soft tissue guide

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Diagnosis and variants M/F Age Abdominal fibromatosis F>M Young Acquired tufted angioma Children Acral myxoinflammatory fibroblastic sarcoma M=F 30-50 Adenomatoid tumor 30-60 Adult rhabdomyoma M>F >40 Aggressive angiomyxoma F>M Alveolar soft part sarcoma F>M 15-35 Amyloidoma Angiolipoma M>F 15-50 - Cellular angiolipoma - Spinal angiolipoma Angiomatoid fibrous histiocytoma 10-40 Angiomatosis (Diffuse hemangioma) 0-20 Angiomyofibroblastoma F>>M Angiomyoma F>M 30-60 Angiosarcoma - Cutaneous angiosarcoma without lymphedema M>F 40+ - Angiosarcoma associated with lymphedema F>M 60-70 - Angiosarcoma of the breast F>>M 20-40 - Angiosarcoma of soft tissue M>F Any - Radiation-induced angiosarcoma Arterial spiders Arteriovenous hemangioma Atypical fibrous histiocytoma 20-50 Atypical fibroxanthoma Elderly Atypical vascular lesion Bacillary angiomatosis M>F Calcifying aponeurotic fibroma M>F 8-14 Calcifying fibrous pseudotumor F>M 10-30 Cardiac rhabdomyoma M=F Infants Cavernous hemangioma Children - Sinusoidal hemangioma F>M Cellular angiofibroma M=F Cherry angioma Chondroid lipoma F>M 20-40 Clear cell sarcoma of tendon and aponeurosis 20-40 Clear cell sarcoma-like tumor of gastrointestinal tract Crystal-storing histiocytosis Cutaneous leiomyoma Early Cutaneous myxoma M>F 20-40 Dedifferentiated liposarcoma M=F 50-70 Dermatofibrosarcoma protuberans M>F 20-50 - Pigmented DFSP (Bednar tumor) Desmoplastic fibroblastoma M>F 40-70 Desmoplastic melanoma Older Desmoplastic small round cell tumor M>F 15-35 Diffuse lipomatosis 0-2 Diffuse malignant mesothelioma M>F 45-75 Elastofibroma F>M 50-70

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It is a trial to differentiate between different types of soft tissue tumors in a table form. Selected from a facebook group. please; revise and write your comments. thanks

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Page 1: Soft Tissue Guide

Diagnosis and variants M/F AgeAbdominal fibromatosis F>M YoungAcquired tufted angioma ChildrenAcral myxoinflammatory fibroblastic sarcoma M=F 30-50Adenomatoid tumor 30-60Adult rhabdomyoma M>F >40Aggressive angiomyxoma F>MAlveolar soft part sarcoma F>M 15-35AmyloidomaAngiolipoma M>F 15-50 - Cellular angiolipoma - Spinal angiolipomaAngiomatoid fibrous histiocytoma 10-40Angiomatosis (Diffuse hemangioma) 0-20Angiomyofibroblastoma F>>MAngiomyoma F>M 30-60Angiosarcoma - Cutaneous angiosarcoma without lymphedema M>F 40+ - Angiosarcoma associated with lymphedema F>M 60-70 - Angiosarcoma of the breast F>>M 20-40 - Angiosarcoma of soft tissue M>F Any - Radiation-induced angiosarcomaArterial spidersArteriovenous hemangiomaAtypical fibrous histiocytoma 20-50Atypical fibroxanthoma ElderlyAtypical vascular lesionBacillary angiomatosis M>FCalcifying aponeurotic fibroma M>F 8-14Calcifying fibrous pseudotumor F>M 10-30Cardiac rhabdomyoma M=F InfantsCavernous hemangioma Children - Sinusoidal hemangioma F>MCellular angiofibroma M=FCherry angiomaChondroid lipoma F>M 20-40Clear cell sarcoma of tendon and aponeurosis 20-40Clear cell sarcoma-like tumor of gastrointestinal tractCrystal-storing histiocytosisCutaneous leiomyoma EarlyCutaneous myxoma M>F 20-40Dedifferentiated liposarcoma M=F 50-70Dermatofibrosarcoma protuberans M>F 20-50 - Pigmented DFSP (Bednar tumor)Desmoplastic fibroblastoma M>F 40-70Desmoplastic melanoma OlderDesmoplastic small round cell tumor M>F 15-35Diffuse lipomatosis 0-2Diffuse malignant mesothelioma M>F 45-75Elastofibroma F>M 50-70 - ElastofibrolipomaEBV-associated smooth muscle tumor ChildrenEpithelioid angiomatous noduleEpithelioid hemangioendothelioma M=F 10-90

