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Zisis V, Poulopoulos A, Fotopoulos I, Lillis T, Dabarakis N, Anagnostou E, Andreadis D. A Differential Clinical Diagnostic Challenge of a Recurrent, Oral Fibrosarcoma Resembling a Periapical Lesion of Endodontic Origin. Cureus 2023; 15:e49836. [PMID: 38164303 PMCID: PMC10758238 DOI: 10.7759/cureus.49836] [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: 12/02/2023] [Indexed: 01/03/2024] Open
Abstract
A fibrosarcoma is a neoplastic growth originating from malignant, fibroblast-like mesenchymal cells. This malignant tumor shows an increased tendency for expansion and recurrence and a propensity to metastasize, especially to the lungs. Despite their rarity, fibrosarcomas have the potential to manifest in any anatomical location. An oncologist referred their patient due to reported mandibular discomfort, ache, and swelling. The biopsy revealed a fibrosarcoma resembling a periapical lesion of endodontic origin. The timely intervention and the collaboration among different but complementary medical and dental specialties ensure that the patient may enjoy a prolonged life expectancy as symptom-free as possible.
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Affiliation(s)
- Vasileios Zisis
- Oral Medicine/Pathology, School of Dentistry, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Athanasios Poulopoulos
- Oral Medicine/Pathology, School of Dentistry, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Ioannis Fotopoulos
- Dentoalveolar Surgery, Implantology and Oral Radiology, School of Dentistry, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Theodoros Lillis
- Dentoalveolar Surgery, Implantology and Oral Radiology, School of Dentistry, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Nikolaos Dabarakis
- Dentoalveolar Surgery, Implantology and Oral Radiology, School of Dentistry, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Eleftherios Anagnostou
- Oral Medicine/ Pathology, School of Dentistry, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Dimitrios Andreadis
- Oral Medicine/Pathology, School of Dentistry, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
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Sharma AE, Kerr DA, Cipriani NA. Small biopsies in the head and neck: Bone and soft tissue. Semin Diagn Pathol 2023; 40:353-370. [PMID: 37453847 DOI: 10.1053/j.semdp.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 04/30/2023] [Accepted: 06/21/2023] [Indexed: 07/18/2023]
Abstract
Bone and soft tissue lesions in the head and neck encompass not only a broad morphologic spectrum but also significant inherent clinicopathologic overlap. Epidemiology, radiology, and location - similar to the diagnostic assessment in other sites - are especially important considerations in the context of an established mesenchymal proliferation. Herein, the approach towards diagnosis is stratified by morphology (spindle, sarcomatoid, epithelioid, round cell), cellular lineage (fibroblastic, nerve sheath, rhabdomyogenic), and tumor grade (benign, low- to high-grade malignant) as the basis of further immunohistochemical or molecular investigation.
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Affiliation(s)
- Aarti E Sharma
- Hospital for Special Surgery, New York, NY, United States
| | - Darcy A Kerr
- Dartmouth Hitchcock Medical Center, Lebanon, NH, United States
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Malan M, Xuejingzi W, Quan SJ. The efficacy of Mohs micrographic surgery over the traditional wide local excision surgery in the cure of dermatofibrosarcoma protuberans. Pan Afr Med J 2019; 33:297. [PMID: 31692830 PMCID: PMC6815477 DOI: 10.11604/pamj.2019.33.297.17692] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 07/09/2019] [Indexed: 12/11/2022] Open
Abstract
