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Scientific Session 21 — Musculoskeletal - Tumor

Thursday, May 4, 2017

Abstracts 2512-3301

3228. Potential Importance of Biopsy of Areas of Soft Tissue Neoplasm Necrosis

Murphey M1*,  Zaklama A1,  Kong S1,  Kumar D2,  Jelinek J2 1. American Institute for Radologica Pathology/American College of Radiology, Silver Spring, MD; 2. Washington Hospital Center, Washington, DC

Address correspondence to S. Kong (

Objective: Historically, musculoskeletal biopsy technique has emphasized the importance of excluding necrosis in material submitted to our pathology colleagues for histologic evaluation. In our experience, this is not always the case, and in certain situations, biopsy not including the necrosis can lead to inaccurate pathologic downgrading of the neoplasm. Our purpose is to describe a small set of soft-tissue neoplasms in which biopsy excluding necrosis initially led to pathologic downgrading of the lesion.

Materials and Methods: We retrospectively reviewed 10 cases of soft-tissue neoplasms from our archives in which initial biopsy suggested a low-grade sarcoma. They included cases of undifferentiated soft-tissue sarcoma, leiomyosarcoma, malignant peripheral nerve sheath tumor, and myxofibrosarcoma. Subsequent to radiologic-pathologic correlation and resection, lesions were higher grade neoplasms leading to an increase in overall tumor staging.

Results: These cases depict the importance in certain situations of biopsy of not only the solid portions of a neoplasm but also areas suspicious for necrosis. Because necrosis is one of the factors in the commonly used grading system of the Fédération Nationale des Centres de Lutte Contre le Cancer (FNCLCC), its identification can lead to alteration and increased lesion grade and stage. Selectively not performing a biopsy of these areas for pathologic evaluation, as has been emphasized for many years, can lead to neoplasm downgrading and downstaging and suboptimal initial treatment. Radiologically, it can be difficult on MRI to distinguish hemorrhage or cyst formation from necrosis. Discussion between pathologists and radiologists in these situations concerning this possibility and potential need for biopsy of areas concerning for necrosis is important. Repeat biopsy may be necessary in some cases.

Conclusion: It may be important in certain cases of soft-tissue neoplasm to biopsy both solid areas and regions of potential necrosis so as not to inaccurately lead to histologic downgrading and downstaging of the lesion. This concept is contrary to a basic tenet many of us were taught but is important to understand to optimize initial patient treatment.