Page 2: Soft Tissue Guide

Epithelioid hemangioma F>M 20-40Epithelioid sarcoma M>F 10-35 - Proximal-type epithelioid sarcomaEpithelioid sarcoma-like hemangioendotheliomaExtra-abdominal fibromatosis F>M 15-40Extra-cranial meningiomaExtra-gastrointestinal stromal tumor AdultsExtra-skeletal chondroma M>F 30-60Extra-skeletal Ewing's sarcoma/PNET M>F 0-30Extra-skeletal mesenchymal chondrosarcoma F>M 15-35Extra-skeletal myxoid chondrosarcoma M>F 35-60Extra-skeletal osteosarcoma M>F 35-80Extra-spinal ependymomaFetal rhabdomyoma - Myxoid fetal rhabdomyoma M>F 0-1 - Intermediate fetal rhabdomyoma M>F Adults - Neural variant of fetal rhabdomyomaFibroma of the tendon sheath M>F 20-50 - Pleomorphic fibroma of the tendon sheathFibrodysplasia ossificans progressiva M=F 0-6Fibromatosis colli M>F NewbornFibrosarcoma, classic type M>F 20-50Fibrous hamartoma of infancy M>F 0-2Fibrous histiocytoma (dermatofibroma) 20-50 - Aneurysmal fibrous histiocytoma - Cellular fibrous histiocytoma - Epithelioid fibrous histiocytoma - Lipidized fibrous histiocytomaFlorid vascular proliferation of the colonGanglion cell choristomaGanglion cyst F>M 25-45Ganglioneuroma M=F 5-40Gardner fibroma M=F YoungGenital rhabdomyoma F>>M YoungGiant cell fibroblastoma M>F 0-10Giant cell tumor of low malignant potentialGiant cell tumor of tendon sheath - Diffuse type F>M 4-76 - Localized type F>M 30-50 - Malignant F>M 12-79Gingival fibromatosis M=F YoungGlial heterotopia InfantsGlomangioma ChildrenGlomangiomatosis ChildrenGlomangiomyomaGlomeruloid hemangiomaGlomus tumor M=F 20-40 - Malignant glomus tumor - Glomus tumor of uncertain malignant potential - Symplastic glomus tumorGranular cell reactionGranular cell tumor F>M 30-60 - Congenital granular cell tumor F>M InfantsHemangioma of peripheral nerves 0-40

Page 3: Soft Tissue Guide

Hemangiopericytoma-like tumor of nasal passagesHemangiopericytoma / solitary fibrous tumor M=F AdultsHemosiderotic fibrohistiocytic lipomatous lesion AdultsHereditary hemorrhagic telangiectasia ChildrenHibernoma M>F 20-40Histoid leprosyHobnail hemangioma YoungHobnail hemangioendothelioma AnyIdiopathic retroperitoneal fibromatosis M>F 20-70Infantile digital fibromatosis F>M 0-3Infantile fibromatosis (lipofibromatosis) M>F 0-8Infantile fibrosarcoma M>F 0-2 - Infantile rhabdomyofibrosarcoma 0-3Infantile hemangiopericytoma 0-1Inflammatory myofibroblastic tumor F>M 0-45Inflammatory pseudotumor M~F 30-50Intra-abdominal fibromatosis F>M 20-35Intramuscular hemangioma M=F 0-30Intramuscular lipoma / Intermuscular lipoma M>F 30-60Intramuscular myxoma F>M 40-70Intranodal palisaded myofibroblastomaIntravenous leiomyomatosis F Pre-MPIschemic fasciitis F>M 70-90Juvenile hemangioma InfantsJuvenile hyaline fibromatosis M>F 0-5Juvenile xanthogranuloma InfantsJuxta-articular myxoma M>F 20-50Kaposi sarcoma - Classic Kaposi sarcoma M>F 50-70 - Endemic Kaposi sarcoma F>M - Iatrogenic Kaposi sarcoma - AIDS-related Kaposi sarcoma M>F YoungerKaposiform hemangioendothelioma ChildrenKeloid M=F 15-50Knuckle pads M=F 30-60 - PachydermatodactylyLeiomyoma of deep soft tissue M=FLeiomyomatosis peritonealis disseminata F Pre-MPLeiomyosarcoma F>M - Retroperitoneal/abdominal leiomyosarcoma F>M 60-70 - Leiomyosarcoma of somatic soft tissue M=F - Cutaneous leiomyosarcoma M>F 40-70 - Leiomyosarcoma of vascular origin F>F 50Lipoblastoma / Lipoblastomatosis M>F 0-35Lipoma M>F 40-60 - Fibrolipoma, sclerotic lipoma, myxolipoma, chondrolipoma, osteolipomaLipoma of joint (lipoma arborescens) M>F AdultsLipoma of tendon sheath M=F 15-35Localized massive edemaLow-grade fibromyxoid sarcoma M>F Wide - Hyalinizing spindle cell tumor with giant rosettes M>F 20-40Lumbosacral lipoma F>M 0-10Lymphangioma M>F 0-2 - Acquired progressive lymphangioma

Page 4: Soft Tissue Guide

- Cystic lymphangioma M>F ChildrenLymphangiomatosis M=F ChildrenMalakoplakiaMalignant extrarenal rhabdoid tumorMalignant fibrous histiocytoma M>F 50-70 - Storiform-pleomorphic MFH - Myxoid MFH - Giant cell MFH - Inflammatory MFHMalignant mesenchymomaMalignant peripheral nerve sheath tumor M~F 20-50Mammary-type myofibroblastoma M>F 60-70Melanotic neuroectodermal tumor of infancy 0-1Melanotic schwannomaMorton's neuroma F>MMucosal neuroma 0-20Multicystic peritoneal mesothelioma F>M YoungMuscular fibrosis 0-3Mycobacterial pseudotumorMyelolipoma >40Myofibroma / myofibromatosis M>F WideMyofibrosarcoma (myofibroblastic sarcoma) M>F 30-40Myolipoma F>M 40-60MyopericytomaMyositis ossificans M>F Young - Fibro-osseous pseudotumor of the digits F>M YoungMyxofibrosarcoma 40-70 M>F - Epithelioid myxofibrosarcomaMyxoid liposarcoma 25-45 - Round cell liposarcomaNasopharyngeal angiofibroma M>>F 10-20Nerve sheath ganglionNeural fibrolipoma (lipofibromatous hamartoma) M>F 0-30Neuroblastoma and ganglioneuroblastoma M>F 0-5Neurofibroma - Localized neurofibroma M=F 20-30 - Plexiform neurofibroma Children - Diffuse neurofibroma - Pigmented neurofibromaNeuromuscular hamartoma ChildrenNeurothekeoma Children - Cellular neurothekeomaNevus flammeusNevus lipomatosus cutaneous superficialis M=F 0-20Nodular fasciitis M=F 20-40 - Cranial fasciitis Infants - Intravascular fasciitis M=F < 30 - Ossifying fasciitisNuchal-type fibroma M>F 20-50Odontogenic myxoma F>M YoungOlfactory neuroblastoma M=F 40-60Ossifying fibromyxoid tumor of soft parts M>F 50Pacinian neuromaPalisaded encapsulated neuroma M=F

