DOCSLIB.ORG

Cd34positive Superficial Myxofibrosarcoma

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Cd34positive Superficial Myxofibrosarcoma J Cutan Pathol 2013: 40: 639–645 © 2013 John Wiley & Sons A/S. doi: 10.1111/cup.12158 Published by John Wiley & Sons Ltd John Wiley & Sons. Printed in Singapore Journal of Cutaneous Pathology CD34-positive superficial myxofibrosarcoma: a potential diagnostic pitfall§ Background: Myxofibrosarcoma (MFS) arises most commonly in the Steven C. Smith1,†,AnnA. proximal extremities of the elderly, where it may involve subcutaneous Poznanski1,†,§, Douglas R. and dermal tissues and masquerade as benign entities in limited biopsy Fullen1,2, Linglei Ma3, samples. We encountered such a case, in which positivity for CD34 and Jonathan B. McHugh1,DavidR. morphologic features were initially wrongly interpreted as a Lucas1 and Rajiv M. Patel1,2 ‘low-fat/fat-free’ spindle cell/pleomorphic lipoma. Case series have not 1 assessed prevalence of CD34 reactivity among cutaneous examples of Department of Pathology, University of Michigan, Ann Arbor, MI, USA, MFS. 2Department of Dermatology, University of Methods: We performed a systematic review of our institution’s Michigan, Ann Arbor, MI, USA, and experience, selecting from among unequivocal MFS resection 3Miraca Life Sciences, Glen Burnie, MD, USA specimens those superficial cases in which a limited biopsy sample §This project was presented orally as a proffered might prove difficult to interpret. These cases were immunostained for paper at the United States and Canadian Academy CD34 and tabulated for clinicopathologic characteristics. of Pathology Annual Meeting in Baltimore, MD, = March 2013. Results: After review of all MFS diagnoses over 5 years (n 56), we †Both the authors contributed equally to this work. identified a study group of superficial MFS for comparison to the index ‡Present address: Department of Biomedical case (total n = 8). Of these, the index and three additional cases (4 of 8, Sciences, Oakland University William Beaumont 50%; 2 low, 2 high grade) demonstrated positive staining for CD34, School of Medicine, Rochester, MI 48309, USA. with diffuse staining of spindled cells including cellular processes. Four additional cases showed no or equivocal/rare staining. Conclusions: CD34 positivity should be recognized as prevalent among such cases and should not be inappropriately construed as inveighing against a diagnosis of MFS in favor of benign entities. Keywords: fibroblasts, histopathology, myxofibrosarcoma, soft tissue Rajiv M. Patel, MD tumors Department of Pathology M3261 Medical Science I 1301 Catherine St., Ann Arbor, MI Smith SC, Poznanski AA, Fullen DR, Ma L, McHugh JB, Lucas DR, 48109-0602, USA Patel RM. CD34-positive superficial myxofibrosarcoma: a potential Tel: 734-764-4460 Fax: 734-764-4690 diagnostic pitfall. e-mail: [email protected] J Cutan Pathol 2013; 40: 639–645. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Accepted for publication March 21, 2013 Myxofibrosarcoma (MFS) represents a tumor malignant fibroblastic cells demonstrating spindle comprised of malignant spindle cells in a myxoid cell morphology and cellular condensation around stroma. The entity was originally considered a characteristic curvilinear blood vessels.3 High- myxoid variant of malignant fibrous histiocytoma.1,2 grade cases are typically more cellular and show As currently classified, MFS constitutes a distinctive large, pleomorphic atypical cells with abundant entity with reproducible histomorphologic and mitoses and necrosis and are essentially pleomorphic clinical features.2 Most distinguishing for MFS, low undifferentiated sarcomas with a myxoid stroma. grade-cases are characterized histopathologically by Individual cases often show a continuum of low cellularity, predominantly myxoid stroma and microscopic grade. Clinically, MFS tends to occur 639 Smith et al. as masses in the proximal