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Mallick J, Thakral B, Wei Q, Medeiros LJ. From the archives of MD Anderson Cancer Center. Mesothelial/monocytic incidental cardiac excrescence with a review of the literature. Ann Diagn Pathol 2024; 71:152296. [PMID: 38531239 DOI: 10.1016/j.anndiagpath.2024.152296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 03/19/2024] [Indexed: 03/28/2024]
Abstract
Mesothelial/monocytic incidental cardiac excrescence (MICE) is a rare benign lesion composed of monocytes and mesothelial cells that is most often encountered during cardiothoracic surgery. We describe a case in a 71-year-old man with known aortic valve stenosis who presented with gradual onset dyspnea over a few weeks, made worse with minimal exertion. A transesophageal echocardiogram revealed severe aortic stenosis and mild pericardial effusion. The patient underwent aortic valve replacement, coronary artery bypass, and amputation of the left atrial appendage. Histological examination of a 0.8 cm blood clot received along with the atrial appendage showed an aggregation of bland cells with features of monocytes associated with small strands and nodules of mesothelial cells, fat cells, fibrin and a minute fragment of bone. Immunohistochemical analysis showed that the monocytic cells were positive for CD4 and CD68 (strong) and negative for calretinin and keratin. By contrast, the mesothelial cells were positive for calretinin and keratin and negative for all other markers. In sum, the morphologic and immunohistochemical findings support the diagnosis of MICE. Based on our review of the literature, about 60 cases of MICE have been reported previously which we have tabulated. We also discuss the differential diagnosis.
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Affiliation(s)
- Jayati Mallick
- Department of Pathology, University of Texas Medical Branch, Galveston, TX, United States of America; The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Beenu Thakral
- Department of Pathology, University of Texas Medical Branch, Galveston, TX, United States of America; The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Qing Wei
- Department of Pathology, University of Texas Medical Branch, Galveston, TX, United States of America; The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - L Jeffrey Medeiros
- Department of Pathology, University of Texas Medical Branch, Galveston, TX, United States of America; The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America.
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Jain H, Kumar A, Singh V, Sivasami K. Paradoxical development of Kimura's disease in a patient treated with mepolizumab for bronchial asthma. BMJ Case Rep 2024; 17:e259311. [PMID: 39074947 DOI: 10.1136/bcr-2023-259311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024] Open
Abstract
A male patient in his early 30s was diagnosed with bronchial asthma 3 years previously. He responded well to inhaled corticosteroids and long-acting beta-agonists. Approximately 18 months from the onset, the patient reported worsening symptoms. These symptoms included severe functional limitations, requiring frequent exposure to high-dose prednisolone. Mepolizumab was added to the treatment, leading to optimal control of bronchial asthma. Despite receiving seven doses of mepolizumab at monthly intervals, the patient developed cervical and postauricular lymphadenopathy and subcutaneous swelling of soft tissue. A cervical lymph node biopsy confirmed the diagnosis of Kimura disease. Following treatment with oral glucocorticoids and methotrexate, the patient experienced a complete resolution of symptoms. He has been in remission and off oral prednisolone for the last 13 months. In this case, we highlight the development of Kimura disease in a patient undergoing mepolizumab treatment.
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Affiliation(s)
- Harsh Jain
- Department of Rheumatology, Army Hospital Research and Referral, New Delhi, Delhi, India
| | - Abhishek Kumar
- Department of Rheumatology, Army Hospital Research and Referral, New Delhi, Delhi, India
| | - Vikram Singh
- Department of Pathology, Army Hospital Research and Referral, New Delhi, Delhi, India
| | - Kartik Sivasami
- Department of Rheumatology, Army Hospital Research and Referral, New Delhi, Delhi, India
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3
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Tsuchihashi K, Baba E. Epithelioid hemangioendothelioma-its history, clinical features, molecular biology and current therapy. Jpn J Clin Oncol 2024; 54:739-747. [PMID: 38555494 DOI: 10.1093/jjco/hyae037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 03/27/2024] [Indexed: 04/02/2024] Open
Abstract
Epithelioid hemangioendothelioma (EHE) is a remarkably rare tumor arising from endothelial cells that is classified as a vascular tumor in the WHO classification. The tumor is predominantly characterized by the presence of fusion genes, such as WWTR1-CAMTA1 or YAP1-TFE3, with a minority of cases exhibiting other rare fusion genes. EHE exhibits a broad age of onset, typically presenting at ~50 years, but it is not uncommon in pediatric populations. It manifests in a variety of organs, including the liver, lung, soft tissue and bone. Initial multiple-organ involvement is also observed. The tumor's biological behavior and prognosis vary substantially based on the primary site of manifestation. From a therapeutic perspective, initial active surveillance might be considered in selected cases, although surgical intervention remains the mainstay of treatment, especially for localized single-organ involvement. Chemotherapy is administered to patients with progressive unresectable tumors. Recent advances in the biological analysis of EHE fusion genes have elucidated their diverse functions. Additionally, next-generation sequencing has facilitated the identification of other mutations beyond the fusion genes. These continuous efforts to understand the biology of the fusion genes themselves and/or the dysregulated signaling by fusion genes are expected to lead to the development of novel therapeutic strategies for EHE. This article aims to provide a comprehensive review of EHE, encompassing its historical context, clinical manifestations, molecular biology and the current state of treatment.
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Affiliation(s)
- Kenji Tsuchihashi
- Department of Hematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Eishi Baba
- Department of Oncology and Social Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
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Al Laham O, Sharaf Aldeen R, Ibrahim Basha Z, Ali A, Alhanwt A. Dual unifocal primary Epithelioid Angiosarcoma: A case report and review of the literature unveiling a rare genre of neoplasia. Int J Surg Case Rep 2024; 115:109310. [PMID: 38281378 PMCID: PMC10839256 DOI: 10.1016/j.ijscr.2024.109310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/24/2024] [Accepted: 01/24/2024] [Indexed: 01/30/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Angiosarcomas are an exceedingly rare and malignant form of soft tissue sarcoma that are derived from endothelial cells. Overall, they comprise <1 % of the total number of soft tissue sarcomas. Due to nonspecific and misleading symptoms, the subsequent clinical presentations can easily result in misdiagnosis. This leads to life-threatening complications for patients. Contemplating this tumor as a differential diagnosis during the preoperative phase allows for essential time-sensitive therapeutic interventions to be accomplished. CASE PRESENTATION Herein, we present the seldom precedented case of a 66-year-old Middle Eastern male who came to our surgical clinic chiefly complaining of an exacerbation of chronic left hypochondriac pain accompanied by gradual inexplicable abdominal distention. Our diagnostic radiological evaluation demonstrated two isolated abdominal mass formations. CLINICAL DISCUSSION Sheer excision of the neoplastic masses with safety margins was successfully executed via open surgery. The stemming histopathological examination through Hematoxylin and Eosin and immunohistochemical staining established the definitive diagnosis of an Epithelioid Angiosarcoma. CONCLUSION Epithelioid Angiosarcomas belong to the category of profoundly rare tumors. The available published literature conveys this rarity through the scarcity of epidemiological parameters and studies. It necessitates being borne in mind when facing similar clinical scenarios so that apt therapeutic interventions can be achieved. Structured diagnostic methods, timely surgical interventions and proper techniques, and comprehensive follow-up patient surveillance protocols are, therefore, merited. After thorough review of the published literature, we reckon herewith that ours is the first documented case from our country of an Epithelioid Angiosarcoma.
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Affiliation(s)
- Omar Al Laham
- Faculty of Medicine, Damascus University, Damascus, (The) Syrian Arab Republic..
| | - Rahaf Sharaf Aldeen
- Faculty of Medicine, Damascus University, Damascus, (The) Syrian Arab Republic.; Department of Surgery, Al-Mouwasat University Hospital, Damascus University, Damascus, (The) Syrian Arab Republic.; Department of Surgery, Al Assad University Hospital, Damascus University, Damascus, (The) Syrian Arab Republic..
| | - Zein Ibrahim Basha
- Faculty of Medicine, Damascus University, Damascus, (The) Syrian Arab Republic.; Department of Pathology, Al Assad University Hospital, Damascus University, Damascus, (The) Syrian Arab Republic..
| | - Amad Ali
- Faculty of Medicine, Damascus University, Damascus, (The) Syrian Arab Republic.; Department of Surgery, Al-Mouwasat University Hospital, Damascus University, Damascus, (The) Syrian Arab Republic.; Department of Surgery, Al Assad University Hospital, Damascus University, Damascus, (The) Syrian Arab Republic..
| | - Alaa Alhanwt
- Faculty of Medicine, Damascus University, Damascus, (The) Syrian Arab Republic.; Department of Surgery, Al Assad University Hospital, Damascus University, Damascus, (The) Syrian Arab Republic..
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Solomon L, Modak K, Paul PAM, John J. A common presentation of an uncommon pathology: Kimura disease. Trop Doct 2023; 53:512-516. [PMID: 37248672 DOI: 10.1177/00494755231177487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Kimura's disease is a chronic, benign inflammatory condition of the subcutaneous tissue. It presents as painless, subcutaneous nodules of the head and neck, which are firm, painless, and may be single or multiple. It is most commonly seen in young adult Asian men. The nodes remain stable or may slowly enlarge over time. Elevated serum immunoglobulin E (IgE) levels, peripheral blood eosinophilia and lymphoid proliferation with eosinophilic infiltration on histopathological examination are the characteristic features. Spontaneous regression is usually seen. The diagnosis of Kimura's disease can be difficult and misleading, and it is important not to ignore histopathological features.
