Treatment modalities and outcomes of pleomorphic hyalinizing angiectatic tumor: a systematic review of the literature

Pleomorphic hyalinizing angiectatic tumor originating in the nasal cavity: A CARE case report

INTRODUCTION

Pleomorphic hyalinizing angiectatic tumor (PHAT) is a rare low-grade malignant mesenchymal neoplasm. It commonly occurs in the limbs and trunk, with limited occurrences in the head and neck region. Only five cases of PHAT occurring in the head and neck have been reported in the literature to date. The etiology of PHAT remains unclear. We described a case of nasal cavity PHAT following CARE guidelines.

CASE SUMMARY

A 32-year-old male with PHAT originating in the nasal cavity recurred after two surgeries. Adjuvant radiotherapy was performed after the third surgery. The patient has been regularly followed up for 36months, and no tumor recurrence or metastasis has been observed.

DISCUSSION

PHAT is a rare soft tissue tumor known for its local aggressiveness. Because of a high risk of recurrence, extensive resection should be implemented, possibly completed by radiotherapy if resection cannot be complete because of proximity to at-risk structures.

Pleomorphic Hyalinizing Angiectatic Tumor of the Larynx

Pleomorphic hyalinizing angiectatic tumor (PHAT) is a rare, benign soft tissue tumor with uncertain pathogenesis and lineage most commonly found in the lower and upper extremities. No reports exist of this tumor metastasizing, though local recurrence is common. To date, only approximately 100 cases have been reported. We present the case of a patient presenting with hoarseness and dyspnea found to have PHAT of the larynx, a location previously unreported in the literature and requiring unique management considerations.

Pleomorphic hyalinizing angiectatic tumor, a rare localization: A case report

INTRODUCTION AND IMPORTANCE

Pleomorphic hyalinizing angiectatic tumor (PHAT) is a very rare soft tissue tumor with locally aggressive behavior but without metastasizing capacity. The most described localization is in the lower extremities. However, other localizations, such as breast or renal hilium, have already been described. Global literature about this type of tumor is rare. Our objective is to review other rare localizations and the main histopathology findings.

CASE PRESENTATION

We report the case of a 70 year old woman who underwent local surgery to remove a soft tissue mass which had a posterior anatomo-pathological diagnosis of PHAT. Histopathology analyses showed tumor cells proliferation and cellular pleomorphism, associated with hemosiderin pigment deposition and papillary endothelial hyperplasia. Immunohistochemical analyses demonstrated positive expression for CD34 with negative expression of SOX-100 and S-100. Secondary surgery was performed to extend margin resection for the purpose of obtaining negative margins.

CLINICAL DISCUSSION

PHAT is a very rare tumor originates in subcutaneous tissues. Although there is no pathognomonic sign, it is frequently found at the microscope hyalinized vasculature, positivity for CD34 or negativity for SOX100 and S-100. Surgery with negative margins is the gold standard treatment. No metastasizing capacity was described for this type of tumor.

CONCLUSION

The aim of this clinical case report - and subsequent literature review - is to update the data about PHAT in order to demonstrate its cytopathological and immunohistochemical characteristics, its differential diagnosis with other soft tissue and malignant tumors and its gold standard treatment.

Pleomorphic hyalinizing angiectatic tumor: FNA analysis of a rare entity and review of the literature

INTRODUCTION

The fine-needle aspiration (FNA) cytopathology of pleomorphic hyalinizing angiectatic tumor (PHAT) is the subject of a very limited number of reports. We undertook a review of our FNA experience with this neoplasm.

MATERIALS AND METHODS

A search was made of our files for PHAT FNA cases with histopathologic confirmation. FNA biopsy smears and cell blocks were performed and examined using standard techniques.

RESULTS

Two primary cases of histologically proven PHAT [both male, ages 56 and 60 years] met study inclusion. FNA sites included buttock and foot. A misdiagnosis of sarcoma was made in each case. Ancillary immunohistochemical testing performed in 1 case suggested angiosarcoma. Cytologic smears showed only modest cellularity with a dual population of bland spindle cells and isolated large pleomorphic cells, many harboring nuclear pseudoinclusions. Smear background was clean, and mitoses absent.

