Sinonasal haemangiopericytoma-like tumour: a sinonasal glomus tumour or a haemangiopericytoma?

AIMS

Sinonasal haemangiopericytoma-like tumour is controversial with regard to its nosologic nature. This study aims to investigate its relationship with glomus tumour and haemangiopericytoma.

METHODS AND RESULTS

Six cases of sinonasal haemangiopericytoma-like tumours identified in our files were reviewed for clinicopathological features, and compared with five cases each of soft tissue glomus tumour and meningeal haemangiopericytoma. Immunohistochemical studies for muscle-specific actin, smooth muscle actin, desmin and CD34 were performed. Sinonasal haemangiopericytoma-like tumour demonstrated a uniform histological appearance with bland-looking short, spindly cells forming sheets and short fascicles. The tumour cells were interspersed with slit-like, round and ectatic blood vessels. Actin immunoreactivity was demonstrated in all six cases, although occasionally patchy. The histological appearance and immunohistochemical phenotype of sinonasal haemangiopericytoma-like tumour were very similar to and focally indistinguishable from glomus tumour. Meningeal haemangiopericytoma, in contrast, was characterized by high tumour cellularity, random nuclear orientation, presence of staghorn vasculature and lack of immunohistochemical evidence of myogenic differentiation.

CONCLUSIONS

We conclude that sinonasal haemangiopericytoma-like tumour is biologically close to or identical to glomus tumour, but is not related to haemangiopericytoma.

Local and systemic expression of basic fibroblast growth factor in a patient with familial glomangioma

Glomangiomas are rare cutaneous tumours composed of glomus cells, which are modified smooth muscle cells. The aetiology of this condition is thought to involve a mutation in a novel gene acting to regulate angiogenesis. We report a patient from a large family with three generations affected by familial multiple glomangiomas. We hypothesized that the growth factors basic fibroblast growth factor and vascular endothelial growth factor, which stimulate/regulate angiogenesis could be involved in the pathogenesis of these lesions. Therefore, using enzyme-linked immunosorbent assays and immunohistochemistry, respectively, we measured systemic and tissue levels of these growth factors in a patient with familial glomangiomas. In addition, we investigated endothelial mitogenicity of the patient's serum as a functional assay of systemic growth factor activity.

Glomus tumors with cystic changes around the ankle

Sizable glomus tumors with cystic changes in the ankle are extremely uncommon. This paper describes painless glomus tumors with cystic changes arising in the ankle of a 22-year-old woman. At the age of 14, a painless mass was noticed on the lateral side of the left ankle, and at age 21, another mass appeared on the medial side of the same ankle. Magnetic resonance imaging (MRI) and computed tomography (CT) scanning revealed 4.5 x 4.0 cm and 2.0 x 2.0 cm sized masses on the medial side and a 3.0 x 4.0 cm sized cystic mass on the lateral side of the ankle. The tumors were removed en bloc. Microscopically, the tumor consisted of perivascularly arranged cells with punched-out, round, and regular nuclei. Immunohistochemically, the tumor cells expressed SMA and HHF-35, indicating smooth muscle cell characters. The patient had no recurrence at 2 years after surgery.

Malignant glomus tumor in the branchial muscle of a 16-year-old girl

Malignant glomus tumor is an extremely rare neoplasm and its histological features are not well characterized. We report a 16-year-old female patient with a malignant glomus tumor. The patient was admitted to our hospital presenting with a mass in the right upper arm that she had noticed for the previous 6 months. Computed tomography and magnetic resonance imaging revealed an expanded mass involving the surrounding tissues. At surgery, an ill-defined and expanded mass was found, 5 x 4 x 3 cm in size, in the right branchial muscle. The tumor was extirpated, along with neighboring muscle tissues. Histologically, tumor cells were round to short-spindle shaped, forming solid sheets admixed with vessels of varying size. Their nuclei were uniformly oval to round, and their cytoplasms were slightly eosinophilic. The growth pattern of the tumor cells resembled that of glomus tumor, but mitotic figures were frequent (as high as 10 per 10 high-power fields). Immunohistochemically, the tumor cells were positive for vimentin and muscle actin, but negative for desmin. There were no areas typical of benign glomus tumor or sarcomatous change. These findings led us to a diagnosis of primary malignant glomus tumor arising de novo. There has been no recurrence or metastasis for 21 months after wide excision.