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Affiliation(s)
- Lydia Solomon
- Department of Internal Medicine, Christian Medical College and Hospital, Ludhiana, Punjab, India
| | - Ketan Modak
- Department of Haematology, Christian Medical College and Hospital, Ludhiana, Punjab, India
| | | | - Joseph John
- Department of Haematology, Christian Medical College and Hospital, Ludhiana, Punjab, India
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Lahori M, Dehghani A, Wilson C, Law W, Agaram N, Murali R, Sigel C. Cytopathologic features of epithelioid hemangioendothelioma including touch imprints for rapid on-site evaluation. Cytojournal 2023; 20:29. [PMID: 37810439 PMCID: PMC10559487 DOI: 10.25259/cytojournal_57_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 06/20/2023] [Indexed: 10/10/2023] Open
Abstract
Objectives Epithelioid hemangioendothelioma (EHE) is a vascular tumor of intermediate malignant potential, which presents as infiltrative lesions involving multiple organs. We reviewed our institutional experience with the cytologic diagnosis of this neoplasm including the performance of rapid on-site evaluation (ROSE). Material and Methods From our institutional database, we identified 29 cytology specimens, obtained between 2012 and 2020, from 21 patients with biopsy confirmation of EHE. ROSE and final diagnosis were compared. All cytology slides were reviewed, and selected cytologic features were recorded. Results The cohort included 29 specimens comprising 17 (59%) from liver, 6 (21%) from lung, 2 (7%) from lymph node, and 4 (14%) from other sites. At ROSE, 8/27 (30%) were reported inadequate, yet on review, all cases contained scattered cells typical of EHE in the touch imprint air-dried slides including two cases reported with a final diagnosis of non-diagnostic. All cases contained epithelioid and plasmacytoid cells with ovoid nuclei, fine chromatin, delicate (or biphasic) cytoplasm, and scattered cells with delicate, elongated cytoplasmic tails. The majority 26/29 (90%) of cases had multi-nucleated and multi-lobated nuclei. Intracytoplasmic lumens/blister cells were in 17/29 (59%), and a subset had erythrocytes therein (4/29, 14%). Metachromatic fibromyxoid or fibrotic stroma fragments were commonly seen (23/29, 79%). Mitoses and necrosis were absent in all cases. Of 11 tested cases, WWTR1::CAMTA1 and YAP1::TFE3 fusions were detected in nine and two cases, respectively. Conclusion EHE has distinctive cytologic features which are often under-recognized during ROSE.
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Affiliation(s)
- Mega Lahori
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Amir Dehghani
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Christina Wilson
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Wyanne Law
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Narasimhan Agaram
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Rajmohan Murali
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Carlie Sigel
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, United States
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Xie T, Masroor M, Chen X, Liu F, Zhang J, Yang D, Liu C, Xiang M. Rheumatism as a cause of cardiac hemangioma: a rare case report and review of literature with special focus on etiology. BMC Cardiovasc Disord 2023; 23:203. [PMID: 37085767 PMCID: PMC10122334 DOI: 10.1186/s12872-023-03241-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 04/12/2023] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND Cardiac hemangioma is a very rare benign tumor of the heart which accounts for 1-2% of all primary cardiac tumors. Multiple cardiac hemangiomas are even rarer with only three cases published in the literature. Pathologically it can be divided into cavernous hemangioma, capillary hemangioma, arteriovenous hemangioma, mixed-type hemangioma, and so on. At present, the etiology of cardiac hemangioma is not completely clear. In this study, we present multiple cardiac hemangiomas located in the right atrium and discuss the new unreported possible cause (rheumatism) of cardiac hemangioma. This is the fourth case of multiple cardiac hemangiomas in the medical literature and the first time to present rheumatism as the cause of cardiac hemangioma. CASE PRESENTATION A 53-year-old man presented to the clinic with intermittent chest tightness and shortness of breath for 2 years. On echocardiography, multiple soft tissue masses in the right atrium were found. The patient had rheumatic heart disease with severe mitral stenosis and moderate tricuspid regurgitation. Two masses with a diameter of about 20 mm and 15 mm were seen in the right atrium. One mass was located on the inferior margin of the fossa ovalis and the other was adjacent to the inferior vena cava. Both masses were successfully removed surgically. The mitral valve replacement and tricuspid valve plasty were performed at the same time. The postoperative histopathology results confirmed the diagnosis of cavernous hemangioma. CONCLUSION The occurrence of multiple hemangiomas in the heart is possible, especially in the presence of rheumatism. Rheumatism is one of the possible etiologies of cardiac hemangioma. Cardiologists and cardiac surgeons should be aware of its occurrence and should consider cardiac hemangioma as a differential diagnosis especially in rheumatic heart disease patients when they present with soft tissue cardiac masses for accurate management.
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Affiliation(s)
- Ting Xie
- Department of Cardiac Surgery, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, 570311, China.
| | - Matiullah Masroor
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
- Department of Cardiothoracic and Vascular Surgery, Amiri Medical Complex, Afshar, Kabul, Afghanistan.
| | - Xuan Chen
- International College of Nursing, Hainan Vocational University of Science and Technology, Haikou, 570311, China
| | - Fujin Liu
- Department of Pathology, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, 570311, China
| | - Jie Zhang
- Department of Ultrasound Medicine, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, 570311, China
| | - Dayan Yang
- Department of Ultrasound Medicine, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, 570311, China
| | - Cong Liu
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Mei Xiang
- Department of Cardiac Surgery, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, 570311, China
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8
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Nagaraj S, Singh SN, Sharma VK, Soni A, Harshvardhan R, Agarwal S. Kimura Disease: A Case Report and Review of Literature. Indian J Otolaryngol Head Neck Surg 2022; 74:1850-1853. [PMID: 36452641 PMCID: PMC9701927 DOI: 10.1007/s12070-020-01870-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 04/29/2020] [Indexed: 10/24/2022] Open
Abstract
Kimura disease is a rare benign chronic inflammatory disorder characterised by multiple subcutaneous nodules and lymphadenopathy most commonly in head and neck region. It is seen in Asian men in their 2nd and 3rd decade. Kimura disease is usually confused for Angiolymphoid hyperplasia with eosinophilia and associated with eosinophilia and increased serum IgE. Kimura disease is also known for its recurrence. Diagnosis is by histopathological examination. Treatment is mainly surgical excision for cosmetic purposes.
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Affiliation(s)
- Sushmitha Nagaraj
- Department of Otorhinolaryngology, SMS Medical College and Hospital, Jaipur, India
| | - Shashank Nath Singh
- Otorhinolaryngology and Head Neck Surgery, SMS Medical College and Hospital, Jaipur, India
| | - Vijay Kumar Sharma
- Department of Otorhinolaryngology, SMS Medical College and Hospital, Jaipur, India
| | - Ankita Soni
- Department of Otorhinolaryngology, SMS Medical College and Hospital, Jaipur, India
| | - Rekha Harshvardhan
- Otorhinolaryngology and Head Neck Surgery, Department of Otorhinolaryngology, SMS Medical College and Hospital, Jaipur, India
| | - Sunita Agarwal
- Otorhinolaryngology and Head Neck Surgery, Department of Otorhinolaryngology, SMS Medical College and Hospital, Jaipur, India
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Schonauer F, Cavaliere A, Pezone G, Calogero A, Sagnelli C, Sica A, D’Andrea L, Baldo A. Epithelioid Hemangioma of the Nose: A Challenging Diagnosis. Healthcare (Basel) 2022; 10:healthcare10040633. [PMID: 35455811 PMCID: PMC9029700 DOI: 10.3390/healthcare10040633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/20/2022] [Accepted: 03/24/2022] [Indexed: 11/16/2022] Open
Abstract
Epithelioid hemangioma is a rare reactive vasoproliferative disease presenting with painless vascular nodules in the dermal and subcutaneous tissues of the head and neck. Clinical diagnosis can be difficult as, in most cases, the only symptom is a progressively tender swelling next to a vessel course. Thus far, few cases of epithelioid hemangioma localized to the nose have been described in the literature. Herein, we present a case of a 47-year-old woman with just such a lesion of the nose, focusing on its diagnosis and treatment.
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Affiliation(s)
- Fabrizio Schonauer
- Unit of Plastic Surgery, University of Naples Federico II, 80131 Naples, Italy; (F.S.); (G.P.)
| | - Annachiara Cavaliere
- Unit of Plastic Surgery, University of Naples Federico II, 80131 Naples, Italy; (F.S.); (G.P.)