Usually most patients with dermatofibrosarcoma protuberans (DFSP) may present rather late when the tumor is in protuberant phase due to its rarity and indolent onset. It has a high propensity for local recurrence and destructive nature. Management of DFSP requires a biopsychosocial and Multidisplinary approach regardless of the clinical or immunohistochemical variant. Surgery is the Gold standard management of localized disease. DFSP rarely exhibits any lymphatic or hematogenous dissemination. It is because of its high recurrence rate associated with Wide Local Excision (WLE), the introduction of Mohs micrographic surgery (MMS) has really helped in reducing the rates of recurrence of DFSP. Thus, the aim of this meta-analysis and systemic review is to advocate for MMS over WLE for DFSP and other cutaneous malignancies using DFSP as a prototype. The objective of this study were to conduct a meta-analysis on comparative surgical methods used in the cure of DFSP with regards to WLE verses MMS, to evaluate the cure rates with relation to recurrence rates, offer a recommendation on the various treatment modalities based on the location of lesion, and use of adjuvant therapy in different clinical-medical setups. A comprehensive retrospective analysis search in EMBASE, Google Scholar and Medline (PubMed) for studies published from 2008 to 2018 containing the surgical management of DFSP with WLE verses MMS were reviewed. Five studies of moderate-quality evidence (level B) with a pooled patient load of 684 was analyzed and found for recurrence of DFSP after WLE and MMS to be 9.10% and 2.72% respectively after an average follow-up time for both groups of 5.32 years with a female predominance of 1.58. The trunk is the commonest site for the DFSP lesion which was at 52.80% then the upper and lower extremities zones and the head and neck zones at 31.75% and 15.45% respectively. The pooled adjusted odds ratio (OR) analysis indicated that there was a direct relationship with regards the reduced recurrence rate of DFSP in the MMS group compared to the WLE group (OR:0.31;95%; CI :0.17-0.56). Furthermore, there was significant association between the reduced recurrence rate with the MMS in DFSP patients with a statistical P-value of 0.0001 at 95% CI. The expected increased recurrence rate by zones was in WLE head and neck zone at 38.19% then trunk and extremities zone at 13.34%. In the MMS group it was at of 23.4% as compared to 16.0% in the head and neck zone. Mohs Micrographic Surgery (MMS) is more efficacious in the cure rate and recurrence reduction of DFSP and should be advocated for as first line therapy especially in high recurrence prone zones.
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Affiliation(s)
- Malumani Malan
- Department of Dermatology and Venereology at Zhongnan Hospital of Wuhan University, Wuhan City, Hubei Province, Peoples Republic of China
- Department of Dermatology and Venereology at Zhongnan Hospital of Wuhan University, Wuhan City, Hubei Province, Peoples Republic of China
| | - Wu Xuejingzi
- Department of Dermatology and Venereology at Zhongnan Hospital of Wuhan University, Wuhan City, Hubei Province, Peoples Republic of China
| | - Song Ji Quan
- Head of Department of Dermatology and Venereology at Zhongnan Hospital of Wuhan University, Wuhan City, Hubei Province, People's Republic of China
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Sun CQ, Arnold RS, Hsieh CL, Dorin JR, Lian F, Li Z, Petros JA. Discovery and mechanisms of host defense to oncogenesis: targeting the β-defensin-1 peptide as a natural tumor inhibitor. Cancer Biol Ther 2019; 20:774-786. [PMID: 30900935 PMCID: PMC6605992 DOI: 10.1080/15384047.2018.1564564] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 11/27/2018] [Accepted: 12/25/2018] [Indexed: 12/28/2022] Open
Abstract
Human beta-defensin-1 (hBD-1) is one of a number of small cationic host-defense peptides. Besides its well-known broad-spectrum antimicrobial function, hBD-1 has recently been identified as a chromosome 8p tumor-suppressor gene. The role of hBD-1 in modulating the host immune response to oncogenesis, associated with cell signaling and potential therapeutic applications, has become increasingly appreciated over time. In this study, multiple approaches were used to illustrate hBD-1 anti-tumor activities. Results demonstrate that hBD-1 peptide alters human epidermal growth factor receptor 2 (HER2) signal transduction and represses retroviral-mediated transgene expression in cancer cells. Loss of orthologous murine defense-1 (mBD1) in mice enhances nickel sulfate-induced leiomyosarcoma and causes mouse kidney cells to exhibit increased susceptibility to HPV-16 E6/7-induced neoplastic transformation. Furthermore, for the first time, a novel function of the urine-derived hBD-1 peptide was discovered to suppress bladder cancer growth and this may lead to future applications in the treatment of malignancy.
