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Chapter 1 – Pathology and Classification

Summary: Pathology and classification

  • STSs represent <1% of all malignant tumours
  • Histological classification of STSs is based on the line of differentiation
  • IHC is used to determine line of differentiation in STSs
  • IHC can also be used as a surrogate for specific molecular alterations
  • Most STSs are histologically graded (Grade 1, 2 or 3) according to FNCLCC
  • Primary bone sarcomas account for only 0.2% of all neoplasms
  • A multidisciplinary approach with correlation between radiological features and morphology is mandatory for a correct diagnosis in bone tumours
  • Grading of most bone sarcomas is determined according to histological subtype


Further Reading

Blay JY, Sleijfer S, Schoffski P, et al. International expert opinion on patient-tailored management of soft tissue sarcomas. Eur J Cancer 2014; 50:679–689.

Blay JY, Soibinet P, Penel N, et al. Improved survival using specialized multidisciplinary board in sarcoma patients. Ann Oncol 2017; 28:2852–2859.

Casali PG, Abecassis N, Aro HT, et al. Soft tissue and visceral sarcomas: ESMO-EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2018; 29(Supplement_4):iv268–iv269.

Casali PG, Bielack S, Abecassis N, et al. Bone sarcomas: ESMO–PaedCan–EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2018; 29(Supplement_4):iv79–iv95.

Demicco EG, Lazar AJ. Clinicopathologic considerations: how can we fine tune our approach to sarcoma? Semin Oncol 2011; 38 Suppl 3:S3–18.

Evans HL, Ayala AG, Romsdahl MM. Prognostic factors in chondrosarcoma of bone: a clinicopathologic analysis with emphasis on histologic grading. Cancer 1977; 40:818–831.

Ray-Coquard I, Montesco MC, Coindre JM, et al. Sarcoma: concordance between initial diagnosis and centralized expert review in a population-based study within three European regions. Ann Oncol 2012; 23:2442–2449.

Trojani M, Contesso G, Coindre JM, et al. Soft-tissue sarcomas of adults; study of pathological prognostic variables and definition of a histopathological grading system. Int J Cancer 1984; 33:37–42.

van der Heijden L, Dijkstra PD, van de Sande MA, et al. The clinical approach toward giant cell tumor of bone. Oncologist 2014; 19:550–561.

WHO Classification of Tumours Editorial Board. Soft Tissue and Bone Tumours; WHO Classification of Tumours, 5th Edition, Volume 3. France: IACR; 2020.

WHO classification of bone sarcomas - 2 ESMO Members: Download the full book!

Chapter 1 – Pathology and Classification

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