- Correspondence: ; Tel.: +39-3388567894
| | - Giuseppe Pezone
- Unit of Plastic Surgery, University of Naples Federico II, 80131 Naples, Italy; (F.S.); (G.P.)
| | - Armando Calogero
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy;
| | - Caterina Sagnelli
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, 80131 Naples, Italy;
| | - Antonello Sica
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, 80131 Naples, Italy;
| | - Luca D’Andrea
- Eye Clinic, Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples Federico II, 80131 Naples, Italy;
| | - Antonello Baldo
- Department of Dermatology, University of Naples Federico II, 80131 Naples, Italy;
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10
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Torrence D, Antonescu CR. The genetics of vascular tumours: an update. Histopathology 2022; 80:19-32. [PMID: 34958509 PMCID: PMC8950088 DOI: 10.1111/his.14458] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 07/16/2021] [Accepted: 07/20/2021] [Indexed: 01/03/2023]
Abstract
Recent molecular advances have shed significant light on the classification of vascular tumours. Except for haemangiomas, vascular lesions remain difficult to diagnose, owing to their rarity and overlapping clinical, radiographic and histological features across malignancies. In particular, challenges still remain in the differential diagnosis of epithelioid vascular tumours, including epithelioid haemangioma and epithelioid haemangioendothelioma at the benign/low-grade end of the spectrum, and epithelioid angiosarcoma at the high-grade end. Historically, the classification of vascular tumours has been heavily dependent on the clinical setting and histological features, as traditional immunohistochemical markers across the group have often been non-discriminatory. The increased application of next-generation sequencing in clinical practice, in particular targeted RNA sequencing (such as Archer, Illumina), has led to numerous novel discoveries, mainly recurrent gene fusions (e.g. those involving FOS, FOSB, YAP1, and WWTR1), which have resulted in refined tumour classification and improved diagnostic reproducibility for vascular tumours. However, other molecular alterations besides fusions have been discovered in vascular tumours, including somatic mutations (e.g. involving GNA family and IDH genes) in a variety of haemangiomas, as well as copy number alterations in high-grade angiosarcomas (e.g. MYC amplifications). Moreover, the translation of these novel molecular abnormalities into diagnostic ancillary markers, either fluorescence in-situ hybridisation probes or surrogate immunohistochemical markers (FOSB, CAMTA1, YAP1, and MYC), has been remarkable. This review will focus on the latest molecular discoveries covering both benign and malignant vascular tumours, and will provide practical diagnostic algorithms, highlighting frequently encountered pitfalls and challenges in the diagnosis of vascular lesions.
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Affiliation(s)
- Dianne Torrence
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Cristina R Antonescu
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY,Corresponding author: Cristina R Antonescu, MD, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065,
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11
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Klimstra DS, Young RH. Juan Rosai, MD (1940-2020): A Tribute. Am J Surg Pathol 2021; 45:e24-e34. [PMID: 34482334 DOI: 10.1097/pas.0000000000001799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- David S Klimstra
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
- James Homer Wright Pathology Laboratories, Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Robert H Young
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
- James Homer Wright Pathology Laboratories, Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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12
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Sbaraglia M, Bellan E, Mentzel T, Dei Tos AP. The contribution of Juan Rosai to the pathology of soft tissue tumors. Pathologica 2021; 113:396-409. [PMID: 34837098 PMCID: PMC8720402 DOI: 10.32074/1591-951x-551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 11/05/2021] [Indexed: 11/30/2022] Open
Abstract
The conceptual evolution in the field of soft tissue tumor pathology has been mostly driven by a relatively small group of individuals that includes giants of the past and the present such as James Ewing, Raffaele Lattes, Arthur Purdy Stout, Franz Enzinger, Sharon Weiss, Lennart Angervall, Harry Evans, Marku Miettinen, and Christopher Fletcher. Juan Rosai, not only exerted an immense impact on surgical pathology in general, but in consideration of his unique talent in identifying novel clinicopathologic entities, has also contributed remarkably to current understanding of mesenchymal neoplasms. The creation of desmoplastic small round cell tumor certainly ranks among his most relevant efforts, although he actually put his mark on a broad variety of soft tissue lesions, including vascular neoplasms. It would be impossible to include in a single article all the entities that he created or contributed to refine; therefore, this review is limited to a selection of what we believe represent true milestones.
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Affiliation(s)
- Marta Sbaraglia
- Department of Pathology, Azienda Ospedale-Università Padova.,Department of Medicine, University of Padua School of Medicine
| | - Elena Bellan
- Department of Medicine, University of Padua School of Medicine
| | | | - Angelo P Dei Tos
- Department of Pathology, Azienda Ospedale-Università Padova.,Department of Medicine, University of Padua School of Medicine
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13
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Abstract
Vascular tumors of bone can be diagnostically challenging because of their rarity and histologic overlap with diverse mimics. Vascular tumors of bone can be categorized as benign (hemangioma), intermediate-locally aggressive (epithelioid hemangioma), intermediate-rarely metastasizing (pseudomyogenic hemangioendothelioma), and malignant (epithelioid hemangioendothelioma and angiosarcoma). Recurrent genetic alterations have been described, such as FOSB rearrangements in pseudomyogenic hemangioendothelioma and a subset of epithelioid hemangiomas; CAMTA1 or TFE3 rearrangements in epithelioid hemangioendothelioma. This review discusses the clinical, histologic, and molecular features of vascular tumors of bone, along with diagnostic pitfalls and strategies for avoidance.
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Affiliation(s)
- Yin P Hung
- Department of Pathology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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14
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Abstract
Kimura disease (KD) is a rare inflammatory disorder which involves the head and neck. Due to its rarity and various findings, definitive diagnosis can be difficult to ascertain. Kimura disease is distinguished from other conditions, including angiolymphoid hyperplasia, by histopathological features including follicular hyperplasia, reactive germinal centers, abundant eosinophilia, eosinophilic microabscesses, preserved nodal architecture, Warthin-Finkeldy polykaryocytes, and capsular fibrosis. Herein, we describe the clinical presentation, pathology, and diagnosis of a single case of a 39-year-old treated at an academic center in Texas.
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15
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Ramkumar S. Epithelioid Haemangioma of Bone: A Case Series and Comprehensive Literature Review Reappraising the Diagnostic Classification of All Epithelioid Vascular Neoplasms of Bone. Cureus 2021; 13:e15371. [PMID: 34094789 PMCID: PMC8168629 DOI: 10.7759/cureus.15371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Epithelioid vascular neoplasms of the bone are classified by the World Health Organization (WHO) into only two tiers: low-grade epithelioid hemangioma (EH) and a more malignant category including both epithelioid hemangioendothelioma and epithelioid angiosarcoma. The World Health Organization defines bone EH as a locally aggressive neoplasm with no connotation of benign or intermediate malignancy. We reviewed three cases of EH in our lab archives with the perspective of appraising their histomorphological approach toward diagnosis. Patients were in the age range of 15-25 years. The site of the neoplasms ranged from the carpal bones to the metatarsal bones. Histomorphological examination of the lesions showed a nodular growth pattern of a vascular neoplasm without demonstrable vessel origin. The vasoformative area increased from the center to the periphery, with prominent epithelioid morphology of the endothelial cells at the periphery and an associated inflammatory infiltrate comprising eosinophils, lymphocytes, and plasma cells. The growth pattern was diffuse, with extension into the deeper dermis of overlying skin.
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Zhao H, Cao ZW, Gu ZW. Case Report: A Rare Case of Nasal Forehead Mass in Kimura's Disease. Front Surg 2021; 8:672291. [PMID: 34095210 PMCID: PMC8176203 DOI: 10.3389/fsurg.2021.672291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 04/19/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Kimura's disease is a rheumatic immune disease and head and neck lymph nodes are often involved. A mass occurring in the nasal forehead is rare. Good prognosis after surgical resection by glucocorticoid therapy is more rare. Case Summary: We report the rare case of a nasal forehead mass in a 45-year-old male patient with Kimura's disease. The patient underwent resection of the mass in October 2018 in a local hospital and the postoperative pathology was unclear. He then underwent a second resection in our department in December 2019 mainly because growth of the mass was affecting his appearance. Postoperative pathology confirmed that the patient had Kimura's disease, and he accepted systemic treatment with prednisone. We followed the patient for 10 months after surgery. He is now recovering well and continues to be closely monitored during follow-up. Conclusion: It is rare that the painless mass in the nasal forehead is diagnosed as a Kimura's disease.After completely resection of the mass and systemic treatment with prednisone, the patient had a good outcome. We provide experience for the treatment of Kimura's disease in nasal forehead.
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Affiliation(s)
| | | | - Zhao-wei Gu
- Department of Otolaryngology Head and Neck Surgery, Shengjing Hospital of China Medical University, Shenyang, China
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17
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Novel GATA6-FOXO1 fusions in a subset of epithelioid hemangioma. Mod Pathol 2021; 34:934-941. [PMID: 33318580 PMCID: PMC8076054 DOI: 10.1038/s41379-020-00723-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/07/2020] [Accepted: 11/10/2020] [Indexed: 12/12/2022]
Abstract
The genetic hallmark of epithelioid hemangioma (EH) is the presence of recurrent gene fusions involving FOS and FOSB transcription factors, which occur in one-third of the cases. Certain clinical, pathologic, and genotypic correlations have been described, with FOS-related fusions being more often detected in skeletal and cellular variants of EH, while FOSB gene rearrangements are more commonly associated with atypical histologic features and penile location. These fusions are infrequently detected in the cutaneous or head and neck EH. Overall, two-thirds of EH lack these canonical fusions and remain difficult to classify, especially when associated with atypical features and/or clinical presentations. Triggered by an index case of an intravascular soft tissue EH with a novel GATA6-FOXO1 gene fusion by targeted RNA sequencing (Archer® FusionPlex® Sarcoma Panel), we have investigated 27 additional EH cases negative for FOS and FOSB gene rearrangements for this novel abnormality to determine its recurrent potential, and its association with clinical and pathologic features. Four additional EH cases were found to display GATA6-FOXO1 fusions (18%). There were three females and two males, with a mean age of 32 years old. Three lesions occurred in the head and neck (dura, nasopharyngeal, and cheek), one in the back and one in the leg. Two of these lesions were cutaneous and one was intravascular in the subcutis of the leg. Microscopically, the tumors showed a variegated morphology, with alternating vasoformative and solid components, extravasated red blood cells and mild to moderate cytologic atypia. None showed brisk mitotic activity or necrosis. Tumors were negative for FOS and FOSB by immunohistochemistry. In conclusion, we report a new GATA6-FOXO1 fusion in a subset of EH, with a predilection for skin, and head and neck location. The relationship of this novel molecular subset with the more common FOS/FOSB fusion-positive EH remains to be determined.