limb girdles of elderly systematic review of our institutional experience with patients where they may involve skeletal muscle, MFS. With approval of the University of Michigan fascia, subcutaneous adipose and through their Institutional Review Board, departmental records propensity for infiltrative growth, the dermis.4 The were searched for all cases with diagnosis of MFS difficulty of rendering a diagnosis in superficially from 2005–2010, resulting in identification of 56 sampled lesions has been recognized in scattered candidate MFS corresponding to 44 patients (10 case reports5–8 and small series.9,10 We recently patients had ≥ 2 specimens evaluated). These cases encountered just such a case, in which a superficial, were deidentified, reviewed to confirm diagnosis, low-grade component of a MFS was sampled by a and canvassed to identify cases where the MFS had superficial cutaneous biopsy. Immunoreactivity for arisen at, or extended to involve, dermis or superficial CD34, along with other features, initially prompted subcutaneous tissues (total n = 8). The University of an incorrect diagnosis of ‘fat-free/low-fat’ spindle Michigan employs the grading system developed cell/pleomorphic lipoma.11,12 by the Fed´ eration´ nationale des Centres de lutte The case concerned an incisional biopsy from contre le cancer (FNCLCC) for soft tissue sarcoma the right upper posterior arm of an 85-year-old grading,20 which is binarized for clinician use into low man, with requisition listing ‘five year history of grade (FNCLCC Grade 1) or high grade (FNCLCC lipoma’. The impression of the patient’s primary Grades 2 and 3) before formal diagnostic reporting. care provider was of a ‘benign cyst’, though a Herein, for ease of general understanding, each case plastic surgery consultation described an indurated was reviewed and the FNCLCC grade reported in but mobile nodule, suggestive of lipoma arising in Table 1. Appropriate sections were selected for CD34 the subcutaneous tissue and pressing against the immunohistochemical staining in the University dermis. Grossly, the specimen was an unoriented of Michigan Clinical Immunohistochemistry Core. skin ellipse, 3.0 cm × 1.0 cm. Sections demonstrated The antibody used was Clone QBEnd10 (Dako, a predominantly well circumscribed lesion with Carpenteria, CA, USA) at 1/100 dilution for 32 min myxoid stroma and mostly bland admixed spindle after preatreatment with CC1 buffer (Dako) for ◦ cells. Scattered foci of adipocytes were present 30minat95C, performed on a Benchmark Ultra and entrapped ‘ropey collagen’ was prominent, autostainer (Ventana, Tucson, AZ, USA). Staining with scattered mast cells; a ‘low-fat/fat-free’ spindle was evaluated by consensus by three pathologists cell/pleomorphic lipoma was suspected clinically and (S.S., A.P., R.P.). For photomicrographs, the slides pathologically (Fig. 1A,B). A CD34 immunostain were scanned on a Scanscope XT whole slide scanner was ordered and demonstrated diffuse positivity and photographed in ImageScope (both Aperio, among spindle cells within the lesion, highlighting its Vista, CA, USA), at indicated magnifications. silhouette at low power (Fig. 1C,D), consistent with a spindle cell/pleomorphic lipoma.11– 14 However, close inspection identified curvilinear vessels with Results perivascular condensation of hyperchromatic spindle Review of 56 cases from 2005 to 2010 confirmed cells (Fig. 1E). On the basis of these worrisome the diagnosis in all cases and identified, among findings, re-excision was recommended. Sections of unequivocal resection specimens, 7 additional cases the re-excision showed a deeper seated MFS with with superficial extension where a limited biopsy greater cellularity and atypia (Fig. 1F), extending to sample may have presented a similar diagnostic within 0.1 cm of the deep margin. conundrum to the index case. Importantly, these On the basis of this experience, awareness of cases presented