This high-grade sarcoma can exhibit all the varied histologic subtypes similar to its soft-tissue counterpart: storiform-pleomorphic, giant-cell-rich, myxoid, and inflammatory. The most common is the pleomorphic/storiform pattern in which there is an admixture of fibroblast-like spindle cells and highly pleomorphic tumor cells in a storiform histologic architecture. The nuclei of the tumor cells can be large and hyperchromatic (Fig. 19). The cytoplasm may be densely eosinophilic or contain vacuolar changes. Atypical mitotic figures are usually present and multiple. Malignant giant tumor cells as well as benign osteoclastic giant cells may be present (66). Most authors divide the tumors into low and high grade.
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