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Tregnago AC, Morbeck DL, D’Almeida Costa F, Campos AHJFM, Soares FA, Vassallo J. Inflammatory pseudotumor-like follicular dendritic cell tumor: an underdiagnosed neoplasia. ACTA ACUST UNITED AC 2017. [DOI: 10.1186/s41241-017-0051-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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2
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Inflammatory pseudotumor (IPT)-surgical cure of an inflammatory syndrome. Eur J Pediatr 2016; 175:903-8. [PMID: 27073061 DOI: 10.1007/s00431-016-2718-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 03/07/2016] [Accepted: 03/21/2016] [Indexed: 10/22/2022]
Abstract
UNLABELLED We report on four female adolescents, who presented with inflammatory symptoms. Extensive diagnostic workup revealed tumors on different locations. After surgical removal, clinical and laboratory signs of inflammation disappeared rapidly. On histology, the tumors showed a mixture of inflammatory cells characteristic of inflammatory pseudotumors in three of the patients. CONCLUSION In patients with unclear inflammatory symptoms, inflammatory pseudotumor should be added to the differential diagnosis. WHAT IS KNOWN • The inflammatory pseudotumor (IPT) is a mostly benign myofibroblastic tumor of the soft tissue and causes inflammatory symptoms. What is new: • IPTs have may wider than hitherto defined histologic features. Removal of IPT is curative.
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3
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Abstract
Inflammatory pseudotumor is a tumor-like lesion with histopathologic characteristics of inflammation. A 63-year-old woman, who presented with complaints of 2 neck masses on the right side of the neck with waxing and waning course in whom excisional biopsy was performed revealing inflammatory pseudotumor of the lymph node in the neck, is presented, and this rare clinical entity is discussed together with relevant literature.
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4
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Abstract
Inflammatory pseudotumor of lymph nodes (IPT-LN) represents an unusual cause of lymphadenitis of unknown etiology. Upon the observation of a case of IPT-LN associated with Treponema pallidum (Tp) infection, we analyzed a series of 9 IPT-LN and 9 extranodal IPT (spleen, 4 cases; lung, orbit, gut, skin, and liver) for the presence of Tp, using a polyclonal antibody anti-Tp. At the time of biopsy, none of the patients was suspected for luetic infection, nor specific serologic tests were available. IPT-LN areas extensively involved the nodal parenchyma in 4 cases, whereas they were focal in the remaining 5 cases. Capsular thickening and inflammation (6/9), venulitis (3/9), small granulomas (3/9), and follicular hyperplasia (7/9) were observed in the associated lymphoid parenchyma. Tp were detected in 4/9 cases of LN-IPT and in none of the extranodal IPT. Tp were extremely abundant within the IPT areas and in the perivascular tissues in the surrounding parenchyma, whereas they were scattered within the capsule. In Tp+ cases, marked follicular hyperplasia was the single distinctively associated feature. Double immunostains revealed that Tp were predominantly contained in the cytoplasm of CD11c+ CD163+ macrophages, some of which co-expressed HLA-DR. In addition, scattered S100+ interdigitating dendritic cells also showed intracytoplasmic Tp. This study shows that a significant number of IPT-LN is associated with Tp infection. A spirochetal etiology can be suspected in cases of IPT-LN, independently from the extension of the lesions, especially when pronounced follicular hyperplasia is found. Infection by Tp of macrophages and dendritic cells are in keeping with in vitro data and indicate that immune mediated mechanisms may be involved in the pathogenesis of the lesions.
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5
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Possible involvement of myofibroblast in the development of inflammatory aortic aneurysm. Pathol Res Pract 2007; 203:21-9. [DOI: 10.1016/j.prp.2006.08.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2006] [Accepted: 08/11/2006] [Indexed: 11/20/2022]
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6
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DeRubertis BG, McGinty J, Rivera M, Miskovitz PF, Fahey TJ. Laparoscopic distal pancreatectomy for inflammatory pseudotumor of the pancreas. Surg Endosc 2004; 18:1001. [PMID: 15054650 DOI: 10.1007/s00464-003-4546-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2003] [Accepted: 11/04/2003] [Indexed: 10/26/2022]
Abstract
An 82-year-old woman presented with abdominal pain, nausea, emesis, and weight loss of ~25 lb over 6 months. A CT scan and MRI of the abdomen revealed a mass in the tail of the pancreas that was suspicious for malignancy. The patient underwent successful laparoscopic distal pancreatectomy and was discharged home on the 4th postoperative day after an uneventful course. Pathology revealed an inflammatory pseudotumor of the pancreas (IPT). Pancreatic IPT is a rare entity, and this case represents the first report of laparoscopic resection of this lesion. The presentation, diagnosis, histologic features, and therapy of IPT of the pancreas are reviewed.