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18
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Gusho CA, Tepper SC, Gitelis S, Blank AT. Epithelioid hemangioendothelioma of bone: A survival analysis of 50 cases from the SEER database (1992-2016). Rare Tumors 2021; 13:20363613211005593. [PMID: 33953894 PMCID: PMC8044559 DOI: 10.1177/20363613211005593] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/03/2021] [Indexed: 11/15/2022] Open
Abstract
Epithelioid hemangioendothelioma (EHE) is a rare vascular tumor that may arise in bone. The purpose of this investigation was to determine the clinicopathological features and outcomes of osseous EHE in a large patient series, and to assess whether survival is impacted by demographics, tumor characteristics, or treatment factors. This was a retrospective review of the Surveillance, Epidemiology and End Results (SEER) database from 1992 to 2016. Kaplan-Meier was used to estimate overall survival (OS) and disease-specific survival (DSS). A Cox regression model was used to identify prognostic factors. Fifty patients from 1992 to 2016 with a median age of 54.5 years (IQR, 37–67) were reviewed. For location, 46% (n = 23) of tumors arose from the appendicular skeleton while 38% (n = 19) occurred within the axial skeleton (overlapping EHE: 16%, n = 8). Of the cases with recorded treatment factors, 54.8% (n = 23) had surgery, 26% (n = 13) received radiation, 22% (n = 11) were treated with chemotherapy, and 26% (n = 13) had surgery plus radiation. The 5-year OS probability was 49.2% (95% CI, 23.6–70.6), and the 5-year DSS probability was 63.9% (95% CI, 33.0–83.5). No surgery (surgery: HR, 0.262; 95% CI, 0.07–0.9); p = 0.041) and age older than 50 years (HR, 4.117; 95% CI, 1.1–15.4; p = 0.035) were negative prognostic factors of disease-specific mortality after controlling for confounding variables. There was no association between disease-specific mortality and adjuvant or multimodal therapy. The prognosis of EHE of bone is less than favorable, and the 5-year DSS probability of 64% emphasizes the intermediate grade nature of this tumor subtype. Surgical treatment, when feasible, is associated with a better prognosis.
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Affiliation(s)
- Charles A Gusho
- Department of Orthopedic Surgery, Division of Orthopedic Oncology, Rush University Medical Center; and Midwest Orthopaedics at Rush, Chicago, IL, USA
| | - Sarah C Tepper
- Department of Orthopedic Surgery, Division of Orthopedic Oncology, Rush University Medical Center; and Midwest Orthopaedics at Rush, Chicago, IL, USA
| | - Steven Gitelis
- Department of Orthopedic Surgery, Division of Orthopedic Oncology, Rush University Medical Center; and Midwest Orthopaedics at Rush, Chicago, IL, USA
| | - Alan T Blank
- Department of Orthopedic Surgery, Division of Orthopedic Oncology, Rush University Medical Center; and Midwest Orthopaedics at Rush, Chicago, IL, USA
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Wiggins CJ, Dibbs RP, Bartlett EL, Ashton DJ, Maricevich RS. Atypical presentation and management of an epithelioid hemangioma: a case report and review of the literature. ANNALS OF PEDIATRIC SURGERY 2020. [DOI: 10.1186/s43159-020-00064-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Epithelioid hemangioma is a rare, benign vascular lesion classically presenting with painless nodules in the head and neck region. Hemangioma lesions are typically small, located within the dermis and subcutaneous tissue, and rarely exceed 10 cm in size. Complete surgical excision, with negative margins, is the recommended treatment as local recurrence is common. We describe an unusual presentation of epithelioid hemangioma that, to our knowledge, has not been previously described in the literature, epithelioid.
Case presentation
We report an atypical case of a large epithelioid hemangioma lesion with deep intramuscular involvement in a 16-year-old male. Ultrasound and MRI showed a hypervascular mass on the patient’s left upper back, and biopsy confirmed the diagnosis. Treatment consisted of preoperative embolization followed by excision and local tissue rearrangement.
Conclusions
Epithelioid hemangiomas are considered uncommon in the pediatric population. Moreover, it is challenging to diagnose these lesions due to their similarities to other vascular anomalies. We aim to increase awareness of this condition and obtain more precision in diagnosis, thus standardizing the approach for those treating individuals with vascular anomalies.
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20
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Saravanam PK, Gajendran A, Dinakaran N, Jayaraman D. Oropharyngeal Kimura's disease: a diagnostic dilemma and therapeutic challenge. BMJ Case Rep 2020; 13:13/10/e236366. [PMID: 33127696 DOI: 10.1136/bcr-2020-236366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Kimura's disease is a chronic inflammatory disorder involving subcutaneous tissue and locoregional lymph nodes of head and neck region, characterised by angiolymphoid proliferation. It is typically associated with peripheral eosinophilia, increased serum IgE and lymphadenopathy. Diagnosis is usually based on histopathological examination. Though various treatment modalities have been put forward, surgical management remains the first line of treatment, followed by systemic steroids application. This case report discusses the diagnostic dilemma and therapeutic management of a rare clinical presentation and management of oropharyngeal Kimura's disease in a young immunocompetent woman.
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Affiliation(s)
| | - Aishwarya Gajendran
- ENT, Head and Neck Surgery, Sri Ramachandra University Medical College, Chennai, India
| | - Nethra Dinakaran
- Otorhinolaryngology, Sri Ramachandra Medical College and Research Institute, Chennai, India
| | - Dhaarani Jayaraman
- Pediatric Hemato Oncology, Sri Ramachandra Medical College and Research Institute, Chennai, India
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21
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Tsuda Y, Suurmeijer AJH, Sung YS, Zhang L, Healey JH, Antonescu CR. Epithelioid hemangioma of bone harboring FOS and FOSB gene rearrangements: A clinicopathologic and molecular study. Genes Chromosomes Cancer 2020; 60:17-25. [PMID: 33034932 DOI: 10.1002/gcc.22898] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/23/2020] [Accepted: 09/23/2020] [Indexed: 01/14/2023] Open
Abstract
The diagnosis of epithelioid hemangioma (EH) remains challenging due to its rarity, worrisome histologic features, and locally aggressive clinical and radiographic presentation. Especially in the bone, EH can be misdiagnosed as a malignant vascular neoplasm due its lytic, often destructive or multifocal growth, as well as atypical morphology. The discovery of recurrent FOS and FOSB gene fusions in the pathogenesis of most EH has strengthened its stand-alone classification, distinct from other malignant epithelioid vascular lesions, such as epithelioid hemangioendothelioma or angiosarcoma. In this study we investigate a group of molecularly confirmed skeletal EH by the presence of FOS or FOSB gene rearrangements to better define its clinical and pathologic characteristics within a homogenous molecular subset. The cohort included 38 patients (25 males, 13 females), with a mean age at diagnosis of 38 years (range, 4-75). Regional, multifocal presentation was noted in 10 cases. Only six cases were correctly recognized as EH by the referring institutions, while most were misdiagnosed as other vascular tumors. Of the 17 patients with follow-up data available, five patients (29%) developed local recurrence after marginal en bloc excision (n = 3) or curettage (n = 2). Local recurrence-free survival rates were 84% at 3 years and 38% at 5 years. No metastasis or disease-related death was identified. Imaging studies exhibited no specific features, showing cortical bone destruction and soft-tissue extension in 14 (38%) cases. FOS gene rearrangements were detected in 28 (74%) of cases, while FOSB rearrangements in 10 (26%) cases. Our results highlight the significant challenges encountered in establishing a correct diagnosis exclusive of the molecular testing, mainly due to its overlap to other malignant epithelioid vascular tumors. Skeletal EH emerges as a genetically defined locally aggressive vascular neoplasm, with a high rate of local recurrence, but lacking the propensity for distant spread.
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Affiliation(s)
- Yusuke Tsuda
- Departments of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Albert J H Suurmeijer
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Yun-Shao Sung
- Departments of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Lei Zhang
- Departments of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - John H Healey
- Department of Surgery, Orthopedic Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Cristina R Antonescu
- Departments of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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22
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Komatsu Y, Miyamoto I, Ohashi Y, Katagiri K, Saito D, Obara M, Takeda Y, Shiga K, Yamada H. Primary epithelioid angiosarcoma originating from the mandibular gingiva: a case report of an extremely rare oral lesion. World J Surg Oncol 2020; 18:260. [PMID: 33010804 PMCID: PMC7533036 DOI: 10.1186/s12957-020-01999-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 08/11/2020] [Indexed: 11/17/2022] Open
Abstract
Background Angiosarcoma occurs very rarely in the oral cavity, and the epithelioid type is even rarer. Here, we report a rare case involving an elderly man with a primary epithelioid angiosarcoma that originated from the mandibular gingiva and resembled a dentigerous cyst on radiographs. Case presentation A 66-year-old Japanese man visited our hospital with a chief complaint of gingival swelling in right mandibular third molar region. A panoramic radiograph showed bone resorption around the crown of right mandibular third molar, which was impacted. Incisional biopsy confirmed a diagnosis of epithelioid angiosarcoma. The lesion exhibited aggressive proliferation after biopsy resulting in uncontrolled bleeding and difficulty in closing the mouth. Mandibular segmental resection including the tumor was performed without reconstruction. Because of the aggressive preoperative course of the tumor, the patient received adjuvant chemotherapy. There were no signs of recurrence during a 2-year follow-up period. Conclusions A review of the literature yielded only four reported cases of epithelioid angiosarcoma in the jaw region, with the lesions occurring in the maxilla in three cases. To our knowledge, this is the second case of primary epithelioid angiosarcoma in the mandible.
