S13C20P18-Epithelioid Sarc


S13C20P18-1: Epithelioid (large cell) sarcoma perhaps is ill-suited as an example of a “borderline” process; it is a malignant neoplasm, that, in a classic setting, is characterized by: progressive, local disease affecting tendon sheaths and aponeuroses (growth in continuity); by patterns of vascular dissemination to produce cutaneous and soft tissue metastases (the cutaneous lesions have a quality of “satellite lesions”); and by dissemination of disease. This category has been polluted by the inclusion of soft tissue lesions which have “epithelioid” qualtities, but have a most questionable relationship to the lesion of tendon sheaths and aponeuroses. The lesion in this illustration is of the classic type. It is composed of spindle and round cells that are histiocytoid in character. In the center of the field, there is an stellate area of necrosis; tumor cells form palisades at the margin of the area of necrosis. This pattern, if discovered in a cutaneous metastasis, might be mistaken for a palisaded granuloma. It is in this context that the lesion is included in the borderline category.



S13C20P18-2: In this field of an epithelioid sarcoma, both a spindle cell component and a round cell component are represented. Following a defintion of the lesion as “large cell sarcoma,” some observers in their presentations characterized the lesion as “acidophilic cell sarcoma.” These same observers later promoted the lesion as “epithelioid sarcoma.” The lesion tends to manifest micro-nodular zones that are cellular with condensations of rather bland fibrous tissue among the cellular nodules. In this field, even in the cellular portions, the cytologic features are rather bland, and histiocytoid.

S13C20P18-3: Round cells are arranged in clusters to the left above the center of the field. Spindle cells are represented below the center of the field. A small portion of a zone of necrosis is seen near the lower left margin of the field.

S13C20P18-4: This is a drawing of a large cell (epithelioid) sarcoma involving the hand (dissected specimen - palmar surface).

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