Page 5: Soft Tissue Guide

Palmar fibromatosis M>F >30Papillary endothelial hyperplasiaParachordoma / mixed tumor / soft tissue myoepithelioma M=F 10-40Paraganglioma - Carotid body paraganglioma M>F 40-60 - Jugulotympanic paraganglioma F>M 40-50 - Vagal paraganglioma F>M - Mediastinal paraganglioma M=F >40 - Retroperitoneal paraganglioma M=F 30-45Paraganglioma-like dermal melanocytic tumorPelvic lipomatosis M>F 20-40Penile fibromatosis M 45-60Perineurioma - Intraneural perineurioma Young - Extraneural perineurioma M=F Adults - Sclerosing perineurioma M>F Young - Reticular perieuriomaPerivascular epithelioid cell neoplasm (PEComa) F>M 30-40 - Angiomyolipoma F>M 40s - Lymphangiomyoma / lymphangiomyomatosis F>>M 40sPhosphaturic mesenchymal tumorPlantar fibromatosis M=F AnyPleomorphic fibroma of the skin F>M 40sPleomorphic hyalinizing angiectatic tumor of soft parts F>M 50sPleomorphic liposarcoma ElderlyPlexiform fibrohistiocytic tumor 0-30Polymorphous hemangioendotheliomaPolyvinylpyrridoline (PVP) granulomaProliferative fasciitis M=F 40-70Proliferative myositis M=F 45-65Proteus syndrome M=FPyogenic granuloma M=F AllReactive nodular fibrous pseudotumorReticulohistiocytoma (solitary) M>F AdultsReticulohistiocytosis (multicentric)Rhabdomyomatous mesenchymal hamartoma M>>F 0-1Rhabdomyosarcoma M>F 0-25 - Embryonal rhabdomyosarcoma (ERMS) 0-10 - ERMS, spindle cell type M>F Young - ERMS, botryoid type - Alveolar rhabdomyosarcoma 10-25 - Pleomorphic rhabdomyosarcoma M>F >45 - Sclerosing rhabdomyosarcoma M~F 18-50Rosai-Dorfman disease (extranodal)Schwannoma M=F 20-50Schwannomatosis M=FSclerosing epithelioid fibrosarcoma M=F WideSilica reactionSpindle cell hemangioma YoungSpindle cell/pleomorphic lipoma M>F 45-60Spindle cell liposarcomaSteroid lipomatosis VariesSymmetric lipomatosis M>F AdultsSynovial chondromatosis

Page 6: Soft Tissue Guide

Synovial hemangioma YoungSynovial sarcoma M>F 15-40Traumatic neuromaTumoral calcinosis M=F YoungVascular transformation of lymph nodesVenous hemangiomaWell-differentiated liposarcoma M=F 50-70 - Lipoma-like well differentiated liposarcoma - Sclerosing well differentiated liposarcoma - Inflammatory well differentiated liposarcoma - LipoleiomyosarcomaWell-differentiated papillary mesothelioma F>M 20-40Xanthoma

Page 7: Soft Tissue Guide

Location Positive IHC and special stainsAbdominal wall

Fingers, hands, toes, feet, ankles Vimentin; +/- CD68Genital tract, rarely others CK, calretinin, D2-40, WT1, CK5/6Head/neck (pharynx, oral cavity) Desmin, MSA, +/- focal SMAVulva, inguinal region, scrotum Vimentin, desmin, MSA, SMALower extremities, head/neck TFE3, +/- S-100; PAS-D (crystals)Anywhere Congo redForearm, trunk, upper arm CD31/CD34 (vascular component)

Arms, legs +/- CD68, desmin, CD99

Vulva, vagina Desmin, ER, PRExtremities, head, trunk, oralSkin, superficial soft tissue, otherHead/neck (scalp, forehead), leg CD31, CD34, thrombomodulinExtremities (arm)BreastLeg, trunk, arm, head/neck CD31, vWF, +/- keratinAbdomen, breast skin

Arms, legsHead/neck (nose, cheek, ear)BreastSkin, organs, soft tissue Warthin-Starry (organisms)Palm, fingers, feetExtremities, trunk +/- SMA, MSA, desmin, CD34Heart ventricles MSA, desmin, +/- HMB-45Upper portion of body

Inguino-scrotal, vulvo-vaginal CD34, +/- SMA, desmin, ER, PRTrunk, extremitiesExtremities, limb girdle PAS, Oil red O, S-100, CD68Foot, ankle, knee, thigh, hand S-100, HMB-45, Melan-A, NSESmall bowel, stomach, colon

CD68Genital region/nipples; elsewhere SMATrunk, legs, head/neck Vimentin, CD34; Alcian blueRetroperitoneumTrunk, legs, arms CD34, apolipoprotein D

Shoulder, arm Focal SMA and MSAHead, neck S-100, clusterin; +/- MiTFAbdominal cavity, pelvis CK, vimentin, desmin, carboxy WT1Extremities, trunk, head/neckPleura, peritoneum, pericardium CK5/6, calretinin, WT1, D2-40Subscapular area Elastic stainsMediastinumSolid organs EBER, SMASkinSoft tissue, lung, liver, bone, skin CD31, CD34, vWF