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Affiliation(s)
- Yuko Komatsu
- Division of Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Reconstructive Surgery, School of Dentistry, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan.,Head and Neck Cancer Center, Iwate Medical University, 2-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 028-3694, Japan
| | - Ikuya Miyamoto
- Division of Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Reconstructive Surgery, School of Dentistry, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan. .,Head and Neck Cancer Center, Iwate Medical University, 2-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 028-3694, Japan.
| | - Yu Ohashi
- Division of Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Reconstructive Surgery, School of Dentistry, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan.,Head and Neck Cancer Center, Iwate Medical University, 2-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 028-3694, Japan
| | - Katsunori Katagiri
- Head and Neck Cancer Center, Iwate Medical University, 2-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 028-3694, Japan.,Department of Head and Neck Surgery, School of Medicine, Iwate Medical University, 2-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 028-3694, Japan
| | - Daisuke Saito
- Head and Neck Cancer Center, Iwate Medical University, 2-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 028-3694, Japan.,Department of Head and Neck Surgery, School of Medicine, Iwate Medical University, 2-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 028-3694, Japan
| | - Mizuki Obara
- Division of Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Reconstructive Surgery, School of Dentistry, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan.,Head and Neck Cancer Center, Iwate Medical University, 2-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 028-3694, Japan
| | - Yasunori Takeda
- Division of Clinical Pathology, Department of Oral and Maxillofacial Reconstructive Surgery, School of Dentistry, Iwate Medical University, 2-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 028-3694, Japan
| | - Kiyoto Shiga
- Head and Neck Cancer Center, Iwate Medical University, 2-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 028-3694, Japan.,Department of Head and Neck Surgery, School of Medicine, Iwate Medical University, 2-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 028-3694, Japan
| | - Hiroyuki Yamada
- Division of Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Reconstructive Surgery, School of Dentistry, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan.,Head and Neck Cancer Center, Iwate Medical University, 2-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 028-3694, Japan
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Huang W, Li L, Gao J, Gao JB. Epithelioid hemangioendothelioma of the right atrium invaded the superior vena cava: case report and review of literature. Int J Cardiovasc Imaging 2020; 37:285-290. [PMID: 32812146 PMCID: PMC7878244 DOI: 10.1007/s10554-020-01963-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 08/05/2020] [Indexed: 12/15/2022]
Abstract
Epithelioid hemangioendothelioma (EHE) is a rare hemangioma that can occur anywhere in the body. It occurs most commonly in the liver and lungs, rarely from the heart, and the etiology or risk factors are unclear. So far, timely detection and radical resection is a more acceptable treatment. Reviewing the literature, few cases of cardiac EHE have been reported. We present a rare case of EHE of the right atrium invaded the superior vena cava.
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Affiliation(s)
- Wenpeng Huang
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, No.1 Eastern Jianshe Road, Zhengzhou, 450052, China
| | - Liming Li
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, No.1 Eastern Jianshe Road, Zhengzhou, 450052, China
| | - Jianbo Gao
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, No.1 Eastern Jianshe Road, Zhengzhou, 450052, China
| | - Jian-Bo Gao
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, No.1 Eastern Jianshe Road, Zhengzhou, 450052, China.
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24
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Abboud S, Trumello C, Sanvito F, Lapenna E, Castiglioni A, Alfieri O, Doglioni C, De Bonis M. Mesothelial or monocytic incidental cardiac excrescence on anterior leaflet of mitral valve. J Card Surg 2020; 35:2418-2421. [PMID: 32627263 DOI: 10.1111/jocs.14827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 06/16/2020] [Indexed: 11/26/2022]
Abstract
Mesothelial or monocytic incidental cardiac excrescence (MICE) is a rare, benign lesion composed of a mixture of mesothelial and inflammatory cells, histiocytes and fibrin without a vascular network usually accidentally found during cardiac surgery or after cardiac catherization. We report the case of a 45-year-old man admitted for suspected myxoma on the mitral valve. The lesion was removed via a minimally invasive video-assisted approach, without compromising the valve competency. The histopathological exam led to the diagnosis of MICE. The 2-year follow-up echocardiography confirmed normal mitral function without recurrence. Most of the cases were treated concomitantly to other cardiac procedure, lesions were more frequently founded in the left cardiac chambers or valves, our experience suggest that these lesions should be safely treated alone by surgical removal, to prevent embolic events.
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Affiliation(s)
- Sabrin Abboud
- Division of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Cinzia Trumello
- Division of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Sanvito
- Division of Experimental Oncology, Pathology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elisabetta Lapenna
- Division of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Castiglioni
- Division of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Ottavio Alfieri
- Division of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Claudio Doglioni
- Division of Experimental Oncology, Pathology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Michele De Bonis
- Division of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
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25
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Stiefel HC, Ng JD, Wilson DJ, Albert DM. Orbital Cellular Epithelioid Hemangioma. Ocul Oncol Pathol 2019; 5:424-431. [PMID: 31768366 PMCID: PMC6873054 DOI: 10.1159/000496207] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 12/11/2018] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To report a case of orbital cellular epithelioid hemangioma (EH) in which FOSB and CAMTA1 immunostains were used to detect a cytogenetic rearrangement as an adjunctive tool in diagnosis. METHODS Case report. RESULTS A patient with a history of prior ligation of a presumed orbital varix presented with recurrent proptosis. Imaging revealed a highly vascular right orbital mass. Microscopic examination revealed a circumscribed neoplasm composed of plump epithelioid endothelial cells with copious mildly eosinophilic cytoplasm and relatively uniform vesicular nuclei. To aid in diagnosis, immunostains for FOSB and CAMTA1 were performed to detect corresponding cytogenetic rearrangements. The presence of multifocal nuclear positivity for FOSB, indicating FOSB genetic rearrangement, and negativity for CAMTA1 were considered reassuring features against a diagnosis of a malignant epithelioid hemangioendothelioma (EHE), supporting a diagnosis of benign cellular EH. CONCLUSIONS This case report demonstrates that the use of immunohistochemical stains to detect cytogenetic rearrangements may aid in the distinction between benign EH and malignant EHE. It also reminds providers of the clinical and histopathologic features of this lesion, which occurs rarely in the orbit, and helps clarify the evolving nomenclature surrounding epithelioid hemangioma.
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Affiliation(s)
- Hillary C Stiefel
- Department of Ophthalmology, Casey Eye Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - John D Ng
- Department of Ophthalmology, Casey Eye Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - David J Wilson
- Department of Ophthalmology, Casey Eye Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Daniel M Albert
- Department of Ophthalmology, Casey Eye Institute, Oregon Health and Science University, Portland, Oregon, USA
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26
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Yang H, Wang J, Song L, Zou H. Intraosseous epithelioid haemangioendothelioma of the mandible: A case report and literature review. Medicine (Baltimore) 2019; 98:e16572. [PMID: 31348287 PMCID: PMC6709201 DOI: 10.1097/md.0000000000016572] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Epithelioid haemangioendothelioma (EHE) is a rare vascular neoplasm that primarily occurs in the soft tissues of the extremities, with "intermediate" or "borderline" malignant biological characteristics and a propensity for recurrence and metastasis. Oral cavity involvement is extremely rare, with only 5 reported cases of intraosseous EHE of the mandible. Herein, we report an additional case and review the related literature. PATIENT CONCERNS A 44-year-old man was referred to our institution with a 2-month history of left lower lip numbness and a 2-week history of painful swelling of the left mandible. He had received antibiotic treatment, which failed to ameliorate his symptoms. His medical and family histories were not significant. DIAGNOSIS Enhanced computed tomography revealed a poorly defined, 4.5 × 3.5 × 1.0 cm osteolytic lesion in the angle and ramus of the mandible, as well as an eroded lingual cortex. Histopathological examination confirmed a diagnosis of EHE. INTERVENTIONS Surgical resection was performed via segmental mandibulectomy and the defect was reconstructed using a vascularized fibular flap. OUTCOMES The patient did not exhibit signs of locoregional recurrence after 3 years of follow-up. CONCLUSIONS Intraosseous EHE of the mandible is an unpredictable lesion with a relatively benign course; however, the few reported cases of this disease do not highlight any factors that can predict the risk of locoregional recurrence or metastasis. There is also no consensus regarding the optimal treatment for intraosseous EHE; however, we recommend extensive local excision with close clinical follow-up.
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Affiliation(s)
- Haili Yang
- Department of Stomatology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi
- Department of Stomatology, Huangshi Central Hospital, Huangshi, Hubei
| | - Jun Wang
- Department of Stomatology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi
| | - Li Song
- Department of Stomatology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi
| | - Haixiao Zou
- Department of Stomatology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi
- State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei -MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China
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27
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Cardiac Excrescences of Unusual Origin. Case Rep Cardiol 2019; 2019:8285304. [PMID: 31110823 PMCID: PMC6487126 DOI: 10.1155/2019/8285304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 03/20/2019] [Indexed: 11/26/2022] Open
Abstract
Mesothelial/monocytic incidental cardiac excrescences (cardiac MICE) are a rare finding that are most often discovered incidentally either upon echocardiography or invasive cardiovascular procedures. In total, less than 50 known cases have been reported since first being discovered over 30 years ago. They are typically benign lesions; however, there has been a reported case of cardiac MICE being responsible for severe cardiopulmonary compromise and another case of the lesion embolizing leading to cerebral infarctions and ultimately death. Cardiac papillary fibroelastomas are also uncommon lesions found in the heart though they are not as rare as cardiac MICE. They are also benign and are typically attached to valvular surfaces; however, they also can be found as mobile masses. Just as cardiac MICE, they are capable of causing turbulent flow and thrombus formation and have been reported as the cause of ischemic events due to their ability to embolize. We present a case of cardiac MICE and cardiac papillary fibroelastoma in an individual who initially presented with neurologic symptoms concerning for a cerebrovascular accident. The patient was found to have a left ventricular mass composed of both cardiac MICE and cardiac papillary fibroelastomas.