Infiltrative glomus tumor arising from a benign glomus tumor: a distinctive immunohistochemical pattern in the infiltrative component

Malignant glomus tumors (MGT) are rare. Although metastatic MGT has been reported, most MGT have only been locally aggressive, some with multiple local recurrences. We report an additional case of an infiltrative glomus tumor. In addition to the pattern of immunohistochemical staining for alpha-smooth muscle actin (SM-actin) previously described, we performed immunohistochemical stains for Ki-67 and CD34. The infiltrative component of the glomus tumor showed variably decreased staining with SM-actin and occasional tumor cells showed nuclear staining with Ki-67. CD34 staining occurred in stromal cells forming the pseudocapsule in the benign component of this tumor and in other benign glomus tumors. The infiltrative component showed increased CD34 stromal cells. Although Ki-67 staining showed only an occasional proliferative cell, the immunohistochemical staining pattern of CD34 and SM-actin raise the possibility that the infiltrative component of this tumor may have differences in the degree of differentiation from the circumscribed part and that local factors could support its spread from a conventional benign glomus tumor.

Congenital multiple plaque-like glomangiomyoma

Congenital glomus tumor is a rare clinical variant of glomus tumor, and glomangiomyoma is the least frequent histologic type of glomus tumor. We report a case of congenital multiple plaque-like glomangiomyoma in a 38-year-old man with multiple nodules and plaques on his left arm and forearm. Histopathologic study showed an angiomatous, nonencapsulated tumor with numerous highly folded dilated vascular lumina scattered throughout the dermis. The lumina were lined by a single layer of flat endothelial cells, and one to several rows of glomus cells were observed adjacent to the endothelial cells. Around large vessels, there was a gradual transition from glomus cells to elongated mature smooth muscle cells with thin and long "blunt-ended" nuclei. Immunohistochemically, there were strong positive reactions for cytoplasmic alpha-smooth muscle actin in glomus cells and smooth muscle cells, vimentin in glomus cells and endothelial cells, and desmin in the smooth muscle cells only. To our knowledge, this is the first case report of congenital multiple plaque-like glomus tumor with the microscopic appearance of a glomangiomyoma.

Nasal glomus tumors: report of two cases with emphasis on immunohistochemical features and differential diagnosis

We describe 2 cases of nasal glomus tumor that presented as nasal polyps. Grossly, each of the polypectomy specimens consisted of small fragments of polypoid soft tissue with glistening mucosa. Histopathological examination of each of the specimens showed sheets and nests of monomorphic round cells intimately associated with capillary-sized blood vessels. The tumor cells were strongly cytoplasmic positive for vimentin, smooth-muscle specific actin, muscle-specific actin, and CD34. Collagen IV showed pericellular positivity. Nasal glomus tumors are extremely rare and represent less than 0.5% of nasal nonepithelial tumors. Nasal polyps are common surgical pathological specimens, with the majority of nasal polyps being inflammatory polyps or a respiratory epithelial proliferation. Histologically, many nasal polyps show vascular proliferation with an inflammatory cell infiltrate, which may be confused with the rare glomus tumor. In addition, other nasal vascular tumors, in particular nasal hemangiopericytoma and neural tumors, may histologically mimic nasal glomus tumors.