Page 8: Soft Tissue Guide

Head/neck, earHand, fingers, forearm, wrist, knee CK, EMA, vimentin; +/- CD34Pelvis, perineum, genital tract +/- desmin, SMAExtremities CK, vimentin, CD31, FLI1Shoulder, chest/back, thigh B-catenin, SMA, MSAScalp, vertebral axisOmentum, mesentery CKIT, CD34, +/- SMAFingers, hands, toes, feetUpper thigh, buttock, arm, shoulder CD99, FLI1, S-100, synaptophysinOrbit, head/neck, thigh, legs S-100 (cartilage); NSE, CD99, Sox9Thigh, popliteal fossa, limb girdle Vimentin; +/- focal, weak S-100Thigh, pelvis, shoulder, RP OsteocalcinSacrococcygeal region

Desmin, MSAHead/neck (auricular area)Head/neck (orbit, tongue, palate)

Fingers, hands SMA, MSA, CD68

Spreads throughout bodySternocleidomastoid muscleThigh, knee, arms, trunk Vimentin; maybe focal SMA, MSAAxilla, upper arm, thigh Actin, +/- CD34Arms, legs Factor XIIIa; +/- desmin, SMMS

Ankle

SkinDorsal wrist, fingers, foot, toesPosterior mediastinum, RPHead/neck, other CD34, nuclear B-catenin, +/- CD99Vagina, vulva, cervix, male tract Desmin, MSAThigh, inguinal region, chest CD34

CD68, SMA, TRAP

Knee, ankle/foot, wrist, fingersFingers, toes, ankle/foot, knee CD68, HAM56; CD45 (giant cells)

GingivaScalp, other GFAPHand, forearm

Finger, palm, wrist, forearm, organs Actin, +/- desmin; type IV collagenActin, type IV collagen

AFBDermis, subcitus, muscle, organs PAS (granules), S-100, NSE, CD68Gingiva negative for S-100Nerves

Page 9: Soft Tissue Guide

Nasal cavity SMA, MSA; +/- desmin, CD34Thigh, pelvic fossa, RP, pleura CD34, CD99; +/- bcl2, EMA, actinFoot, ankleFace, lips, oral mucosa, tongueThigh, shoulder, back, neck, chest S-100, Oil red OSubcutis, dermis Fite-FaracoExtremities CD31, VEGFR3, D2-40Distal extremities CD34, CD31, vWF, VEGFR3RetroperitoneumFingers, toes Actin; trichrome for inclusion bodiesHead/neck, shoulder, upper armFoot, ankle, hand, wrist +/- SMA, MSA

SMA, desmin; - myoglobinOral cavity, subcutisLung, mesentery, omentum SMA, MSA; +/- desmin, ALKMostly GU organs SMA, MSA, desmin, CK, +/- ALKPelvis, mesentery B-cateninMuscles of lower extremity (thigh)Thigh, shoulder, upper armThigh, shoulder, buttocks, upper arm Vimentin; Alcian blue (background)Groin, submandibular Actin, vimentinUterus, can reach heartShoulder, chest Focal actin, CD68Head/neck, parotid VEGF, CD31, vWF, SMA, GLUT1Head/neck, fingers, trunk Hyaline material: PAS, Alcian blueHead/neck, trunk CD68, CD31, factor XIIIa, A1ATKnee, shoulder, elbow, hip, ankle

CD31, LANA1 (HHV8), VEGFR3Extremities (legs, arms), organs

Lines of cleavage, mucosa, organsSuperficial and deep soft tissue CD31, CD34, FLI1, D2-40Face, shoulders VimentinKnuckles

Extremities; retroperitoneum ER, PR (gynecologic type)Peritoneum

SMA, MSA, +/- desmin, caldesmonRetroperitoneum, abdomenLower extremitiesExtremities (extensor surfaces)IVC, pulmonary artery, otherExtremities, head/neck, trunkUpper back, neck, extremities

Knee, shoulder, hip, elbowWrist, hand, ankle, footMedial extremitiesLegs/thigh, chest wall Focal SMA, MSA; +/- desmin, CKLegs/thigh Rounded cells: S-100, NSELumbosacralHead, neck, axilla, pectoral, other VEGFR3, D2-40

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+/- Factor VIII-related antigenMultiple CD31GU organs, retroperitoneum PAS-DParaspinal region, neck, others Vimentin, EMA, CK, INI1 lossLegs, thigh, arms, retroperitoneum +/- focal keratin, desmin, NF

Retroperitoneum +/- CD68

Sciatic nerve, brachial plexus +/- S-100 (focal), nestin, Leu-7, p53Breast, other Desmin, actin, CD34Jaw, others CK, HMB-45; NSE, synaptophysinMidline/autonomic nerves S-100, HMB-45Metatarsals (3rd-4th, 2nd-3rd)Lips, mouth, eyelid, intestinesUterus, cul-de-sac, bladder surface CK, EMA, calretinin, CK 5/6QuadricepsLymph nodes, other AFB, CD68, S-100; +/- desminAdrenal, rarely otherHead/neck, trunk ActinHead/neck SMA, calponin, +/- desmin, MSARetroperitoneum, abdomen SMA, desmin, trichromeLower extremities SMA, h-caldesmon; +/- desminLimbs, head, neckDigits Vimentin, actinExtremities +/- SMA, MSA

Extremities, thigh, popliteal area

Nasopharynx CD31, CD34, SMA, AR, B-cateninExternal popliteal nerveHand (left > right), wrist, forearmSympathetic ganglia, incl. adrenal NSE, NF, S-100, synapto, chromo

No site predilection S-100 (focal)

Head/neckMelanin markers (pigmented cells)