clinicopathologic characteristics con- the expanding spectrum of CD34-positive cutaneous sistent with reported MFS cohorts1,3,4,18 including entities,15,16 and relative lack of published data on the age range (52–88 years), 4:3 male : female ratio and prevalence of CD34 immunoreactivity among MFS wide anatomic distribution (see Table 1). In 5 of 7 in large,1–3,17 recent4,18,19 and cutaneous series, we cases, benign disease was specifically favored in the undertook a review of our institutional experience relevant pre-procedural clinician notes; in no case with MFS. Cases with superficial involvement were was MFS suspected prior to pathologic diagnosis. selected for study and stained with CD34, with CD34 staining was unequivocally positive in three the intention of better characterizing this potential additional cases (Fig. 2A–J). Case 2 concerned a diagnostic pitfall. lesion on the left forearm of a 52-year-old male, clinically thought to be ‘benign’; this low grade MFS dissected along tissue planes in the superficial Materials and methods subcutis, with similar architectural and cytologic After encountering the index case described below features to that of the index case (Fig. 2A). On during routine diagnostic practice, we undertook a higher power, diagnostic hyperchromatic, atypical 640 CD34-positive myxofibrosarcoma AB C D E F Fig. 1. Index case of CD34 positive myxofibrosarcoma masquerading as ‘fat-free/low-fat’ spindle cell/pleomorphic lipoma. A) Low-power micrograph demonstrating a bland spindle cell proliferation with myxoid stroma involving the dermis (×20). B) High power micrograph showing a focus of mature adipose and ropey collagen (*), with intervening scattered mast cells (arrows) (×400). C) Low-power micrograph of CD34 immunostain (×200). D) High power micrograph showing unequivocally positive CD34 in cytoplasm and cellular
Load more

Recommended publications
  • Soft Tissue Cytopathology: a Practical Approach Liron Pantanowitz, MD
    4/1/2020 Soft Tissue Cytopathology: A Practical Approach Liron Pantanowitz, MD Department of Pathology University of Pittsburgh Medical Center [email protected] What does the clinician want to know? • Is the lesion of mesenchymal origin or not? • Is it begin or malignant? • If it is malignant: – Is it a small round cell tumor & if so what type? – Is this soft tissue neoplasm of low or high‐grade? Practical diagnostic categories used in soft tissue cytopathology 1 4/1/2020 Practical approach to interpret FNA of soft tissue lesions involves: 1. Predominant cell type present 2. Background pattern recognition Cell Type Stroma • Lipomatous • Myxoid • Spindle cells • Other • Giant cells • Round cells • Epithelioid • Pleomorphic Lipomatous Spindle cell Small round cell Fibrolipoma Leiomyosarcoma Ewing sarcoma Myxoid Epithelioid Pleomorphic Myxoid sarcoma Clear cell sarcoma Pleomorphic sarcoma 2 4/1/2020 CASE #1 • 45yr Man • Thigh mass (fatty) • CNB with TP (DQ stain) DQ Mag 20x ALT –Floret cells 3 4/1/2020 Adipocytic Lesions • Lipoma ‐ most common soft tissue neoplasm • Liposarcoma ‐ most common adult soft tissue sarcoma • Benign features: – Large, univacuolated adipocytes of uniform size – Small, bland nuclei without atypia • Malignant features: – Lipoblasts, pleomorphic giant cells or round cells – Vascular myxoid stroma • Pitfalls: Lipophages & pseudo‐lipoblasts • Fat easily destroyed (oil globules) & lost with preparation Lipoma & Variants . Angiolipoma (prominent vessels) . Myolipoma (smooth muscle) . Angiomyolipoma (vessels + smooth muscle) . Myelolipoma (hematopoietic elements) . Chondroid lipoma (chondromyxoid matrix) . Spindle cell lipoma (CD34+ spindle cells) . Pleomorphic lipoma . Intramuscular lipoma Lipoma 4 4/1/2020 Angiolipoma Myelolipoma Lipoblasts • Typically multivacuolated • Can be monovacuolated • Hyperchromatic nuclei • Irregular (scalloped) nuclei • Nucleoli not typically seen 5 4/1/2020 WD liposarcoma Layfield et al.
