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Mazzucco M, Hwang S, Linos K, Hameed M, Shahzad F, Schmitt A, Boland P, Vaynrub M. Chordoma arising from the coccygeal disc and mimicking a pilonidal cyst. Skeletal Radiol 2024; 53:1431-1435. [PMID: 37953332 DOI: 10.1007/s00256-023-04492-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/29/2023] [Accepted: 10/19/2023] [Indexed: 11/14/2023]
Abstract
Chordomas are rare, low-grade malignant tumors often found in the sacrococcygeal region and prone to local recurrence. We report an atypical presentation of a 40-year-old patient with a symptomatic midline retrococcygeal lesion that was presumptively treated as a pilonidal cyst due to its clinical and imaging features. After surgical pathology rendered the diagnosis of chordoma, the patient required salvage surgery in the form of partial sacrectomy with soft tissue flap coverage. In addition to the unusually predominant retrococcygeal location, surgical pathology identified an intervertebral disc origin rather than the typical osseous origin. To our knowledge, this presentation of chordoma with coccygeal intervertebral origin and a large subcutaneous mass at imaging has rarely been reported in the literature. We describe this case to raise awareness of atypical presentations of sacrococcygeal chordoma that may lead to erroneous presumptive diagnosis and treatment.
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Affiliation(s)
- Michael Mazzucco
- Weill Cornell/Rockefeller/Sloan Kettering Tri-Institutional MD-PhD Program, New York, NY, 10065, USA
| | - Sinchun Hwang
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Konstantinos Linos
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Meera Hameed
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Farooq Shahzad
- Plastic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Adam Schmitt
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Patrick Boland
- Orthopaedic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Max Vaynrub
- Plastic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
- Orthopaedic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
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2
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Dellino M, Magazzino F, Domenici L, Cicogna S, Miano ST, Pignata S, Mangili G, Cormio G. Aggressive Angiomyxoma of the Lower Female Genital Tract: A Review of the MITO Rare Tumors Group. Cancers (Basel) 2024; 16:1375. [PMID: 38611053 PMCID: PMC11011140 DOI: 10.3390/cancers16071375] [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: 02/12/2024] [Revised: 03/12/2024] [Accepted: 03/23/2024] [Indexed: 04/14/2024] Open
Abstract
Aggressive angiomyxoma (AAM) is a rare, locally aggressive, myxoid mesenchymal neoplasm primarily found in the pelvic and perineal regions of young adult females. It is a slow growing and locally infiltrating tumor. Preoperative diagnosis is difficult due to the rarity of these tumors and absence of characteristic signs and symptoms. The primary management is tumor excision. Incomplete excision is common because of the infiltrating nature of the neoplasm and absence of a definite capsule. Other non- surgical modalities have been employed, such as radiotherapy, embolization, GnRH analogues or other anti-estrogenic agents. Local relapses occur in 30-40% of the cases, and often appear many years (sometimes decades) after the first excision. Occasional distant metastasis has also been reported. A limited number of cases have been reported in the literature, mostly in the form of small case series or isolated case reports. Therefore, the aim of this paper by a team of experts from the MITO rare tumors group is to review clinical findings, pathologic characteristics and outcome of patients affected by this rare condition in order to be able to offer up-to-date guidance on the management of these cases.
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Affiliation(s)
- Miriam Dellino
- Department of Interdisciplinary Medicine (DIM), University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy;
| | - Francescapaola Magazzino
- Complex Operating Unit Ginecologia E Ostetricia, Ospedale Civile Di San Dona’ Di Piave (Venezia), Aulss4 Veneto Orientale, 30027 San Donà di Piave, Italy;
| | - Lavinia Domenici
- Division of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Pisana, University of Pisa, 56126 Pisa, Italy;
| | - Stefania Cicogna
- Institute for Maternal and Child Health-IRCCS “Burlo Garofolo”, 34145 Trieste, Italy;
| | - Salvatora Tindara Miano
- Complex Operating Unit of Oncology, Azienda Ospedaliera Universitaria Senese, 53100 Siena, Italy;
| | - Sandro Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS ‘Fondazione G Pascale’, 80144 Napoli, Italy;
| | - Giorgia Mangili
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy;
| | - Gennaro Cormio
- Department of Interdisciplinary Medicine (DIM), University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy;
- Gynecologic Oncology, IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy
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3
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Ruan S, Zhang P, Huang J, Gong T, Ji C. Multiple cutaneous myxofibrosarcoma on the right arm: Clinicopathological features and differential diagnosis. Clin Case Rep 2024; 12:e8346. [PMID: 38371344 PMCID: PMC10870797 DOI: 10.1002/ccr3.8346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 11/29/2023] [Accepted: 12/07/2023] [Indexed: 02/20/2024] Open
Abstract
The clinical presentations and pathological features of low-grade myxofibrosarcoma can be misleading, frequently resulting in diagnostic errors. An accurate diagnosis requires the application of immunohistochemistry techniques and the discerning diagnostic acumen of experienced pathologists. A 62-year-old male patient visited our outpatient clinic with multiple painful and rapidly enlarging subcutaneous nodules on his right forearm. Initially, the condition was misdiagnosed as multiple lipomas. The final pathology revealed characteristics consistent with low-grade myxofibrosarcoma.
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Affiliation(s)
- Shi‐Fan Ruan
- Department of Dermatologythe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
- Key Laboratory of Skin Cancer of Fujian Higher Education Institutions, the First Affiliated HospitalFujian Medical UniversityFuzhouChina
| | - Peng Zhang
- Department of Dermatologythe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
- Key Laboratory of Skin Cancer of Fujian Higher Education Institutions, the First Affiliated HospitalFujian Medical UniversityFuzhouChina
| | - Jinwen Huang
- Department of Dermatologythe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
- Key Laboratory of Skin Cancer of Fujian Higher Education Institutions, the First Affiliated HospitalFujian Medical UniversityFuzhouChina
| | - Ting Gong
- Central Laboratory, the First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
| | - Chao Ji
- Department of Dermatologythe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
- Key Laboratory of Skin Cancer of Fujian Higher Education Institutions, the First Affiliated HospitalFujian Medical UniversityFuzhouChina
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4
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Doi R, Ichikawa H, Matsumoto K, Tomoshige K, Machino R, Okano S, Nagayasu T. Curved Axillary Incision with Video-Assisted Thoracoscopic Surgery: An Alternative Approach for Teenage Female with Large Apical Chest Wall Tumor. Ann Thorac Cardiovasc Surg 2024; 30:23-00189. [PMID: 38462474 PMCID: PMC11060835 DOI: 10.5761/atcs.cr.23-00189] [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: 10/30/2023] [Accepted: 02/14/2024] [Indexed: 03/12/2024] Open
Abstract
Primary chest wall tumors are rare, their common clinical features are not well known, and surgical resection remains the main treatment. Apical chest wall tumors require large skin incisions and dissection of the chest wall muscles, making it difficult to maintain cosmetic appearance, respiratory function, and support of the upper extremity. There are few treatment options and no studies have reported on thoracotomy that spares muscles and preserves cosmetic superiority. However, in benign chest wall tumors in young patients, it is necessary to consider radicality, cosmetic superiority, and muscle sparing. We used a combined axillary incision and thoracoscopic approach to treat a massive myxoid neurofibroma at the apical chest wall in a 14-year-old female and were able to preserve the chest wall, upper limb function, and cosmetic aspects. This report provides a detailed description of the combined axillary incision and thoracoscopic approach for apical chest wall tumors.
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Affiliation(s)
- Ryoichiro Doi
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Nagasaki, Japan
| | - Hiromi Ichikawa
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Nagasaki, Japan
| | - Keitaro Matsumoto
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Nagasaki, Japan
| | - Koichi Tomoshige
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Nagasaki, Japan
| | - Ryusuke Machino
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Nagasaki, Japan
| | - Shinji Okano
- Department of Pathology, Nagasaki University Hospital, Nagasaki, Nagasaki, Japan
| | - Takeshi Nagayasu
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Nagasaki, Japan
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5
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Singh A, Rawat S, Kumar G, Singh US, Sagar M. Solitary superficial angiomyxoma of the ear pinna: a diagnostic dilemma with a review of literature. Arch Clin Cases 2023; 10:128-132. [PMID: 37767055 PMCID: PMC10521636 DOI: 10.22551/2023.40.1003.10258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023] Open
Abstract
Superficial angiomyxoma is an extremely rare subcutaneously placed myxoid soft tissue neoplasm. There are few case reports with fine needle aspiration cytological and histopathological findings available for this tumor because of its rarity. Here, we describe a case of superficial angiomyxoma in a 24-year-old girl who had a solitary left ear pinna mass without a Carney's complex at the time of presentation or at the end of two years of follow-up next to the surgical removal of the tumor. The clinical, cytomorphological, and histological findings, together with the immunohistochemical markers, in a case of superficial angiomyxoma are described in this rare case report for the first time in the English literature.
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Affiliation(s)
- Anurag Singh
- Department of Pathology, King George Medical University, Lucknow, India
| | - Shalini Rawat
- Department of Pathology, King George Medical University, Lucknow, India
| | - Gulshan Kumar
- Department of Pathology, King George Medical University, Lucknow, India
| | - Uma Shankar Singh
- Department of Pathology, King George Medical University, Lucknow, India
| | - Mala Sagar
- Department of Pathology, King George Medical University, Lucknow, India
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6
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Bahauddin R, Adam R. A Case of Myxoma Mimicking Scapulothoracic Bursa. Cureus 2023; 15:e44973. [PMID: 37822424 PMCID: PMC10563640 DOI: 10.7759/cureus.44973] [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] [Accepted: 09/09/2023] [Indexed: 10/13/2023] Open
Abstract
Myxoid soft tissue tumors are an unusually diverse group of neoplasms, most commonly involving the extremities. They are mesenchymal neoplasms characterized by the abundant production of myxoid matrix with a gelatinous appearance. They have varying characteristics in medical imaging and histopathology. The prognosis is variable for recurrence. Less regularly, they are found in bone, skin, the genitourinary tract, aponeurotic tissue, and subcutaneous tissue. We present a case of myxomatous tumor at the scapulothoracic region mimicking bursitis.
