Tumor Matrix |
| Download the Tumor Matrix Excel Spreadsheet (blank) |
| Download the Tumor Matrix Excel Spreadsheet (with data) |
| Metastatic Carcinoma | |
| Age | >40 |
| Clinical Presentation | hx cancer, bone pain |
| X-Ray | lytic = lung, renal; mixed = breast, thyroid; blastic = prostate; anterior column spine, prox bones |
| CT | path fx |
| MRI | path fx, edema |
| Histology | glandular islands of epithelial cells in fibrous background, cytokeratin + |
| Rx | IM Rod; Mirel's; bisphosphonates; preop emboliz renal |
| Syndromes | 25% mets present with pathologic fx |
| Renal Cell Carcinoma Metastasis | |
| Age | >40 |
| Clinical Presentation | hx cancer, bone pain |
| X-Ray | lytic = lung, renal; mixed = breast, thyroid; blastic = prostate; anterior column spine, prox bones |
| CT | path fx |
| MRI | path fx, edema |
| Histology | glandular islands of epithelial cells in fibrous background, cytokeratin + |
| Rx | IM Rod; Mirel's; bisphosphonates; preop emboliz renal |
| Syndromes | 25% mets present with pathologic fx |
| Myeloma | |
| Age | 50-80 |
| Clinical Presentation | bone pain (esp. spine/ribs); path fx; fatigue (anemia); renal disease; hypercalcemia |
| X-Ray | punched out lytic lesions; osteopenia |
| CT | lytic lesions |
| MRI | extent of disease |
| Histology | sheets of plasma cells |
| Rx | prednisone/alk agent; bisphosphonates; RTX; BMT; stabilize fx |
| Syndromes | SPEP - double protein spike ("Goal post" sign); M (whole IgG>IgA>>IgM) &/or Bence-Jone (light chain only) proteins in >99% pts; 50% die of renal failure; 18-24 month survival |
| Lymphoma | |
| Age | >40 |
| Clinical Presentation | bone pain; path fx; fatigue |
| X-Ray | long lesion; mottled; reactive and destructive; cortex thickened |
| CT | path fx |
| MRI | large soft tissue masses |
| Histology | most are large B cell, mixed cell infiltrate |
| Rx | chemo and RTX (multiple sites), RTX (solitary), surgery to stabilize fx |
| Syndromes | |
| Chondrosarcoma | |
| Age | 30-70 |
| Clinical Presentation | pain and/or mass in shoulder, pelvis, knee, spine |
| X-Ray | primary metaphyseal radiolucent with calcification; secondary osteochondroma with large >2cm soft tissue mass with calcification; axial skeleton; 85% cortical changes |
| CT | calcification in radiolucent lesion |
| MRI | soft tissue mass |
| Histology | malignant cartilage formation; 75% low grade |
| Rx | wide resection; RTX/chemo resistant |
| Syndromes | |
| MFH | |
| Age | 20-60 |
| Clinical Presentation | pain or mass; distal femur; prox tib/femur/hum, ilium |
| X-Ray | extensive lytic/blastic creates mottled bone |
| CT | |
| MRI | extent of soft tissue |
| Histology | giant cells, storiform, "cartwheels", chronic inflammatory cells |
| Rx | wide resection and chemo; pulm mets in 30-40% = RTX |
| Syndromes | #1 sarcoma to complicate a preexisting condition (paget's, bone infarct, radiation osteitis, etc.) |
| Fibrosarcoma | |
| Age | 20-60 |
| Clinical Presentation | pain or mass |
| X-Ray | "moth eaten" |
| CT | |
| MRI | extent of soft tissue |
| Histology | spindle cells, collagen, ""herringbone pattern"" (fascicles cut transversely and sagittaly) |
| Rx | wide resection and chemo; pulm mets in 30-40% = RTX |
| Syndromes | |
| Hyperparathyroidism | |
| Age | 20+ |
| Clinical Presentation | stones, moans, groans, abdomenal overtones (PUD, pancreat), pth, Ca++ |
| X-Ray | bone resorption, lytic, phalanges |
| CT | |
| MRI | |
| Histology | tunneling resorption b/c osteoclasts cannot penetrate unmineralized osteoid on cortex |
| Rx | gland resection, bisphosphonates |
| Syndromes | |
| Osteonecrosis (AVN) | |
| Age | any |
| Clinical Presentation | joint pain, effusion, weight bearing pain |
| X-Ray | periarticular, Ficat, crescent sign, collapse, OA |
| CT | look for reactive bone, collapse |
| MRI | MRI detects before pain (ficat), cartilage changes |