Brachial and sciatic nerve trunksHead, neck, shoulder S-100, PGP9.5

negative for S-100Mid-forehead, eyelid, nape of neckPelvic girdle (in multifocal cases)Arm, trunk SMA, MSAScalp/skullArm, head/neck

Nuchal area CD34, nuclear B-catenin, +/- CD99Tissue around maxilla or mandible CK19Sinonasal (nasal vault) NSE, CD56, synapto/chromoExtremities, trunk, head/neck Vimentin, S-1000; +/- Leu-7, NSEDigitsFace

Page 11: Soft Tissue Guide

Palms Focal B-catenin; +/- SMA, MSAHead, neck, fingers, trunkThigh, calf, upper arm, forearm CK8/18, EMA, S-100

Carotid artery bifurcation NSE, NF, synapto/chromo; S-100Temporal bone/middle earHead/neck (around vagus nerve)Pulmonary artery, aortic archRetroperitoneum

Perirectal, perivesicalPenis

Upper extremity EMATrunk, extremities, deep tissue EMA, claudin-1, GLUT1Hand EMA, GLUT1; +/- SMA, MSA

Uterus, soft tissue, viscera, bone HMB-45, Melan-A, SMA, +/- desminKidney, soft tissue Actin, desmin, HMB-45, Melan ALung, mediastinum, retroperitoneum HMB-45

FGF23Plantar aponeurosis SMAExtremities, trunk MSA, +/- CD34 and CD99Ankle/foot, lower leg, thigh, perineum Vimentin, CD34, factor XIIIaRetoperotineum, extremities +/- keratin, actin, desmin, S-100Arms, legs CD68, SMA

Liver, spleen, lymph nodes Congo red, mucicarmine, ironArm, trunk SMA, MSATrunk, shoulderVariesGingiva, fingers, lips, face, tongueMesentery Actin, desmin, CD117Anywhere CD68, SMA; +/- A1AT, lysozyme

CD68, A1At, lysozyme, PAS-DFace/neck (chin)Head/neck, GU tract, RP MSA, desmin, myogenin, myoD1Head/neck (orbit, parameninges)Paratesticular, head/neck MSA, desmin, titin, troponin DVagina, bladder, nasopharynxExtremities, head/neck MyogeninExtremities (thigh), RP, chest MSA, desmin, myoglobin, myoD1

MyoD1; focal myogenin, desminS-100; +/- CD1a

Head, neck, flexor surfaces S-100, Leu-7, GFAP

Legs, limb girdle, trunk EMA; rarely S-100, NSEInguinal region, abdominal wall PAS-DDistal extremities (hand)Posterior neck, shoulder, back CD34, Bcl-2

Neck, cheeks, breast, arm, axillaJoints (knee, hip, elbow, shoulder)

Page 12: Soft Tissue Guide

Para-articular regions of extremities CK7, CK19, EMA, TLE1, CD99, bcl2

Near joints: hip, shoulder, elbowLymph nodes (axilla)

Extremities, retroperitoneum MDM2, CDK4

Groin, retroperitoneumRetroperitoneum

Omentum, mesentery, pelvisDepends on type

Page 13: Soft Tissue Guide

Molecular

Inheritance linked to EDR, ENG, FLT4?

12q13-15 (HMGA2) mutationt(X;17) TFE3-ASPL

t(12;16) ATF1-FUS or t(12;22) ATF1-EWSR1

Possible link to CMC1 on 5q

t(11;16)t(12;16) EWS-ATF1t(12;16) EWS-ATF1

Germline 1q43 mutation (link to HLRCC)PRKAR1A mutation (Carney complex patients)MDM2, CDK4t(17;22) COL1A1-PDGFB

t(11;22) EWS-WT1

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Rearrangements of 22q11 (INI1), 8q, 18q11Aberration of 22q11 (INI1)

KIT, PDGFRA

t(11;22) EWS-FLI1; t(21;22) EWS-ERG; others

t(9;22) EWS-NOR1 or t(9;17) RBP56-NOR1

PTCH

Possible mutations at 4q27-31 or 17q21-22

t(17;22) COL1A1-PDGFB

t(1;2) COL6A3-CSF1t(1;2) COL6A3-CSF1

Truncating glomulin mutation at 1p21-22

Page 15: Soft Tissue Guide

HHT1 on 9q, HHT2 on 12q11q13-21 (GARP?) rearrangement

t(12;15); + 8, 11, 17, 20

+/- ALK+/- ALK

GNAS1 mutations

Nonrandom X-inactivation patterns

8q11-13 (PLAG1) rearrangement12q13-15 (HMGIC) aberrations, others

t(7;16) FUS-CREB3L2t(7;16) FUS-CREB3L2

Page 16: Soft Tissue Guide

Aberration of 22q11 (INI1)various gains, losses

NF1, other gains/losses

t(12;16) FUS-CHOP; rarely t(12;22); p53

B-catenin

del(1p); MYCN amplification in some

NF1

CMC1 on 5q in some lesions11 deletion (in Michelin tire baby syndrome)

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Germline mutation in SDH

Can have TSC1 and TSC2 deletions

PTEN in some patients

LOH at 11p15.5; trisomy 8

t(2;13) PAX3-FKHR; t(1;13) PAX7-FKHR

Mutated gene on chromosome 22+/- FUS

loss of 16q, 13q

Page 18: Soft Tissue Guide

t(X;18) SYT-SSX1, SYT-SSX2, or SYT-SSX4

GALNT3 or FGF23 mutation (familial cases)

VMCM1 mutation on chromosome 9Giant and ring chromosomes (12q13-15)

