Soft Tissue Tumors of the Skin

507 Pages·2019·121.42 MB·English

by  Steven D. Billings

Soft Tissue Tumors
of the Skin
Steven D. Billings
Rajiv M. Patel
Darya Buehler
Editors
123
Soft Tissue Tumors of the Skin
Steven D. Billings
Rajiv M. Patel • Darya Buehler
Editors
Soft Tissue Tumors
of the Skin
Editors
Steven D. Billings Rajiv M. Patel
Department of Anatomic Pathology Departments of Pathology and
Cleveland Clinic Dermatology
Cleveland, OH University of Michigan Medical Center
USA Ann Arbor, MI
USA
Darya Buehler
Department of Pathology and
Laboratory Medicine
University of Wisconsin–Madison
Madison, WI
USA
ISBN 978-1-4939-8810-5 ISBN 978-1-4939-8812-9 (eBook)
https://doi.org/10.1007/978-1-4939-8812-9
Library of Congress Control Number: 2018960891
© Springer Science+Business Media, LLC, part of Springer Nature 2019
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Preface
Soft tissue pathology is arguably the most challenging area in dermatopathol-
ogy. Cutaneous soft tissue tumors are relatively rare, have significant histo-
logic overlap, and yet encompass a remarkable morphological diversity of
entities. This book is our effort to provide a comprehensive, but succinct and
well-illustrated, survey of soft tissue tumors and the non-mesenchymal mim-
ics that may present in the skin. In this work, we emphasize the clinicopatho-
logic features, differential diagnosis, and important diagnostic pitfalls
encountered with these lesions. We hope that our undertaking will be a useful
and practical resource for daily sign-out.
Cleveland, OH, USA Steven D. Billings
Ann Arbor, MI, USA Rajiv M. Patel
Madison, WI, USA Darya Buehler
v
Acknowledgment
We would like to thank all of our teachers in pathology, but especially
Drs. Sharon Weiss, Andrew L. Folpe, John Goldblum, and Brian Rubin. Not
only did they teach us soft tissue pathology but also the mentorship and
wisdom they have provided has shaped our careers and practice. We are
tremendously grateful to our contributing authors, Drs. Andrew L. Folpe,
Karen J. Fritchie, Reena Singh, Youran Zou, and Aaron M. Udager, without
whom, this book would not have been possible. We would also like to thank
Dr. Paul Weisman of the University of Wisconsin for valuable editorial
insights on select chapters and Lisa Stephens of the ePathology Department
of the Cleveland Clinic for her expert assistance with many of the figures in
the book. We would also like to thank Drs. Carly Elston, Cody Carter, Grace
Wang, and Joseph Zahn for their critical proofreading of the chapters.
vii
Contents
1 Introduction and General Approach . . . . . . . . . . . . . . . . . . . . . . 1
Steven D. Billings and Rajiv M. Patel
2 Ancillary Diagnostic Tests in the Diagnosis
of Cutaneous Soft Tissue Neoplasms . . . . . . . . . . . . . . . . . . . . . . 15
Andrew L. Folpe
3 Mimics of Cutaneous Mesenchymal Tumors . . . . . . . . . . . . . . . 57
Darya Buehler, Rajiv M. Patel, and Steven D. Billings
4 Benign Fibrous, Fibrohistiocytic,
and Myofibroblastic Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Rajiv M. Patel, Reena Singh, Aaron M. Udager,
and Steven D. Billings
5 Fibrous, Fibrohistiocytic, and Myofibroblastic
Tumors of Intermediate Malignancy . . . . . . . . . . . . . . . . . . . . . . 175
Reena Singh, Aaron M. Udager, Steven D. Billings,
and Rajiv M. Patel
6 Malignant Fibrous, Fibrohistiocytic,
and Myofibroblastic Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
Aaron M. Udager, Reena Singh, Steven D. Billings,
and Rajiv M. Patel
7 Cutaneous Vascular Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235
Darya Buehler and Steven D. Billings
8 Perivascular Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307
Steven D. Billings and Rajiv M. Patel
9 Adipocytic Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 323
Steven D. Billings and Rajiv M. Patel
10 Nerve Sheath and Related Tumors . . . . . . . . . . . . . . . . . . . . . . . 345
Steven D. Billings
11 Genital Mesenchymal Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . 383