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Affiliation(s)
- Carrie Q. Sun
- Department of Urology and Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Rebecca S. Arnold
- Department of Urology and Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Chia-Ling Hsieh
- Department of Molecular Medicine, China Medical University Hospital, Taipei, Taiwan
| | - Julia R. Dorin
- Center for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - Fei Lian
- Emory University School of Medicine, Emory University, Atlanta, Georgia
| | - Zhenghong Li
- School of Medicine, Central South University, Changsha City, Human Province, P. R. China
| | - John A. Petros
- Department of Urology and Winship Cancer Institute, Emory University, Atlanta, Georgia
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia
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Effiom OA, Olojede ACO, Akinde OR, Olawuyi AB, Amoo AT, Arotiba GT. Dermatofibrosarcoma protuberans: clinicopathologic presentation in Nigerians. Pan Afr Med J 2018; 31:25. [PMID: 30918552 PMCID: PMC6430858 DOI: 10.11604/pamj.2018.31.25.13665] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 08/03/2018] [Indexed: 11/16/2022] Open
Abstract
Introduction Dermatofibrosarcoma protuberance (DFSP) is in general a rare low grade malignant sarcoma and possesses a tendency for local recurrence. It has a site predilection for the trunk. Occurrence in the facial area is extremely rare. Ample knowledge of its clinical, histological and biologic characteristics is vital for accurate and prompt recognition. Methods Over 13 years, clinicohistologic information of cases was retrieved. Histological and immunohistochemical re-evaluation were performed to re-confirm diagnosis. Data collected and analyzed with SPSS Statistics version 20 were presented as frequency tables, charts and proportions as appropriate. Results Of 191 soft tissue sarcomas, a total of 28 cases were diagnosed as DFSP (14.7%). Facial types occurred in 3 cases (1.6%). Tumour had age and site predilections for the 4th decade and trunk respectively. There was an equal gender distribution among cases. Most common clinical presentation was in form of painless protruding nodular mass. General histologic presentation revealed cellular lesions composed of spindle to oval neoplastic cells arranged in a storiform pattern. Mitotic figures were rare. All cases showed positive expressions to CD34. Conclusion Facial DFSP is rare among Nigerians. Its clinical appearance may mimic other common benign lesions of the head and neck region often resulting in misdiagnoses. A comprehensive knowledge of its clinical and histologic presentations and biologic behavior, combined with its identification with the aid of advanced histologic and radiographic techniques results in prompt confirmatory diagnosis. Appropriate treatment should include adequate surgical excision techniques combined with adjuvant radiotherapy or chemotherapy.
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Affiliation(s)
- Olajumoke Ajibola Effiom
- Department of Oral and Maxillofacial Pathology/Biology, College of Medicine, University of Lagos, Nigeria
| | | | - Olakanmi Ralph Akinde
- Department of Anatomic and Molecular Pathology, College of Medicine, University of Lagos, Nigeria
| | | | - Abiodun Taofeek Amoo
- Department of Oral and Maxillofacial Surgery, Lagos University Teaching Hospital, Nigeria
| | - Godwin Toyin Arotiba
- Department of Oral and Maxillofacial Surgery, College of Medicine University of Lagos, Nigeria
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Update from the 4th Edition of the World Health Organization of Head and Neck Tumours: Tumours of the Oral Cavity and Mobile Tongue. Head Neck Pathol 2017; 11:33-40. [PMID: 28247230 PMCID: PMC5340733 DOI: 10.1007/s12105-017-0792-3] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 02/02/2017] [Indexed: 12/27/2022]
Abstract
There have been several additions and deletions in Chapter 4 on Tumours of the oral cavity and mobile tongue in the 2017 fourth edition of the World Health Organization Classification of Tumours of the Head and Neck. This chapter excludes the oropharynx, which now is a stand-alone chapter acknowledging the uniqueness of the oropharynx from the oral cavity. New entries in Chapter 4 include rhabdomyoma, haemangioma, schwannoma, neurofibroma and myofibroblastic sarcoma in the section titled Soft tissue and neural tumours. Discussion of salivary gland entities have been reduced and includes mucoepidermoid carcinoma and pleomorphic adenoma as the other salivary gland types are discussed elsewhere. In the Haematolymphoid tumours section, like the salivary gland section, only tumors that commonly present in the oral cavity are discussed in Chapter 4. Excluded entities in the updated classification include papillary hyperplasia, median rhomboid glossitis, keratoacanthoma, focal oral mucinosis, and secondary tumors. This article will summarize the changes in the new classification since the 2005 edition focusing on selected entities that have had significant changes along with new entries.