Catecholamine secreting glomus tumor detected by iodine-123-MIBG scintigraphy

We report the case of a 41-yr-old woman who presented with arterial hypertension and tinnitus in the right ear synchronous with pulse. She had previously undergone surgery for suspected pheochromocytoma without positive therapeutic effect. CT and MRI revealed a homogenous tumor with contrast enhancement in the right hypotympanon and foramen jugulare, and [123I]metaiodobenzylguanidine (MIBG) scintigraphy demonstrated strong tracer uptake in the same area. Selective venous sampling of catecholamines in the ipsilateral jugular vein confirmed the tumor to have originated from hormone production.

Epithelioid glomus tumor

Reported are five cases of an unusual histological variant of glomus tumor that we have designated epithelioid glomus tumor. Unlike conventional glomus tumors, which consist of small polygonal cells with dark round nuclei and scanty cytoplasm, the epithelioid lesions were composed of large polygonal to spindle-shaped cells with abundant eosinophilic cytoplasm and large, irregularly shaped nuclei: The cells had both epithelioid and myoid qualities. Two of the cases studied were predominantly epithelioid, with small remnants of conventional glomus tumor at the periphery. The three other lesions were purely epithelioid. Epithelioid glomus tumors are of particular importance because they may be mistaken for other lesions histologically. Both benign and malignant epithelial lesions may be considered in the differential diagnosis; spindle-cell lesions, such as schwannoma, leiomyoma, hemangiopericytoma, and others, are in the histological differential diagnosis. Immunohistochemical and ultrastructural studies indicated that epithelioid glomus tumors had characteristics identical to those of conventional glomus tumors: the cells showed features consistent with smooth muscle derivation. The epithelioid areas frequently exhibited cytological atypicality--features that we believe to be a manifestation of cellular degeneration or senescence (analogous to "ancient" change in schwannomas or symplastic change in leiomyomas) rather than evidence of neoplastic progression. Simple surgical excision seems to have been curative (mean duration of follow-up of 4 years in the three cases in which such information was available). To our knowledge, no similar cases have previously been reported.

In situ expression of beta 1, beta 3 and beta 4 integrin subunits in non-neoplastic endothelium and vascular tumours

Endothelial cells play an important role in adhesive interactions between circulating cells and extracellular matrix proteins. In vitro studies have shown that many of these processes are mediated by a superfamily of alpha beta heterodimeric transmembrane glycoproteins called integrins. The distribution patterns of beta 1, beta 3 and beta 4 integrin subunits in endothelial cells (EC) in situ were examined immunohistochemically on serial frozen sections of a wide range of non-neoplastic tissues and of vascular tumours, both benign and malignant. Expression of the beta 1 subunit was a constitutive feature of EC. Among the beta 1-associated alpha subunits, alpha 5 and alpha 6 were broadly distributed in EC, irrespective of vessel size and microenvironment. The alpha 3 subunit displayed intermediate levels of expression with a slight preference for small vessel EC. Presence of alpha 1 was confined to EC of capillaries and venules/small veins. Expression of alpha 2 in EC was inconsistent. With rare exceptions, the alpha 4 chain was absent in EC. The beta 3 and alpha v subunits were expressed in most EC, though not always concomitantly. In contrast to the beta 1 chain, however, these integrin subunits were absent in EC of glomerular capillaries and were expressed variably in sinusoidal EC. The beta 4 chain was evenly present in the great majority of EC, except for those of large vessels. In vascular tumours, the patterns of beta 1 and alpha 1 to alpha 6 subunit expression generally corresponded to those found in their non-neoplastic counterparts. Expression of beta 3, alpha v and beta 4 chains, however, decreased in neoplasia, especially in angiosarcomas. These data show that EC dispose of broad and at the same time differential repertoires of integrin subunits that presumably reflect vessel-type associated functional differences among these cells. In vascular tumours, the orthologous distribution patterns of beta 1 and alpha 1 to alpha 6 chains are conserved in most instances while the amounts of beta 3, alpha v and beta 4 subunits expressed in EC tend to decrease in the course of malignant transformation.

