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XXVI Congress of the IAP: Abstracts 179 Transplant Nephrectomies in Which Extensive Infarcts Are Present

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XXVI Congress of the IAP: Abstracts 179 Transplant Nephrectomies in Which Extensive Infarcts Are Present XXVI Congress of the IAP: Abstracts 179 transplant nephrectomies in which extensive infarcts are present. hemangioma and locally had DT-like appearance, as in the fi rst lesion. About 10 months after the second resection, another recurrence took place. This time, apart from the Soft Tissue primary tumor, CT examination demonstrated metastases in the lungs. Histopathological examination of the excised primary tumor showed locally persistent traits of DT, as well as evident angiosarcoma with infi ltration of soft tissue and muscle of the buttock. The patient 824 A CASE REPORT: ANGIOSARCOMA ARISING IN AN A-V FISTULA SITE died three years after having been fi rst diagnosed with DT. IN A RENAL TRANSPLANT RECIPIENT Conclusion: There remains some controversy regarding DT’s malignancy though currently Alia Albawardi; Atilla Omeroglu, McGill University, Montreal, QC, Canada it is more and more often classifi ed as a tumor of intermediate biologic malignancy. Complete Background: Angiosarcoma is a rare malignancy of endothelial origin, comprising < 1% surgical excision is the treatment of choice. Prognosis is good following complete surgical of all sarcomas. Angiosarcoma can occur at any site of the body with a predilection for the excision of the primary lesion, although spread to regional lymph nodes is possible. Our skin and soft tissue of adults. Predisposing factors include chronic lymphedema, prolonged case proves that DT, once regarded as a low-grade lesion has the potential to transform into immunosuppression, certain chemicals and possibly viruses. Renal transplant patients have angiosarcoma which makes it a tumor of intermediate malignancy. Therefore, the Dabska an increased risk for developing angiosarcoma due to both immunosuppression and chronic Tumor should never be overlooked. lymphedema. In this patient population approximately 50% of angiosarcomas arise at the site of arterio-venous fi stula. Here we present a case of an epithelioid angiosarcoma in a 827 SUPERFICIAL ANGIOMYXOMA OF THE TONGUE renal transplant patient arising in a defunctionalized arterio-venous fi stula site, clinically Sharon Bihlmeyer; Lisa Cole; Masotoshi Kida, University of Vermont/Fletcher Allen mimicking a pseudo-aneurysm formation. Health Care, Burlington, VT, United States Case report: A 58-year-old renal transplant male presented with progressive swelling, Background: Superfi cial angiomyxomas are poorly recognized soft tissue tumors typically redness and pain at the arterio-venous fi stula site in the left elbow. The patient was located on the head and neck, trunk and lower limbs. These benign tumors have a high risk transplanted 8 years ago because of chronic renal failure secondary to diabetes mellitus of local recurrence with no reports of metastatic potential. Only 2 intra-oral cases have been type 2 and hypertension. The patient was maintained on immunosuppressive agents. reported in the English literature, on the buccal mucosa and on the fl oor of the mouth. The swelling at the arterio-venous fi stula was thought to represent a hematoma with Design: We will report the fi rst case on a superfi cial angiomyxoma arising in the tongue superimposed infection. A surgical exploration and excision of the lesion was performed. along with a review of the literature. Due to profuse bleeding during the operation a pseudo-aneurysm formation at the fi stula Results: A 62-year-old female presented to the Otolaryngology clinic with a 12-month site was suspected. The histological examination of the lesion revealed an epithelioid history of a persistent `sore` on her tongue. Examination revealed a 3x4 mm area of thickened angiosarcoma. The patient’s clinical condition suddenly deteriorated. A chest CT showed epithelium on the tip of the tongue with some associated induration. An excisional biopsy several pleural masses consistent with metastasis. In an attempt to confi rm the diagnosis was performed revealing the histopathology of a superfi cial angiomyxoma. Histologic an US guided transthoracic lung biopsy was attempted. The procedure was complicated by examination revealed a biopsy of unremarkable mucosa. Within the submucosa was a massive hemothorax. The patient expired secondary to this complication. myxoid lesion composed of numerous small blood vessels, acellular mucin pools, stellate Conclusion: There is a predilection of angiosarcomas to arise at arterio-venous fi stula sites and bipolar fi broblastic cells, muciphages and a sparse mixed infl ammatory cell infi ltrate. in renal transplant patients. Those patients should be followed-up and changes in arterio- Conclusion: This is the fi rst reported case in the English literature of superfi cial venous sites should be carefully examined to rule out the possibility of an angiosarcoma. angiomyxoma involving the tongue. Angiosarcomas arising in the setting of old AV fi stulas are highly aggressive. Hence early diagnosis is of utmost importance. 