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Affiliation(s)
| | - Renan Adam
- Musculoskeletal Radiology, Hamad Medical Corporation (HMC), Doha, QAT
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7
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Garcia‐Mora J, Parker RL, Cecere T, Robertson JL, Rossmeisl JH. The T2-FLAIR mismatch sign as an imaging biomarker for oligodendrogliomas in dogs. J Vet Intern Med 2023; 37:1447-1454. [PMID: 37246729 PMCID: PMC10365042 DOI: 10.1111/jvim.16749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/09/2023] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND In humans, the T2-weighted (T2W)-fluid-attenuated inversion recovery (FLAIR) mismatch sign (T2FMM) is a specific imaging biomarker for the isocitrate dehydrogenase 1 (IDH1)-mutated, 1p/19q non-codeleted low-grade astrocytomas (LGA). The T2FMM is characterized by a homogeneous hyperintense T2W signal and a hypointense signal with a hyperintense peripheral rim on FLAIR sequences. In gliomas in dogs, the T2FMM has not been described. HYPOTHESES/OBJECTIVES In dogs with focal intra-axial brain lesions, T2FMM will discriminate gliomas from other lesions. The T2FMM will be associated with the LGA phenotype and presence of microcysts on histopathology. Interobserver agreement for T2FMM magnetic resonance imaging (MRI) features will be high. ANIMALS One hundred eighty-six dogs with histopathologically diagnosed focal intra-axial lesions on brain MRI including oligodendrogliomas (n = 90), astrocytomas (n = 47), undefined gliomas (n = 9), cerebrovascular accidents (n = 33), and inflammatory lesions (n = 7). METHODS Two blinded raters evaluated the 186 MRI studies and identified cases with the T2FMM. Histopathologic and immunohistochemical slides of T2FMM cases were evaluated for morphologic features and IDH1-mutations and compared to cases without the T2FMM. Gene expression analyses were performed on a subset of oligodendrogliomas (n = 10) with and without T2FMM. RESULTS The T2FMM was identified in 14/186 (8%) of MRI studies, and all dogs with T2FMM had oligodendrogliomas (n = 12 low-grade [LGO], n = 2 high-grade [HGO]; P < .001). Microcystic change was significantly associated with the T2FMM (P < .00001). In oligodendrogliomas with T2FMM, IDH1-mutations or specific differentially expressed genes were not identified. CONCLUSION AND CLINICAL IMPORTANCE The T2FMM can be readily identified on routinely obtained MRI sequences. It is a specific biomarker for oligodendroglioma in dogs, and was significantly associated with non-enhancing LGO.
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Affiliation(s)
- Josefa Garcia‐Mora
- Department of Small Animal Clinical Sciences and Animal Cancer Care and Research CenterVirginia‐Maryland College of Veterinary Medicine, Virginia TechBlacksburgVirginiaUSA
- Veterinary and Comparative Neuro‐Oncology Laboratory, Virginia‐Maryland College of Veterinary Medicine, Virginia TechBlacksburgVirginiaUSA
| | - Rell L. Parker
- Department of Small Animal Clinical Sciences and Animal Cancer Care and Research CenterVirginia‐Maryland College of Veterinary Medicine, Virginia TechBlacksburgVirginiaUSA
| | - Thomas Cecere
- Department of Biomedical Sciences & PathobiologyVirginia‐Maryland College of Veterinary Medicine, Virginia TechBlacksburgVirginiaUSA
| | - John L. Robertson
- Veterinary and Comparative Neuro‐Oncology Laboratory, Virginia‐Maryland College of Veterinary Medicine, Virginia TechBlacksburgVirginiaUSA
- School of Biomedical Engineering and Sciences, Virginia Tech‐Wake Forest UniversityBlacksburgVirginiaUSA
- Comprehensive Cancer Center and Brain Tumor Center of Excellence, Wake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - John H. Rossmeisl
- Department of Small Animal Clinical Sciences and Animal Cancer Care and Research CenterVirginia‐Maryland College of Veterinary Medicine, Virginia TechBlacksburgVirginiaUSA
- Veterinary and Comparative Neuro‐Oncology Laboratory, Virginia‐Maryland College of Veterinary Medicine, Virginia TechBlacksburgVirginiaUSA
- School of Biomedical Engineering and Sciences, Virginia Tech‐Wake Forest UniversityBlacksburgVirginiaUSA
- Comprehensive Cancer Center and Brain Tumor Center of Excellence, Wake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
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8
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de Boer HC, Musson R. Imaging features of myxoid soft-tissue tumours. Clin Radiol 2023:S0009-9260(23)00214-3. [PMID: 37349202 DOI: 10.1016/j.crad.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/28/2023] [Accepted: 05/06/2023] [Indexed: 06/24/2023]
Abstract
Myxoid soft-tissue tumours are mesenchymal neoplasms, which are characterised by the production of abundant extracellular myxoid matrix. Imaging plays an important role in the diagnosis of these tumours as well as treatment planning. The imaging features as well as the clinical course for these lesions are highly variable, depending on both the anatomical location of the tumour and the histopathological subtype. This article, illustrated by histopathologically proven cases from our tertiary referral soft-tissue sarcoma centre, reviews the spectrum of imaging findings and characteristic signs seen with different types of benign and malignant myxoid soft-tissue neoplasms.
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Affiliation(s)
- H C de Boer
- Sheffield Teaching Hospitals NHS Foundation Trust, Herries Road, Sheffield S5 7AU, UK.
| | - R Musson
- Sheffield Teaching Hospitals NHS Foundation Trust, Herries Road, Sheffield S5 7AU, UK
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9
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Abstract
Myxoid tumors of the soft tissue encompass a group of heterogenous tumors that are characterized by the presence of abundant extracellular myxoid or chondromyxoid matrix material. Fine needle aspiration (FNA) is variably used for diagnosing primary, recurrent, and metastatic myxoid soft tissue tumors. The spectrum of myxoid soft tissue tumors encountered in practice ranges from benign lesions such as simple ganglion cysts to high-grade malignant sarcomas such as myxofibrosarcoma. These myxoid tumors have clinical, cytologic, and histologic overlap. Therefore, making an accurate diagnosis by FNA alone is challenging. Despite this challenge, using a systematic cytomorphologic approach and ancillary studies, an accurate diagnosis is feasible in the majority of cases. This article provides a systematic approach to diagnosing myxoid soft tissue tumors by FNA along with a review of the literature.
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Affiliation(s)
- Swati Satturwar
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Paul E Wakely
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH
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10
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Chang H, Kang Y, Ahn JM, Lee E, Lee JW, Kang HS. Texture analysis of magnetic resonance image to differentiate benign from malignant myxoid soft tissue tumors: A retrospective comparative study. PLoS One 2022; 17:e0267569. [PMID: 35587928 PMCID: PMC9119440 DOI: 10.1371/journal.pone.0267569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 04/12/2022] [Indexed: 11/18/2022] Open
Abstract
It is important to differentiate between benign and malignant myxoid tumors to establish the treatment plan, determine the optimal surgical extent, and plan postoperative surveillance, but differentiation may be complicated by imaging-feature overlap. Texture analysis is used for quantitative assessment of imaging characteristics based on mathematically calculated pixel heterogeneity and has been applied to the discrimination of benign from malignant soft tissue tumors (STTs). In this study, we aimed to assess the diagnostic value of the texture features of conventional magnetic resonance images for the differentiation of benign from malignant myxoid STTs. Magnetic resonance images of 39 patients with histologically confirmed myxoid STTs of the extremities were analyzed. Qualitative features were assessed and compared between the benign and malignant groups. Texture analysis was performed, and texture features were selected based on univariate analysis and Fisher’s coefficient. The diagnostic value of the texture features was assessed using receiver operating curve analysis. T1 heterogeneity showed a statistically significant difference between benign and malignant myxoid STTs, with substantial inter-reader reliability. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of T1 heterogeneity were 55.6%, 83.3%, 88.2%, 45.5%, and 64.1%, respectively. Among the texture features, T2w-WavEnLL_s-3 showed good diagnostic performance, and T2w-WavEnLL_s-4 and GeoW4 showed fair diagnostic performance. The logistic regression model including T1 heterogeneity and T2_WavEnLL_s-4 showed good diagnostic performance. However, there was no statistically significant difference between the overall qualitative assessment by a radiologist and the predictor model. Geometry-based and wavelet-derived texture features from T2-weighted images were significantly different between benign and malignant myxoid STTs. However, the texture features had a limited additive value in differentiating benign from malignant myxoid STTs.
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Affiliation(s)
- Hyunsik Chang
- Department of Radiology, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do, Korea
| | - Yusuhn Kang
- Department of Radiology, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do, Korea
- * E-mail:
| | - Joong Mo Ahn
- Department of Radiology, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do, Korea
| | - Eugene Lee
- Department of Radiology, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do, Korea
| | - Joon Woo Lee
- Department of Radiology, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do, Korea
| | - Heung Sik Kang
- Department of Radiology, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do, Korea
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11
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Artificial intelligence significantly improves the diagnostic accuracy of deep myxoid soft tissue lesions in histology. Sci Rep 2022; 12:6965. [PMID: 35484289 PMCID: PMC9051062 DOI: 10.1038/s41598-022-11009-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 04/18/2022] [Indexed: 12/04/2022] Open
Abstract
Deep myxoid soft tissue lesions have posed a diagnostic challenge for pathologists due to significant histological overlap and regional heterogeneity, especially when dealing with small biopsies which have profoundly low accuracy. However, accurate diagnosis is important owing to difference in biological behaviors and response to adjuvant therapy, that will guide the extent of surgery and the need for neo-adjuvant therapy. Herein, we trained two convolutional neural network models based on a total of 149,130 images representing diagnoses of extra skeletal myxoid chondrosarcoma, intramuscular myxoma, low-grade fibromyxoid sarcoma, myxofibrosarcoma and myxoid liposarcoma. Both AI models outperformed all the pathologists, with a significant improvement of accuracy up to 97% compared to average pathologists of 69.7% (p < 0.00001), corresponding to 90% reduction in error rate. The area under curve of the best AI model was on average 0.9976. It could assist pathologists in clinical practice for accurate diagnosis of deep soft tissue myxoid lesions, and guide clinicians for precise and optimal treatment for patients.