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Behavior / NotesBenign; linked to pregnancy, FAP, or trauma; typically 3-10 cm; can recur locallyBenign; may be same lesion as kaposiform hemangioendotheliomaIntermediate; has a predilection to recur; metastases rareBenign; usually < 2 cm; usually solitaryBenign; can be multifocal; does not regress; can recurBenign but locally aggressive; can exceed 20 cm; recurs oftenMalignant; grows slowly; poor prognosis; metastasizes early; age and tumor size prognosticBenign; can be associated with hematopoietic neoplasms, other conditionsBenign; subcutaneous; painful to palpation; usually multiple; rarely > 2 cm

Intermediate; anemia, pyrexia, weight loss; rarely recurs or metastasizesBenign; causes pain and swelling; almost always recursBenign; overlaps with other benign genital stromal tumors; can rarely be malignantBenign; usually < 2 cm; half of cases cause pain; recurrence very rareMalignant; behavior varies based on site and etiology; linked to many possible factorsMalignant; most common angiosarcoma subtype; metastasizes often; size is prognosticMalignant; usually in post-mastectomy patients; metastasizes oftenMalignant; rapidly growing; often metastatic at time of presentation; grade is prognosticMalignant; often syndrome-associated; can be large; often recurs or metastasizesMalignant; develop 3-5 years after radiation; often recurs or metastasizesBenign; acquired in altered physiologic statesBenign; more a clinical than a pathologic diagnosisIntermediate; < 2 cm; low rates of recurrence, metastasisBenign/intermediate; solitary; < 2 cm; secondary to radiation; recurrence rareBenign; < 1 cm; usually develop within 3 years of radiationBenign; caused by Bartonella infection in immunocompromised patientsBenign; slow-growing, < 3 cm, gritty; high recurrence rateBenign; 3-5 cm; gritty; can recurBenign; often multiple; can cause cardiac symptoms; regress; linked to tuberous sclerosisBenign; large, can be deep; do not regress; linked to Kasabach-Merritt, other syndromesBenign; solitary, well-demarcatedBenign; overlaps with angiomyofibroblastoma-like tumor of male genital tractBenign; few millimeters in size; may be linked to infection or chemical exposureBenign; slow-growing; 1-11 cmMalignant; 2-6 cm; can be grossly pigmented; size prognostic; often recur or metastasizeMalignant; often metastasizeBenign; linked to monoclonal immunoglobulin productionBenign; pilar type 1-2 cm, painful, can be multifocal; genital type solitary and rarely painfulBenign; linked to Carney's complex; usually 1-5 cm; often recurMalignant; often recurs or metastasizes; site is most important prognostic factorIntermediate; slow, persistent growth; high rate of recurrence; metastases uncommon

Benign; slow-growing, < 4 cmMalignant; nodal spread rare; often recurs; may have better prognosis than typical melanomaMalignant; poor prognosis; often metastasizes widelyBenign; linked to osseous hypertrophy, tuberous sclerosis; tends to recurMalignant; symptoms depend on location; linked to asbestos, SV40; dismal prognosisBenign; often history of manual labor; often bilateral (subclinically?)1 reported caseBenign(?); seen in immunocompromised patients; half of patients have multiple lesionsBenign; may be variant of epithelioid hemangiomaIntermediate; can arise in vessels; rarely multifocal; low rate of recurrence or metastasis

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Benign; reactive?; patients can have peripheral eosinophilia; can recur; rarely regressMalignant; typically 3-6 cm; possible trauma link; often recurs multiple times or metastasizesMalignant; possibly linked to malignant extrarenal rhabdoid tumorIntermediate; can recur or metastasizeBenign; 5% multicentric; usually 5-10 cmBenign; two types depending on origin and siteBenign or malignant (criteria: cellularity, mitoses, necrosis); linked to Carney triad, NF1Benign; slow-growing; painless; solitary; < 3 cm; can recurMalignant; typically in Caucasians; usually 5-10 cm; often metastasizes; prognosis improvingMalignant; grows rapidly; metastasizes oftenMalignant; slow-growing; late recurrence and metastasis commonMalignant; 5-10 cm; related to radiation, potentially trauma; recurs and metastasizes oftenIntermediate; link to spina bifida and similar abnormalities; can metastasizeBenign; associated with nevoid basal cell carcinoma syndrome; does not regress

Benign; grows slowly over several years, < 2 cm, can recur

Benign but progressive,debilitating, and typically fatal within 10-15 years; can be familialBenign; causes torticollis; 1-3 cm; grows rapidly; may spontaneously regress; does not recurMalignant; slow-growing, painless, 3-8 cm; recurs, metastasizes; possibly injury-relatedBenign; solitary; grows rapidly (3-5 cm); does not regress; may recurBenign, possibly reactive; 1/3 multiple; can recur; metastases extremely rareBenign; can evolve rapidly; higher risk of local recurrenceBenign; higher risk of local recurrence

Benign; larger than normal fibrous histiocytomaBenign; secondary to intussusception and prolapseBenign; incidental findingBenign; half of cases linked to trauma; typically 1.5-2.5 cm; recurrence rareBenign; ganglioneuromatous polyposis can occur in NF1 and MEN IibBenign; linked to Gardner syndrome; may recur; see nuchal-type fibromaBenign; usually < 3 cm; does not regressIntermediate; painless nodule; 1-8 cm; can recur; not known to metastasize; link to DFSPIntermediate; can recur; not known to metastasize