| Histology | empty osteocyte lacunae, +/- marrow necrosis |
| Rx | observation, core decompression, arthroplasty |
| Syndromes | |
| Bone Infarct | |
| Age | any |
| Clinical Presentation | incidental |
| X-Ray | metaphysical radiodensity |
| CT | calcification |
| MRI | necrosis, calcification |
| Histology | empty osteocyte lacunae, +/- marrow necrosis |
| Rx | observation |
| Syndromes | |
| Paget's Disease | |
| Age | >40 |
| Clinical Presentation | pain; axial > appendicular |
| X-Ray | hot phase (flame shaped lucency meta to diaph); intermed phase ("cotton wool" pattern), cold (coarse trabeculae and bony enlargement") |
| CT | thickened cortex |
| MRI | no soft tissue involvement |
| Histology | coarsened trabeculae (blastic appearance); cement lines, osteoclastic, fibrous vascular tissue between trabeculae; measles inclusion bodies (electron microscopy) |
| Rx | bisphosphonates, calcitonin, methotrexate |
| Syndromes | |
| Enostosis (Bone Island) | |
| Age | >40 |
| Clinical Presentation | no pain |
| X-Ray | radiodensity in medullary canal |
| CT | pseudopodia |
| MRI | no soft tissue involvement |
| Histology | cortical bone surrounded by medullary bone |
| Rx | observation |
| Syndromes | |
| Osteosarcoma | |
| Age | 10->20 |
| Clinical Presentation | pain, swelling, fracture, mass |
| X-Ray | knee metaphysis, lucent/blastic with cortical destruction, stage IIB at presentation, codman's, sunburst |
| CT | pathologic fracture +/- |
| MRI | usually extracompartmental |
| Histology | spindle shaped tumor cells that produce osteoid; lace-like osteoid |
| Rx | preop chemo 12 weeks, restage, wide resection, 6-9 months adjuvant; 60% survival |
| Syndromes | |
| Ewing's Sarcoma | |
| Age | 5->30 |
| Clinical Presentation | pain; +/- fever; increased ESR/WBC; anemia |
| X-Ray | pelvis, distal femur, prox tibia/humerus; femoral diaphysis, large destructive metaphy/diaphy lesion, radiolucent with reactive new bone, onion skin |
| CT | onion skin/periostel rxn |
| MRI | soft tissue component |
| Histology | small round blue cell tumor; t(11,22); fusion protein EWS-FLI 1 |
| Rx | chemo, RTX, surgical resection; 60-70% survival |
| Syndromes | poor px: spine and pelvic tumors, tumors greater than 100 cm3, poor response to chemo (<90% necrosis), elevated LDH |
| Osteomyelitis | |
| Age | any |
| Clinical Presentation | pain, fever, constitutional sx, redness, swelling, chronic wound drainage, bone exposed in wound |
| X-Ray | early periosteal rxn, late lucent or rxn thickened traebeculae |
| CT | cortical breech |
| MRI | target lesion, edema |
| Histology | inflammatory cells, necrosis |
| Rx | irrigation, debridement, antibiotic beads or spacers |
| Syndromes | cultures |
| Eosinophilic Granuloma (HistioX) | |
| Age | 5->10 |
| Clinical Presentation | pain, great imitator |
| X-Ray | well circumscribed, radiolucent, reactive rim of bone, vertebra plana spine |
| CT | evaluate multiple locations… Hand Schuller Christian Disease (all over viscera, lytic skull lesions, exophthalmus) |
| MRI | no soft tissue extension |
| Histology | langerhan's cell histiocyte with coffee bean shape nuclei, multinucleated giant cells, eosinophils |
| Rx | methylprednisolone acetate; systemic form Rx with chemo; brace spine |
| Syndromes | |
| Osteoid Osteoma | |
| Age | 0-20 |
| Clinical Presentation | painful joint, relieved with salicylates, night pain, insidious |
| X-Ray | intensely reactive bone, radiolucent nidus <1.5cm, well circumscribed, cortical |
| CT | same as x-ray |
| MRI | |
| Histology | distinction between nidus and reactive bone; nidus = osteoid trabeculae with greatest mineralization in center |
| Rx | observation, CT guided RF ablation, or excision |
| Syndromes | |
| Osteoblastoma | |
| Age | 0-30 |
| Clinical Presentation | (same as osteoid osteoma) painful joint, relieved with salicylates, night pain, insidious |