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12
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Bargunam P, Chandrashekhar T, Boya K. Histopathological spectrum of myxoid soft-tissue neoplasms in a tertiary care center with a special focus on vascular patterns: A 13-year compilation. ACTA MEDICA INTERNATIONAL 2022. [DOI: 10.4103/amit.amit_50_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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13
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Sigamani K, Ponnuswamy K. Clinicopathological profile of myxoid soft tissue tumors- A retrospective study in a tertiary care hospital in South India. Niger J Clin Pract 2022; 25:1584-1592. [DOI: 10.4103/njcp.njcp_292_22] [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]
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14
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Pankova V, Thway K, Jones RL, Huang PH. The Extracellular Matrix in Soft Tissue Sarcomas: Pathobiology and Cellular Signalling. Front Cell Dev Biol 2021; 9:763640. [PMID: 34957097 PMCID: PMC8696013 DOI: 10.3389/fcell.2021.763640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/09/2021] [Indexed: 11/22/2022] Open
Abstract
Soft tissue sarcomas are rare cancers of mesenchymal origin or differentiation comprising over 70 different histological subtypes. Due to their mesenchymal differentiation, sarcomas are thought to produce and deposit large quantities of extracellular matrix (ECM) components. Interactions between ECM ligands and their corresponding adhesion receptors such as the integrins and the discoidin domain receptors play key roles in driving many fundamental oncogenic processes including uncontrolled proliferation, cellular invasion and altered metabolism. In this review, we focus on emerging studies that describe the key ECM components commonly found in soft tissue sarcomas and discuss preclinical and clinical evidence outlining the important role that these proteins and their cognate adhesion receptors play in sarcomagenesis. We conclude by providing a perspective on the need for more comprehensive in-depth analyses of both the ECM and adhesion receptor biology in multiple histological subtypes in order to identify new drug targets and prognostic biomarkers for this group of rare diseases of unmet need.
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Affiliation(s)
- Valeriya Pankova
- Division of Molecular Pathology, The Institute of Cancer Research, Sutton, United Kingdom
| | - Khin Thway
- Division of Molecular Pathology, The Institute of Cancer Research, Sutton, United Kingdom
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Robin L. Jones
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Division of Clinical Studies, The Institute of Cancer Research, Sutton, United Kingdom
| | - Paul H. Huang
- Division of Molecular Pathology, The Institute of Cancer Research, Sutton, United Kingdom
- *Correspondence: Paul H. Huang,
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15
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Zamani M, Mollabashi M, Mehrabi N, Alizadeh S. Aggressive angiomyxoma of vulva in 28-years old patient: A case report of second recurrence. Ann Med Surg (Lond) 2021; 69:102706. [PMID: 34429960 PMCID: PMC8368991 DOI: 10.1016/j.amsu.2021.102706] [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: 07/15/2021] [Revised: 08/06/2021] [Accepted: 08/07/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Aggressive angiomyxoma is an uncommon mesenchymal tumor in women who are in reproductive age, that occurring in the pelvis and perineal zone with a high risk of local infiltration and recurrence. Case presentation We describe a case of a 28-year-old woman with a huge recurrent vulvar aggressive angiomyxoma. Clinical Discussion Our patients underwent surgery and tumor resection for two times but had relapsed every 2 years through 5 years and finally she underwent total vulvectomy. The patient received Decapeptide for 3 months to prevent tumor recurrence after surgery and to date,there has been no evidence of local recurrence. Conclusion Aggressive angiomyxoma is a rare tumor with high recurrence rate. The best treatment is surgical resection by experienced Gyn-oncologist in teamwork and territory Hospital. Aggressive angiomyxoma has a high trend to local recurrence. Radical surgery with wide margins is the first line of treatment. All patients counseled about the need for long-term surveillance.
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Affiliation(s)
- Mehrangiz Zamani
- Department of Obstetrics & Gynecology, Hamadan University of Medical Science, Hamadan, Iran
| | - Mina Mollabashi
- Department of Radiology, Hamadan University of Medical Science, Hamadan, Iran
| | - Narges Mehrabi
- Hamadan University of Medical Sciencesence, Hamedan, Iran
| | - Shima Alizadeh
- Gynecologist; Board Certified at Tehran University of Medical Science, Tehran, Iran
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16
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Zhang M, Wong SW, Lummus S, Han M, Radmanesh A, Ahmadian SS, Prolo LM, Lai H, Eghbal A, Oztekin O, Cheshier SH, Fisher PG, Ho CY, Vogel H, Vitanza NA, Lober RM, Grant GA, Jaju A, Yeom KW. Radiomic Phenotypes Distinguish Atypical Teratoid/Rhabdoid Tumors from Medulloblastoma. AJNR Am J Neuroradiol 2021; 42:1702-1708. [PMID: 34266866 DOI: 10.3174/ajnr.a7200] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 04/05/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND PURPOSE Atypical teratoid/rhabdoid tumors and medulloblastomas have similar imaging and histologic features but distinctly different outcomes. We hypothesized that they could be distinguished by MR imaging-based radiomic phenotypes. MATERIALS AND METHODS We retrospectively assembled T2-weighted and gadolinium-enhanced T1-weighted images of 48 posterior fossa atypical teratoid/rhabdoid tumors and 96 match-paired medulloblastomas from 7 institutions. Using a holdout test set, we measured the performance of 6 candidate classifier models using 6 imaging features derived by sparse regression of 900 T2WI and 900 T1WI Imaging Biomarker Standardization Initiative-based radiomics features. RESULTS From the originally extracted 1800 total Imaging Biomarker Standardization Initiative-based features, sparse regression consistently reduced the feature set to 1 from T1WI and 5 from T2WI. Among classifier models, logistic regression performed with the highest AUC of 0.86, with sensitivity, specificity, accuracy, and F1 scores of 0.80, 0.82, 0.81, and 0.85, respectively. The top 3 important Imaging Biomarker Standardization Initiative features, by decreasing order of relative contribution, included voxel intensity at the 90th percentile, inverse difference moment normalized, and kurtosis-all from T2WI. CONCLUSIONS Six quantitative signatures of image intensity, texture, and morphology distinguish atypical teratoid/rhabdoid tumors from medulloblastomas with high prediction performance across different machine learning strategies. Use of this technique for preoperative diagnosis of atypical teratoid/rhabdoid tumors could significantly inform therapeutic strategies and patient care discussions.
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Affiliation(s)
- M Zhang
- From the Departments of Neurosurgery (M.Z.)
| | - S W Wong
- Department of Statistics (S.W.W.), Stanford University, Stanford, California
| | - S Lummus
- Department of Physiology and Nutrition (S.L.), University of Colorado, Colorado Springs, Colorado
| | - M Han
- Department of Pediatrics (M.H.), Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - A Radmanesh
- Department of Radiology (A.R.), New York University Grossman School of Medicine, New York, New York
| | - S S Ahmadian
- Pathology (S.S.A., H.V.), Stanford Medical Center, Stanford University, Stanford, California
| | - L M Prolo
- Departments of Neurosurgery (L.M.P., G.A.G.)
| | - H Lai
- Department of Radiology (H.L., A.E.), Children's Hospital of Orange County, Orange, California and University of California, Irvine, Irvine, California
| | - A Eghbal
- Department of Radiology (H.L., A.E.), Children's Hospital of Orange County, Orange, California and University of California, Irvine, Irvine, California
| | - O Oztekin
- Department of Neuroradiology (O.O.), Cigli Education and Research Hospital, Bakircay University, Izmir, Turkey.,Department of Neuroradiology (O.O.), Tepecik Education and Research Hospital, Health Science University, Izmir, Turkey
| | - S H Cheshier
- Division of Pediatric Neurosurgery (S.H.C.), Department of Neurosurgery, Huntsman Cancer Institute, Intermountain Healthcare Primary Children's Hospital, University of Utah School of Medicine, Salt Lake City, Utah
| | | | - C Y Ho
- Departments of Clinical Radiology & Imaging Sciences (C.Y.H.), Riley Children's Hospital, Indiana University, Indianapolis, Indiana
| | - H Vogel
- Pathology (S.S.A., H.V.), Stanford Medical Center, Stanford University, Stanford, California
| | - N A Vitanza
- Division of Pediatric Hematology/Oncology (N.A.V.), Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington
| | - R M Lober
- Division of Neurosurgery (R.M.L.), Department of Pediatrics, Wright State University Boonshoft School of Medicine, Dayton Children's Hospital, Dayton, Ohio
| | - G A Grant
- Departments of Neurosurgery (L.M.P., G.A.G.)