    [Show full text]
  • Well-Differentiated Spindle Cell Liposarcoma
    Modern Pathology (2010) 23, 729–736 & 2010 USCAP, Inc. All rights reserved 0893-3952/10 $32.00 729 Well-differentiated spindle cell liposarcoma (‘atypical spindle cell lipomatous tumor’) does not belong to the spectrum of atypical lipomatous tumor but has a close relationship to spindle cell lipoma: clinicopathologic, immunohistochemical, and molecular analysis of six cases Thomas Mentzel1, Gabriele Palmedo1 and Cornelius Kuhnen2 1Dermatopathologie, Friedrichshafen, Germany and 2Institute of Pathology, Medical Center, Mu¨nster, Germany Well-differentiated spindle cell liposarcoma represents a rare atypical/low-grade malignant lipogenic neoplasm that has been regarded as a variant of atypical lipomatous tumor. However, well-differentiated spindle cell liposarcoma tends to occur in subcutaneous tissue of the extremities, the trunk, and the head and neck region, contains slightly atypical spindled tumor cells often staining positively for CD34, and lacks an amplification of MDM2 and/or CDK4 in most of the cases analyzed. We studied a series of well-differentiated spindle cell liposarcomas arising in two female and four male patients (age of the patients ranged from 59 to 85 years). The neoplasms arose on the shoulder, the chest wall, the thigh, the lower leg, the back of the hand, and in paratesticular location. The size of the neoplasms ranged from 1.5 to 10 cm (mean: 6.0 cm). All neoplasms were completely excised. The neoplasms were confined to the subcutis in three cases, and in three cases, an infiltration of skeletal muscle was seen. Histologically, the variably cellular neoplasms were composed of atypical lipogenic cells showing variations in size and shape, and spindled tumor cells with slightly enlarged, often hyperchromatic nuclei.
    [Show full text]
  • Appendix 4 WHO Classification of Soft Tissue Tumours17
    S3.02 The histological type and subtype of the tumour must be documented wherever possible. CS3.02a Accepting the limitations of sampling and with the use of diagnostic common sense, tumour type should be assigned according to the WHO system 17, wherever possible. (See Appendix 4 for full list). CS3.02b If precise tumour typing is not possible, generic descriptions to describe the tumour may be useful (eg myxoid, pleomorphic, spindle cell, round cell etc), together with the growth pattern (eg fascicular, sheet-like, storiform etc). (See G3.01). CS3.02c If the reporting pathologist is unfamiliar or lacks confidence with the myriad possible diagnoses, then at this point a decision to send the case away without delay for an expert opinion would be the most sensible option. Referral to the pathologist at the nearest Regional Sarcoma Service would be appropriate in the first instance. Further International Pathology Review may then be obtained by the treating Regional Sarcoma Multidisciplinary Team if required. Adequate review will require submission of full clinical and imaging information as well as histological sections and paraffin block material. Appendix 4 WHO classification of soft tissue tumours17 ADIPOCYTIC TUMOURS Benign Lipoma 8850/0* Lipomatosis 8850/0 Lipomatosis of nerve 8850/0 Lipoblastoma / Lipoblastomatosis 8881/0 Angiolipoma 8861/0 Myolipoma 8890/0 Chondroid lipoma 8862/0 Extrarenal angiomyolipoma 8860/0 Extra-adrenal myelolipoma 8870/0 Spindle cell/ 8857/0 Pleomorphic lipoma 8854/0 Hibernoma 8880/0 Intermediate (locally
    [Show full text]
  • Pleomorphic Lipoma: a Rare Tumor in the Retropharyngeal Space Pleomorphic Lipoma: a Rare Tumor in the Retropharyngeal Space