| X-Ray | radiolucent nidus >1.5cm, well defined, fluffy mineralization, bone destruction without characteristic bone formation as in osteoid osteoma |
| CT | same as bone |
| MRI | not as much bone formation or edema as osteoid osteoma |
| Histology | |
| Rx | osteoblastic rimming of trabeculae |
| Syndromes | |
| Chondroblastoma | |
| Age | 0-20 |
| Clinical Presentation | joint pain, swelling; distal femur, prox tibia/humerus, triradiate cartilage |
| X-Ray | open physes, epiphysis, eccentric, apophysis, radiolucency with rim of reactive bone |
| CT | same as x-ray, evaluate for fx/intraarticular |
| MRI | no soft tissue extension of mass; soft tissue edema if fracture, joint effusion if intraarticular |
| Histology | chondroblasts, cobblestoning, chicken wire calcification, giant cells |
| Rx | currettage, phenol, sterile water, bone graft, hydrocet (90% success) |
| Syndromes | 2% benign chondroblastomas metastasize to lung; chromosomes 5 and 8 may have genetic abnormalities |
| Chondromyxoid Fibroma | |
| Age | 10->20 |
| Clinical Presentation | pain (months to years) |
| X-Ray | long bones (esp tibia); lytic; eccentric; no matrix mineralization |
| CT | |
| MRI | |
| Histology | chondroid, fibromatoid, myxoid |
| Rx | resection |
| Syndromes | chromosome 6 at q13 position |
| Osteochondroma | |
| Age | >10 |
| Clinical Presentation | painless mass, after trauma |
| X-Ray | surface lesion, cortex of lesion continuous with bone cortex, medullary canal flows into it, pedunculated, sessile |
| CT | same as x-ray |
| MRI | no edema, fx or soft tissue changes |
| Histology | bone covered by cartilage cap |
| Rx | observation; <1% chance of conversion to sarcoma |
| Syndromes | malignant transformation signs: mineralization of soft tissue mass, subchondral bone destruction, inhomogenous appearance… usually chondrosarcoma |
| Enchondroma | |
| Age | 20-50 |
| Clinical Presentation | painless, incidental x-ray after trauma |
| X-Ray | lucent area in medullary canal; calcifications inside |
| CT | |
| MRI | |
| Histology | cartialge in bone |
| Rx | observation |
| Syndromes | Ollier's - multiple enchondromas and skeletal dysplasia |
| NOF | |
| Age | 0-20 |
| Clinical Presentation | painless, incidental x-ray after trauma |
| X-Ray | metaphyseal eccentric fibrous cortical defect scalloped long bones |
| CT | |
| MRI | |
| Histology | cellular, giant cells, lipophages, storiform spindle cells |
| Rx | observation (currettage/graft if >75% cortex or painful) |
| Syndromes | Jaffe-Campanacci Syndrome - multiple NOF, café au lait, endocrine abn |
| Fibrous Dysplasia | |
| Age | 0-30 |
| Clinical Presentation | monostotic or polystotic; café au lait spots |
| X-Ray | any bone; ground glass; lucency; rim of reactive bone |
| CT | |
| MRI | |
| Histology | fibroblasts; osteoid and bone within fibrous stroma; no osteoblastic rimming |
| Rx | observation; surgical stabilization for impending fx; currettage and graft if symptomatic |
| Syndromes | McCune Albright - polyostotic FD, café au lait, endocrine |
| UBC | |
| Age | 0-20 |
| Clinical Presentation | pain from path fx from minor trauma prox humerus most common/prox femur |
| X-Ray | central lucency; symmetric / thinning of cortex;"fallen leaf" |
| CT | bone expanded but not usually greater than physis; +/- path fx |
| MRI | fluid |
| Histology | thin fibrous lining; lining has fibrous tissue, giant cells, hemosiderin, infl cells |
| Rx | aspirate to confirm; methyl prednisolone acetate injection; currettage/graft if recalcitrant |
| Syndromes | ? etiology; possibly from disturbing physis |
| Aneurysmal Bone Cyst | |
| Age | 0-30 |
| Clinical Presentation | pain/swelling months to years |
| X-Ray | eccentric, lytic, expansile, metaphysis, +/- path fx |
| CT | thin rim of periosteal new bone; +/- path fx |
| MRI | fluid/fluid |