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Avallone G, Helmbold P, Caniatti M, Stefanello D, Nayak RC, Roccabianca P. The Spectrum of Canine Cutaneous Perivascular Wall Tumors: Morphologic, Phenotypic and Clinical Characterization. Vet Pathol 2016; 44:607-20. [PMID: 17846233 DOI: 10.1354/vp.44-5-607] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Perivascular wall tumors (PWTs) are defined as neoplasms deriving from mural cells of blood vessels, excluding the endothelial lining. The spectrum of human cutaneous PWT includes glomus tumor, hemangiopericytoma (HEP), myopericytoma, angioleiomyoma/sarcoma, angiomyofibroblastoma, and angiofibroma. The purpose of this study was to revise clinical presentation, cytology, histopathology, and immunohistology of canine cutaneous PWT with cytology typical of canine HEP. Diagnosis was established on the basis of vascular growth patterns (staghorn, placentoid, perivascular whorling, bundles from media) and immunohistology, including 7 smooth muscle markers and the cell membrane ganglioside of unknown origin recognized by the antibody 3G5 (CMG-3G5). Twenty cases were included. Ages ranged from 6 to 13 years; 12 dogs were males and 8 were females, and there was a prevalence of crossbreeds. Tumors arose from a single site with preferential acral location (10/20). Cytology revealed moderate to high cellularity in all cases, cohesive groups of cells (19/20), capillaries (18/20), and bi- to multinucleated cells (18/20). Six myopericytomas, 5 angioleiomyomas, 2 angioleiomyosarcomas, 2 HEP, 1 angiofibroma, and 1 adventitial tumor were identified. A definitive diagnosis was not possible in 3 cases. Smoothelin, heavy caldesmon, desmin, myosin, calponin, and CMG-3G5 were the most valuable markers to differentially diagnose canine PWT. Similar to reports in humans, canine HEP embodied a spectrum of neoplastic entities arising from different vascular mural cells. Before canine PWTs are assimilated into one prognostic category, a consistent classification and characterization of their biology is necessary. As proposed in humans, HEP should also be considered a diagnosis of exclusion in dogs.
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Affiliation(s)
- G Avallone
- DiPAV--Sezione Anatomia Patologica Veterinaria e Patologia Aviare, Facolta' di Medicina Veterinaria, Via Celoria 10, 20133 Milano, Italy
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Thway K, Ng W, Noujaim J, Jones RL, Fisher C. The Current Status of Solitary Fibrous Tumor: Diagnostic Features, Variants, and Genetics. Int J Surg Pathol 2016; 24:281-92. [PMID: 26811389 DOI: 10.1177/1066896915627485] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Solitary fibrous tumor (SFT) is a fibroblastic mesenchymal tumor originally described in the pleura but now shown at almost every anatomic site. Histopathologically, SFT is characteristically a circumscribed neoplasm composed of variably cellular and patternless distributions of bland spindle and ovoid cells within prominent collagenous stroma and shows diffuse expression of CD34, but it has a broad spectrum of both morphology and of biologic behavior. Many different names (particularly hemangiopericytoma) were previously used in the course of our understanding of this neoplasm but are now subsumed under the term "SFT," and the putative cell of origin was debated. However, it is now recognized that SFT is a translocation-associated neoplasm, consistently associated with NAB2-STAT6 gene fusions arising from recurrent intrachromosomal rearrangements on chromosome 12q, and this translocation is a likely major contributor to its pathogenesis. While most SFT with classical morphologic features behave in an indolent manner and those with overtly malignant histologic features tend to be aggressive neoplasms that behave as high-grade sarcomas, the behavior of SFT is unpredictable, and it is important to be aware of the propensity for aggressive behavior in a minority of histologically classical SFT and to ensure adequate clinical follow-up. Surgical excision remains the treatment gold standard; while radiotherapy and conventional chemotherapeutic agents have only shown limited efficacy, further understanding of the molecular events underlying tumorigenesis may allow the development of novel targeted treatments. We review SFT, discussing the morphologic spectrum and variants, including malignant and dedifferentiated subtypes, clinicopathological aspects, recent molecular genetic findings, and the differential diagnosis.