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Yadav V, Bhagat A, Mohapatra S, Arora KS. Kimura's disease: a diagnostic dilemma. BMJ Case Rep 2019; 12:12/3/e228194. [PMID: 30826781 DOI: 10.1136/bcr-2018-228194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Vishesh Yadav
- Oral Medicine and Radiology, Shree Guru Gobind Singh Tricentenary University Faculty of Dental Sciences, Gurgaon, Haryana, India
| | - Ankur Bhagat
- Oral Medicine and Radiology, Rayat Bahra Dental College & Hospital, Mohali, Punjab, India
| | - Shreeyam Mohapatra
- Oral Medicine and Radiology, SCB Dental College and Hospital, Cuttack, Odisha, India
| | - Karandeep Singh Arora
- Oral Medicine and Radiology, Maharishi Markandeshwar College of Dental Sciences & Research, Mullana, Ambala, Harayana, India
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Girolami I, Eccher A, Gilioli E, Novelli L, Di Stefano G, Brunelli M, Cima L. Mesothelial/monocytic incidental cardiac excrescences (MICE): report of a case and review of literature with focus on pathogenesis. Cardiovasc Pathol 2018; 36:25-29. [DOI: 10.1016/j.carpath.2018.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 04/29/2018] [Accepted: 06/04/2018] [Indexed: 10/14/2022] Open
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Tauziède-Espariat A, Raffoul J, Sun SR, Lassabe C, Monnin C. [A cutaneous case of angiolymphoid hyperplasia with eosinophilia: Presentation of a rare entity]. Ann Pathol 2018; 38:386-390. [PMID: 30119962 DOI: 10.1016/j.annpat.2018.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 09/11/2016] [Accepted: 06/11/2018] [Indexed: 11/25/2022]
Abstract
We report the case of a Caucasian 73-year-old woman, without medical history, who is operated of two lesions of the forehead and the scalp measuring 0.4 and 1cm. There is no adenopathy. Histopathological examination revealed a diffuse vascular proliferation of the dermis and the hypodermis composed of small vessels bordered of plump "epthelioid" endothelial cells. There is no mitotic figure. The stroma is slightly fibrous accompanied by a polymorphic inflammatory infiltrate rich in lymphocytes, sometimes arranged in lymphoid follicles, plasma cells and eosinophils. The proposed diagnosis is angiolymphoid hyperplasia with eosinophilia. This is a rare vascular tumor, benign according with the OMS classification and preferentially observed in the skin. We report a cutaneous case, clinical and histopathological data of the reported cases and present the main differential diagnoses.
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Affiliation(s)
- Arnault Tauziède-Espariat
- Service de pathologie, centre hospitalier Montbéliard, 12, rue Docteur Flamand, 25200 Montbéliard, France.
| | - Johnny Raffoul
- Service de pathologie, centre hospitalier Montbéliard, 12, rue Docteur Flamand, 25200 Montbéliard, France
| | - Shan Rong Sun
- Service de pathologie, centre hospitalier Montbéliard, 12, rue Docteur Flamand, 25200 Montbéliard, France
| | - Catherine Lassabe
- Service de pathologie, centre hospitalier Montbéliard, 12, rue Docteur Flamand, 25200 Montbéliard, France
| | - Christine Monnin
- Service de pathologie, centre hospitalier Montbéliard, 12, rue Docteur Flamand, 25200 Montbéliard, France
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Bisceglia M, Bosman C, Carlesimo OA, Innocenzi D, Quirke P. Kaposi's Sarcoma: A Clinico-Pathologic Overview. TUMORI JOURNAL 2018; 77:291-310. [PMID: 1746049 DOI: 10.1177/030089169107700402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A careful overview of the classical appearances of Kaposi's sarcoma (KS) as well as of its variants were reviewed from the clinical and pathological point of view. The growth phases (stages) and the cellular patterns were histopathologically compared with emphasis on the developmental progression of disease as well as mitotic activity. Other morphological aspects were also assessed such as the features of the early phases and the incidence of hyaline bodies. One hundred and forty-three lesions from 96 patients mostly of the Italian sporadic type were investigated. A complete list of those entities which should be considered in differential diagnosis is shown and the dilemma of whether KS is a neoplasia or a hyperplasia is discussed.
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Affiliation(s)
- M Bisceglia
- Anatomic Pathology Department, Casa Sollievo della Sofferenza Hospital, Istituto di Ricovero e Cure a Carattere Scientifico (I.R.C.C.S.), S. Giovanni Rotondo Foggia, Italy
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Abstract
Eleven cases of Masson's hemangioendothelioma are reported. This benign condition must be distinguished histologically from numerous malignant endothelial lesions. Two different papillary structures were observed; one defined as « inflammatory papilla » was constantly associated with a thrombus; the other, defined as «fibrous papilla» was observed in 4 cases where no thrombus could be found. It is postulated that the inflammatory papillae are an exuberant endothelial growth during the normal organisation of a thrombus; fibrous papillae, it is suggested, might be reactive to blood or lymph stasis.
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Ortins-Pina A, Llamas-Velasco M, Turpin S, Soares-de-Almeida L, Filipe P, Kutzner H. FOSB immunoreactivity in endothelia of epithelioid hemangioma (angiolymphoid hyperplasia with eosinophilia). J Cutan Pathol 2018. [DOI: 10.1111/cup.13141] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Ana Ortins-Pina
- Centro Hospitalar Lisboa Norte EPE, Hospital de Santa Maria, Serviço de Dermatologia; Lisbon Portugal
| | - Mar Llamas-Velasco
- Dermatology Faculty, Department of Dermatology; Hospital Universitario de La Princesa; Madrid Spain
| | - Sara Turpin
- Hospital do SAMS, Unidade de Anatomia Patológica; Lisbon Portugal
| | - Luís Soares-de-Almeida
- Centro Hospitalar Lisboa Norte EPE, Hospital de Santa Maria, Serviço de Dermatologia; Lisbon Portugal
- Faculdade de Medicina, Clínica Universitária de Dermatologia de Lisboa; Universidade de Lisboa; Lisbon Portugal
- Instituto de Medicina Molecular; Lisbon Portugal
| | - Paulo Filipe
- Centro Hospitalar Lisboa Norte EPE, Hospital de Santa Maria, Serviço de Dermatologia; Lisbon Portugal
- Faculdade de Medicina, Clínica Universitária de Dermatologia de Lisboa; Universidade de Lisboa; Lisbon Portugal
- Instituto de Medicina Molecular; Lisbon Portugal
| | - Heinz Kutzner
- Dermatopathologie Friedrichshafen; Friedrichshafen Germany
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Grossi VGR, Lee K, Demarchi LM, Castelli JB, Aiello VD. Occurrence of mesothelial/monocytic incidental cardiac excrescences in material from open-heart procedures: case reports and literature review. AUTOPSY AND CASE REPORTS 2018. [PMID: 29515977 PMCID: PMC5828284 DOI: 10.4322/acr.2018.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Mesothelial/monocytic incidental cardiac excrescences (MICE) are unusual findings during the histological analysis of material from the pericardium, mediastinum, or other tissues collected in open-heart surgery. Despite their somewhat worrisome histological appearance, they show a benign clinical course, and further treatment is virtually never necessary. Hence, the importance of recognizing the entity relays in its differential diagnosis, as an unaware medical pathologist may misinterpret it for a malignant neoplasm. Other mesothelial and histiocytic proliferative lesions, sharing very close histological morphology and immunohistochemistry features with MICE, have been described in sites other than the heart or the mediastinum. This similarity has led to the proposal of the common denomination "histiocytosis with raisinoid nuclei." We report three cases from the pathology archives of the Heart Institute of São Paulo University (Incor/HC-FMUSP), diagnosed as "mesothelial/monocytic incidental cardiac excrescence," with immunohistochemical documentation, and provide a literature review of this entity.
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Affiliation(s)
| | - Karen Lee
- University of São Paulo (USP), School of Medicine, Department of Anatomic Pathology. São Paulo, SP, Brazil
| | - Léa Maria Demarchi
- University of São Paulo (USP), School of Medicine, Heart Institute, Laboratory of Pathology. São Paulo, SP, Brazil
| | - Jussara Bianchi Castelli
- University of São Paulo (USP), School of Medicine, Heart Institute, Laboratory of Pathology. São Paulo, SP, Brazil
| | - Vera Demarchi Aiello
- University of São Paulo (USP), School of Medicine, Heart Institute, Laboratory of Pathology. São Paulo, SP, Brazil
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Mignogna C, Simonetti S, Galloro G, Magno L, De Cecio R, Insabato L. Duodenal Epithelioid Angiosarcoma: Immunohistochemical and Clinical Findings. A Case Report. TUMORI JOURNAL 2018; 93:619-21. [DOI: 10.1177/030089160709300619] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Angiosarcomas are uncommon malignant tumors of vascular endothelium that represent less than 1% of all sarcomas. The epithelioid variant of angiosarcomas is exceptionally rare, and the gastrointestinal tract is rarely involved. Angiosarcomas mainly involve skin and soft tissue and rarely occur in breast, liver, bone, and spleen. We present the case of a 30-year-old man who underwent an upper gastrointestinal endoscopy for melena. A duodenal reddish polypoid lesion was found, which on microscopic examination turned out to be an epithelioid angiosarcoma. The immunohistochemical features of the lesion supported this diagnosis. The patient died eight months after the diagnosis. Epithelioid angiosarcoma is an aggressive variant of angiosarcoma and must be considered in the differential diagnosis of gastrointestinal tumors.