| Histology | cavernous blood filled spaces without endothelial lining; giant cells; thin strands of bone in fibrous tissue |
| Rx | curettage and bone grafting; local recurrence common w/ open physes |
| Syndromes | in association with GCT, CB, CMF, FD |
| Giant Cell Tumor | |
| Age | 20-50 |
| Clinical Presentation | pain referred to joint |
| X-Ray | radiolucent eccentric; metaphyseal/epiphyseal; knee (50%); vertebrae/sacrum (10%); uncommon w/ open physes |
| CT | benign bone tumor with mets to lung |
| MRI | reactive rim of bone; secondary necrosis or ABC |
| Histology | Giant Cells; secondary ABC/necrosis/reactive new bone |
| Rx | currettage, phenol, sterile water, bone graft, hydrocet (90% success) |
| Syndromes | 9% of GCT metastasize to lungs |
| Chordoma | |
| Age | >50 |
| Clinical Presentation | pelvic or LBP, hip pain, GI symptoms; 50% found on rectal exam |
| X-Ray | sacrum and spheno-occipital region; 10% in vertebral bodies |
| CT | midline bone destruction, sacrum expanded, distinct lobules, vertebral mixed pattern |
| MRI | soft tissue mass irregular mineralization |
| Histology | notochordal tissue; physaliferous cells |
| Rx | wide surgical excision, RTX if not wide surgical excision |
| Syndromes | 30-50% cases metastasize; mortality due to local extension |
| Adamantinoma | |
| Age | 30-50 |
| Clinical Presentation | months to years of pain |
| X-Ray | tibia most common; multiple, sharply circumscribed lucent defects w/ sclerotic bone interspersed between; pathologic fx |
| CT | path fx |
| MRI | path fx |
| Histology | epithelial-like islands in background of FD; palisading or glandular |
| Rx | wide surgical excision |
| Syndromes | may metastasize either early or after multiple failed attempts at local control |
| Osteofibrous Dysplasia | |
| Age | <10 |
| Clinical Presentation | pain |
| X-Ray | ground glass; diaphysis; eccentric; tibia confined to cortex, bowing, +/- path fx |
| CT | radiolucency |
| MRI | no soft tissue extension; edema if fx |
| Histology | bx not needed; fibrous tissue in background of bone trabeculae with osteoblastic rimming |
| Rx | nonop until skeletal maturity |
| Syndromes | |
| Neuroblastoma | |
| Age | <5 |
| Clinical Presentation | abd/bone pain, constitu sx; urine catachol |
| X-Ray | multiple lytic lesions |
| CT | |
| MRI | adrenal mass |
| Histology | Homer-Wright pseudorosettes, neuropil |
| Rx | |
| Syndromes | hepatomegaly; blanching subcutaneous nodules; or a large, irregular, firm abdominal mass; Homer-Wright pseudorosettes clusters neuroblasts surrounding areas of eosinophilic neuropil (neuritic process) |
| Soft Tissue - Vascular |
| Angiosarcoma | |
| Age | 20-70 bone; >50 skin |
| Clinical Presentation | mass, pain, skin changes/wound |
| X-Ray | soap bubble lesions; lytic mass irregular |
| CT | |
| MRI | decr T1; incr T2; soft tissue extension |
| Histology | endothelium of blood vessels |
| Rx | amputation, pulm mets common |
| Syndromes | soft tissue and bone forms |
| Hemangioma | |
| Age | any |
| Clinical Presentation | pain or path fx |
| X-Ray | phleboliths; radiolucent; coarsened honey-comb; vertebral bodies |
| CT | irregular blood vessels within lesion |
| MRI | cavernous (most common), capillary, or mixed |
| Histology | blood channels |
| Rx | alcohol injection; stockings; wide resection (recurrence common) |
| Syndromes | |
| Soft Tissue - Skeletal Muscle |
| Rhabdomyoma | |
| Age | <20 |
| Clinical Presentation | mass |
| X-Ray | neg |
| CT | neg |
| MRI | mass in muscle |
| Histology | muscle without pleomorphism or atypia |
| Rx | resection |
| Syndromes | |
| Rhabdomyosarcoma | |
| Age | <20 |
| Clinical Presentation | mass, pain |
| X-Ray | neg |
| CT | neg |
| MRI | heterogeneous mass in muscle |
| Histology | spindle cells in parallel bundles; giant cells; racquet shaped cells; rhabdomyoblasts (cross striations within the tumor cells) |