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Affiliation(s)
| | - Wen Ng
- Royal Marsden Hospital, London, UK
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Meschi N, Hilkens P, Lambrichts I, Van den Eynde K, Mavridou A, Strijbos O, De Ketelaere M, Van Gorp G, Lambrechts P. Regenerative endodontic procedure of an infected immature permanent human tooth: an immunohistological study. Clin Oral Investig 2015; 20:807-14. [DOI: 10.1007/s00784-015-1555-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Accepted: 07/28/2015] [Indexed: 11/27/2022]
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Iwafuchi H, Tsuzuki T, Ito R, Miyake H, Okita H, Hamazaki M. Generalized infantile myofibromatosis with a monophasic primitive pattern. Pathol Int 2015; 65:432-7. [DOI: 10.1111/pin.12312] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 04/21/2015] [Indexed: 12/20/2022]
Affiliation(s)
- Hideto Iwafuchi
- Department of Pathology; National Center for Child Health and Development; Tokyo Japan
- Department of Pathology; Shizuoka Children's Hospital; Shizuoka Japan
| | - Toyonori Tsuzuki
- Department of Pathology; Nagoya Daini Red Cross Hospital; Nagoya Japan
| | - Rieko Ito
- Division of Hematology and Oncology; Shizuoka Children's Hospital; Shizuoka Japan
| | - Hiromu Miyake
- Department of Pediatric Surgery; Shizuoka Children's Hospital; Shizuoka Japan
| | - Hajime Okita
- Department of Pathology; National Center for Child Health and Development; Tokyo Japan
- Department of Pathology; Keio University School of Medicine; Tokyo Japan
| | - Minoru Hamazaki
- Department of Pathology; Shizuoka Children's Hospital; Shizuoka Japan
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Orenstein JM. The "myofibroblast" that is omnipresent in pathology and key to the EMT concepts does not actually exist, since normal fibroblasts contain stress fibril organelles (SMA bundles with dense bodies) variably detected by TEM and IHC: conclusions by a diagnostic pathologist with decades of ultrastructural experience. Ultrastruct Pathol 2014; 38:387-98. [PMID: 25084158 DOI: 10.3109/01913123.2014.940231] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The so-called "enigmatic" unique "myofibroblast" has been erroneously substituted for virtually all things fibroblastic in soft tissue pathology and believed to be the ultimate fibrogenic cell. It is also internationally considered to be the mesenchymal cell in un-proven post-natal EMT, EMT organ/tissue fibrosis, and the assumption that EMT/MET is key to carcinoma/adenocarcinoma invasion and metastasis. However, no such cell exists, having been mistaken for our normal ubiquitous fibrogenic fibroblasts that contain peripheral bundles of actin (SMA) with dense bodies, i.e. stress fibril (SF) organelles variably detectable by TEM and SMA IHC, depending on the degree of activation. The only detectable features distinguishing what are erroneously believed to be two unique fibrogenic spindle cells are the SF. Is the variable detection of SF/SMA in fibroblastic and non-fibroblastic lesions significant? Carcinosarcomas are not bi-phasic malignancies or proof of EMT/MET. What does it mean that the fibroblasts of so-called "carcinoma-associated fibroblasts (CAF)" are not "myofibroblasts"? The true myofibroblast is the ultrastructurally and functionally unique, terminally-differentiated, pathognomonic cell of physiologic wound-healing, which unfortunately has been confused with the activated fibroblast. This study fails to demonstrate any ultrastructural evidence that either normal epithelial (EMT) or carcinoma/adenocarcinoma cells can undergo reversible transition into mesenchymal cells (EMT/MET) under any circumstances. The SF/SMA-positive fibrogenic cell in organ/tissue fibrosis is the genetically up-regulated, activated fibroblast, which has no relationship to EMT. Are any of the innumerable biochemical factors/elements considered to be associated with this non-existent cell and its related processes related to the activated fibroblast? The conclusions are based on review of every electron micrograph taken during a 40-year career in diagnostic and research ultrastructural pathology, and by confirming that the published TEM figures of so-called "myofibroblasts", are actually of fibroblasts.