Benign; cause pain, tenderness, joint symptoms; unencapsulated; often recursBenign; slow-growing; circumscribed; may be reactive or neoplastic; can recurMalignant; can recur or metastasizeBenign; many forms, some linked to syndromes; tends to recur; can be familialBenignBenign; malformation; not painfulBenign; deep, extensive, painful lesionsBenignBenign; seen in POEMS syndrome and multicentric Castleman's diseaseBenign; usually solitary; usually < 1 cm; causes sudden, radiating pain; infrequently recurMalignant; can metastasizeIndeterminate; follow-up lacking on known examplesBenignBenign; linked to surgical traumaBenign; typically < 3 cm; poorly circumscribed; can be multifocal; very rarely malignantBenign; typically 1-2 cm; often regressBenign; often painful

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Benign; can cause nasal obstruction or epistaxis; can be locally aggressiveIntermediate; can cause hypoglycemia; malignant examples can recur, metastasizeBenign; can recur; possible link to pleomorphic hyalinizing angiectatic tumor of soft partsBenign; lesions frequently hemorrhageBenign; slow-growing; 5-15 cm; has prominent vascularity; does not recurBenign; linked to sulfone-treated lepromatous leprosy; expansive subcutaneous nodule

Intermediate; can recur; lymph node metastases uncommonBenign; obstructs ureters or aorta; sometimes due to drugs or malignancyBenign; < 2 cm; many recur; regresses; X-linked dominant inheritance?Benign; usually asymptomatic; can become large; may recur; possible trauma linkMalignant, can recur/metastasize; good prognosis; 1/3 present at birthMalignant, can metastasize; very few reported casesBenign; rarely multiple; may regress; can recur or rarely metastasizeUsually benign; 5-10 cm; can be multiple; can cause anemia, elevated ESRBenign; often history of trauma; relationship to IMT?Benign; often > 10 cm; some mesenteric cases linked to Gardner's syndromeBenign; often painful; can impair local function; can recurBenign; can be greater than 20 cmBenign; painless, fluctuant; linked to Mazabraud syndrome; typically 5-10 cmBenignBenign; associated with recent pregnancy, enlarged uterus, pelvic pain; can recurBenign; mass overlying bone in debilitated patients (< 6 months)Benign; type of capillary hemangioma; one-fifth of cases multiple; enlarge, then regressBenign; multiple; can be up to 10 cm; do not regressBenign; often multiple; usually regress spontaneously; can occur in adulthoodBenign; usually 2-6 cm; recurrence not uncommonMalignant; caused by HHV8; can be aggressive; prognosis depends on numerous factorsMalignant; prevalent in Poland, Russia, Italy, parts of Africa; linked to immunocompromiseMalignant; heterogeneous disease; seen in children with bulky lymphadenopathyMalignant; typically develops several months after a renal transplantMalignantIntermediate; associated with Kasabach-Merritt phenomenon; rarely metastasizesBenign; induced by injury, trauma, or infection in dark-skinned patientsBenign; often asymptomatic; linked to palmar and plantar fibromatosis

Benign; often calcified; can be > 10 cm; must be distinguished from leiomyosarcomaBenign; linked to pregnancy; nodules can be several cm; can regress or recurMalignant; prognosis varies by siteMalignant; usually > 5 cm; aggressive local extension and metastasesMalignant; often vessel-associated; can recur and metastasizeMalignant; usually < 2 cm; excellent prognosis; can recur but infrequently metastasizeMalignant; causes site-based symptoms; worse prognosis in vena cava lesionsBenign; may grow slowly or quickly; usually 3-5 cm; can recur in diffuse diseaseBenign; slow-growing, soft mass; rarely > 10 cm; can be multiple or familial; may recur

Benign; causes effusions, joint swelling; possibly a reactive processBenign; often bilateral; can cause local symptomsBenign; patients morbidly obese; overlying skin thickened, hyperkeratotic; can recurMalignant; slow-growing, painless, 1-18 cm; recurs often; can metastasize after decades

Benign; causes myelopathy or radiculopathy in 2/3 of cases; imaging is essentialBenign; can wax and wane; in utero cases linked to Turner, other syndromesBenign; spontaneous in children, follows injury/irradiation in adults; may recur

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Benign; patients can have multiple bone lesions; prognosis depends on disease extent

Malignant; typically < 5 cm; poor prognosis; often metastasizes widelyMalignant; can grow slowly or quickly; 5-10 cm; recurs and metastasizes oftenMost common subtypeBetter prognosis than storiform-pleomorphic type; recurs more than metastasizes

Fever, leukocytosis; grossly yellow; may be dedifferentiated liposarcomaMalignant; term is variably applied and does not refer to a lone entity; not a WHO diagnosisMalignant; roughly half of cases associated with NF1; large; often recurs, metastasizesBenign; can be bilateralIntermediate; locally destructive; can increase VMA; often recurs; can metastasizeIntermediate; link to Carney syndrome; heavily pigmented; can metastasizeBenign; non-tumorous fibrosing process secondary to wearing high heelsBenign; link to MEN Iib; usually multipleBenign; causes nonspecific symptoms; can recur; can uncommonly lead to patient deathBenign; congenital or acquired (injection-related); severely affects movementBenign; immunocompromised patientsBenign; usually 3-7 cm, but can be giantBenign but may cause organ failure; multicentricity more common; regressMalignant; slow-growing, painless, 1-12 cm; recurs, rarely metastasizesBenign; can be up to 15 cm if deepBenign; solitary; painless; can be intravascular; very rarely recur or metastasizeBenign; self-limiting; may regress; usually related to traumaBenign; painful, localized; often related to traumaMalignant; often subcutaneous; grade influences behavior; recurs more than metastasizes

Malignant; often metastasizes; age, round cell areas, and necrosis worsen prognosisMalignant; significant round cell areas imparts worse prognosis in myxoid liposarcomasBenign; facial deformity, epistaxis; may recur destructively; linked to FAP?Benign; degenerative processBenign; slow-growing; causes compression neuropathy; can be seen with macrodactylyMalignant; symptoms vary; urine catecholamines increase; detailed classification systems

Benign; not associated with neurofibromatosis 1; slow-growing, painlessBenign but can have malignant transformation; pathognomonic of neurofibromatosis 1

Benign; causes neurologic symptomsBenignEntity contestedBenign; very common; typically regress; can be indicative of many syndromesBenign; can be multiple or solitary; typically does not recurBenign; reactive; rapid growth (1-2 weeks), slight pain, solitary, < 2 cmRelated to birth trauma?