| | - A Jaju
- Department of Medical Imaging (A.J.), Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - K W Yeom
- Radiology (K.W.Y.), Lucile Packard Children's Hospital, Stanford University, Palo Alto, California
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17
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Scalise M, Torella M, Marino F, Ravo M, Giurato G, Vicinanza C, Cianflone E, Mancuso T, Aquila I, Salerno L, Nassa G, Agosti V, De Angelis A, Urbanek K, Berrino L, Veltri P, Paolino D, Mastroroberto P, De Feo M, Viglietto G, Weisz A, Nadal-Ginard B, Ellison-Hughes GM, Torella D. Atrial myxomas arise from multipotent cardiac stem cells. Eur Heart J 2021; 41:4332-4345. [PMID: 32330934 PMCID: PMC7735815 DOI: 10.1093/eurheartj/ehaa156] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 12/22/2019] [Accepted: 03/03/2020] [Indexed: 12/11/2022] Open
Abstract
Aims Cardiac myxomas usually develop in the atria and consist of an acid-mucopolysaccharide-rich myxoid matrix with polygonal stromal cells scattered throughout. These human benign tumours are a valuable research model because of the rarity of cardiac tumours, their clinical presentation and uncertain origin. Here, we assessed whether multipotent cardiac stem/progenitor cells (CSCs) give rise to atrial myxoma tissue. Methods and results Twenty-three myxomas were collected and analysed for the presence of multipotent CSCs. We detected myxoma cells positive for c-kit (c-kitpos) but very rare Isl-1 positive cells. Most of the c-kitpos cells were blood lineage-committed CD45pos/CD31pos cells. However, c-kitpos/CD45neg/CD31neg cardiac myxoma cells expressed stemness and cardiac progenitor cell transcription factors. Approximately ≤10% of the c-kitpos/CD45neg/CD31neg myxoma cells also expressed calretinin, a characteristic of myxoma stromal cells. In vitro, the c-kitpos/CD45neg/CD31neg myxoma cells secrete chondroitin-6-sulfate and hyaluronic acid, which are the main components of gelatinous myxoma matrix in vivo. In vitro, c-kitpos/CD45neg/CD31neg myxoma cells have stem cell properties being clonogenic, self-renewing, and sphere forming while exhibiting an abortive cardiac differentiation potential. Myxoma-derived CSCs possess a mRNA and microRNA transcriptome overall similar to normal myocardium-derived c-kitpos/CD45neg/CD31negCSCs , yet showing a relatively small and relevant fraction of dysregulated mRNA/miRNAs (miR-126-3p and miR-335-5p, in particular). Importantly, myxoma-derived CSCs but not normal myocardium-derived CSCs, seed human myxoma tumours in xenograft’s in immunodeficient NOD/SCID mice. Conclusion Myxoma-derived c-kitpos/CD45neg/CD31neg CSCs fulfill the criteria expected of atrial myxoma-initiating stem cells. The transcriptome of these cells indicates that they belong to or are derived from the same lineage as the atrial multipotent c-kitpos/CD45neg/CD31neg CSCs. Taken together the data presented here suggest that human myxomas could be the first-described CSC-related human heart disease. ![]()
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Affiliation(s)
- Mariangela Scalise
- Department of Experimental and Clinical Medicine, Molecular and Cellular Cardiology, Magna Graecia University, Viale Europa, 88100 Catanzaro, Italy
| | - Michele Torella
- Department of Translational Medical Sciences, AORN dei Colli/Monaldi Hospital, University of Campania "L. Vanvitelli", Via Leonardo Bianchi, 80131 Naples, Italy
| | - Fabiola Marino
- Department of Experimental and Clinical Medicine, Molecular and Cellular Cardiology, Magna Graecia University, Viale Europa, 88100 Catanzaro, Italy
| | - Maria Ravo
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Laboratory of Molecular Medicine and Genomics, University of Salerno, Via Salvador Allende, 84081 Baronissi (Salerno), Italy.,Genomix4Life, Spin-Off of the Laboratory of Molecular Medicine and Genomics, Department of Medicine, Surgery and Dentistry, University of Salerno, Via Salvador Allende, 84081 Baronissi (Salerno), Italy
| | - Giorgio Giurato
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Laboratory of Molecular Medicine and Genomics, University of Salerno, Via Salvador Allende, 84081 Baronissi (Salerno), Italy.,Genomix4Life, Spin-Off of the Laboratory of Molecular Medicine and Genomics, Department of Medicine, Surgery and Dentistry, University of Salerno, Via Salvador Allende, 84081 Baronissi (Salerno), Italy
| | - Carla Vicinanza
- Department of Experimental and Clinical Medicine, Molecular and Cellular Cardiology, Magna Graecia University, Viale Europa, 88100 Catanzaro, Italy
| | - Eleonora Cianflone
- Department of Experimental and Clinical Medicine, Molecular and Cellular Cardiology, Magna Graecia University, Viale Europa, 88100 Catanzaro, Italy.,Department of Medical and Surgical Sciences, Magna Graecia University, Viale Europa, 88100 Catanzaro, Italy
| | - Teresa Mancuso
- Department of Experimental and Clinical Medicine, Molecular and Cellular Cardiology, Magna Graecia University, Viale Europa, 88100 Catanzaro, Italy
| | - Iolanda Aquila
- Department of Experimental and Clinical Medicine, Molecular and Cellular Cardiology, Magna Graecia University, Viale Europa, 88100 Catanzaro, Italy
| | - Luca Salerno
- Department of Experimental and Clinical Medicine, Molecular and Cellular Cardiology, Magna Graecia University, Viale Europa, 88100 Catanzaro, Italy
| | - Giovanni Nassa
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Laboratory of Molecular Medicine and Genomics, University of Salerno, Via Salvador Allende, 84081 Baronissi (Salerno), Italy
| | - Valter Agosti
- Department of Experimental and Clinical Medicine, Magna Graecia University, Viale Europa, 88100 Catanzaro, Italy
| | - Antonella De Angelis
- Department of Experimental and Clinical Medicine, Magna Graecia University, Viale Europa, 88100 Catanzaro, Italy
| | - Konrad Urbanek
- Department of Experimental and Clinical Medicine, Molecular and Cellular Cardiology, Magna Graecia University, Viale Europa, 88100 Catanzaro, Italy.,Department of Experimental Medicine, University of Campania "L. Vanvitelli", Via Santa Maria di Costantinopoli, 80138 Naples, Italy
| | - Liberato Berrino
- Department of Experimental Medicine, University of Campania "L. Vanvitelli", Via Santa Maria di Costantinopoli, 80138 Naples, Italy
| | - Pierangelo Veltri
- Department of Medical and Surgical Sciences, Magna Graecia University, Viale Europa, 88100 Catanzaro, Italy
| | - Donatella Paolino
- Department of Experimental and Clinical Medicine, Magna Graecia University, Viale Europa, 88100 Catanzaro, Italy
| | - Pasquale Mastroroberto
- Department of Experimental and Clinical Medicine, Magna Graecia University, Viale Europa, 88100 Catanzaro, Italy
| | - Marisa De Feo
- Department of Translational Medical Sciences, AORN dei Colli/Monaldi Hospital, University of Campania "L. Vanvitelli", Via Leonardo Bianchi, 80131 Naples, Italy
| | - Giuseppe Viglietto
- Department of Experimental and Clinical Medicine, Magna Graecia University, Viale Europa, 88100 Catanzaro, Italy
| | - Alessandro Weisz
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Laboratory of Molecular Medicine and Genomics, University of Salerno, Via Salvador Allende, 84081 Baronissi (Salerno), Italy.,Genomix4Life, Spin-Off of the Laboratory of Molecular Medicine and Genomics, Department of Medicine, Surgery and Dentistry, University of Salerno, Via Salvador Allende, 84081 Baronissi (Salerno), Italy
| | - Bernardo Nadal-Ginard
- Department of Experimental and Clinical Medicine, Molecular and Cellular Cardiology, Magna Graecia University, Viale Europa, 88100 Catanzaro, Italy
| | - Georgina M Ellison-Hughes
- Centre for Human and Applied Physiological Sciences and Centre for Stem Cells and Regenerative Medicine, School of Basic and Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, Guys Campus - Great Maze Pond rd, SE1 1UL London, UK
| | - Daniele Torella
- Department of Experimental and Clinical Medicine, Molecular and Cellular Cardiology, Magna Graecia University, Viale Europa, 88100 Catanzaro, Italy
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18
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Tran V, Slavin J. Soft Tissue Tumour Pathology. Sarcoma 2021. [DOI: 10.1007/978-981-15-9414-4_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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19
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Malukani K, Varma AV, Choudhary D, Dosi S. Aggressive angiomyxoma in pregnancy: A rare and commonly misdiagnosed entity. J Lab Physicians 2020; 10:245-247. [PMID: 29692596 PMCID: PMC5896197 DOI: 10.4103/jlp.jlp_179_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Aggressive angiomyxoma (AAM) is an uncommon mesenchymal tumor that predominantly involves the pelvis and perineum of young females. It is often clinically mistaken for more common superficial lesions such as vaginal cysts, labial cysts, and lipomas. A review of the medical literature reveals very few cases of AAM reported in pregnancy. We describe a rare case of AAM in pregnancy, clinically misdiagnosed as prolapsed cervical fibroid.
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Affiliation(s)
- Kamal Malukani
- Department of Pathology, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India
| | - Amit V Varma
- Department of Pathology, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India
| | - Devashish Choudhary
- Department of Pathology, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India
| | - Shilpi Dosi
- Department of Pathology, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India
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20
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Mujtaba B, Wang F, Taher A, Aslam R, Madewell JE, Nassar S. Myxoid Liposarcoma With Skeletal Metastases: Pathophysiology and Imaging Characteristics. Curr Probl Diagn Radiol 2019; 50:66-73. [PMID: 31813645 DOI: 10.1067/j.cpradiol.2019.10.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 10/17/2019] [Accepted: 10/23/2019] [Indexed: 12/14/2022]
Abstract
Liposarcoma is a commonly occurring soft tissue sarcoma that can be divided into 4 subtypes. Myxoid and round cell liposarcoma (MRCL) represent one of these subtypes and are classified together due to their shared chromosomal translocation. Histologic analysis of MRCL reveals a myxoid matrix with a delicate capillary network and dispersed lipoblasts. Varying degrees of round cell component are also observed, with greater amounts of round cells indicating a higher histologic grade and poorer prognosis. MRCL has a unique pattern of spread due to its initial tendency to spread to extrapulmonary sites. Additionally, skeletal metastases are frequently found in cases of MRCL. While various imaging techniques are used to visualize MRCL and metastases, magnetic resonance imaging is generally the preferred method. This article reviews the pathophysiology and imaging features of MRCL as well as the imaging characteristics, advantages, and drawbacks of multiple imaging modalities for visualizing bone metastases.
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Affiliation(s)
- Bilal Mujtaba
- Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Felicia Wang
- Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Ahmed Taher
- Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rizwan Aslam
- Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
| | - John E Madewell
- Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sameh Nassar
- Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
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21
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Abstract
Soft tissue neoplasms with myxoid features are collectively not uncommon. Their often complex differential diagnosis makes them significantly over-represented among consultation cases. This applies not only to sarcomas but in particular to benign lesions as well. Generally, myxoid soft tissue lesions are divided into two major groups: (1) myxoid lesions by definition (which can however rarely be non-myxoid) and (2) rare myxoid variants of otherwise non-myxoid entities.Four major diagnostic challenges are responsible for the complexity of myxoid soft tissue neoplasms: (1) Diagnosis of malignancy in many cases is not based on conventional malignancy criteria but is defined by the entity itself, making under-diagnosis of malignancy likely in entities such as low-grade fibromyxoid sarcoma. (2) On the other hand, harmless myxoid lesions with features of high proliferation, e.g. nodular and proliferative fasciitis, tend to be over-diagnosed as malignant by the unworried. (3) The necessity to assess not only cellular morphology/differentiation, but also the stromal, vascular and architectural characteristics adds to the complexity of the differential diagnostic algorithm. (4) Last but not least, recognition of unexpected myxoid variants of non-myxoid entities is basically impossible if focal conventional areas are absent, underlining the need for high suspicion index and sufficient sampling.This review illuminates the various aspects related to the differential diagnostic workup of these challenging entities.
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22
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Comparison of the diagnostic performances of core needle biopsy in myxoid versus non-myxoid tumors. Eur J Surg Oncol 2019; 45:1293-1298. [DOI: 10.1016/j.ejso.2019.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 04/07/2019] [Accepted: 05/01/2019] [Indexed: 01/09/2023] Open
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23
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Calreticulin as A Novel Potential Metastasis-Associated Protein in Myxoid Liposarcoma, as Revealed by Two-Dimensional Difference Gel Electrophoresis. Proteomes 2019; 7:proteomes7020013. [PMID: 30974841 PMCID: PMC6631384 DOI: 10.3390/proteomes7020013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 03/07/2019] [Accepted: 04/08/2019] [Indexed: 12/12/2022] Open
Abstract
Myxoid liposarcoma (MLS) is a mesenchymal malignancy. To identify innovate seeds for clinical applications, we examined the proteomes of primary tumor tissues from 10 patients with MLS with different statuses of postoperative metastasis. The protein expression profiles of tumor tissues were created, and proteins with differential expression associated with postoperative metastasis were identified by two-dimensional difference gel electrophoresis (2D-DIGE) and mass spectrometry. The validation was performed using specific antibodies and in vitro analyses. Using 2D-DIGE, we observed 1726 protein species and identified proteins with unique expression levels in metastatic MLS. We focused on the overexpression of calreticulin in metastatic MLS. The higher expression of calreticulin was confirmed by Western blotting, and gene silencing assays demonstrated that reduced expression of calreticulin inhibited cell growth and invasion. Our findings suggested the important roles of calreticulin in MLS metastasis and supported its potential utility as a prognostic biomarker in MLS. Further investigations of the functional properties of calreticulin and other proteins identified in this study will improve our understanding of the biology of MLS and facilitate novel clinical applications.