    AIJOC 10.5005/jp-journals-10003-1141 CASE REPORT Pleomorphic Lipoma: A Rare Tumor in the Retropharyngeal Space Pleomorphic Lipoma: A Rare Tumor in the Retropharyngeal Space Vidya Bhushan Rangappa, Raghavendra Suresh, Kapila Manikantan, AM Balasubramanya ABSTRACT well encapsulated, hypodense lesion in the retropharyngeal Lipomas are benign tumors arising from fat cells. Occurrence space extending into right parapharyngeal space pushing of lipoma in retropharyngeal space is very rare entity. To the larynx and pharynx to left and displacement of right great best of our knowledge, this is the second case of pleomorphic vessels laterally (Fig. 2). The lesion was seen extending lipoma being reported in the retropharyngeal space. They are from skull base to upper mediastinum. Fine needle aspiration usually asymptomatic until they are of large size. We report a case of a large pleomorphic lipoma in the retropharyngeal space, cytology (FNAC) of the lesion was consistent with features with emphasis on the clinical characters and histologic of lipoma. Surgically the mass was removed with a extended characteristics of the lesion. These tumors are best managed thyroidectomy incision extending from right mastoid tip surgically by a transcervical approach. down to left lateral part of the neck. Mass was dissected Keywords: Pleomorphic, Retropharyngeal space, Lipoma, from the surrounding structures completely with the capsule Benign, Neck swelling. (Figs 3 and 4). The mass was measuring 8 × 6 cm (Fig. 5). How to cite this article: Rangappa VB, Suresh R, Manikantan Histopathological examination showed characteristic K, Balasubramanya AM. Pleomorphic Lipoma: A Rare Tumor in 'floret' cells which are large hyperchromatic multinucleated the Retropharyngeal Space.
    [Show full text]
  • Spindle Cell Lipoma of the Anterior Triangle of the Neck
    Braz J Otorhinolaryngol. 2011;77(3):401. CASE REPORT BJORL .org Spindle cell lipoma of the anterior triangle of the neck: a rare entity Smita Upadhyay1, Arpit Sharma2, Shashikant Mhashal3, Jyoti P Dabholkar4 Keywords: immunohistochemistry, lipoma, neck. INTRODUCTION involves the elderly males. Most common both of these have similar cytogenetics they locations involve the posterior neck, shoulder are considered as a single entity 5. Solitary lipomas are the most common and back however in our case the anterior It is important to differentiate SCL from soft tissue tumor. Lipomas include a gamut triangle of the neck were involved. liposarcoma. Liposarcoma are characterized of subtypes. Spindle cell lipoma (SCL) is a by more numerous spindle cells, presence of distinct entity accounting for about 1.5% of nuclear pleomorphism and MDM-2 amplifica- all lipomas1. The diagnosis of SCL is a his- tion1. Myxoid stroma can sometimes be seen tological one and careful study is required to in SCL when it mimics myxoid liposarcomas. differentiate it from the liposarcoma. However the superficial location and the circumscribed lesion helps differentiate SCL CASE REPORT from the latter. Also the vascular pattern, pleomorphism and mitotic activity should A 48 year old male reported with a be assessed6. The other differential diagnosis history of a left sided neck swelling since 2 includes dermatofibrosarcoma protuberans, years which was progressively increasing in mammary type solitary fibrous tumor and size. A 4x4 cm swelling was present in the an- myofibroblastoma. terior triangle of the neck which was firm and The treatment is surgical excision mobile. ENT examination and investigations and recurrences are extremely rare even with were unremarkable.
