration of mineral salts, enzymes, a flexible pH, and an adequate blood supply. Whether or not the local cells control this complicated, physiochemical interaction is unknown.
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The photomicrograph shows multiple and sometimes cystic lymphatic vessels with foci of lymphoid tissue.
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Tumors of the Soft Tissues ., •, *
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They propose the name parosteal osteoma for it; the term is unfortunate, since the tumor is malignant while the name osteoma connotes a benign tumor. Generally this tumor can be distinguished histologically from simple myositis ossificans because there is some degree of atypism in the formation of the bone trabeculae and the fibroblastic stroma and because the bony growth is not interdigitated with the striated muscle fibers.
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The presence of fibrous tissue as one element in a tumor is so frequent that it seems wise not to call a tumor mesenchymoma if it is composed of fibrous tissue and only one other element, such as fat or smooth muscle, but to reserve the term for any tumor made up of two or more mesenchymal elements other than fibrous tissue. It is a term included here among the benign tumors for convenience.
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It shows differentiated cartilage and osteoid. which has extended between small groups of muscle fibers.
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Tumors of fhe Soft Tissues Fig.
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The reasons for supposing that these fibrous tumors are derived from mesothelial cells are based upon the observation of Murray that the cells of a malignant variant of a solitary mesothelioma grew mesothelial cells when explanted in vitro and upon the observations of Maximow that normal mesothelial cells can behave like fibroblasts in vitro. Blue Nevus The characteristics of the blue nevus necessary for its diagnosis are that it is a fibrous growth resembling a skin fibroma that does not touch the epidermis or extend into the papillary layer, contains varying numbers of elongated, strap-shaped, often stellate melanoblasts, and has no ordinary mole cells.
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Tumors of the Soft Tissues TSC -- •»• ""^ *
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Tumors of the Soft Tissues PLATE III FIBROSARCOMA f A Fibrosarcoma of abdominal wall extending into the subcutaneous fat.
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Tumors of the Soft Tissues I PLATE III
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Tumors of the Soft Tissues Fig.
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The tumor still has a relatively adult appearance of its fibroblasts with many intercellular connective tissue fibers but a rather high mitotic rate, which is indicative of malignancy.
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Tumors of the Soft Tissues I*
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The cells and hyaluronic acid are enclosed within a delicate meshwork of reticulin fibers. The quantity and density of the connective tissue vary not only in different tumors but in different parts of the same tumor.
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Tumors of the Soft Tissues -- .
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P Liposarcoma, the malignant tumor of lipoblasts.
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Tumors of the Soft Tissues / Fig.
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A: Here they form bundles of spindle-shaped cells of varying sizes, which might be mistaken for myoblasts. B: The bizarre giant cells with loamy cytoplasm betray the true nature of the neoplasm.
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Tumors of the Soft Tissues 'S"%Jfi Fig. 51 tffelB v*
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B:* There are many undifferentiated anaplastic lipoblasts, but the signet ring cell betrays the true nature of the neoplasm.
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Tumors of fhe Soft Tissues Fig.
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MALIGNANT TUMORS OF MUSCLE Leiomyosarcoma SYNONYMS AND RELATED TERMS: Malignant leiomyoma; metastasizing leiomyoma: myosarcoma. Malignant tumors of smooth muscle have been infrequently reported except in the uterus, broad ligament, and gastrointestinal tract.
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Tumors of the Soft Tissues B Fig.
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Rhabdomyoblasts from two different malignant tumors show variations in shape and size. The high magnification is necessary to demonstrate indistinct cross striations.
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Tumors of the Soft Tissues Fig.
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218822-59. MALIGNANT GRANULAR CELL MYOBLASTOMA Figure 60.
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Tumors of the Soft Tissues • •/ \ , ,]
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These three groups are all composed of granular cells, and according to him all are benign tumors; (4) a malignant form in which the myoblasts are not granular but assume atypical aspects and vary in size, so that the tumor resembles a polymorphous sarcoma.
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It is uncertain whether or not this is a true neoplastic process; nevertheless, it seems impossible to avoid reference to it in any consideration of malignant vascular tumors. It is possible that the smooth muscle of veins and arteries may give rise to leiomyosarcoma, since the smooth muscle of veins can produce benign leiomyomas; but proof of this is exceedingly difficult to obtain, for when such a tumor is found attached to a large vessel, there is no sure way of proving whether it sprang from or invaded it.
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When the tumor cells have overgrown the entire field so that in ordinary stains the nature of the tumor is obscured, the silver reticulin impregnation may still show the basic vascular pattern by emphasizing the reticulin sheaths of the capillaries. Confirmation of the nature of the cells composing such a tumor may be gained if tissue culture can be done (Murray and Stout)
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Detail from figure 64. The proliferated tissue consists of capillaries, many of which are inconspicuous, because they are intermingled with more easily apparent, spindle-shaped fibroblastic cells resembling those seen in a fibrosarcoma.
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Tumors of fhe Soft Tissues Fig.
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A malignant tumor composed of cells identified as probable reticuloblasts is found on rare occasions in the deeper soft tissues involving subcutaneous tissues and muscles or their sheaths. It has apparently no connection with bone marrow, lymph nodes, or skin; it does not form follicles or lymphocytic tumor cells; and it has been presumed, fattte de mieux, that the origin is from cells of the reticuloendothelial system, since these are ubiquitous.
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Reticulum cell sarcoma of scapular region. A 23-year-old woman developed a painless lump on the left shoulder, which in a year reached a size of 9X?
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Tumors of the Soft Tissues ,*
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