Glomus tumor. A histological, histochemical and immunohistochemical study of the various types

Glomus tumors are benign lesions composed of vessels and glomocytes in varying proportions. The histological appearance of the tumors depend upon the ratio of the vascular to the glomus cells and their differentiation as well as upon the amount and composition of the stroma. The aim of the present study was the establishment of criteria for the distinction of glomus tumor-like malformations from neoplasms with glomus cell differentiation. Using a panel of monoclonal and polyclonal antibodies (vimentin, a-smooth muscle actin, desmin, pan-keratin, low molecular weight cytokeratin, EMA, NSE, S-100 protein, Factor VIII, a1-ACT) glomus tumors could be separated into three types: vascular, cellular with myxoid stroma and cellular, solid type. In the first two types the tumor growth is composed of all three components found in normal glomus body, but in a haphazard fashion and thus might be considered as tumor-like malformations. The third type is composed of perivascular arranged cells most of which acquire the phenotypical characteristics of glomocytes. This last tumor probably represent the neoplastic variant of the group of lesions designated by the term glomus tumor.

Aggressive glomus tumor of the nasal region. Report of a case with multiple local recurrences

We describe a locally aggressive glomus tumor that occurred in the nasal region of a 32-year-old woman. The neoplasm recurred six times over a period of 14 years following the initial excision. This aggressive behavior resulted in problems with the diagnosis of the neoplasm. Although grossly cystic, the tumor contained large areas with a solid growth pattern and exhibited an infiltrative margin. There was no cytological atypia, mitoses were scanty, and necrosis was absent. The neoplasm did not metastasize.

Malignant glomus tumor originating in the superior mediastinum--an immunohistochemical and ultrastructural study

An extremely rare case of malignant glomus tumor originating in the superior mediastinum was evaluated immunohistochemically and ultrastructurally. A 78-year-old woman who had been suffering from dysphagia and dyspnea had poorly-defined soft tissue mass, 4.5 x 2.5cm, in the superior mediastinum with direct invasion into the esophagus, trachea, and bilateral thyroid glands. This case is believed to be unique in several respects. There were neither recognizable findings of benign glomus tumor nor sarcomatous areas, in contrast to the previously reported cases. A definite direct invasion into the surrounding organs was identified. We therefore interpreted this case as primary malignant glomus tumor, not as glomangiosarcoma arising in a benign glomus tumor.

Intravascular glomus tumour: a previously undescribed phenomenon

We report the first case of an intravascular glomus tumour, which was located in the right forearm of a 40-year-old male. Microscopically the lesion originated from the wall of a vein and protruded into the lumen of the affected blood vessel. The tumour cells were characterized immunohistochemically by the presence of vimentin, actin and myosin. Within the tumour, small nerves, immunopositive for S-100 protein and neurofilaments, could be identified. Histogenetically, the tumour is thought to derive from intramural epithelioid cells of the venous part of an arteriovenous anastomosis.

Intraosseous glomus tumor in the sacrum. A case report

Primary intraosseous glomus tumor is rare and may occur in the medullary cavity of bone. A 22-year-old woman with a one-year history of spontaneous and persistent sacral pain was found to have an intraosseous glomus tumor in this unusual location. Curettage was followed by complete relief from pain. This case of glomus tumor originating in the sacrum is thought to be the first reported in the world literature.

Glomus tumours: an immunohistochemical profile of 11 cases

We studied 11 glomus tumours immunohistochemically, with a panel of connective tissue and epithelial markers. Most tumours contained small nerve fibres located in connective tissue septae between groups of glomus cells, thus accounting for the frequent occurrence of pain associated with glomus tumours. All tumours stained positively for muscle-specific actin and vimentin. Immunostaining for high and low molecular weight cytokeratins, desmin, myoglobin, S-100 protein, neurofilaments and Factor VIII related antigen was negative. Our findings confirm and amplify the proposed smooth muscle histogenesis of glomus tumours. This immunohistochemical profile may be of diagnostic value in the differential diagnosis of atypical glomus tumours.

