Pathologic necrosis following neoadjuvant radiotherapy or chemoradiotherapy is prognostic of poor survival in soft tissue sarcoma.

PURPOSE: Neoadjuvant radiotherapy ± chemotherapy and wide local excision is an accepted management of localized soft tissue sarcomas (STS). Necrosis is prognostic for survival in osteosarcomas, but the significance for STS is undetermined. This study aimed to determine if percent true necrosis, opposed to a combination of necrosis and fibrosis, leads to improved survival in extremity and trunk STS. METHODS: From 2000 to 2015, 162 patients with STS were treated with neoadjuvant therapy and resection. Patient and tumor variables were reviewed, and resected specimens underwent pathological assessment. Necrosis was ratiometrically determined. Overall (OS), distant metastasis-free (DMFS), and progression-free survival (PFS) were calculated using Kaplan-Meier estimator. Survival was determined using the Fisher's exact test for univariate analysis (UVA) and logistic regression for multivariate analysis (MVA). RESULTS: Median follow-up was 4.5 years and median necrosis was 24.97%. Necrosis predicted worse OS, DMFS, and PFS on UVA, and DMFS and PFS on MVA. Necrosis was positively correlated with size and grade. To mitigate the role of size, a sub-analysis of ≥ 10 cm tumors was performed revealing necrosis predicted decreased DMFS and PFS on UVA and MVA. In high-grade tumors, necrosis correlated with decreased DMFS and PFS on UVA. Necrosis did not predict OS in ≥ 10 cm or high-grade tumors. CONCLUSIONS: Our data suggests necrosis may be an additional independent, prognostic variable with increased necrosis predicting a worse prognosis. Necrosis may not be a measure of treatment response and instead suggests more aggressive tumor biology as high-grade, large STS were associated with increased necrosis.

Typical and Atypical Granular Cell Tumors of Soft Tissue: A Clinicopathologic Study of 50 Patients.

OBJECTIVES: Granular cell tumors are rare neoplasms of neural origin. Despite the mesenchymal nature of these tumors, they rarely occur in the soft tissue, and as a result, this subset is not well characterized. We present the largest case series to date comprising 50 patients with benign and atypical soft tissue granular cell tumors in an effort to better define the pathologic features in this subset of lesions. METHODS: All cases of soft tissue granular cell tumors from the Ohio State Medical Center and the Medical College of Wisconsin over a 10-year period were reviewed for histologic and clinical findings. RESULTS: The most common location was the upper extremity. The mean age was 38.6 years, and the mean size of the tumor was 2.1 cm. An infiltrative growth pattern was seen in 58.8% of cases, and positive margins were found in 68.2%. Eleven (21.6%) cases showed evidence of cytologic atypia and fulfilled the criteria for a diagnosis of atypical giant cell tumor. Two of 11 patients with long-term follow-up experienced local recurrence. CONCLUSIONS: Compared with granular cell tumors overall, the soft tissue subset shows a larger average size and higher propensity for incomplete resections, with atypical features being relatively common. Our findings suggest that soft tissue granular cell tumors may be slightly more aggressive than their dermal or organ-confined counterparts.

Dedifferentiated chondrosarcoma of bone with prominent rhabdoid component.

Dedifferentiated chondrosarcomas (DDCS) are rare lesions, defined as tumors having a low-grade chondrosarcomatous component with an abrupt transition to a high-grade sarcoma. Although "malignant fibrous histiocytoma" (undifferentiated pleomorphic sarcoma) is the most common high grade saromatous component, many different types of sarcoma have been described. We present a case of dedifferentiated chondrosarcoma with rhabdomyosarcomatous differentiation harboring a prominent rhabdoid tumor component. To our knowledge, rhabdoid morphology in dedifferentiated chondrosarcoma has not been described in the English-language literature. The pathologic and radiologic features of this case are presented.

Intraoperative imprint cytology of ovarian transitional cell (Brenner) tumors: a retrospective study.

Literature on fine-needle aspiration of ovarian transitional cell tumor or Brenner tumors is sparse and mostly confined to isolated case reports of metastatic transitional cell tumors. We undertook a retrospective study of intraoperative imprint cytology of ovarian transitional cell tumors to better define the cytologic features of this uncommon ovarian tumor. Between 2005 and 2012, a total of 19 ovarian transitional cell tumors were recorded in our surgical pathology files, 10 of which had concomitant imprint cytologic material available for review. The 10 patients included in this study ranged in age between 43 and 73 years (mean age: 54 years). Nine neoplasms were histologically benign and one was borderline. Nine cases had satisfactory cytologic material for review. The cytologic features can be summarized as follows: the eight benign tumors showed abundant naked nuclei in the background, small and large clusters of tumor cells, abundant cytoplasm, smooth nuclear membranes, and lack of nuclear pleomorphism and mitoses. Single plasmacytoid cells with dense blue abundant cytoplasm, perinuclear vacuoles, nucleoli, microfollicle formation, nuclear grooves, binucleation/multinucleation, and extracellular eosinophilic material were some of the other features that were appreciated. The cytologic features of the one case of borderline transitional cell tumor were similar to those of the benign tumors except for the presence of rare mitoses, easily identifiable nuclear pleomorphism and irregular nuclear membranes. This study highlights some characteristic cytologic features of benign/borderline transitional cell tumors of the ovary which can be of help in recognizing this uncommon neoplasm.