Karen J. Fritchie
ix
x Contents
12 Soft Tissue Tumors of Uncertain Histogenesis . . . . . . . . . . . . . . 405
Darya Buehler
13 Miscellaneous Mesenchymal Tumors: Smooth Muscle,
Skeletal Muscle, Cartilaginous, and Osseous Tumors . . . . . . . . 469
Steven D. Billings and Rajiv M. Patel
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 491
Contributors
Steven  D.  Billings, MD Department of Pathology, Cleveland Clinic,
Cleveland, OH, USA
Darya Buehler, MD Pathology and Laboratory Medicine, University of
Wisconsin School of Medicine and Public Health, Madison, WI, USA
Andrew L. Folpe, MD Department of Laboratory Medicine and Pathology,
Mayo Clinic, Rochester, MN, USA
Karen J. Fritchie, MD Mayo Clinic, Department of Laboratory Medicine
and Pathology, Division of Anatomic Pathology, Rochester, MN, USA
Rajiv M. Patel, MD Department of Pathology, University of Michigan
Medical School, Ann Arbor, MI, USA
Reena Singh, MD Department of Pathology, Oregon Health and Science
University School of Medicine, Portland, OR, USA
Aaron M. Udager, MD, PhD Department of Pathology, University of
Michigan Medical School, Ann Arbor, MI, USA
xi
1
Introduction and General
Approach
Steven D. Billings and Rajiv M. Patel
Abstract soft tissue tumors. It is meant to be a practical
Soft tissue tumor is a difficult area in dermato- book that is useful in everyday sign-out, and we
pathology. Although some soft tissue tumors hope you find it so.
like dermatofibromas are commonly encoun- Similar to inflammatory dermatopathology,
tered, many are rare. Therefore dermatopa- it is important to recognize growth patterns and
thologists and pathologists are often unfamiliar the cellular constituents of a given lesion. Low-
with relevant diagnostic criteria or even a magnification observation is critical to the eval-
method for approaching these challenging uation of the overall growth pattern. The first
cases. This chapter will provide an introduc- thing that should be assessed is circumscription.
tion to the assessment of cutaneous soft tissue Is the tumor circumscribed or infiltrative? As a
tumors, focusing on broad concepts. general rule, although admittedly there are many
exceptions, circumscription favors benignity,
It is almost universal that soft tissue tumors pose while an infiltrative growth pattern favors malig-
some of the most difficult challenges in the realm nancy. With regard to circumscribed tumors,
of dermatopathology. There is significant histo- one should also assess whether the tumor has
logic and immunophenotypic overlap between a true capsule (e.g., schwannoma) (Fig. 1.1) or
entities, and given their relative rarity, dermato- pseudocapsule (e.g., angiomatoid fibrous his-
pathologists and pathologists are often unfamil- tiocytoma) (Fig. 1.2), or lacks a capsule, but
iar with key diagnostic criteria. This book is our remains relatively circumscribed (e.g., dermato-
attempt to help clarify this difficult subject and fibroma) (Fig. 1.3). For infiltrative tumors, the
provide some guidance in the approach to this pattern of infiltration can also be informative.
area. We concentrate on cutaneous lesions, and For example, does the tumor have a diffuse pat-
this is therefore not an all-encompassing tome on tern of infiltration (e.g., dermatofibrosarcoma
protuberans) (Fig. 1.4)? Does it infiltrate along
cutaneous structures like subcutaneous septa
(e.g., myxofibrosarcoma and variants of nodular
S. D. Billings (*) fasciitis) (Fig. 1.5a, b)?
Department of Pathology, Cleveland Clinic,
After assessing circumscription, one should
Cleveland, OH, USA
determine the growth pattern, with the caveat
e-mail: [email protected]
that some tumors may exhibit a variety of differ-
R. M. Patel
ent patterns. The principle ones encountered are
Department of Pathology, University of Michigan
Medical School, Ann Arbor, MI, USA
© Springer Science+Business Media, LLC, part of Springer Nature 2019 1
S. D. Billings et al. (eds.), Soft Tissue Tumors of the Skin,
https://doi.org/10.1007/978-1-4939-8812-9_1