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Affiliation(s)
- Chiara Mignogna
- Department of Biomorphological and Functional Sciences, Pathology Section, University of Naples “Federico II”, Naples, Italy
| | - Sara Simonetti
- Department of Biomorphological and Functional Sciences, Pathology Section, University of Naples “Federico II”, Naples, Italy
| | - Giuseppe Galloro
- Department of General Surgery, Special Section of Digestive Surgical Endoscopy, University of Naples “Federico II”, Naples, Italy
| | - Luca Magno
- Department of General Surgery, Special Section of Digestive Surgical Endoscopy, University of Naples “Federico II”, Naples, Italy
| | - Rossella De Cecio
- Department of Biomorphological and Functional Sciences, Pathology Section, University of Naples “Federico II”, Naples, Italy
| | - Luigi Insabato
- Department of Biomorphological and Functional Sciences, Pathology Section, University of Naples “Federico II”, Naples, Italy
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Swarnkar M, Agrawal A. Kimura's disease. FORMOSAN JOURNAL OF SURGERY 2018. [DOI: 10.4103/fjs.fjs_56_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Al-Qattan MM, Arafah M, Al-Marshad F. Angiolymphoid hyperplasia with eosinophilia involving the common digital artery of the hand: A case report and classification of upper limb lesions. Int J Surg Case Rep 2017; 39:84-87. [PMID: 28822892 PMCID: PMC5565780 DOI: 10.1016/j.ijscr.2017.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 08/08/2017] [Accepted: 08/08/2017] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION Angiolymphoid hyperplasia with eosinophilia (ALHE) is a rare benign reactive inflammatory lesion. The usual presentation is a single or multiple skin nodules of the head and neck. Involvement of the hand is very rare and there have been no comprehensive reviews on ALHE of the upper limb. In this paper, we report on a case involving the common digital artery of the hand. We also review the literature and offer two classification systems for upper limb lesions: One according to the primary structure involved, and the other according to the presentation with either single or multiple lesions. PRESENTATION OF CASE A 32-year old female presented with a slowly growing subcutaneous mass at the second web space of the left hand. The mass was neither tender or mobile. An MRI showed a tri-lobed soft tissue lesion. At the time of surgery, the lesion was found to be within the common digital artery of the second web space. Complete excision was done. Histopathology confirmed the diagnosis of ALHE There has been no recurrence or cold tolerance at final follow-up 1year later. DISCUSSION We offer two classification systems for upper limb lesions: One according to the primary structure involved, and the other according to the presentation with either a single or multiple lesions. CONCLUSION A rare case of ALHE of the hand is presented. The literature is reviewed and two classification systems for upper limb lesions are offered and their implications are discussed.
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Affiliation(s)
| | - Maha Arafah
- Department of Pathology, King Saud University, Riyadh, Saudi Arabia
| | - Felwa Al-Marshad
- Division of Plastic Surgery, King Saud University, Riyadh, Saudi Arabia
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DeSandis B, Karnovsky SC, Perino G, Drakos MC. The Disappearing Phalanx: A Case Report of a Vascular Tumor of the Toe. J Foot Ankle Surg 2017. [PMID: 28633787 DOI: 10.1053/j.jfas.2017.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We report a unique case of an epithelioid hemangioma of the third middle phalanx in which the lesion replaced the phalanx, became symptomatic, and then required resection, bone grafting, and joint arthroplasty. To the best of our knowledge, this is the first report of an epithelioid hemangioma in the toe that was treated using this approach.
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Affiliation(s)
| | | | - Giorgio Perino
- Associate Attending Pathologist, Department of Pathology, Hospital for Special Surgery, New York, NY
| | - Mark C Drakos
- Associate Attending Orthopedic Surgeon, Department of Orthopedic Surgery, Foot and Ankle Service, Hospital for Special Surgery, New York, NY
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Dokania V, Patil D, Agarwal K, Thakur P, Prajapati P. Kimura's Disease without Peripheral Eosinophilia: An Unusual and Challenging Case Simulating Venous Malformation on Imaging Studies-Case Report and Review of literature. J Clin Diagn Res 2017; 11:ME01-ME04. [PMID: 28764210 DOI: 10.7860/jcdr/2017/28603.10063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 05/16/2017] [Indexed: 11/24/2022]
Abstract
Kimura's Disease (KD) is a rare chronic inflammatory disorder presenting as multiple painless solitary subcutaneous nodules, predominantly in the head and neck region and frequently associated with regional lymphadenopathy and/or salivary gland involvement. Because of painless nature and indolent course, there is usually a delay in the patient's presentation. KD may radiologically mimic other chronic inflammatory conditions like tuberculosis, vascular malformations and neoplasms. Clinical correlation and histological evaluation along with elevated peripheral eosinophil and serum IgE level are considered important for confirmatory diagnosis. We report a case of painless swelling over right submandibular region extending to the right superficial parotid. The haematological reports were within normal limits. Ultrasound (USG), Magnetic Resonance Imaging (MRI) and Magnetic Resonance Angiogram (MRA) favoured a diagnosis of venous malformation. However, histopathological examination of excised lesion confirmed a diagnosis of KD. This case proves the possibility of the KD even in the absence of peripheral eosinophilia and/ or elevated serum IgE level, and may mimic venous malformation on imaging studies. Therefore, KD must find a place in the differentials of solitary painless neck swelling even in the absence of peripheral eosinophilia and/or elevated IgE level.
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Affiliation(s)
- Vivek Dokania
- Resident, Department of Ear, Nose and Throat, Krishna Institute of Medical Sciences University, Karad, Maharashtra, India
| | - Digvijay Patil
- Professor, Department of Oncosurgery, Krishna Institute of Medical Sciences University, Karad, Maharashtra, India
| | - Ketan Agarwal
- Resident, Department of Ear, Nose and Throat, Krishna Institute of Medical Sciences University, Karad, Maharashtra, India
| | - Prajakta Thakur
- Student, Department of Clinical Research and Data Management, James Lind Institute, Hyderabad, Telangana, India
| | - Piyush Prajapati
- Resident, Department of Medicine, Krishna Institute of Medical Sciences University, Karad, Maharashtra, India
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Kharkwal N, Agarwal Y, Mathur N, Rajni. Giant epithelioid hemangioma of the external auditory canal: Role of imaging in clinical management. APOLLO MEDICINE 2017. [DOI: 10.1016/j.apme.2016.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Wick MR, Santa Cruz DJ, Gru AA. Non-lymphoid lesions that may mimic cutaneous hematopoietic neoplasms histologically. Semin Diagn Pathol 2017; 34:99-107. [DOI: 10.1053/j.semdp.2016.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Drouillard M, Steve M, Ranoarivony T, Souraud JB. Kimura's disease in a 50-year-old Tunisian man. Eur Ann Otorhinolaryngol Head Neck Dis 2016; 134:127-129. [PMID: 28040460 DOI: 10.1016/j.anorl.2016.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Kimura's disease is an uncommon disease of unknown aetiology affecting men in their thirties from Southeast Asia. The authors report a case of Kimura's disease in a 50-year-old Tunisian man that was diagnosed after surgery. CASE REPORT This patient had two 2-cm diameter chronic nodular lesions over the right mandible with no local inflammation and no other clinical findings of systemic disease. Histopathological examination showed germinal centre hyperplasia, eosinophilic micro-abscesses and hyperplasia of postcapillary venules, suggestive of Kimura's disease, which was confirmed by the laboratory work-up: elevated total IgE (519g/L), and eosinophilia (580/mm3). Renal function tests were normal. DISCUSSION We concluded on a probable diagnosis of Kimura's disease in view of male gender, the head and neck site, the suggestive histological appearance, elevated IgE, and eosinophilia. However, this patient's age and ethnic origin were unusual for Kimura's disease. The main differential diagnosis is angiolymphoid hyperplasia with eosinophilia (ALHE) and renal function tests can distinguish between the two entities due to the kidney damage observed in Kimura's disease.
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Affiliation(s)
- M Drouillard
- Service maxillo-faciale et ORL, hôpital d'instruction des armées Bégin, 94160 Saint-Mandé, France.
| | - M Steve
- Service maxillo-faciale et ORL, hôpital d'instruction des armées Bégin, 94160 Saint-Mandé, France
| | - T Ranoarivony
- Service maxillo-faciale et ORL, hôpital d'instruction des armées Bégin, 94160 Saint-Mandé, France
| | - J-B Souraud
- Service d'anatomopathologie, hôpital d'instruction des armées Bégin, 94160 Saint-Mandé, France
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Histiocytosis With Raisinoid Nuclei: A Unifying Concept for Lesions Reported Under Different Names as Nodular Mesothelial/Histiocytic Hyperplasia, Mesothelial/Monocytic Incidental Cardiac Excrescences, Intralymphatic Histiocytosis, and Others. Am J Surg Pathol 2016; 40:1507-1516. [DOI: 10.1097/pas.0000000000000687] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Petrakis IE, Di Gioia CRT, Sciacca V. Angiolymphoid Hyperplasia with Eosinophilia and Radial Artery Pseudoaneurysm. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/153857440003400632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A case of angiolymphoid hyperplasia with eosinophilia arising from the radial artery is presented. Histologically, there was proliferation of atypical endothelial cells forming vascular spaces and solid cords, with a background infiltrate of inflammatory cells and prominent tissue eosinophilia. Immunohistochemical studies demonstrated vimentin and Factor VIII-related antigen in the endothelial cells. The lymphoid infiltrate was polyclonal. The authors discuss the probable nature of this process, which typically occurs in the dermis and subcutaneous tissue of the head and neck and is known by a variety of different names, reflecting disagreement regarding pathogenesis. This case draws attention to the fact that it can arise not only within the dermis and subcutaneous tissue of the head and neck, but also from major peripheral arteries. Angiolymphoid hyperplasia with eosinophilia should be considered promptly in the doubtful case of a pulsatile mass arising from peripheral arteries as it may lead to an earlier diagnosis and timely treatment with lower morbidity.
