Leiomyosarcoma Arising in Vessels
Grading / Staging / Report
- According to the guidelines of the ADASP, grading may be prognostically useful
- French Federation of Cancer Centers System (FNCLCC) grading scheme for adult sarcomas
- Tumor differentiation score = 2 for leiomyosarcoma
- Mitotic index
- Score 1 0-9 mitoses per 10 hpf (0.1744 sq mm)
- Score 2 10-19 mitoses per 10 hpf
- Score 3 >19 mitoses per 10 hpf
- Tumor cell necrosis
- Score 0 No necrosis on any slide (one slide per 2 cm tumor diameter)
- Score 1 <50% of tumor is necrotic on slides examined
- Score 2 >50% of tumor is necrotic on slides examined
- Final Grade (add the three scores above)
- Grade 1 Sum of scores = 2 or 3
- Grade 2 Sum of scores = 4 or 5
- Grade 3 Sum of scores = 6 or more
- One large study found that neither FNCLCC grading nor the presence of necrosis correlated with outcome in IVC tumors (Laskin 2010)
Use TNM Staging
The surgical pathology report should contain or address the following:
- Location
- Type of resection or biopsy
- Histologic diagnosis
- Managerial category III (Local recurrence common; Metastasis occurs)
- Extent of tumor cell necrosis
- Grade
- Stage
- Size
- Depth (dermis, subcutis, below fascia, body cavity)
- Margins
- Involved
- Not involved
- If under 2 cm give all such distances and sites
- If over 2 cm give minimum distance and site
- Results of supplementary studies if performed
- Relationship to other specimens from the same patient
