Skeletal

1. dr. Sanggam B Hutagalung, M.BioMed,SpPA
Dept. Patologi Anatomi Fakultas Kedokteran
Universitas Methodist Indonesia
PATOLOGI SISTEM
MUSCULOSKELETAL
Joint and Soft tissue diseases

2. SOFT TISSUE TUMORS.
• Adipose tissue.: Lipomas –Liposarcomas
• Fibrous tissue: Fibroma-Fibrosarcoma
• Skeletal muscle : Rhabdomyoma ,
Rhabdomyosarcoma
• Smooth muscle: Leiomyoma-Leiomyosarcoma
• Vascular tumors: Hemangioma-Angiosarcoma
• Peripheral nerve tumors.
• Unknown exact cell of origin

3. • Malignant soft tissue tumors are graded
according to differentiation into I-III grades
• Grades I&II may recur but rarely metastasize
prognosis of malignant tumours depends on the
histologic type,its degree of differentiation (
Grade), size and the anatomic site( Stage).
• The prognosis depends on Type, Grade,
Stage, & Site

4. Tumors of Adipose tissue:
Lipoma
• Commonest of soft tissue tumors
• Most in subcutaneous tissue
• Single or multiple, may be familial
• No malignant transformation
• Grossly : Circumscribed yellow mass
• Histologically : Mature fatty tissue
• Many histological variants

5. Liposarcoma
• Adults 50-60yrs
• Deep soft tissue & retroperitoneum
• Grossly : Large yellow glistening mass
• Histologically :
– Low grade : Well differentiated & Myxoid
– High grade :Round & Pleomorphic
(Diagnosis depends on identification of lipoblasts)
• Prognosis depends on type

6. FAT
• LIPOMA
• LIPOSARCOMA
NORMAL FAT LIPOMA,
encapsulated
LIPOSARCOMA, often
retroperitoneal

8. • Fibrous Tumors & Reactive
Proliferations

9. 1- Nodular fasciitis
Reactive fibroblastic proliferation frequently
misdiagnosed as sarcoma.
Mostly affects young adults and presents as
rapidly enlarging sometimes painful mass .
Location:- Upper extremity and trunk.
10% of patients have history of local trauma.
Self limiting
Similar reactive lesion is Myositis Ossificans

10. Morphology
Grossly: Unencapsulated < 3 cm mass in
subcutaneous tissue, muscle or fascia
Micro:- immature appearing fibroblasts with
high mitoses but no atypia set in myxoid
background.
( Tissue culture like appearance)

12. 2- Fibromatosis
 A group of fibroblastic proliferation, grow in
infiltrative fashion and to recur after surgical excision
but do not metastasize.
 Various age groups ,various gene mutations
 Two types:
A. Superficial:- palmar (Dupuytren contracture) and
penile ( Peyronie disease)
B. Deep called desmoid tumours that arise in the
abdomen,muscles of the trunk and extremities and
these tend to be more aggressive.

13. 3-Fibrosarcoma
Mostly affects adults, rare congenital in infants
Sites:- Deep tissues of thighs,knees and
retroperitoneum.
They tend to grow slowly.
Gross: are solitary,infiltrative or well circumscribed.
Micro: Fasicles of fibroblasts arranged in herringbone
appearance
Recurrence and metastatic rates depend on the grade.

15. 4- Fibrohistiocytic Tumors
• Several types
• Benign & malignant
• Most are in adults
• Superficial usually benign
• Deep often malignant, larger, highly
pleomorphic, metastasizing.
• Treatment by excision

16. Benign Fibrous Histiocytoma :
(Dermatofibroma)
• Common tumor
• Circumscribed tumor in dermis or
subcutaneous tissue < 1 cm.
• Histology : Spindle cells & histiocytes
No mitoses
Dermatofibrosarcoma Protruberance :
• As above, but larger, deeper
• Mitoses present, CD 34 positive
• Recurs after excision

17. • Tumors of Smooth Muscle :
• Benign : Leiomyoma , mainly uterine
but could arise from vascular smooth muscle
anywhere
• Malignant : Leiomyosarcoma,uterus or
soft tissue.
Superficial or large retroperitoneum or
extremities.

18. • Tumors of Skeletal Muscle

19. Rhabdomyosarcoma :
• Commonest sarcoma of children,adolescents
& young adults.
• Chromosomal translocation t(2;13)produces a
fusion gene (PAX gene) controlling muscle
differentiation
• Sites: Soft tissue, head & neck, genito-urinary
tract
• Aggressive tumor, treated by surgery,chemo
& radiation

20. SKELETAL MUSCLE
• RHABDOMYOMA
• RHABDOMYOSARCOMA

21. • Types :
 Embryonal:- most common type mainly
in head & neck, genitourinary &
retroperitoneum.
 Alveolar type: in extremities of
adolescents.
 Pleomorphic: in soft tissues of adults.
Diagnostic cell is the Rhabdomyoblast
which is Tadpole or Strap cell

22. Diseases of skeletal muscle

23. Diseases of skeletal muscle.
 Muscular atrophy
 Neurogenic atrophy
Muscular Dystrophies
 Duchenne muscle dystrophy.
 Becker muscle dystrophy.
Neuromuscular junction disorders.
 Myasthenia Gravis.
Inflammatory myopathies.
Inherited metabolic & congenital diseases.
Acquired metabolic and toxic diseases.

24. Spinal muscular atrophy with groups of atrophic muscle fibers resulting
from denervation atrophy of muscle in early childhood.
Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 28 September 2009 11:10 PM)
© 2007 Elsevier

25. A, Dermatomyositis. Note the rash affecting the eyelids.
B, Dermatomyositis. The histologic appearance of muscle shows
perifascicular atrophy of muscle fibers and inflammation..
Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 28 September 2009 11:10 PM)
© 2007 Elsevier

27. FIBROUS TISSUE
• NODULAR FASCIITIS (pseudosarcomatous)
• FIBROMATOSES (plantar,
palmar, penile)
• FIBROSARCOMA

28. FIBROHISTIOCYTIC
• FIBROUS HISTIOCYTOMA
• DERMATOFIBROSARCOMA PROTUBERANS
• MALIGNANT FIBROUS HISTIOCYTOMA

29. SMOOTH MUSCLE
• LEIOMYOMA
• LEIOMYOSARCOMA

32. VASCULAR
• HEMANGIOMA
• LYMPHANGIOMA
• HEMANGIOENDOTHELIOMA
• HEMANGIOPERICYTOMA
• ANGIOSARCOMA

33. PERIPHERAL NERVE
• NEUROFIBROMA
• SCHWANNOMA
• GRANULAR CELL TUMOR
• MALIGNANT (SCHWANNOMA)

34. UNCERTAIN
• SYNOVIAL SARCOMA
• ALVEOLAR “SOFT PART” SARCOMA
• EPITHELIOD SARCOMA