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24
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Abstract
Myxoid adipocytic tumors encompass a broad heterogeneous group of benign and malignant adipocytic tumors, which are typically myxoid (e.g. myxoid liposarcoma, lipoblastoma and lipoblastoma-like tumor of the vulva) or may occasionally appear predominantly myxoid (e.g. pleomorphic liposarcoma, atypical lipomatous tumor, dedifferentiated liposarcoma, chondroid lipoma, spindle cell/pleomorphic lipoma, atypical spindle cell lipomatous tumor and atypical pleomorphic lipomatous tumor). There have been significant advances in recent years in classification and understanding the pathogenesis of adipocytic tumors, based on the correlation of histologic, immunohistochemical, and cytogenetic/molecular findings. Despite these advances, the morphologic diagnosis and accurate classification of a myxoid adipocytic tumor can be challenging due to major morphologic overlap between myxoid adipocytic and non-adipocytic tumors. This article will provide a review on the currently known morphological, immunohistochemical and molecular features of myxoid adipocytic tumors and their differential diagnosis.
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Affiliation(s)
- David Creytens
- Department of Pathology, Ghent University and Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium; CRIG, Cancer Research Institute Ghent, Ghent University and Ghent University Hospital, Ghent, Belgium.
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25
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Sunitsch S, Gilg MM, Kashofer K, Gollowitsch F, Leithner A, Liegl-Atzwanger B. Detection of GNAS mutations in intramuscular / cellular myxomas as diagnostic tool in the classification of myxoid soft tissue tumors. Diagn Pathol 2018; 13:52. [PMID: 30111377 PMCID: PMC6094570 DOI: 10.1186/s13000-018-0734-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 07/30/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intramuscular / cellular myxomas and low-grade myxofibrosarcomas are two different tumor entities with a significant histological overlap, especially if dealing with small biopsies. Despite the morphological similarities, they differ considerably in their biological behaviour. Intramuscular / cellular myxoma rarely shows signs of recurrence and never metastasizes, in contrast to myxofibrosarcoma that tends to recur more aggressively and to metastasize haematologically. Therefore, it is of great importance to distinguish these lesions - evaluation of GNAS mutation status could be of tremendous help. METHODS We reviewed 13 cases with intramuscular / cellular myxomas. The 13 cases included 5 men and 8 women, aged from 33 to 71 years (mean age 55.5 years). Immunohistochemistry was performed as well as next generation sequencing. Ten cases were located in the lower extremities and three cases were located in the upper extremities. Two lesions were initially misdiagnosed as a low-grade myxofibrosarcoma. RESULTS Performing next generation sequencing 12 out of 13 specimens showed a GNAS mutation. CONCLUSIONS Our findings demonstrate that GNAS mutations are more common in intramuscular / cellular myxomas, than had been reported in literature in the past. Next generation sequencing for determining GNAS mutation status on small biopsies or diagnostically challenging cases facilitates the diagnosis of intramuscular / cellular myxoma and separates this tumor entity from its mimics.
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Affiliation(s)
- Sandra Sunitsch
- Institute of Pathology, Klinikum Klagenfurt am Wörthersee, Feschnigstraße 11, 9020, Klagenfurt am Wörthersee, Austria.,Institute of Pathology, Medical University of Graz, Neue Stiftingtalstraße 6, 8010 Graz, Austria
| | - Magdalena Maria Gilg
- Department of Orthopedics and Trauma Surgery, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria.
| | - Karl Kashofer
- Institute of Pathology, Medical University of Graz, Neue Stiftingtalstraße 6, 8010 Graz, Austria
| | - Franz Gollowitsch
- Institute of Pathology, Medical University of Graz, Neue Stiftingtalstraße 6, 8010 Graz, Austria
| | - Andreas Leithner
- Department of Orthopedics and Trauma Surgery, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
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26
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Sun D, Wu Y, Liu Y, Yang J. Primary cardiac myxofibrosarcoma: case report, literature review and pooled analysis. BMC Cancer 2018; 18:512. [PMID: 29720127 PMCID: PMC5932848 DOI: 10.1186/s12885-018-4434-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 04/25/2018] [Indexed: 12/18/2022] Open
Abstract
Background Primary cardiac myxofibrosarcoma is a very rare cardiac malignancy. The majority of publications are limited to case reports. No pooled analyses of primary cardiac myxofibrosarcoma cases are available. Little clinical features and outcome patterns are acknowledged. The purpose of this study is to identify the clinical characteristics and prognostic factors of primary cardiac myxofibrosarcoma. Case presentation A case report of primary cardiac myxofibrosarcoma was presented, and a review of English language literatures of primary cardiac myxofibrosarcomas were performed electronically. Demographics, clinicopathologic data, therapy and follow-up were summarized. The median survival time and the mean survival time were calculated by Kaplan-Meier method. Survival distribution and overall survival were figured by log-rank test and cox proportional hazards models. We present a case, and retrospectively analyzed additional 30 patients derived from 24 isolated articles. The cohort consisted of 18 male and 13 female patients. The age was 41.87 ± 17.89 years. Some common features were found in clinical presentations, pathologic features, treatments and outcome patterns of primary cardiac myxofibrosarcoma. There were special features in echocardiography, histological and immunohistochemical examinations, which should be considered in diagnosis of primary cardiac myxofibrosarcoma. The median survival time/mean survival time (MST) was 14/32.66 months. The median survival time/mean survival time (MST) was 14/32.66 months. Compared to the other groups, the following groups had shorter survival characteristics, including age ≥ 40 years (14/11.79 months), female (14/26.26 months), mass diameter ≥ 40 mm (14/14.64 months), high-grade (2/11.81 months), and no post-treatment (14/28.09 months). Statistical analyses revealed that primary cardiac myxofibrosarcomas were more likely to present with local recurrences and dismal metastases. Tumors ≥ 40 mm in size (P = 0.055, HR = 6.79) or with high-grade (P = 0.063, HR = 11.45) had significantly worse prognosis. Conclusions Primary cardiac myxofibrosarcomas were more likely to present with local recurrences and dismal metastases. Echocardiography, together with histological method should be considered in ordinary diagnosis. Tumors ≥ 40 mm in size or with high-grade had significantly worse prognosis, which should be early diagnosed and treated with rational surgery.
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Affiliation(s)
- Dandan Sun
- Department of Cardiovascular Ultrasound, the First Affiliated Hospital of China Medical University, 155 North Nanjing Street, Heping District, Shenyang, 110001, Liaoning Province, China.
| | - Yupeng Wu
- 2nd Department of Neurosurgery, The People's Hospital of China Medical University and The People's Hospital of Liaoning Province, Shenyang, 110016, Liaoning Province, China
| | - Yan Liu
- Department of Cardiovascular Ultrasound, the First Affiliated Hospital of China Medical University, 155 North Nanjing Street, Heping District, Shenyang, 110001, Liaoning Province, China
| | - Jun Yang
- Department of Cardiovascular Ultrasound, the First Affiliated Hospital of China Medical University, 155 North Nanjing Street, Heping District, Shenyang, 110001, Liaoning Province, China
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27
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Alhousami T, Sabharwal A, Gupta S, Aguirre A, Park E, Kramer JM. Fibromyxoma of the Jaw: Case Report and Review of the Literature. Head Neck Pathol 2018; 12:44-51. [PMID: 28508997 PMCID: PMC5873478 DOI: 10.1007/s12105-017-0823-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 05/04/2017] [Indexed: 10/19/2022]
Abstract
We report a case of fibromyxoma of the mandible, a rare benign odontogenic tumor. Our patient presented in the first trimester of pregnancy with a large mass in the right body of the mandible exhibiting displacement of teeth and destruction of an extensive area of the mandibular bone. The mass was biopsied and diagnosed as a fibromyxoma. The large size of the tumor dictated a wide mandibular resection. We will review the clinical, radiographic, and histologic features of fibromyxoma and discuss its differential diagnoses. In addition, we will provide an overview of patient management. Fibromxyoma is a benign gnathic tumor that can be locally aggressive. To ensure appropriate treatment, it is important to distinguish this neoplasm from other mimickers in which myxoid, spindle mesenchymal cell proliferation is prominent.
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Affiliation(s)
- Thabet Alhousami
- Department of Oral Diagnostics Sciences, School of Dental Medicine, University at Buffalo, The State University of New York, Buffalo, NY, USA
- Department of Basic and Clinical Oral Sciences, Faculty of Dentistry, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Amarpreet Sabharwal
- Department of Endodontics and Periodontics, School of Dental Medicine, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Shivane Gupta
- Department of Oral and Maxillofacial Surgery, School of Dental Medicine, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Alfredo Aguirre
- Department of Oral Diagnostics Sciences, School of Dental Medicine, University at Buffalo, The State University of New York, Buffalo, NY, USA
- Immco Diagnostics Inc, Buffalo, NY, USA
| | - Etern Park
- Department of Oral and Maxillofacial Surgery, School of Dental Medicine, University at Buffalo, The State University of New York, Buffalo, NY, USA
- Christiana Health Care Services, Wilmington Hospital, Wilmington, DE, 19801, USA
| | - Jill M Kramer
- Department of Oral Diagnostics Sciences, School of Dental Medicine, University at Buffalo, The State University of New York, Buffalo, NY, USA.
- Immco Diagnostics Inc, Buffalo, NY, USA.
- Department of Oral Biology, School of Dental Medicine, University at Buffalo, The State University of New York, 3435 Main Street, 211 Foster Hall, Buffalo, NY, 141214, USA.