    [Show full text]
  • Atypical Fibroxanthoma - Histological Diagnosis, Immunohistochemical Markers and Concepts of Therapy
    ANTICANCER RESEARCH 35: 5717-5736 (2015) Review Atypical Fibroxanthoma - Histological Diagnosis, Immunohistochemical Markers and Concepts of Therapy MICHAEL KOCH1, ANNE J. FREUNDL2, ABBAS AGAIMY3, FRANKLIN KIESEWETTER2, JULIAN KÜNZEL4, IWONA CICHA1* and CHRISTOPH ALEXIOU1* 1Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Erlangen, Erlangen, Germany; 2Dermatology Clinic, 3Institute of Pathology, and 4ENT Department, University Hospital Mainz, Mainz, Germany Abstract. Background: Atypical fibroxanthoma (AFX) is an in 1962 (2). The name 'atypical fibroxanthoma' reflects the uncommon, rapidly growing cutaneous neoplasm of uncertain tumor composition, containing mainly xanthomatous-looking histogenesis. Thus far, there are no guidelines for diagnosis and cells and a varying proportion of fibrocytoid cells with therapy of this tumor. Patients and Methods: We included 18 variable, but usually marked cellular atypia (3). patients with 21 AFX, and 2,912 patients with a total of 2,939 According to previous reports, AFX chiefly occurs in the AFX cited in the literature between 1962 and 2014. Results: In sun-exposed head-and-neck area, especially in elderly males our cohort, excision with safety margin was performed in 100% (3). There are two disease peaks described: one within the 5th of primary tumors. Local recurrences were observed in 25% of to 7th decade of life and another one between the 7th and 8th primary tumors and parotid metastases in 5%. Ten-year disease- decade. The former disease peak is associated with lower specific survival was 100%. The literature research yielded 280 tumor frequency (21.8%) and tumors that do not necessarily relevant publications. Over 90% of the reported cases were manifest on skin areas exposed to sunlight (4).
    [Show full text]
  • The Role of Cytogenetics and Molecular Diagnostics in the Diagnosis of Soft-Tissue Tumors Julia a Bridge
    Modern Pathology (2014) 27, S80–S97 S80 & 2014 USCAP, Inc All rights reserved 0893-3952/14 $32.00 The role of cytogenetics and molecular diagnostics in the diagnosis of soft-tissue tumors Julia A Bridge Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA Soft-tissue sarcomas are rare, comprising o1% of all cancer diagnoses. Yet the diversity of histological subtypes is impressive with 4100 benign and malignant soft-tissue tumor entities defined. Not infrequently, these neoplasms exhibit overlapping clinicopathologic features posing significant challenges in rendering a definitive diagnosis and optimal therapy. Advances in cytogenetic and molecular science have led to the discovery of genetic events in soft- tissue tumors that have not only enriched our understanding of the underlying biology of these neoplasms but have also proven to be powerful diagnostic adjuncts and/or indicators of molecular targeted therapy. In particular, many soft-tissue tumors are characterized by recurrent chromosomal rearrangements that produce specific gene fusions. For pathologists, identification of these fusions as well as other characteristic mutational alterations aids in precise subclassification. This review will address known recurrent or tumor-specific genetic events in soft-tissue tumors and discuss the molecular approaches commonly used in clinical practice to identify them. Emphasis is placed on the role of molecular pathology in the management of soft-tissue tumors. Familiarity with these genetic events
    [Show full text]
  • Case Reports Article – Rapidly Growing Mass in the Ear Canal: A
    Arepen et al. (2020): Rapidly growing mass in the ear canal May 2020 Vol. 23 Issue 8 Case reports article – Rapidly growing mass in the ear canal: A rare case of isolated superficial angiomyxoma Siti Asmat Md Arepen1,2, Nor Eyzawiah Hassan1,2, Azlina Abd Rani1, Shahrul Hitam2 Mohd Khairi Md Daud3 1Faculty of Medicine & Health Sciences,Universiti Sains Islam Malaysia, Selangor, Malaysia. 2Department of Otorhinolaryngology Head & Neck Surgery, Hospital Ampang, Selangor, Malaysia. 3Department of Otorhinolaryngology Head & Neck Surgery, Faculty of Medicine & Health Sciences, Universiti Sains Malaysia, Kelantan, Malaysia. Corresponding author: Nor Eyzawiah Hassan ([email protected]) Abstract: Superficial angiomyxoma is a rare benign skin tumour and usually present as an asymptomatic lesion. It is known to be highly recurrent and complete wide excision is the best treatment. This cace reported of 56 yr old gentleman presented with fleshy, pink coloured right external auditory mass. The mass arisen from the posterior wall of the canal at the bony–cartilaginous junction. Clinical diagnosis of an anaural polyp was made and the mass was excised. However, it rapidly recurred bigger than its actual size within a week. The histopathological examination was reported as superficial angiomyxoma. A differential diagnosis of isolated superficial angiomyxoma should be considered in the case of external auditory canal mass and Carney complex needs to be considered. Complete excision and regular follow up is recommended. Keywords: Benign tumour, external auditory canal, myxoma How to cite this article: How to cite this article: Arepen et al. (2020): Case reports article – Rapidly growing mass in the ear canal: A rare case of isolated superficial angiomyxoma, Ann Trop & Public Health, 23 (S8): 1279–1282.