| Rx | preop chemo, wide resection, RTX |
| Syndromes | |
| Soft Tissue - Smooth Muscle |
| Leiomyoma | |
| Age | 20-60 |
| Clinical Presentation | nodule, pain, arise from pilar erector muscles; extensor surfaces |
| X-Ray | neg |
| CT | neg |
| MRI | mass in skin, sharp demarcation |
| Histology | spindle cells and cigar shaped nuclei |
| Rx | excision; recurrence after excision 50% |
| Syndromes | |
| Leiomyosarcoma | |
| Age | 20-60 |
| Clinical Presentation | small or large extremity mass |
| X-Ray | neg |
| CT | neg |
| MRI | may or may not be associated with vessels |
| Histology | leoimyoma w/ pleomorphism, atypia |
| Rx | preop RTX; resection; postop RTX |
| Syndromes | |
| Soft Tissue - Fibrohistiocytic |
| Benign Fibrous Histiocytoma | |
| Age | 20-50 |
| Clinical Presentation | small slow growing painless mass; dermatofibroma |
| X-Ray | neg |
| CT | neg |
| MRI | skin mass superficial |
| Histology | fibroblasts, histiocytes, storiform |
| Rx | excision, recurrence is uncommon |
| Syndromes | |
| Dermatofibrosarcoma Protuberans | |
| Age | 20-50 |
| Clinical Presentation | slow growing skin mass through skin, horizontal spread |
| X-Ray | soft tissue mass |
| CT | soft tissue mass |
| MRI | determines depth and invasion of tumor |
| Histology | fibroblasts, storiform, infiltrative, central portion with uniform plump fibroblasts, CD34 |
| Rx | chemo, resection, RTX if margins positive |
| Syndromes | |
| MFH | |
| Age | 10-90 |
| Clinical Presentation | mass |
| X-Ray | soft tissue mass |
| CT | soft tissue mass |
| MRI | heterogeneous intramuscular mass; calcification, necrosis, hemorrhage |
| Histology | fibroblasts, histiocytes, anaplastic, pleomorphism |
| Rx | wide or radical excision |
| Syndromes | |
| Soft Tissue - Adipose |
| Lipoma | |
| Age | any |
| Clinical Presentation | long standing mass, no pain |
| X-Ray | soft tissue mass |
| CT | soft tissue mass |
| MRI | sub-Q; IM or intermusc mass; well demarcated lesion with same signal as mature fat |
| Histology | |
| Rx | observation or excision |
| Syndromes | |
| Liposarcoma | |
| Age | >40 |
| Clinical Presentation | painful mass |
| X-Ray | soft tissue mass |
| CT | soft tissue mass |
| MRI | lipoblasts (signet ring-type cells); low to high grade |
| Histology | preop RTX; excision; postop RTX |
| Rx | well differen liposarc <10% mets; 10-30% intermed grade; >50% high grade |
| Syndromes | |
| Soft Tissue - Fibrous |
| Nodular Fascitis | |
| Age | 30-40 |
| Clinical Presentation | fast growing lesion in subQ fascia or deep fascia; forearm common; numb if near nerve |
| X-Ray | neg |
| CT | soft tissue mass |
| MRI | mass |
| Histology | "reactive pseudosarcoma"; nodular nonencapsulated mases, high mitosis |
| Rx | excision, few recurrences |
| Syndromes | |
| Deep and Superficial Fibromatosis | |
| Age | juvenile vs. adult |
| Clinical Presentation | mass, flexion contracture of figures, dupuytren |
| X-Ray | neg |
| CT | soft tissue mass |
| MRI | mass |
| Histology | fibroblasts, myofibroblasts, collagen |
| Rx | observation, surgical excision of the abnormal fibrous tissue; RTX/chemo to reduce recurrence rate |
| Syndromes | Lederhosen's disease (sole of foot) and Peyronie's Disease (penis) |
| Fibrosarcoma | |
| Age | 35-55 |
| Clinical Presentation | enlarging painless mass extrem/trunk |
| X-Ray | neg |
| CT | soft tissue mass |
| MRI | mass |
| Histology | vimentin, spindle cells, herringbone |
| Rx | |
| Syndromes | infantile fibrosarcoma - for less than one year old, most common sarcoma |
| Soft Tissue - Synovial |
| Synovial Chondromatosis | |
| Age | 30-50 |
| Clinical Presentation | knee pain, swelling |
| X-Ray | radiodensities (cartilage nodules) |
| CT | loose bodies in knee |
| MRI | cartilage lesions growing out of synovium |
| Histology | hyaline nodules may undergo ossification and become loose bodies growing out of synovium |
