Non-Odontogenic Connective Tissue Malignant Tumors: A Focus on Fibrosarcoma

Non-Odontogenic Connective Tissue Malignant Tumors: A Focus on Fibrosarcoma

Question. Enumerate non-odontogenic connective tissue malignant tumors. Discuss in detail about clinical features, etiology, and histopathology of fibrosarcoma.

Answer. Enumeration of non-odontogenic connective tissue malignant tumors

• Fibrous connective tissue: Fibrosarcoma
• Adipose Tissue: Liposarcoma
• Cartilage: Chondrosarcoma
• Bone
  • Osteosarcoma
  • Osteochondrosarcoma
• Vascular:
  • Hemangioendothelioma
  • Angiosarcoma
  • Kaposi sarcoma

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• Neural tissue: Neurosarcoma or Neurofirosarcoma
• Muscle
  • Leiomyosarcoma
  • Rhabdomyosarcoma
• Lymphoid tissue
  • Hodgkin and Non­Hodgkin lymphoma
  • Lymphosarcoma
  • Reticular cell sarcoma
  • Ewing’s sarcoma
  • Burkitts lymphoma
  • Multiple myeloma
  • Leukemia.

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Fibrosarcoma

• Fibrosarcoma is the malignant firous connective tissue tumor and is the malignant tumor of firoblasts.

Fibrosarcoma Clinical Features

• Fibrosarcoma arises at any age but mean age is 40 years.
• Male predilection is seen.
• Fibrosarcoma is most commonly seen in lower extremities i.e. femur and tibia.
• In oral cavity tumor involves mandible, maxilla, maxillary sinus, lip and palate.
• Tumor is generally a large painless mass which lies deep to fascia and has ill-defied margin.
• Associated teeth become mobile.
• Tumors in starting show benign growth and later on they spread rapidly producing large tumor with ulceration and hemorrhage.
• They can also cause pathological fracture.

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Fibrosarcoma Etiology

• Most of the firosarcomas arise from preexisting lesions such as Paget’s disease, firous dysplasia chronic osteomyelitis, bone infarcts and in previously irradiated areas of bone.
• Congenital firosarcomas are thought to arise from genetic mutations.

Fibrosarcoma Histopathology

• Various histological grading of firosarcoma are:

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Fibrosarcoma Well-differentiated

• In this multiple plump-shaped firoblasts with pale eosinophilic cytoplasm, hyperchromatic spindle­shaped nuclei with tapered ends is seen.
• Malignant firoblasts are dispersed in rich collagen area.
• Few mitotic fiures are evident.

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Fibrosarcoma Intermediate Grade

• In this tumor show Herring bone pattrn, i.e. parallel sheets of cells arranged in intertwining whorls.
• Cellularity is high.
• Cellular pleomorphism is evident.
• Areas of hyalinization can be appreciated.

Fibrosarcoma High Grade

• Marked cellular atypia and mitotic activity is evident.
• This grade is highly anaplastic and pleomorphic with bizarre nuclei.