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Bembem K, Jaiswal A, Singh M, Verma N, Jain S, Bhat A. Cyto-Histo Correlation of a Very Rare Tumor: Superficial Angiomyxoma. J Cytol 2017; 34:230-232. [PMID: 29118482 PMCID: PMC5655664 DOI: 10.4103/0970-9371.216119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Superficial angiomyxoma (SA) is one of the superficially located myxoid soft tissue tumor. Because of the rarity of this tumor, there is paucity of fine needle aspiration cytology (FNAC) findings. Here, we present a case of SA in a 14-year-old girl who presented with a left leg swelling. The cytology of the lesion along with the histopathologic correlation is presented.
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Affiliation(s)
- Khuraijam Bembem
- Department of Pathology, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| | - Ankita Jaiswal
- Department of Pathology, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| | - Meeta Singh
- Department of Pathology, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| | - Nidhi Verma
- Department of Pathology, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| | - Shyama Jain
- Department of Pathology, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| | - Anusha Bhat
- Department of Pathology, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
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Zhang Y, Liu F, Pan Y, Liang J, Jiang Y, Jin Y. Clinicopathological analysis of myxoid proximal-type epithelioid sarcoma. J Cutan Pathol 2017; 45:151-155. [PMID: 29068073 DOI: 10.1111/cup.13069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 10/16/2017] [Accepted: 10/19/2017] [Indexed: 12/28/2022]
Abstract
Proximal-type epithelioid sarcoma (ES) with a diffuse myxoid stroma is rare. Here, we report the case of a 33-year-old man with a perineal mass. Imaging showed the presence of a poorly demarcated 6.9 × 5.3-cm mass in the subcutaneous perineal region. Macroscopic examination showed that the resected tissues were partially necrotic. Histological examination showed that the tumor comprised numerous large or pleomorphic epithelioid cells with large vesicular nuclei and prominent nucleoli. A clear background of necrosis and inflammatory exudates was also present. Immunohistochemical examination showed that the tumor cells were positive for vimentin and CD34 - both of which were expressed throughout the cytoplasm - but typically did not express nuclear INI1 (SMARCB1). Hematoxylin-eosin staining (HE staining) showed that the mucin content of the tumor was approximately 80%. The patient was diagnosed with proximal-type ES with myxoid features. The patient died due to disease progression after 2 months of follow-up and without undergoing further treatment in our department. To our knowledge, only 2 cases of proximal-type ES with diffuse myxoid stroma have been reported. Proximal-type ES is rare, and this is the first case report of proximal ES with myxoid features in the perineal area.
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Affiliation(s)
- Yanyang Zhang
- Department of Interventional Radiology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Furong Liu
- Department of General Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yuhang Pan
- Department of Pathology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jing Liang
- Department of Pathology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ye Jiang
- Department of Pathology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yi Jin
- Department of Pathology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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30
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Sharif M, Mohamed A, Reinacher M. Malignant renal schwannoma in a cat. Open Vet J 2017; 7:214-220. [PMID: 28795017 PMCID: PMC5538086 DOI: 10.4314/ovj.v7i3.3] [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: 12/10/2016] [Accepted: 07/05/2017] [Indexed: 11/21/2022] Open
Abstract
A nine-year-old male European shorthair cat with rapidly enlarging mass at the left kidney doubted to be malignant was presented. The purpose of this study is to present the clinical, radiological and pathological findings of a primary renal tumor in the cat. Grossly, the mass mostly encapsulated the kidney. Histologically, excisional biopsy showed worrying histological features. A sarcoma-like tumor composed mainly of neoplastic spindle-shaped cells. Neoplastic nodules of aggregations of fusiform cells arranged in multidirectional bundles. Immunohistochemically, several immunohistochemical satins (melan-A, S-100, vimentin, actin, desmin, cytokeratin, neurofilament, melan-A, NSE, synaptophysin, chromogranin, Glial Fibrillary Acidic Protein GFAP, Collagen IV and CD99) were used to differentially diagnose the mass. The stained neoplastic sections positively tested to S-100, but negative to the other aforementioned immunohistochemical stains. Immunohistochemistry with S-100 antibody staining showed an unusually strong positive reaction throughout the tumor cells. Based on our comparative diagnosis relative to other tumors, in addition to the progressive clinical signs, histopathological and immunohistochemical results, this case was presumptively diagnosis as a malignant schwannoma. According to our investigation of the relevant literature, this study of malignant renal Schwannoma (malignant peripheral nerve sheath tumor) is a highly rare case not previously characterized in a cat.
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Affiliation(s)
- Monier Sharif
- Department of Pathology and Anatomy, Faculty of Veterinary Medicine, University of Omar Al-Mukhtar, Al-Beida, Libya
| | - Adel Mohamed
- Department of Pathology and Anatomy, Faculty of Veterinary Medicine, University of Omar Al-Mukhtar, Al-Beida, Libya
| | - Manfred Reinacher
- Institute for Veterinary Pathology, Justus-Liebig-University, Frankfurter Str. 96, 35392 Giessen, Germany
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31
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Kim HS, Kim JH, Yoon YC, Choe BK. Tumor spatial heterogeneity in myxoid-containing soft tissue using texture analysis of diffusion-weighted MRI. PLoS One 2017; 12:e0181339. [PMID: 28708850 PMCID: PMC5510859 DOI: 10.1371/journal.pone.0181339] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 06/03/2017] [Indexed: 01/01/2023] Open
Abstract
The objective of this study was to examine the tumor spatial heterogeneity in myxoid-containing soft-tissue tumors (STTs) using texture analysis of diffusion-weighted imaging (DWI). A total of 40 patients with myxoid-containing STTs (23 benign and 17 malignant) were included in this study. The region of interest (ROI) was manually drawn on the apparent diffusion coefficient (ADC) map. For texture analysis, the global (mean, standard deviation, skewness, and kurtosis), regional (intensity variability and size-zone variability), and local features (energy, entropy, correlation, contrast, homogeneity, variance, and maximum probability) were extracted from the ADC map. Student’s t-test was used to test the difference between group means. Analysis of covariance (ANCOVA) was performed with adjustments for age, sex, and tumor volume. The receiver operating characteristic (ROC) analysis was performed to compare diagnostic performances. Malignant myxoid-containing STTs had significantly higher kurtosis (P = 0.040), energy (P = 0.034), correlation (P<0.001), and homogeneity (P = 0.003), but significantly lower contrast (P<0.001) and variance (P = 0.001) compared with benign myxoid-containing STTs. Contrast showed the highest area under the curve (AUC = 0.923, P<0.001), sensitivity (94.12%), and specificity (86.96%). Our results reveal the potential utility of texture analysis of ADC maps for differentiating benign and malignant myxoid-containing STTs.
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Affiliation(s)
- Hyun Su Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, #50 Irwon-dong, Gangnam-gu, Seoul, Republic of Korea
| | - Jae-Hun Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, #50 Irwon-dong, Gangnam-gu, Seoul, Republic of Korea
- * E-mail:
| | - Young Cheol Yoon
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, #50 Irwon-dong, Gangnam-gu, Seoul, Republic of Korea
| | - Bong Keun Choe
- Department of Preventive Medicine, Medical College, Kyung Hee University, Seoul, Republic of Korea
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Song Y, Yoon YC, Chong Y, Seo SW, Choi YL, Sohn I, Kim MJ. Diagnostic performance of conventional MRI parameters and apparent diffusion coefficient values in differentiating between benign and malignant soft-tissue tumours. Clin Radiol 2017; 72:691.e1-691.e10. [PMID: 28274509 DOI: 10.1016/j.crad.2017.02.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 01/23/2017] [Accepted: 02/03/2017] [Indexed: 12/15/2022]
Abstract
AIM To compare the abilities of conventional magnetic resonance imaging (MRI) and apparent diffusion coefficient (ADC) in differentiating between benign and malignant soft-tissue tumours (STT). MATERIAL AND METHODS A total of 123 patients with STT who underwent 3 T MRI, including diffusion-weighted imaging (DWI), were retrospectively analysed using variate conventional MRI parameters, ADCmean and ADCmin. RESULTS For the all-STT group, the correlation between the malignant STT conventional MRI parameters, except deep compartment involvement, compared to those of benign STT were statistically significant with univariate analysis. Maximum diameter of the tumour (p=0.001; odds ratio [OR], 8.97) and ADCmean (p=0.020; OR, 4.30) were independent factors with multivariate analysis. For the non-myxoid non-haemosiderin STT group, signal heterogeneity on axial T1-weighted imaging (T1WI; p=0.017), ADCmean, and ADCmin (p=0.001, p=0.001), showed significant differences with univariate analysis between malignancy and benignity. Signal heterogeneity in axial T1WI (p=0.025; OR, 12.64) and ADCmean (p=0.004; OR, 33.15) were independent factors with multivariate analysis. CONCLUSION ADC values as well as conventional MRI parameters were useful in differentiating between benign and malignant STT. The ADCmean was the most powerful diagnostic parameter in non-myxoid non-haemosiderin STT.
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Affiliation(s)
- Y Song
- Department of Radiology, Hanyang University Hospital, Seoul, Republic of Korea; Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Y C Yoon
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea.
| | - Y Chong
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - S W Seo
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Y-L Choi
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea; Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - I Sohn
- Department of Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Seoul, Republic of Korea
| | - M-J Kim
- Biostatistics Team, Samsung Biomedical Research Institute, Seoul, Republic of Korea
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33
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Intramuscular myxoma: clinical and surgical observation notes on eleven cases. INTERNATIONAL ORTHOPAEDICS 2017; 41:837-843. [DOI: 10.1007/s00264-016-3396-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 12/27/2016] [Indexed: 11/25/2022]
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34
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Crombe A, Alberti N, Stoeckle E, Brouste V, Buy X, Coindre JM, Kind M. Soft tissue masses with myxoid stroma: Can conventional magnetic resonance imaging differentiate benign from malignant tumors? Eur J Radiol 2016; 85:1875-1882. [DOI: 10.1016/j.ejrad.2016.08.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 08/04/2016] [Accepted: 08/24/2016] [Indexed: 12/23/2022]
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35
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Primary rhabdomyosarcoma of the thyroid in an adult with auricular thrombosis. Eur Ann Otorhinolaryngol Head Neck Dis 2016; 134:49-51. [PMID: 27595524 DOI: 10.1016/j.anorl.2016.01.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 12/14/2015] [Accepted: 01/01/2016] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Rhabdomyoscarcoma (RMS) is the most common soft-part tumour in children, however, it is infrequent in adults. Thyroid involvement is exceptional and only four cases have been reported: two primary RMS in children and another two cases in young adults with RMS metastasis to the thyroid. We report the first case in the literature of a primary adult RMS with thyroid involvement and superior vena cava syndrome. CASE PRESENTATION A 67-year-old male was admitted for an oedema of the arm extending to the laterocervical region. Computed tomography showed a 6cm mass in the hemithyroid with venous thrombosis to the auricle. Fine-needle aspiration was compatible with Bethesda category III. Surgery revealed a stone-hard consistency thyroid. An intraoperative biopsy showed an undifferentiated neoplasia, and no additional surgical intervention was undertaken. The patient died 48hours later. Definitive histology showed a RMS. DISCUSSION Venous thrombosis due to a thyroid tumour is infrequent. The scarce information in the literature recommends that thyroid carcinomas with auricular thrombosis be resected as soon as they are diagnosed. However, in cases of anaplastic or poorly differentiated carcinomas is controversial. Had there been a preoperative diagnosis in the histology in our case, surgery would not have been indicated.