| Rx | open or arthroscopic total synovectomy and removal loose bodies |
| Syndromes | |
| PVNS | |
| Age | 20-40 |
| Clinical Presentation | knee involvement 80% in a 20-40 year old |
| X-Ray | lytic lesion on one or both sides of joint |
| CT | lytic lesion on one or both sides of joint |
| MRI | numerous foci of signal dropout "dark" on T2 |
| Histology | mononuclear cells, hemosiderophages, giant cells, foam cells deep to synovial lining (dark brown synovitis) |
| Rx | open or arthroscopic total synovectomy recurrence 5-10% |
| Syndromes | rheumatoid arthritis of a single joint; hemosiderin staining |
| Ganglia | |
| Age | 20-60 |
| Clinical Presentation | mass assoc w/joint, transilluminate |
| X-Ray | DJD of affected joint |
| CT | same as x-ray |
| MRI | fluid filled cyst assoc with joint |
| Histology | synovium; hyaluronic acid in cyst |
| Rx | aspirate and steroid injection, high recurrence rate; surgery w/ excision better |
| Syndromes | |
| Synovial Sarcoma | |
| Age | 20-40 |
| Clinical Presentation | mass near knee (most common), most common sarcoma of foot |
| X-Ray | calcification; biphasic; epithelial with fibrous/spindle component |
| CT | may detect secondary bone involvement |
| MRI | low T1, high T2 soft tissue mass, homogenous unless calcification present |
| Histology | S100, vimentin, CD99; cell origin unknown; (most are monophasic (only epithelial or spindle cells) and mistaken for fibrosarc |
| Rx | preop chemo; wide or radical resection; postop RTX |
| Syndromes | t(X,18); fused SSX-SYT gene; <10% intraarticular |
| Soft Tissue - Peripheral Nerves |
| NF | |
| Age | any |
| Clinical Presentation | most superficial, slow growing, painless (if pain think sarcoma) |
| X-Ray | neg |
| CT | neg |
| MRI | PNST |
| Histology | interlacing elongated cells with wavy dark nuclei; wire-like collagen strands |
| Rx | marginal excision |
| Syndromes | neurofibromatosis - café au lait spots, variable skeletal abnorm (NOF, scoliosis, bowing); 5-30% malignant change |
| Schwannoma | |
| Age | 20-50 |
| Clinical Presentation | asymptomatic mass |
| X-Ray | neg |
| CT | neg |
| MRI | eccentric mass from peripheral nerve; high on T2/low T1 |
| Histology | Antoni A/B; Verocay bodies |
| Rx | excise mass while leaving nerve intact |
| Syndromes | |
| Malignant PNST (malginant schwannoma, neurofibrosarcoma) | |
| Age | 20-40 |
| Clinical Presentation | painful mass; neuro symptoms |
| X-Ray | neg |
| CT | neg |
| MRI | >5cm diameter (most) |
| Histology | spindle cells resembling schwann; hyaline nodules, cartilage/bone islands, mitotic figures |
| Rx | excise mass +/- RTX/chemo if >5cm or aggressive |
| Syndromes | |
| Glomus Tumor | |
| Age | any, more common adults |
| Clinical Presentation | subungual mass; nail ridging; cold intolerance; pain; exquisite TTP |
| X-Ray | 50% erosions in distal phalanx |
| CT | same as x-ray |
| MRI | well circum nodules, fibrous surrounding; vascular; glomus cells |
| Histology | perivascular proliferation |
| Rx | marginal excision |
| Syndromes | the glomus cells are monomorphous round or polygonal cells with plump nuclei and scant eosinophilic cytoplasm |
| Miscellaneous |
| Clear Cell Sarcoma / Amelanotic Melanoma | |
| Age | 15-35 |
| Clinical Presentation | slow grow, foot and ankle mass |
| X-Ray | neg |
| CT | neg |
| MRI | mass assoc w/tendons, aponeuroses |
| Histology | nests polygonal round clear cells fibrous septae divide; giant cells, S100 |
| Rx | wide resection, postop RTX |
| Syndromes | t(12,22) |
| Alveolar Soft Parts Sarcoma | |
| Age | 15-35 |
| Clinical Presentation | slow growing painless mass anterior thigh |
| X-Ray | neg |
| CT | neg |
| MRI | soft tissue mass anterior thigh common |
| Histology | dense fibrous divides tumor into nests; large round cells; vascular |
| Rx | wide resection, postop RTX |
| Syndromes | |