    [Show full text]
  • Dermatopathology
    Dermatopathology Clay Cockerell • Martin C. Mihm Jr. • Brian J. Hall Cary Chisholm • Chad Jessup • Margaret Merola With contributions from: Jerad M. Gardner • Talley Whang Dermatopathology Clinicopathological Correlations Clay Cockerell Cary Chisholm Department of Dermatology Department of Pathology and Dermatopathology University of Texas Southwestern Medical Center Central Texas Pathology Laboratory Dallas , TX Waco , TX USA USA Martin C. Mihm Jr. Chad Jessup Department of Dermatology Department of Dermatology Brigham and Women’s Hospital Tufts Medical Center Boston , MA Boston , MA USA USA Brian J. Hall Margaret Merola Department of Dermatology Department of Pathology University of Texas Southwestern Medical Center Brigham and Women’s Hospital Dallas , TX Boston , MA USA USA With contributions from: Jerad M. Gardner Talley Whang Department of Pathology and Dermatology Harvard Vanguard Medical Associates University of Arkansas for Medical Sciences Boston, MA Little Rock, AR USA USA ISBN 978-1-4471-5447-1 ISBN 978-1-4471-5448-8 (eBook) DOI 10.1007/978-1-4471-5448-8 Springer London Heidelberg New York Dordrecht Library of Congress Control Number: 2013956345 © Springer-Verlag London 2014 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. Exempted from this legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied specifi cally for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work.
    [Show full text]
  • Pathology and Genetics of Tumours of Soft Tissue and Bone
    bb5_1.qxd 13.9.2006 14:05 Page 3 World Health Organization Classification of Tumours WHO OMS International Agency for Research on Cancer (IARC) Pathology and Genetics of Tumours of Soft Tissue and Bone Edited by Christopher D.M. Fletcher K. Krishnan Unni Fredrik Mertens IARCPress Lyon, 2002 bb5_1.qxd 13.9.2006 14:05 Page 4 World Health Organization Classification of Tumours Series Editors Paul Kleihues, M.D. Leslie H. Sobin, M.D. Pathology and Genetics of Tumours of Soft Tissue and Bone Editors Christopher D.M. Fletcher, M.D. K. Krishnan Unni, M.D. Fredrik Mertens, M.D. Coordinating Editor Wojciech Biernat, M.D. Layout Lauren A. Hunter Illustrations Lauren A. Hunter Georges Mollon Printed by LIPS 69009 Lyon, France Publisher IARCPress International Agency for Research on Cancer (IARC) 69008 Lyon, France bb5_1.qxd 13.9.2006 14:05 Page 5 This volume was produced in collaboration with the International Academy of Pathology (IAP) The WHO Classification of Tumours of Soft Tissue and Bone presented in this book reflects the views of a Working Group that convened for an Editorial and Consensus Conference in Lyon, France, April 24-28, 2002. Members of the Working Group are indicated in the List of Contributors on page 369. bb5_1.qxd 22.9.2006 9:03 Page 6 Published by IARC Press, International Agency for Research on Cancer, 150 cours Albert Thomas, F-69008 Lyon, France © International Agency for Research on Cancer, 2002, reprinted 2006 Publications of the World Health Organization enjoy copyright protection in accordance with the provisions of Protocol 2 of the Universal Copyright Convention.