Benign; linked to diabetes; may recur; see Gardner fibromaBenign but can be locally destructive; recurrence commonMalignant; causes local symptoms; late recurrence and metastasis commonIntermediate; typically 3-5 cm; usually benign, but can recur or metastasizeBenign; linked to trauma; typically painful; Pacinian structures are typically > 1.5 mmBenign; not linked to syndromes

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Benign; 50% bilateral, can impair use of hand; linked to diabetes, alcoholBenign; small (average 2 cm); exuberant form of organizing thrombus; sometimes recursIntermediate; can be histologically malignant; can recur, sometimes late; metastases rareUsually benign; cause hypertension if functional; can be familial; uncommonly metastasizes

Occasionally multifocal or metastaticCan occur in patients with Carney's triad; higher rate of recurrence, metastasis, and deathCan be multiple and/or occur in patients with Carney's triadBenignBenign; causes local genitourinary symptoms; can lead to recurrent DVTBenign; causes penile curvature; linked to palmar and plantar fibromatosisBenignBenign; causes muscle weaknessBenign; circumscribed; can reach 20 cm; rarely recursBenignBenignIntermediate; rarely linked to tuberous sclerosis complex; can recur or metastasizeBenign; often associated with tuberous sclerosis complex; can involve lymph nodes benignlyBenign; associated with tuberous sclerosis complex; can cause severe pulmonary symptomsIntermediate; causes osteomalacia, phosphaturia, hyperphosphatemia; can metastasizeBenign; 33% bilateral; linked to palmar fibromatosis, diabetes, alcoholBenign; 0.5-2 cmIntermediate; grows slowly; recurrences common; does not metastasizeMalignant; high recurrence and metastasis rate; age, size, and location affect outcomeIntermediate; 1-3 cm, ill-defined; recurrences frequent; metastases rareNo longer a distinct entity per the WHO

BenignBenign; rapid growth (3 weeks), usually < 3 cmBenign; sporadic; wide range of manifestationsBenign; type of capillary hemangioma; reactive?; one-third occur after trauma; can recur

Benign; rarely multiple; recurrence uncommonBenign; waxes and wanes; can be paraneoplastic; weight loss, crippling arthritisBenign; usually < 2 cm; does not regress; linked to congenital anomalies

Malignant; intermediate prognosis among rhabdomyosarcomaMalignant; superior prognosis among rhabdomyosarcomasMalignant; superior prognosis among rhabdomyosarcomasMalignant; poor prognosis among rhabdomyosarcomasMalignant; rapidly growing, large (> 10 cm), painless; metastasizes early; poor prognosis

Benign; may be associated with lymphadenopathy; can resolve spontaneouslyBenign; typically sporadic, but linked to NF2; rarely undergo malignant transformationBenign; patients have multiple painful schwannomasMalignant; 5-10 cm; may recur or metastasize; link to LGFMS?Benign; exuberant reaction to large amount of injected silica (polarizable)Benign; may be multifocal; usually asymptomatic; often recur; linked to Mafucci syndromeBenign; slow-growing; rarely multiple or familial; can reach 14 cm

Benign; may be due to endogenous or exogenous steroidsBenign; linked to alcoholism and liver disease; causes neuropathy; can be familialBenign

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Benign; may be diffuse; may be trauma-relatedMalignant; often recurs or metastasizes, though rates lowering due to better treatmentBenign; non-neoplastic response to injury; typically < 5 cm; can be painfulBenign; often multifocal; can be familial; slow-growing; 5-15 cm; calclium level normalBenignBenign; malformation; can be superficial or deep; may be linked to cavernous hemangiomaMalignant; slow-growing, often large; recur but do not metastasize; can dedifferentiate

Benign if localized; aggressive if widespread (can metastasize); possible link to asbestosBenign; reactive, seen in hyperlipidemic patients; asymptomatic in and of themselves

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Subtypes

verrucous hemangioma

Pilar, genital

Epithelial, sarcomatoid, mixed

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Usual type, fibroma-like

Fibrochondroma, osteochondroma, myxochondroma, chondroblastoma-like

Oncocytic

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Lipomatous, meningeal, with giant cells

Typical; myxoid; lipoma-like; spindle cell

Retiform, Dabska-type

Pelvic, mesentericCapillary type, cavernous type

Somatic, gynecologic

Usual, myxoid, inflammatory, granular cell

Subcutaneous, deep; sometimes termed based on site

Head/neck type, intra-abdominal type, cutaneous type

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Malignant Triton tumor, glandular, epithelioid, superficial epithelioid

Epithelioid neurofibroma

Port-wine stain

Subcutaneous, intramuscular, fascial types

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Nasopharyngeal, laryngeal, orbital, gangliocytic, of cauda equina, cardiac

Epithelioid

Traditional, small-cell/epithelioid (not official terms)

Pregnancy-related (granuloma gravidarum) ; intravenous

Embryonal rhabdomyosarcoma with anaplasia

Clear cell rhabdomyosarcoma

Ancient, cellular, plexiform, epithelioid

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Biphasic, monophasic fibrous, monophasic epithelial

Eruptive, tuberous, tendinous, xanthelasma, plane