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Affiliation(s)
- Ioannis E. Petrakis
- First Department of General Surgery, “Policlinico Umberto I,” University of Rome, “La Sapienza,” Rome, Italy
| | - Cira R. T. Di Gioia
- Department of Experimental Medicine and Pathology, “Policlinico Umberto I,” University of Rome, “La Sapienza,” Rome, Italy
| | - Vincenzo Sciacca
- First Department of General Surgery, “Policlinico Umberto I,” University of Rome, “La Sapienza,” Rome, Italy
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Floris G, Deraedt K, Samson I, Brys P, Sciot R. Epithelioid Hemangioma of Bone: A Potentially Metastasizing Tumor? Int J Surg Pathol 2016; 14:9-15; discussion 16-20. [PMID: 16501828 DOI: 10.1177/106689690601400102] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The case of a 15-year-old boy with a severe swelling of the 2nd toe in the left foot and a large swelling of the left inguinofemoral region is described. Histologic examination of the foot lesion showed a typical epithelioid hemangioma of bone that extended into the soft tissues, with a secondary location in the groin, suggestive of lymph node involvement. Subsequently, imaging also revealed swelling of iliac and para-aortic lymph nodes, which probably indicates further lymph node spread.. Besides the fact that epithelioid hemangioma of the toe has not been reported yet, our case showed a noncontinuous localization, most likely in draining lymph nodes. This finding suggests metastatic disease, an event that is extremely rare for epithelioid hemangioma. As such, epithelioid hemangioma might be comparable to another benign vascular tumor, the retiform hemangioendothelioma, which occasionally metastasizes to the lymph nodes without systemic spread.
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Affiliation(s)
- Giuseppe Floris
- Department of Pathology, University Hospitals, Catholic University of Leuven, Leuven, Belgium
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Bharath Raju G, Shivanand S, Subramanian K. Epithelioid hemangioendothelioma of the proximal phalanx of the left second toe - a rare occurence. J Orthop Case Rep 2016; 3:34-7. [PMID: 27298916 PMCID: PMC4719254 DOI: 10.13107/jocr.2250-0685.113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Epithelioid hemangioendothelioma (EHE) of the bone is extremely rare and occurs predominantly in males. It most frequently occurs during the second and third decades of life. The lower extremities are most commonly involved. We describe a diagnostically challenging case of epithelioid hemangioendothelioma of proximal phalanx of 2nd toe of left foot with histological features reminiscent of osteoblastomatosis. CASE REPORT A 52 year old man presented with history of intermittent pain with swelling in second toe since 6 months. Radiograph showed a lytic lesion in proximal phalanx of the great toe. CT and MRI reported non specific lesion in the toe. Pain was quite severe and as the patient was a labourer and wanted to get back to his work as soon as possible a decision of disarticulation of the second toe at metatarsophalnageal joint was taken. Histopathology confirmed the diagnosis of Epithelioid hemangioendothelioma and patient was called for regular follow up. There are no complications and recurrence at two year follow up. CONCLUSION EHE of the bone is extremely rare vascular tumor. To our knowledge, this is the first case of EHE with such features. EHE should be kept as one of the important differential diagnosis while diagnosing vascular tumors. Careful attention to the histopathological features is necessary for the confirmation of the diagnosis.
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Affiliation(s)
- G Bharath Raju
- Assistant professor, Department of Orthopaedics, Kempegowda Institute of Medical Sciences. India
| | - S Shivanand
- Assistant professor, Department of Orthopaedics, Kempegowda Institute of Medical Sciences. India
| | - Karthik Subramanian
- Assistant professor, Department of Orthopaedics, Kempegowda Institute of Medical Sciences. India
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Wick MR. Contributions of Dr. Juan Rosai to the pathology of cutaneous vascular proliferations: A review of selected lesions. Semin Diagn Pathol 2016; 33:284-93. [PMID: 27318413 DOI: 10.1053/j.semdp.2016.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Vascular proliferations in the skin have been thoroughly studied over the past 35 years, and a great deal of knowledge has been accrued regarding their pathobiological features. Dr. Juan Rosai has been a consistent contributor to the literature on this topic throughout most of his career, and this article reviews selected cutaneous endothelial lesions that he helped to characterize. They include histiocytoid-epithelioid hemangioma, targetoid-hobnail hemangioma, acquired tufted hemangioma, glomeruloid hemangioma, spindle cell hemangioma, retiform hemangioendothelioma, and angiosarcoma. Two potential simulants of angiosarcoma-papillary intravascular endothelial hyperplasia and cutaneous rudimentary meningocele-meningothelial hamartoma-are also considered.
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Affiliation(s)
- Mark R Wick
- Division of Surgical Pathology, University of Virginia Medical Center, Charlottesville, Virginia; Division of Cytopathology, University of Virginia Medical Center, Charlottesville, Virginia; Division of Autopsy Pathology, University of Virginia Medical Center, Charlottesville, Virginia.
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Huang SC, Zhang L, Sung YS, Chen CL, Krausz T, Dickson BC, Kao YC, Agaram NP, Fletcher CDM, Antonescu CR. Frequent FOS Gene Rearrangements in Epithelioid Hemangioma: A Molecular Study of 58 Cases With Morphologic Reappraisal. Am J Surg Pathol 2015; 39:1313-21. [PMID: 26135557 DOI: 10.1097/pas.0000000000000469] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Epithelioid hemangioma (EH) is a unique benign vasoformative tumor composed of epithelioid endothelial cells. Although a small subset of EHs with atypical features harbor ZFP36-FOSB fusions, no additional genetic abnormalities have been found to date in the remaining cases. On the basis of a novel FOS-LMNA gene fusion identified by RNA sequencing in an index case of a skeletal EH with typical morphology, we sought to investigate the prevalence of FOS rearrangement in a large cohort of EHs. Thus 57 additional EH cases lacking FOSB rearrangements were studied for FOS gene abnormalities by fluorescence in situ hybridization, and results were correlated with morphologic appearance and clinical presentation. The EHs were subclassified as typical (n=25), cellular (n=21), and angiolymphoid hyperplasia with eosinophilia (ALHE) (n=12) variants. The ALHE was defined as an EH with a vascular "blow-out" pattern associated with a variable degree of inflammation. There were 17 (29%) cases bearing FOS gene rearrangements among 58 cases tested, including 12 male and 5 female patients, with a mean age of 42 years. Most FOS-rearranged EHs occurred in the bone (10) and soft tissue (6), whereas only 1 case was cutaneous. The predominant anatomic site was the extremity (12), followed by trunk (3), head and neck (1), and penis (1). The incidence of FOS rearrangement was significantly higher in bone (59%, P=0.006) and lower in head and neck (5%, P=0.009). Twelve of the FOS-rearranged cases were cellular EH (P=0.001) associated with moderate mitotic activity (2 to 5/10 HPF) and milder inflammatory background. All 12 ALHE cases lacked FOS gene abnormalities, suggesting different pathogenesis. In conclusion, FOS rearrangement was present in a third of EHs across different locations and histologic variants; however, it was more prevalent in cellular EH and intraosseous lesions, compared with those in skin, soft tissue, and head and neck. This genetic abnormality can be useful in challenging cases, to distinguish cellular EHs from malignant epithelioid vascular tumors. These results also suggest that dysregulation of the FOS family of transcription factors through chromosomal translocation is as a key event in the tumorigenesis of EH except for the ALHE variant.
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Affiliation(s)
- Shih-Chiang Huang
- *Department of Pathology, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan ∥Department of Pathology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan †Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY ‡Department of Pathology, University of Chicago, Chicago, IL ¶Department of Pathology, Brigham and Women's Hospital, Boston, MA §Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada
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Epidemiology and treatment of angiolymphoid hyperplasia with eosinophilia (ALHE): A systematic review. J Am Acad Dermatol 2015; 74:506-12.e11. [PMID: 26685720 DOI: 10.1016/j.jaad.2015.10.011] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 09/18/2015] [Accepted: 10/12/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Current knowledge of angiolymphoid hyperplasia with eosinophilia (ALHE) derives from retrospective reports and case series, leading to a nonevidence-based treatment approach. OBJECTIVE We sought to systematically review the literature relating to cutaneous ALHE to estimate its epidemiology and treatment outcomes. METHODS A literature search of PubMed, EMBASE, Web of Science, and Google Scholar was conducted. Articles detailing cases of histologically confirmed cutaneous ALHE were included. RESULTS In all, 416 studies were included in the review, representing 908 patients. There was no sex predominance among patients with ALHE. Mean age at presentation was 37.6 years. There was a significant association between presence of multiple lesions and pruritus, along with bleeding. Surgical excision was the most commonly reported treatment for ALHE. Treatment failure was lowest for excision and pulsed dye laser. Mean disease-free survival after excision was 4.2 years. There were higher rates of recurrence postexcision with earlier age of onset, longer duration of disease, multiple lesions, bilateral lesions, pruritus, pain, and bleeding. LIMITATIONS Potential for publication bias is a limitation. CONCLUSIONS Surgical excision appears to be the most effective treatment for ALHE, albeit suboptimal. Pulsed dye and other lasers may be effective treatment options. More studies are needed to improve the treatment of ALHE.
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