Pathology: SOFT TISSUE TUMORS

in medicine •  9 months ago

Introduction:

I am soon to be a certified pathologist in Norway.
Pathologist look in the microscope and make diagnoses based on a morphological analysis of the pathological tissues sampled.

The field of pathology is certainly going to undergo major changes in the years to come, where the microscope is going to be replaced by image analysis only (digital pathology) Peter Bankhead et al., Lab Invest. 2018 Jan;98(1).
However, I am a little uncertain if blockchain technology will be implemented as well, because it has some aspects that will make it very suitable as a use case. The images could be stored on the blockchain forever, and pathology is a very international field, so it is possible to collaborate with people across borders.

Right now I am mostly working with soft tissue tumor pathology:

Most soft tissue tumors are benign (i.e. lipoma), but sarcomas are very rare tumors, with benign entities at a ratio of 100:1. Most tumors are originated from the mesenchym (the mesoderm). The term sarcoma from Greek (sarx is flesh), meaning “fleshy tumor”.
They are very rare tumors:
In Norway approximately 170 case of soft tissue sarcomas and 44 bone sarcomas are diagnosed yearly (The Cancer Registry of Norway, 2013).

I will put some description on some of the cases in sarcoma pathology and other fields of pathology, but with out any mention of particular cases or images (only Wikipedia images for now).

Solitary Fibrous Tumor


Definition:


A fibroblastic tumor displaying a hemangiopericytoma-like growth pattern with staghorn vessels.

General:


Solitary fibrous tumor (SFT) is rare tumor that was formerly called hemangiopericytoma.
In the WHO classification 2013 the entity is called SFT.
Usually middle aged aged adults (20-70 years).
Can be localised almost everywhere.
The symptoms are few as the tumor grows as a slow growing painless mass, but compression symptoms may arise (e.g. orbita and nose).
Some tumors may metastazise.

Macroscopic description:


The tumor is often well-defined (1-25 cm) with a multinodular, whitish and firm cut surface. Infiltrative growth and necrosis can be seen in malignant variants.

Histologic description:


Very varied cellular presentation, displaying a patternless pattern with hypo- and hypercellular areas separated by thick hyalinized collagen
Dilated and branching vessels (staghorn) with perivascular sclerosis can be seen
The tumor cells are dispersed along thing collagen bands and are oval, spindle shaped with sparse cytoplasma and small elongated nuclei with indistinct nucleoli
Some pleomorph cells may be seen
Usually few mitotic figures (< 3 mitoses/ 10 HPF)

Histologic images:


Solitary_fibrous_tumour_low_mag.jpg
By Nephron - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=10728962
Solitary_fibrous_tumour_high_mag.jpg
By Nephron - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=10728934

Positive stains:


STAT6
CD34 80-95%
CD99 70%

Negative stains:


Desmin
Keratin
S-100
CD117

Molecular and cytogenetics:


The gene fusion, NAB2-STAT6 (12q13.3) is pathognomonic.

Differential diagnosis:


Benign: Benign fibrous histiocytoma, Schwannoma
Malignant: Synovial sarcoma, malignant peripheral nerve sheath tumor, undifferentiated pleomorphic sarcoma (UPS).

Treatment and prognosis:


Complete surgical excision
The prognosis of SFT may vary, and histological presentation does not necessarily predict the potential for malignancy
Approximately 10% have a malignant presentation
The criteria for malignant is not fixed, but > 3 mitosis/ 10 HPF is highly suspect of malignancy.

References:

WHO Classification of Tumours of Soft Tissue and Bone (IARC WHO Classification of Tumours), 4th Edition, 2013, edited by Christopher D. M. Fletcher, Julia A. Bridge, Pancras C. W. Hogendoorn and Fredrik Mertens
Enzinger & Weiss’s Soft Tissue Tumours, 6th Edition, edited by John R. Goldblum, Andrew L. Folpe and Sharon W. Weiss
Chan JK. Solitary fibrous tumour - everywhere, and a diagnosis in vogue. Histopathology. 1997 Dec;31(6):568-76.
Robinson DR et al. Identification of recurrent NAB2-STAT6 gene fusions in solitary fibrous tumor by integrative sequencing. Nat Genet. 2013 Feb;45(2):180-5

By @janusface

Authors get paid when people like you upvote their post.
If you enjoyed what you read here, create your account today and start earning FREE STEEM!
Sort Order:  

It's great to hear that you're close to accomplishing your goal!

Question: Do you mean that microscopes will be useless in the years to come?

·

The future is uncertain, but it is probable that the individual pathologist would make diagnoses on digital images an not by looking in the microscope. That would save some time and microscopes take up space and are expensive. Digital pathology has been hyped for many years, so it is still not used much, at least not in Norway.

·
·

That's interestring to learn. Thank you! You say it's not used in Norway. And judging by how slow technological advances reach Greece's public health system, we have an even loooonger way to go :P

Sounds like some complicated stuff. Better you than me with a career like this. My new expertise is knowing the price of a taxi from the Historic center of Cuscu Peru to the airport! lol

Congratulations on your certification! Wishing you the best as always! -Dan

To listen to the audio version of this article click on the play image.

Brought to you by @tts. If you find it useful please consider upvote this reply.

·

Nice audio version:)

·

That's great thanks

Am not much into the field of medicine.. but I know a thing or two about pathology from the movies. Having 170 cases of soft tissue sarcomas and 44 bone sarcomas diagnosed in Norway yearly is so absurd. It gets me wondering how developing countries with less support are managing.
Blockchain technology is making a great success in many fields of profession and this is one field it will make a huge impact on.

Although I do not have any ideas on this topic, I think you have created a great post ... Your writing experience is very good ...... Thanks

just ah perfect click!

I have some information about this. Soft tissue tumors form a large variety of tumors, most of them benign, some malignant and called sarcoma - sarcomas.
The source of these tumors is the intermediate, multi-force, and primitive mesenchymal cells, which are classified during their evolution into a tumor, into one or more cells.
Soft tissue tumors are classified according to the type of tissue that the tumor tries to develop (lipid, connective tissue, muscle, etc.). Thanks for the valuable participation @ janusface

Congratulation for becoming a certified pathlogist. Well explained and described, but i didnot understand your whole post, because its too tough te be understood :-)..
By the way nice post :-)

Glad to hear about that buddy !congrats for getting to be near a pathologist !

All the very best for your coming days !

I do not really understand the whole message. I just do not want such a terrible disease to anyone.

You have received an upvote from STAX. Thanks for being a member of the #steemsilvergold community and opting in (if you wish to be removed please follow the link). Please continue to support each other in this great community. To learn more about the #steemsilvergold community and STAX, check this out.


For Your Information (FYI)
Mr. Magoo faught against lot of comment spams. Due to that battle against comment spammers, they are creating copy-cats of Mr. Magoo as: They spam comment sections & trying to pretend themselves as bot accounts of Mr. Magoo. They refer Mr. Magoo's data sources & going after your generous rewards. Mr. Magoo has no business with these fake spammer bot accounts & Mr. Magoo is a genuine, single project which directly fight against comment spammers.

Thanks & Best Regards,
Mr. Magoo

Thanks for this excellent post friend 👌

thanks for sharing about it and congratulations in advanced :D