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Affiliation(s)
- Jan Marc Orenstein
- Department of Pathology, George Washington University Medical Center , Washington, DC , USA
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Orenstein JM. The so called “Malignant Fibrous Histiocytoma” is actually an Unusual Fibrosarcoma. Ultrastruct Pathol 2014; 38:52-4. [DOI: 10.3109/01913123.2013.840709] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Murakami Y, Tsubamoto H, Hao H, Nishimoto S, Shibahara H. Long-term disease-free survival after radical local excision of low-grade myofibroblastic sarcoma of the vulva. GYNECOLOGIC ONCOLOGY CASE REPORTS 2013; 5:34-6. [PMID: 24371691 DOI: 10.1016/j.gynor.2013.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 03/29/2013] [Indexed: 10/27/2022]
Abstract
•A second case of low-grade myofibroblastic sarcoma of the vulva.•Six-year follow-up with no evidence of disease after radical local excision.•Adequate margin resection is important.
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Affiliation(s)
- Yumi Murakami
- Department of Obstetrics and Gynecology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan
| | - Hiroshi Tsubamoto
- Department of Obstetrics and Gynecology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan
| | - Hiroyuki Hao
- Department of Surgical Pathology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan
| | - Soh Nishimoto
- Department of Plastic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan
| | - Hiroaki Shibahara
- Department of Obstetrics and Gynecology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan
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Llombart B, Serra-Guillén C, Monteagudo C, López Guerrero JA, Sanmartín O. Dermatofibrosarcoma protuberans: a comprehensive review and update on diagnosis and management. Semin Diagn Pathol 2013; 30:13-28. [DOI: 10.1053/j.semdp.2012.01.002] [Citation(s) in RCA: 160] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Gomez-Rivera F, Fakhri S, Williams MD, Hanna EY, Kupferman ME. Surgical management of sinonasal hemangiopericytomas: a case series. Head Neck 2012; 34:1492-6. [PMID: 22021153 DOI: 10.1002/hed.21926] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2011] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Sinonasal hemangiopericytomas are rare low-grade sarcomas. The role of endoscopic management has not been adequately studied. METHODS This study was conducted through retrospective medical chart review of patients seen with sinonasal hemangiopericytomas at 2 institutions over a 19-year period. Demographic, clinicopathological, and surgical information was analyzed with descriptive statistics. RESULTS Thirteen patients with a diagnosis of sinonasal hemangiopericytomas were treated. The most common symptoms were obstruction (69%) and epistaxis (35%). All tumors were localized in the nasal cavity, and half had extension to 1 or more sinuses. Resection was performed endoscopically in 6 patients. Median intraoperative blood loss was 500 mL; median operative time was 165 minutes. Two patients received postoperative radiation. There were no recurrences with a median follow-up of 25 months. Three patients presented with recurrences, 2 local and 1 distant, up to 13 years after primary tumor removal. CONCLUSION Surgery for sinonasal hemangiopericytomas can be challenging; both endoscopic and open approaches may be used to treat these highly vascular tumors.
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Affiliation(s)
- Fernando Gomez-Rivera
- Department of Otorhinolaryngology, The University of Texas Health Science Center at Houston School of Medicine, Houston, Texas, USA
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Salgado R, Llombart B, M Pujol R, Fernández-Serra A, Sanmartín O, Toll A, Rubio L, Segura S, Barranco C, Serra-Guillén C, Yébenes M, Salido M, Traves V, Monteagudo C, Sáez E, Hernández T, de Álava E, Llombart-Bosch A, Solé F, Guillén C, Espinet B, López-Guerrero JA. Molecular diagnosis of dermatofibrosarcoma protuberans: A comparison between reverse transcriptase-polymerase chain reaction and fluorescence in situ hybridization methodologies. Genes Chromosomes Cancer 2011; 50:510-7. [PMID: 21484928 DOI: 10.1002/gcc.20874] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Accepted: 03/02/2011] [Indexed: 12/28/2022] Open
Affiliation(s)
- Rocío Salgado
- Laboratori de Citogenètica Molecular, Servei de Patologia, GRETNHE, Programa de Recerca en Càncer, IMIM-Institut de Recerca del Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
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Abstract
Immunohistochemistry in soft tissue tumours, and especially sarcomas, is used to identify differentiation in the neoplastic cells. In some cases, specific antigens are expressed; however, an initial panel of antibodies is often required in order to establish the broad lineage, with a subsequent, more focused, panel to allow classification. Immunohistochemical evaluation must be employed with the clinical picture, the morphology, and, when necessary, other ancillary techniques such as molecular genetics and cytogenetics. Whereas some diagnoses are evident on morphology, many soft tissue neoplasms are seen microscopically as spindle cell, epithelioid cell, small round cell or pleomorphic tumours that need to be further characterized. This article reviews selected applications of immunohistochemistry in the diagnosis of each of the principal morphological groups, concentrating on areas of most use in daily practice.
