Dr. Rajasekhar A.

National Pathology Laboratory

HYDERABAD.
Definition of Sarcoma
 Malignant tumor arising from the mesenchymal
tissues – Malignant Mesenchymal Tumor (MMT)

 Malignant tumor s of bone, cartilage, fat, muscle,

vascular or haematopoetic tissues.

 Greek σάρξ sarx meaning "flesh“.

 Sarcomas - Overview

Sarcomas of Jaw bones are rare – 1 % of all the

malignant tumors.
Age group : 1 to 80 years : Bimodal distribution.
 Pain and swelling are common symptoms.
 Ulceration and hemorrhage.
 Skin/Mucosa – red, inflamn, vascular prominence.
 Short duration indicating rapid growth rate
Sarcomas - Overview
 Highly aggressive in behaviour.

 Accurate diagnosis is necessary .

 Histopathological confirmation +/-

Immunohistochemistry are helpful.
Diagnostic work-up
 Routine clinical and biochemical investigations.
 Radiological work-up – X-ray/OPG.
 Cytology – Fine Needle Sampling or Aspiration.
 Biopsy – Trucut or Punch or Open
 Immunohistochemistry
Radiological features :
 X-rays (Orthopantomogram)

 Computerized Tomography

 Magnetic Resonance Imaging.

 Angiography
Radiological features :
 Diffuse radiolucent lesion.
 Ill-defined borders.

 Wide bone destruction.

 New bone formation.

 High vascularity.
Osteosarcoma of mandible.
FNS/AC in Sarcomas: Advantages.
 Rapid preliminary diagnosis – few hours-one day.

 No need of hospitalization or anesthesia.

 Excellent patient compliance – minimal pain

 Minimal complications – local hematoma.

FNS or FNAC – Material & Methods
 23-25 G Needles.
 10 ml Syringe.
 8-10 Glass slides.
 95% Alcohol solution.
 Couplin Jar with label.
 Wait for 10 minutes.
 Stain with Papanicolou’s, H & E and MGGiemsa.
Fine Needle Aspiration Cytology
 FNS/AC in Sarcomas: Disadvantages

 Experienced Cytologist is needed.

 Inability to hit deeper regions or penetrate bone.

 ? Tumor spread along the needle tract.

 Tissue architecture is difficult to ascertain.

Histology techniques :
 Biopsy tissue fixed in 10% Neutral Buffered Formalin.

 Processed routinely to Paraffin wax.

 Sectioned in 3-4 micron slices.

 Routine Haematoxylin and Eosin staining.

Histological types of sarcomas
 Osteosarcomas.
 Osteogenic or Chondroid types.
 Rhabdomyosarcoma.
 Ewing’s sarcoma.
 Lymphoma – Burkitt’s type.
 Granular sarcomas (Myeloid leukemia)
 Kaposi’s sarcoma.
Histological patterns :
 Spindle cell sarcomas
 Fibrosa, Neurofibrosa.
 Pleomorphic sarcomas.
 Osteosa, Rhabdomyosa.

 Round cell sarcomas

 Lymphoma, leukemia, Ewings
 Vascular sarcomas
 Kaposi sa. or rare Osteosa.
Sarcoma : Spindle cell pattern
Sarcoma : Pleomorphic pattern
Sarcomas : Round cell pattern
Grading of Sarcomas (NCI):
 Grade I :
 Fibrosa., Liposa., Leiomyosa., Chondrosa.,
Hemangipericytoma.

 Grade II :

 Grade III :
 Osteosa., Rhabdosa., Ewing’s, Lymph./Leukemia,
Kaposi’s types.
Immunohistochemistry of Sarcomas
 Cytokeratin+EMA – Sarcoma vs. Carcinoma
 Desmin + SMA – Myogenic / Myofibroblastic origin.
 S100 protein – Neurogenic / Melanocytic origin.
 CD99 antigen – Ewing’s sarcoma.
 Leucocyte Common Antigen – Burkitt’s+Granulocytic
 HMB45 antigen – Melanoma.
 Vimentin – Not an useful marker.
 Ki67 antigen – Proliferative index – malignant/benign
Spindle cell sa… S100 antigen
Pleomorphic sa… Cytokeratin
Round cell tumor : CD99 antigen
IHC : Vascular pattern: CD31
IHC : Ki antigen staining

Benign tumor Malignant tumor

 Dr. Rajasekhar A.
National Pathology Laboratory