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36
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Xu X, Low OW, Ng HW, Lim J, Lim TC, Ong WC. Nodular fasciitis of the head and neck: case report and review of literature. EUROPEAN JOURNAL OF PLASTIC SURGERY 2016. [DOI: 10.1007/s00238-016-1238-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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37
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Zou Y, Billings SD. Myxoid cutaneous tumors: a review. J Cutan Pathol 2016; 43:903-18. [DOI: 10.1111/cup.12749] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 02/16/2016] [Accepted: 04/05/2016] [Indexed: 01/16/2023]
Affiliation(s)
- Youran Zou
- Department of PathologyCleveland Clinic Cleveland OH USA
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38
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Meel R, Lokdarshi G, Kashyap S, Sharma S. Giant myxofibrosarcoma of the orbit: a rare case and a review of the literature. BMJ Case Rep 2016; 2016:bcr-2015-214107. [PMID: 27298287 DOI: 10.1136/bcr-2015-214107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 65-year-old man presented with giant orbital myxofibrosarcoma with no extraorbital extension. Imaging was suggestive of mesenchymal malignancy with significant vascularity. Incisional biopsy was suggestive of low-grade fibromyxoid sarcoma. The clinical and imaging features did not support the pathological diagnosis. Histopathology of the exenterated sample revealed features of high-grade myxofibrosarcoma. To the best of our knowledge, this is the largest reported myxofibrosarcoma of the orbit. Adjuvant radiotherapy was advised. Correlating the case history, imaging and histopathology, this case can best be summarised as a natural history of conversion from a low to high-grade myxoid malignancy. We emphasise that the overlapping features of myxoid malignancy (fibromyxosarcoma vs myxofibrosarcoma) and regional variation in tumour morphology in biopsy specimen may mislead the clinician. Therefore, knowledge about the key differentiating features as well as incisional biopsy of each radiologically different area can increase the possibility of correct diagnosis and management of each case.
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Affiliation(s)
- Rachna Meel
- Dr RP Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Gautam Lokdarshi
- Dr RP Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Seema Kashyap
- Department of Ocular Pathology, Dr RP Centre, All India Institute of Ophthalmic Sciences, New Delhi, Delhi, India
| | - Sanjay Sharma
- Department of Radiodiagnosis, All India Institute of Medical Sciences (AIIMS), New Delhi, Delhi, India
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39
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Draeger DL, Protzel C, Hakenberg OW. Aggressive Angiomyxoma as a Rare Differential Diagnosis of Enlargement of the Scrotum. Clin Genitourin Cancer 2016; 14:e237-9. [PMID: 26774350 DOI: 10.1016/j.clgc.2015.12.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 12/19/2015] [Indexed: 11/19/2022]
Affiliation(s)
| | - Chris Protzel
- Department of Urology, University of Rostock, Rostock, Germany
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40
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Pai VB, Ravilla R, Lindberg M, Steliga M, Arnaoutakis K. Myxoid mesenchymal neoplasm presenting as massive arm and chest wall oedema with pleural effusion. Ecancermedicalscience 2015; 9:590. [PMID: 26635894 PMCID: PMC4659703 DOI: 10.3332/ecancer.2015.590] [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: 05/07/2015] [Indexed: 11/06/2022] Open
Abstract
Myxoid mesenchymal tumours are a heterogeneous group of neoplasms characterised histologically by their abundant mucoid and myxoid extracellular matrix (ECM). Encompassing a broad spectrum of clinical behaviour ranging from benign to malignant, there are more than 60 reactive and neoplastic entities currently classified under its domain. Its varied clinical and histopathologic features continue to pose a diagnostic challenge to clinicians and pathologists. Here, we describe a rare case of myxoid mesenchymal tumour presenting as oedema of the upper extremity with pleural metastasis and partial response to chemotherapy, which to the best of our knowledge has not yet been described in the literature.
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Affiliation(s)
- Vidya B Pai
- Department of Internal Medicine, Paediatrics, University of Arkansas For Medical Sciences, AR 72205, USA
| | - Rahul Ravilla
- Department of Internal Medicine, University of Arkansas for Medical Sciences, AR 72205, USA
| | - Matthew Lindberg
- Department of Pathology, University of Arkansas For Medical Sciences, AR 72205, USA
| | - Matthew Steliga
- Division of Thoracic Surgery, University of Arkansas For Medical Sciences, AR 72205, USA
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41
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Petscavage-Thomas JM, Walker EA, Logie CI, Clarke LE, Duryea DM, Murphey MD. Soft-tissue myxomatous lesions: review of salient imaging features with pathologic comparison. Radiographics 2015; 34:964-80. [PMID: 25019435 DOI: 10.1148/rg.344130110] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Myxoid soft-tissue lesions are a heterogeneous group of benign and malignant mesenchymal tumors with an abundance of extracellular mucoid material. These lesions may mimic cysts on radiologic evaluation because of the high water content, and histopathologic features also overlap. Benign myxoid lesions include intramuscular myxoma, synovial cyst, bursa, ganglion, and benign peripheral nerve sheath tumor, including neurofibroma and schwannoma. Malignant entities include myxoid liposarcoma, myxoid leiomyosarcoma, myxoid chondrosarcoma, ossifying fibromyxoid tumor, and myxofibrosarcoma. Some syndromes are associated with myxoid soft-tissue lesions, such as Mazabraud syndrome in patients with soft-tissue myxomas and fibrous dysplasia. Certain discriminating features, such as intralesional fat in a myxoid liposarcoma, perilesional edema and a rim of fat in soft-tissue myxoma, and the swirled T2-weighted signal intensity and enhancement pattern of aggressive angiomyxoma, assist the radiologist in differentiating these lesions. The presence of an internal chondroid matrix or incomplete peripheral ossification may suggest myxoid chondrosarcoma or ossifying fibromyxoid tumor, respectively. The entering-and-exiting-nerve sign is suggestive of a peripheral nerve sheath tumor. Communication with a joint or tendon sheath and peripheral enhancement may indicate a ganglion or synovial cyst. This article (a) reviews the magnetic resonance, computed tomographic, and ultrasonographic imaging characteristics of soft-tissue myxomatous lesions, emphasizing imaging findings that can help differentiate benign and malignant lesions; (b) presents differential diagnoses; and (c) provides pathologic correlation.
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Affiliation(s)
- Jonelle M Petscavage-Thomas
- From the Departments of Radiology (J.M.P., E.A.W., D.M.D.) and Pathology (L.E.C.), Penn State Milton S. Hershey Medical Center, 500 University Dr, Room HG300, Hershey, PA 17033; Department of Radiology and Nuclear Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md (E.A.W., M.D.M.); Musculoskeletal Section, American Institute for Radiologic Pathology, Silver Spring, Md (C.I.L., M.D.M.); and Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (M.D.M.)
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Kane PM, Gaspar MP, Rekant MS. Solitary Myxoid Neurofibroma of the Palm. J Hand Microsurg 2015; 7:330-1. [PMID: 26578840 DOI: 10.1007/s12593-015-0200-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 09/01/2015] [Indexed: 10/23/2022] Open
Affiliation(s)
- Patrick M Kane
- The Philadelphia Hand Center, Thomas Jefferson University, The Franklin, Suite G114, 834 Chestnut Street, Philadelphia, PA 19107 USA
| | - Michael P Gaspar
- The Philadelphia Hand Center, Thomas Jefferson University, The Franklin, Suite G114, 834 Chestnut Street, Philadelphia, PA 19107 USA
| | - Mark S Rekant
- The Philadelphia Hand Center, Thomas Jefferson University, The Franklin, Suite G114, 834 Chestnut Street, Philadelphia, PA 19107 USA
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43
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Intramuscular myxoma of the paraspinal muscles: A case report and systematic review of the literature. Oncol Lett 2015; 11:466-470. [PMID: 26870235 DOI: 10.3892/ol.2015.3864] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 09/04/2015] [Indexed: 11/05/2022] Open
Abstract
Intramuscular myxoma (IM) is a rare mesenchymal tumor of the head and neck region. The current study reports a case of a 45-year-old man who presented with a painless neck mass. Imaging showed involvement of the levator scapulae and scalene muscles. Core needle biopsy was consistent with intramuscular myxoma. Surgical excision was performed and follow-up for 30 months showed no recurrence. The present study includes a systematic review of head and neck IMs, with a summary of the clinical and demographic parameters of all reported cases in the head and neck region. Surgery was curative in 28 of the 29 published cases, as well as in the current case (96.7%), with the lone recurrent tumor cured following re-resection. Females constituted 57% of the cases and the mean age was 49.7±20.4 years. Although uncommon, IM should be considered in the differential diagnosis of deep neck masses, and surgical excision is the treatment of choice with a low risk of recurrence.