Glomangiosarcoma in a glomus tumor. An immunohistochemical and ultrastructural study

An extremely rare case of glomangiosarcoma (GS) occurring in a glomus tumor (GT) was evaluated ultrastructurally and histochemically. A man 65 years of age who was suffering from back pain underwent resection of a deep cutaneous nodule. Cells of a solid type GT showed numerous subplasmalemmal pinocytotic vesicles, thin filaments with scattered dense bodies, and thick external lamina, but negative desmin staining and a lack of glycogen. Similar findings also were observed in the GS, but were less obvious. The GS compressed the surrounding GT, exhibited many mitotic figures, prominent nucleoli, elongated nuclei and cytoplasm, and reacted more strongly to vimentin staining than the GT. The GT contained S-100 protein-positive Schwann cells, a few substance P-positive nerve fibers, and moderate numbers of infiltrating mast cells. None of these findings were observed in the GS. Results were consistent with the view that GS was transformed possibly from the GT, and that the good prognosis for GS may be due to its small size that may be related to the preexistence of a pain-causing GT.

Oncocytic glomus tumour: a new variant

A new variant of glomus tumour characterized by oncocytic change is reported. The light and electron microscopy and immunohistological findings are described. This is the first reported case of an oncocytoma of non-epithelial origin.

Renin secretion from malignant pulmonary metastatic tumour cells of vascular origin

1. A pulmonary chemodectoma/glomangiosarcoma that had metastasized from the thigh was studied after removal from a 22 year old Algerian patient with hypertension, high plasma prorenin and signs of secondary aldosteronism. 2. Renin and renin mRNA were localized in sections of the tumour tissue using monoclonal anti-human renin antibody and human renin cDNA probe, respectively. 3. The cells grew prolifically in culture, but, even though their renin content was similar to that of transfected human juxtaglomerular cell tumour cells (approximately 1 pg/microgram DNA), their rate of secretion of renin was much lower (0.05-0.15 cf. 0.5-1.5 pg/h per microgram DNA). 4. Forskolin (10 mumol/l for 24 h) increased secretion of renin from 1.9 +/- 0.36 to 4.1 +/- 0.64 pg/ml per h of culture (P less than 0.001, n = 11), consistent with cAMP being a second messenger in the secretory mechanism. 5. The cells should provide valuable information about intracellular mechanisms for the regulation of renin synthesis and secretion.

Glomus tumor of the lip. A case report and immunohistochemical study

A rare glomus tumor of the lip is reported and--with nineteen glomus tumors from other sites--examined immunohistochemically with both monoclonal and polyclonal antibodies. In every case, the glomus cells showed strong reactivity with antivimentin, and factor VIII-related antigen was consistently identified in the endothelial cells but not in the glomus cells. Antiblood group A antigen was located in endothelial cells in nine cases; of these nine, five also showed focal staining in glomus cells. In no case was there reactivity with antibodies to common leukocyte antigen or cytokeratin proteins. These results support the hypothesis of Tajima et al. that the glomus cell is transitional--between smooth muscle and vascular endothelium--being essentially a modified, smooth muscle cell with some endothelial cell properties.

Glomus tumor of the cheek: an immunohistochemical demonstration of actin and myosin

A rare case of a buccal glomus tumor was examined by light and electron microscopy. Histologically, the tumor consisted of various vascular spaces surrounded by masses of epithelioid glomus cells, coexisting with a hemangiomatous proliferation of the vessels. Immunohistochemical stainings revealed that the tumor cells were positive for smooth-muscle actin and myosin, with various intensities of the stainings. The electron microscope invariably showed microfilaments in the tumor cells. The results suggest that the glomus tumor cells have characteristics of the smooth-muscle cell and the tumor has a hamartomatous nature.

Endocrine-type granules in cells of glomus tumor of the stomach

The ultrastructure of a gastric glomus tumor was studied. The tumor cells were found to possess structural features similar to those of smooth muscle cells. In addition, hitherto undescribed granules of endocrine type and cilia were identified.