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Affiliation(s)
- Cyril Fisher
- Department of Histopathology, Royal Marsden Hospital, London, UK.
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19
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Llombart B, Sanmartín O, López-Guerrero JA, Monteagudo C, Serra C, Requena C, Poveda A, Vistós JL, Almenar S, Llombart-Bosch A, Guillén C. Dermatofibrosarcoma protuberans: clinical, pathological, and genetic (COL1A1-PDGFB ) study with therapeutic implications. Histopathology 2009; 54:860-72. [PMID: 19635106 DOI: 10.1111/j.1365-2559.2009.03310.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIMS To analyse the presence of collagen type I alpha 1-platelet-derived growth factor beta (COL1A1-PDGFB) transcripts in 20 cases of dermatofibrosarcoma protuberans (DFSP) and to assess the relationship between COL1A1 breakpoints and clinical and histopathological variables. METHODS AND RESULTS Multiplex reverse transcriptase-polymerase chain reaction was carried out using frozen tissue. Our series contained 14 men and six women. Histologically, most cases were of conventional type (n = 9), followed by fibrosarcoma (n = 4), Bednar tumour (n = 2), sclerosing (n = 2), myoid (n = 1) and atrophic (n = 1) DFSP, and giant cell fibroblastoma (n = 1). Immunohistochemistry revealed CD34 expression in 90% of cases. COL1A1-PDGFB fusion transcripts were present in 89% of cases (exons 18, 19, 20, 25, 26, 31, 33/34, 39, 40, 46, 47 and 48 of COL1A1 with exon 2 of PDGFB). There was no recurrence of DFSP in any of the 19 patients treated by Mohs surgery. A partial response was obtained in the two patients treated with imatinib. CONCLUSIONS The COL1A1-PDGFB fusion was present in all histological subtypes of DFSP, but not all cases expressed the fusion transcript. No association was observed between different COL1A1 breakpoints and clinicopathological parameters. Imatinib mesylate can be useful in locally advanced tumours and metastases.
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Affiliation(s)
- Beatriz Llombart
- Department of Dermatology, University of Valencia, Valencia, Spain.
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20
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Sidebotham EL, DeLair D, Comerci JT, Kayton ML, Abu-Rustum NR. Pediatric radical abdominal trachelectomy for solitary fibrous tumor of the uterine cervix. Gynecol Oncol 2009; 115:302-5. [DOI: 10.1016/j.ygyno.2009.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2009] [Revised: 07/01/2009] [Accepted: 07/03/2009] [Indexed: 02/05/2023]
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Santucci M, Franchi A. Recognizing Hidden Phenotypes in Sarcomas Through the Electron Microscope. Ultrastruct Pathol 2009; 32:51-61. [DOI: 10.1080/01913120801897000] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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22
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Houreih MA, Eyden B, Deolekar M, Banerjee S. A case of fibroblastic low-grade malignant peripheral nerve sheath tumor--a true neurofibrosarcoma. Ultrastruct Pathol 2007; 31:347-56. [PMID: 17963184 DOI: 10.1080/01913120701577827] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The authors report a case of low-grade retroperitoneal malignant peripheral nerve sheath tumor (MPNST) showing Schwannian and fibroblastic differentiation in individual tumor cells. The tumor was detected in a 29-year-old male and posed diagnostic difficulty because of the unusual morphologic and immunophenotypic features. Morphologic examination of the H&E sections revealed a rather circumscribed, highly vascular, moderately cellular spindle cell tumor. The neoplastic cells were arranged in vague, short fascicles, distributed haphazardly amid hemangiopericytoma-like vascular channels, and showed occasional whorls. Myxoid stroma and keloid-like collagen bundles were frequently seen. There were satellite nodules outside the main tumor mass and low mitotic activity but no necrosis. The tumor cells stained strongly and diffusely for both S-100 protein and CD34. Electron microscopy revealed cells with processes and focal lamina, and prominent rough endoplasmic reticulum. Although the capacity of MPNST to exhibit divergent differentiation is well known, fibroblastic differentiation is generally poorly and inconsistently documented. The present case represents an unambiguous demonstration of the co-expression within individual tumor cells of Schwannian and fibroblastic differentiation in a low-grade MPNST. The literature on this subject is reviewed.