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44
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Naresh N, Srinivas V, Malik A, Sahoo N, Dutta V. Myxofibroma of the soft tissue of face. Med J Armed Forces India 2015; 71:S282-4. [PMID: 26265859 PMCID: PMC4529517 DOI: 10.1016/j.mjafi.2012.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2011] [Revised: 03/31/2012] [Accepted: 06/01/2012] [Indexed: 11/29/2022] Open
Affiliation(s)
- Nitesh Naresh
- Dental Officer, Oral & Maxillofacial Pathology, 3 Corps Dental Unit, C/o 99 APO
| | - V. Srinivas
- Assoc Prof, Dept of Pathology, Armed Forces Medical College, Pune 40, India
| | - A. Malik
- Assoc Prof, Dept of Pathology, Armed Forces Medical College, Pune 40, India
| | - N.K. Sahoo
- Prof & HOD, Dept of Dental Surgery, Armed Forces Medical College, Pune 40, India
| | - Vibha Dutta
- Prof & HOD, Dept of Pathology, Armed Forces Medical College, Pune 40, India
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45
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Squamous Cell Carcinoma Arising From Massive Localized Lymphedema of Scrotum Mimicking Scrotal Smooth Muscle Hamartoma of Dartos: A Case Report. Am J Dermatopathol 2015; 37:551-4. [PMID: 26091513 DOI: 10.1097/dad.0000000000000135] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Massive localized lymphedema (MLL) is an uncommon benign skin lesion typically presenting with prominent edema and vascular proliferation in the adipose tissue of lower limbs. When rarely occurring in scrotum, it instead is characterized by a striking proliferation of dermal smooth muscle bundles mimicking acquired smooth muscle hamartoma of dartos. The authors report a rare case of scrotal MLL. A 57-year-old obese man with a history of previous surgery for rectal adenocarcinoma, 20 years earlier, presented with progressive nodular enlargement of the scrotum for 2 years, causing discomfort, difficulty in ambulation, and cosmetic problems. The preoperative radiographic investigation revealed thickening of the scrotal wall with multiple soft-tissue nodules. The patient underwent a wide excision of the scrotal wall, perineum, and penile skin. The pathological examination showed a scrotal MLL associated with well-differentiated squamous cell carcinoma. The authors speculate that prior radiotherapy and surgery together with morbid obesity led to long-standing lymphedema that triggered the proliferation of smooth muscle cells, chronic epidermal change, and finally squamous cell carcinoma.
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46
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Myxoid soft-tissue neoplasms: comprehensive update of the taxonomy and MRI features. AJR Am J Roentgenol 2015; 204:374-85. [PMID: 25615761 DOI: 10.2214/ajr.14.12888] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE. The purpose of this article is to review the classification, clinical presentation, and histopathologic and MRI features of myxoid soft-tissue neoplasms. CONCLUSION. MRI is the modality of choice for characterization of myxoid soft-tissue tumors. A combination of imaging features (including certain characteristic signs), clinical features, and patient demographics can help the radiologist in coming to a specific diagnosis or in narrowing down the differential diagnoses.
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Subbiah V, McMahon C, Patel S, Zinner R, Silva EG, Elvin JA, Subbiah IM, Ohaji C, Ganeshan DM, Anand D, Levenback CF, Berry J, Brennan T, Chmielecki J, Chalmers ZR, Mayfield J, Miller VA, Stephens PJ, Ross JS, Ali SM. STUMP un"stumped": anti-tumor response to anaplastic lymphoma kinase (ALK) inhibitor based targeted therapy in uterine inflammatory myofibroblastic tumor with myxoid features harboring DCTN1-ALK fusion. J Hematol Oncol 2015; 8:66. [PMID: 26062823 PMCID: PMC4467062 DOI: 10.1186/s13045-015-0160-2] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 05/25/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Recurrent, metastatic mesenchymal myxoid tumors of the gynecologic tract present a management challenge as there is minimal evidence to guide systemic therapy. Such tumors also present a diagnostic dilemma, as myxoid features are observed in leiomyosarcomas, inflammatory myofibroblastic tumors (IMT), and mesenchymal myxoid tumors. Comprehensive genomic profiling was performed in the course of clinical care on a case of a recurrent, metastatic myxoid uterine malignancy (initially diagnosed as smooth muscle tumor of uncertain malignant potential (STUMP)), to guide identify targeted therapeutic options. To our knowledge, this case represents the first report of clinical response to targeted therapy in a tumor harboring a DCTN1-ALK fusion protein. METHODS Hybridization capture of 315 cancer-related genes plus introns from 28 genes often rearranged or altered in cancer was applied to >50 ng of DNA extracted from this sample and sequenced to high, uniform coverage. Therapy was given in the context of a phase I clinical trial ClinicalTrials.gov Identifier: ( NCT01548144 ). RESULTS Immunostains showed diffuse positivity for ALK1 expression and comprehensive genomic profiling identified an in frame DCTN1-ALK gene fusion. The diagnosis of STUMP was revised to that of an IMT with myxoid features. The patient was enrolled in a clinical trial and treated with an anaplastic lymphoma kinase (ALK) inhibitor (crizotinib/Xalkori®) and a multikinase VEGF inhibitor (pazopanib/Votrient®). The patient experienced an ongoing partial response (6+ months) by response evaluation criteria in solid tumors (RECIST) 1.1 criteria. CONCLUSIONS For myxoid tumors of the gynecologic tract, comprehensive genomic profiling can identify clinical relevant genomic alterations that both direct treatment targeted therapy and help discriminate between similar diagnostic entities.
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Affiliation(s)
- Vivek Subbiah
- Division of Cancer Medicine, Department of Investigational Cancer Therapeutic (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, FC8.3038, Box 0455, Houston, TX, 77030, USA.
| | | | - Shreyaskumar Patel
- Division of Cancer Medicine, Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
| | - Ralph Zinner
- Division of Cancer Medicine, Department of Investigational Cancer Therapeutic (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, FC8.3038, Box 0455, Houston, TX, 77030, USA.
| | - Elvio G Silva
- Division of Diagnostic Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
| | - Julia A Elvin
- Foundation Medicine, Inc, Cambridge, MA, 02141, USA.
| | - Ishwaria M Subbiah
- Division of Cancer Medicine, Department of Investigational Cancer Therapeutic (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, FC8.3038, Box 0455, Houston, TX, 77030, USA.
| | - Chimela Ohaji
- Division of Cancer Medicine, Department of Investigational Cancer Therapeutic (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, FC8.3038, Box 0455, Houston, TX, 77030, USA.
| | - Dhakshina Moorthy Ganeshan
- Division of Diagnostic Imaging and Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
| | - Deepa Anand
- Division of Diagnostic Imaging and Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
| | - Charles F Levenback
- Division of Surgery, Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Jenny Berry
- Division of Cancer Medicine, Department of Investigational Cancer Therapeutic (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, FC8.3038, Box 0455, Houston, TX, 77030, USA.
| | - Tim Brennan
- Foundation Medicine, Inc, Cambridge, MA, 02141, USA.
| | | | | | - John Mayfield
- Foundation Medicine, Inc, Cambridge, MA, 02141, USA.
| | | | | | | | - Siraj M Ali
- Foundation Medicine, Inc, Cambridge, MA, 02141, USA.
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Val-Bernal JF, García-González MR, Mayorga M, Marrero RH, Jorge-Pérez N. Primary renal myxofibrosarcoma. Pathol Res Pract 2015; 211:619-24. [PMID: 26008776 DOI: 10.1016/j.prp.2015.04.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 04/08/2015] [Accepted: 04/14/2015] [Indexed: 11/28/2022]
Abstract
Kidney sarcomas are rare, representing only 1% of malignant renal tumors. We herein report the case of a 70-year-old woman that was admitted for an episode of confusion in relation to hypertensive encephalopathy. Imaging investigations revealed a large mass in the right kidney with extension to the renal hilum. The patient underwent right open radical nephrectomy. The histopathologic study disclosed a 15-cm, myxoid and cellular, pleomorphic tumor with elongated, curvilinear, thin-walled vessels, and focal necrosis that involved the upper and middle segments of the kidney. Immunohistochemically, the tumor cells showed strong positivity for vimentin, bcl2 protein (nuclear staining pattern), CD34, CD99, and alpha-methylacyl coenzyme A racemase. The tumor was diagnosed as myxofibrosarcoma (MFS) grade 2 according to the FNCLCC system. To the best of our knowledge, this is the first report of an MFS arising from the kidney. Thus, MFS is an uncommon soft tissue tumor that can exceptionally arise from the kidney. The differential diagnosis with other myxoid tumors is of vital importance because it includes lesions with subtle differences and extremely variable biological behavior. Radical surgery is the treatment of choice. Long-term follow-up is recommended because of the tumor's capability for local recurrence and distant metastasis.
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Affiliation(s)
- José-Fernando Val-Bernal
- Department of Anatomical Pathology, Marqués de Valdecilla University Hospital, Medical Faculty, University of Cantabria and IDIVAL, Santander, Spain.
| | - M Rosa García-González
- Service of Anatomical Pathology, Doctor Negrín University Hospital, Las Palmas de Gran Canaria, Spain
| | - Marta Mayorga
- Department of Anatomical Pathology, Marqués de Valdecilla University Hospital, Medical Faculty, University of Cantabria and IDIVAL, Santander, Spain
| | - Reinaldo H Marrero
- Service of Urology, Doctor Negrín University Hospital, Las Palmas de Gran Canaria, Spain
| | - Nicolás Jorge-Pérez
- Service of Urology, Doctor Negrín University Hospital, Las Palmas de Gran Canaria, Spain
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Cell cycle and apoptosis regulatory proteins, proliferative markers, cell signaling molecules, CD209, and decorin immunoreactivity in low-grade myxofibrosarcoma and myxoma. Virchows Arch 2015; 467:211-6. [PMID: 25940995 DOI: 10.1007/s00428-015-1778-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 03/10/2015] [Accepted: 04/14/2015] [Indexed: 12/26/2022]
Abstract
The histologic differential diagnosis between intramuscular myxoma and low-grade myxofibrosarcoma can be quite difficult in some cases. To identify a diagnostic immunohistochemical marker, we compared the staining profiles of 19 different antigens, including cell cycle proteins, apoptosis proteins, and proliferative markers, and selected other signaling and structural proteins in these two tumors. Ten cases each of intramuscular myxoma and low-grade myxofibrosarcoma were stained with antibodies directed against apoptosis regulatory proteins (Bcl2, activated caspase-3, phospho-H2A.X, and cleaved PARP), cell cycle regulatory proteins (Rb1, Cyclin-A, CDKN1B, and Cdt1), proliferative markers (KI67, MCM2, phospho-histone H3, and geminin), cell signalling molecules (c-Myc, EGF, EGFR, PLA2G4A, and HSP90), a dendritic cell marker (CD209), and the extracellular matrix proteoglycan decorin. Staining patterns of myxoma and myxofibrosarcoma were compared using Fisher's exact test and the Mann-Whitney test. For each potential diagnostic marker studied, the proportions of cases scored as positive on both dichotomous or ordinal scales were not significantly different between myxoma and myxofibrosarcoma. Myxoma and myxofibrosarcoma share a common immunophenotype for each of the markers studied. Distinction between these tumors is still predominantly based on morphologic criteria.
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Hino S, Masuda I, Fukai S, Kaneko T, Horie N, Shimoyama T. A case of nodular fasciitis involving the tongue. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, MEDICINE, AND PATHOLOGY 2015. [DOI: 10.1016/j.ajoms.2014.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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