CONCLUSIONS

The imitative cytopathology of PHAT with a pleomorphic sarcoma remains a pitfall in FNA specimens. Awareness of this entity and its lack of hypercellularity, necrosis, and cohesive groups of atypical cells in smears should assist the cytopathologist in avoiding a misdiagnosis of malignancy.

Pelvic retroperitoneal pleomorphic hyalinizing angiectatic tumor: A case report and review of literature

Pleomorphic hyalinizing angiectatic tumor (PHAT) is a rare tumor of the soft tissue, usually located in lower extremities. There are rarely tumors reported in other anatomic locations. Herein, we report retroperitoneal PHAT in a male patient. A 41-year-old man was referred to our clinic due to an incidentally found retroperitoneal mass. Computed tomography (CT) scan showed a solid hypoechoic lesion containing fat component and calcified elements measuring about 80*72*45 mm in the right lower quadrant (RLQ) of the abdomen. Magnetic resonance imaging (MRI) showed circumscribe lesion measuring about 60 x 48 mm with partial enhancement and fat component. In pelvic exploration, a large mass was found that had encased the right external iliac artery and vein. Therefore, the mass and its surrounding iliac vessels were excised and removed en block. Then, the external iliac vessels were reconstructed with Gortex graft. No recurrence was found in 1 month and 3 months post-operation follow up. We report a pelvic retroperitoneal PHAT as a rare location of this tumor. It seems that PHAT must be considered in differential diagnosis in patients with soft tissue tumors in the pelvic cavity.

Pleomorphic hyalinizing angiectatic tumor of the vulva: literature review based on a rare presentation

Pleomorphic hyalinizing angiectatic tumor (PHAT) of soft tissues is a rare, non-metastatic tumor of unknown etiology and uncertain behavior, which may recur locally. There are few reports on this condition, and due to the rarity of the disease, its lineage has not yet been fully elucidated. The present study aims to report the case of an unusual entity observed for the first time in vulval topography. A female patient, 83 years old, presented with a tumor in the vulvar region that had evolved for approximately 4 months. Magnetic resonance imaging showed an expansive perineal formation of 8.5 × 3.5 cm, and a hemivulvectomy with a flap rotation was performed. The review of the slides revealed a mesenchymal lesion without significant atypia, which was richly vascularized. In the areas of interest, the immunohistochemical (IHC) study demonstrated positivity for CD34, estrogen, and progesterone receptors; it was negative for the other tested markers. Morphological findings associated with the IHC staining panel supported the diagnosis of PHAT. The main morphological features of PHAT are clusters of ectatic vessels of different sizes that show deposits of subendothelial and intraluminal fibrin. Fusiform and pleomorphic cells randomly arranged in leaves or long fascicles intermingle these vessels. It is essential to recognize this entity and consider it among the differential diagnoses of a mesenchymal lesion, given the wide variety of entities that comprise this group of lesions.

Pleomorphic Hyalinizing Angiectatic Tumor (PHAT): Review of the Literature with Case Presentation

Pleomorphic hyalinizing angiectatic tumor (PHAT) is a very rare entity of soft tissue considered a "neoplasm of uncertain behaviour of connective or other soft tissue" by the World Health Organization (2020). It develops in subcutaneous tissue of the lower extremities, more frequently in the region of the ankle and foot, and rarely as a deep-seated soft tissue mass in locations such as the perineum, buttock, arms, head and neck, and viscera. Although inconsistent cytogenetic data have been reported on PHAT so far, there are potential morphological and genetic overlaps with hemosiderotic fibrolipomatous tumor (HFLT) and myxoinflammatory fibroblastic sarcoma (MIFS). Here we report a case of PHAT at the level of the upper third of the right thigh in a 48-year-old patient and we also focus on the differential diagnoses of these entities and conduct a literature review of reported cases.

High FDG Uptake in Pleomorphic Hyalinizing Angiectatic Tumor

PHAT (pleomorphic hyalinizing angiectatic tumor) is a rare, locally aggressive, low-grade mesenchymal neoplasm of uncertain lineage with a predilection for the lower extremities. We report a 74-year-old woman with an enlarging mass on the right popliteal fossa undergoing FDG PET/CT to characterize its biological activity. Increased accumulation of FDG (SUVmax, 23.0) in the solid component of the tumor was seen. Diagnosis of PHAT was confirmed by examination of the surgical resection specimens. This case showed significant FDG accumulation relative to its pathological low-grade malignant nature.