828 EXPRESSION OF K-2, A NEW MARKER OF ADIPOCYTES AND LIPOBLASTS, IN PLEOMORPHIC HIGH GRADE SARCOMA 825 AN UNUSUAL SITE OF PLEOMORPHIC LIPOMA: A CASE REPORT Jennifer Black; Jae Ro, The Methodist Hospital, Houston, TX, United States; Fan Lin, Adham Ammar; Jenish Patel; Martin B. Gillett, Department of Histopathology, Arrowe Geisinger Health System, Danville, PA, United States; Alberto Ayala; Jim Zhai, The Park Hospital, Wirral, United Kingdom Methodist Hospital, Houston, TX, United States Background: Although, lipoma is the most common primary benign paratesticular Background: Pleomorphic high grade sarcomas (PHGS) have usually been diagnosed as neoplasm and the most common tumour of the spermatic cord, the pleomorphic lipoma malignant fi brous histiocytoma (MFH) in cases of high grade sarcomas where no clear is a rare tumour in this site, which histologically may resemble a well differentiated differentiation is identifi ed. This diagnosis is confi rmed by negative immunoperoxidase liposarcoma. We present a case of pleomorphic lipoma in the paratesticular tissue, which to staining for epithelial, mesenchymal, hematopoietic and melanocytic markers. K-2, a our knowledge, there have been no previous cases reported of patients with paratesticular clone of Ki-67, demonstrates a dual staining pattern: a nuclear staining pattern can be pleomorphic lipoma in the English-language literature. The differential diagnosis and used as a proliferation index (essentially identical to Mib-1), while a cytoplasmic staining the relationship between pleomorphic lipoma and recurrent giant lipoma are briefl y pattern is sensitive and specifi c for mature adipocytes and lipoblasts. Identifi cation of discussed. subtle lipogenic differentiation within MFH using K-2 would provide more accurate Design: A case report and review of literature. A 57 year old man, presented with 9 month diagnostic information. history of right scrotal mass. Previous resection of a giant lipoma of the right epididymis Design: Thirty-four cases of PHGS were studied using immunoperoxidase staining against was also done three years ago. An ultrasound scan revealed a large complex solid mass K-2 and S-100 protein. The staining pattern and density were recorded. occupying the right scrotum but it was not possible to determine the exact site. Right Results: Of 34 cases, 4 cases of PHGS showed focal cytoplasmic staining and 3 cases orchidectomy was carried out. revealed patchy/multifocal cytoplasmic staining pattern, for a total of 7 cases (21%) Result: The lesion is characterized by bizarre multinucleated cells in a background of mature demonstrating a possible lipogenic differentiation. S-100 stained only mature adipocytes adipose tissue and loosely textured collagen. The nuclear chromatin has a characteristic in 6 cases, adjacent to benign adipose tissue. These mature adipocytes, also stained with smudge appearance. Floret cells with ring nuclei are also present. Immunohistochemically, K-2, may represent entrapment of mature adipocytes by malignant cells rather than true the tumour cells stained positively with CD34 and were negative for S-100 protein. tumor lipogenic differentiation. Nuclear staining was positive diffusely in 14 cases, with Conclusion: The unusual benign pattern of differentiation in this tumour can present a patchy positivity in 8 cases and focal positivity in 10 cases. diagnostic challenge and the unusual site is also of clinical and radiological dilemma. Conclusions: 1) Bubbly cytoplasmic staining with K-2 in allomorphic cells suggests Therefore, establishment of accurate diagnosis is of crucial importance to avoid unnecessary lipogenic differentiation; 2) S-100 demonstrates membranous staining only in mature radical surgery. adipocytes; 3) In our study, 21% of PHGS, diagnosed as MFH previously, are positive for K-2, indicating lipogenic differentiation; 4) K-2 positive PHGS may represent cases 826 ANGIOSARCOMA ARISING WITHIN A MALIGNANT ENDOVASCULAR of pleomorphic liposarcoma, however, this hypothesis requires clinical validation; 5) K-2, PAPILLARY ANGIOENDOTHELIOMA (DABSKA TUMOR) as a novel marker for lipogenic differentiation, should be added to the immuno-panel in Zbigniew Antosz, District Specialist Hospital, Tychy, Poland; Maciej Zaniewski; Jacek evaluating cases of PHGS. Kostecki, Department of Surgery, Medical University of Silesia, District Specialist Hospital, Tychy, Poland 829 EXPRESSION OF EPIDERMAL GROWTH FACTOR RECEPTOR (EGFR) Background: The Dabska tumor is a rare vascular neoplasm also known as malignant IN SYNOVIAL SARCOMA endovascular papillary angioendothelioma. There have been 31 cases reported
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