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Abstract
Inflammatory myofibroblastic tumor (IMT) is a mesenchymal neoplasm composed of transformed myofibroblastic spindle cells with infiltration of a large number of inflammatory cells and/or lymphocytes. The etiology of IMT remains unknown. IMT occurs at various sites and often affects young adults and children. IMT of the liver mostly arises in the right lobe of liver. Biopsy, computed tomography (CT) and magnetic resonance imaging (MRI) are beneficial to diagnosis and differential diagnosis. Vimentin, smooth muscle actin (SMA), muscle-specific actin (MSA) are often positive by immunohistochemistry. The prognosis of most patients is favorable after surgery. In this article, we reviewed the overseas and domestic literatures and summarized the advancement of research on the IMT of the liver about etiology, pathogenesis, clinical presentations, imaging feature, histological appearance, immunohistochemical and electron microscopic feature, diagnosis, differential diagnosis and therapy.
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24
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Llombart B, Sanmartín O, López-Guerrero JA. Dermatofibrosarcoma protuberante en la infancia. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/s0213-9251(06)72532-1] [Citation(s) in RCA: 5] [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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25
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Hansen T, Katenkamp K, Brodhun M, Katenkamp D. Low-grade fibrosarcoma—report on 39 not otherwise specified cases and comparison with defined low-grade fibrosarcoma types. Histopathology 2006; 49:152-60. [PMID: 16879392 DOI: 10.1111/j.1365-2559.2006.02480.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS Low-grade fibrosarcomas are tumours that mainly affect the extremities and trunk of adults of either sex. Among these, low-grade fibromyxoid sarcoma (FMS), hyalinizing spindle cell tumour with giant collagen rosettes (HST) and sclerosing epithelioid fibrosarcoma (SEF) are well-established entities. In this study, our aim was to describe a group of low-grade fibrosarcomatous tumours, which could not be encompassed by these entities. These low-grade fibrosarcomas, not otherwise specified (FNOS) were provisionally designated as 'fibrosarcoma, low-grade fibroblastic type'. METHODS AND RESULTS In the soft tissue tumour registry we found 39 FNOS (46%), 31 FMS (36%), 11 SEF (13%) and four HST (5%). FNOS occurred in older patients than FMS (mean age 56.3 years versus 33.7 years). They mainly showed fibrous features, but myxoid areas could also be seen. While cells tended to be loosely arranged in the myxoid areas, densely packed sheets with a storiform pattern, fascicular arrangements or regions without a defined growth pattern were observed in the fibrous areas. However, neither whirling nor swirling patterns were found. Arcade-like vessels were not visible; pseudolipoblasts did not occur. FNOS exhibited increased atypia and mitotic count compared with the other sarcomas studied [FNOS, mean value 4.6 mitoses/10 high-power field (HPF); FMS, 0.7/10 HPF). Follow-up data were available in 21 FNOS patients. In seven cases (33.3%), local recurrences were reported. Three patients (14.3%) developed metastases and all of them died of tumour. CONCLUSIONS The term 'fibrosarcoma, low-grade fibroblastic type' should be used as a diagnosis of exclusion. Further studies should elucidate whether it represents a distinct fibrosarcoma type.
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Affiliation(s)
- T Hansen
- Institute of Pathology, Friedrich-Schiller-University of Jena, Germany.
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