    [Show full text]
  • 2016 Essentials of Dermatopathology Slide Library Handout Book
    2016 Essentials of Dermatopathology Slide Library Handout Book April 8-10, 2016 JW Marriott Houston Downtown Houston, TX USA CASE #01 -- SLIDE #01 Diagnosis: Nodular fasciitis Case Summary: 12 year old male with a rapidly growing temple mass. Present for 4 weeks. Nodular fasciitis is a self-limited pseudosarcomatous proliferation that may cause clinical alarm due to its rapid growth. It is most common in young adults but occurs across a wide age range. This lesion is typically 3-5 cm and composed of bland fibroblasts and myofibroblasts without significant cytologic atypia arranged in a loose storiform pattern with areas of extravasated red blood cells. Mitoses may be numerous, but atypical mitotic figures are absent. Nodular fasciitis is a benign process, and recurrence is very rare (1%). Recent work has shown that the MYH9-USP6 gene fusion is present in approximately 90% of cases, and molecular techniques to show USP6 gene rearrangement may be a helpful ancillary tool in difficult cases or on small biopsy samples. Weiss SW, Goldblum JR. Enzinger and Weiss’s Soft Tissue Tumors, 5th edition. Mosby Elsevier. 2008. Erickson-Johnson MR, Chou MM, Evers BR, Roth CW, Seys AR, Jin L, Ye Y, Lau AW, Wang X, Oliveira AM. Nodular fasciitis: a novel model of transient neoplasia induced by MYH9-USP6 gene fusion. Lab Invest. 2011 Oct;91(10):1427-33. Amary MF, Ye H, Berisha F, Tirabosco R, Presneau N, Flanagan AM. Detection of USP6 gene rearrangement in nodular fasciitis: an important diagnostic tool. Virchows Arch. 2013 Jul;463(1):97-8. CONTRIBUTED BY KAREN FRITCHIE, MD 1 CASE #02 -- SLIDE #02 Diagnosis: Cellular fibrous histiocytoma Case Summary: 12 year old female with wrist mass.
    [Show full text]
  • Cellular Angiofibroma: Analysis of 25 Cases Emphasizing Its Relationship to Spindle Cell Lipoma and Mammary-Type Myofibroblastoma
    Modern Pathology (2011) 24, 82–89 82 & 2011 USCAP, Inc. All rights reserved 0893-3952/11 $32.00 Cellular angiofibroma: analysis of 25 cases emphasizing its relationship to spindle cell lipoma and mammary-type myofibroblastoma Uta Flucke1, J Han JM van Krieken1 and Thomas Mentzel2 1Department of Pathology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands and 2Dermatopathologie Bodensee, Friedrichshafen, Germany Cellular angiofibroma represents a rare benign mesenchymal tumor, occurring mainly in the superficial soft tissue of the genital region. The involvement of 13q14 in some cases confirmed the morphological suggested link with spindle cell lipoma and mammary-type myofibroblastoma. We analyzed the clinicopathological and immunohistochemical features of 25 cases, and performed in a number of cases additional molecular studies. There were 17 female and 8 male patients (age ranged from 27 to 83 years); females tended to be younger. A marked predilection for the vulva (n ¼ 13) was observed, and neoplasms in males were predominantly located in the inguinal region (n ¼ 4), and one case each in the scrotum, perianal, the knee, and the upper eyelid. The tumors arose most commonly in the superficial soft tissue and were well circumscribed in all but two cases. The tumor size ranged from 1 to 9 cm. All lesions were composed of spindle-shaped cells associated with numerous small- to medium-sized blood vessels; however, a broad morphological variation with foci of lipogenic differentiation in nine cases and sarcomatous transformation in one case was found. By immunohistochemistry, 11 out of 22 cases expressed CD34. A focal reaction for a-smooth muscle actin was observed in 9 out of 22 cases, and two cases each stained weak and focally positive for epithelial membrane antigen and CD99.
    [Show full text]