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Surgical pathology criteria use browser back button to return leiomyosarcoma of deep soft tissue, retroperitoneum, mesentery and omentum definition malignant neoplasm exhibiting smooth muscle differentiation located in the deep soft tissues, retroperitoneum, mesentery and omentum diagnostic criteria the definition of malignancy for smooth muscle tumors varies by site the features listed here apply only to the stated sites smooth muscle differentiation elongate eosinophilic cytoplasm pleomorphic or epithelioid cases may require desmin or caldesmon reactivity to support smooth muscle differentiation any one of the following is sufficient to diagnose a smooth muscle tumor as malignant for the stated sites cytologic pleomorphism or atypia tumor cell necrosis in retroperitoneum, mesentery and omentum mitotic rate >4 or >10 per 50 hpf (results from different published series) in deep soft tissue mitotic rate >4 per 50 hpf occasional findings epithelioid cytoplasm may be clear multinucleated, osteoclast-like cells inflammatory infiltrate palisading / verocay bodies stroma may range from hyalinized to myxoid smooth muscle tumor of uncertain malignant potential criteria vary by site in deep soft tissue bland tumors with 1-4 mitotic figures per 50 hpf tumors with multiple recurrences in retroperitoneum, mesentery and omentum bland tumors with 1-10 mitotic figures per 50 hpf neoplasms with the morophologic features of smooth muscle tumors arising in the bowel wall and expressing cd117 are considered gi stromal tumors richard l kempson md robert v rouse md department of pathology stanford university school of medicine stanford ca 94305-5342 original posting:: december 1, 2007 supplemental studies immunohistology smooth muscle actin and muscle specific actin positive actin reactivity is not specific desmin and caldesmon positive more specific than actin but may be less extensive keratin and ema may show occasional, usually patchy or dot-like staining s100 has been reported in smooth muscle tumors of various sites the combination of actin negative and s100 positive should strongly suggest nerve sheath tumor cd34 is occasionally positive, usually weakly differential diagnosis leiomyoma and smooth muscle tumor of uncertain malignant potential malignant fibrous histiocytoma dedifferentiated liposarcoma inflammatory myofibroblastic tumor gastrointestinal stromal tumor parasitic leiomyoma mesenteric fibromatosis angiomyolipoma   in the deep soft tissue: leiomyoma (requires all below) smooth muscle tumor of uncertain malignant potential (used for any of below) leiomyosarcoma (requires any one of below) cytologically bland   cytologic pleomorphism or atypia <1 mitotic figure / 50 hpf bland but 1-4 mitotic figures / 50 hpf >4 mitotic figures / 50 hpf no tumor cell necrosis multiple recurrences but lacking other atypical features coagulative tumor cell necrosis malignant fibrous histiocytoma leiomyosarcoma of deep soft tissue, retroperiton. where to buy viagra cheapest canadian pharmacy for viagra viagra for sale cheap viagra viagra for sale viagra without doctor prescription viagra online cheap generic viagra generic viagra online buy cheap viagra
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