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Affiliation(s)
- B G DeRubertis
- Department of Surgery, Weill Medical College of Cornell University, 525 East 68th Street, New York, NY 10021, USA
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7
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Brittig F, Ajtay E, Jaksó P, Kelényi G. Follicular dendritic reticulum cell tumor mimicking inflammatory pseudotumor of the spleen. Pathol Oncol Res 2004; 10:57-60. [PMID: 15029264 DOI: 10.1007/bf02893411] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2003] [Accepted: 01/20/2004] [Indexed: 11/24/2022]
Abstract
In the course of a routine clinical check up of the 54 year old male a splenic well circumscribed tumor like mass of 12 cm in diameter was discovered. Splenectomy with removal of splenic hilar lymph nodes and liver wedge biopsy were performed. Four years later the patient is symptom free. In the removed spleen the tumor like lesion showed a pattern consistent with the diagnosis of inflammatory pseudotumor. However, besides lymphocytes, plasma cells, macrophages, eosinophils and myofibroblasts a high number of slightly polymorphic, frequently binucleated cells positive for CD21 and CD23 were seen. These cells which were scattered or formed smaller or larger groups and fascicles were considered to represent follicular dendritic reticulum cells (FDRCs) and the lesion a FDRC tumor. Flow cytometric DNA ploidy analysis showed a hyperdiploid cell population inside the tumor like lesion. Besides FDRC tumors of high and of intermediate malignancy the present case may represent a low grade type of moderate proliferation activity. The FDRCs of the lesion and a few smaller spindle cells were EBER positive indicative of the presence of EBV. No EBER positive cells were seen in the uninvolved spleen.
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Affiliation(s)
- Ferenc Brittig
- Department of Pathology, County Hospital, Veszprém, Hungary
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8
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Marcolongo R, Tavolini IM, Laveder F, Busa M, Noventa F, Bassi P, Semenzato G. Immunosuppressive therapy for idiopathic retroperitoneal fibrosis: a retrospective analysis of 26 cases. Am J Med 2004; 116:194-7. [PMID: 14749165 DOI: 10.1016/j.amjmed.2003.08.033] [Citation(s) in RCA: 109] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Renzo Marcolongo
- Clinical Immunology Unit, 5th Medical Clinic, University Hospital, Padua, Italy.
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9
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Esposito I, Bergmann F, Penzel R, di Mola FF, Shrikhande S, Büchler MW, Friess H, Otto HF. Oligoclonal T-cell populations in an inflammatory pseudotumor of the pancreas possibly related to autoimmune pancreatitis: an immunohistochemical and molecular analysis. Virchows Arch 2004; 444:119-26. [PMID: 14722765 DOI: 10.1007/s00428-003-0949-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2003] [Accepted: 11/26/2003] [Indexed: 12/31/2022]
Abstract
Inflammatory pseudotumors (IPT), also known as inflammatory myofibroblastic tumors (IMT), are benign inflammatory processes that may have an infectious etiology and are very rare in the pancreatico-biliary region. Recent studies suggest a biological distinction between IPT and IMT, the latter being a true neoplastic process. We describe a case of pancreatic IPT, originally diagnosed as malignancy, which presumably recurred 4 months after the operation. Histologically, the tumor consisted of a smooth muscle actin and CD68-positive spindle cell population and a more abundant mononuclear inflammatory cell population, primarily composed of macrophages and T-lymphocytes. Inflammatory cells were the source of connective tissue growth factor and transforming growth factor-beta1 and tended to accumulate around nerves and blood vessels, as well as around residual pancreatic parenchymal elements, where an intense angiogenetic response was detected. Comparative genomic hybridization analysis of the tumor showed no chromosomal imbalances. Polymerase chain reaction-based analysis of T-cell receptor gamma gene rearrangement revealed an oligoclonal pattern. These findings suggest that the pathogenesis of aggressive cases of IPT could be related to the development of an intense and self-maintaining immune response, with the emergence of clonal populations of T-lymphocytes. The relation of the pancreatic IPT to autoimmune pancreatitis is emphasized.
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Affiliation(s)
- Irene Esposito
- Department of Pathology, University of Heidelberg, Im Neuenheimer Feld 220, 69120, Heidelberg, Germany.
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10
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Manganelli P, Fietta P, Martella EM, Quaini F. Clinical and histological coexistence of inflammatory pseudotumour of the lymph nodes and rheumatoid arthritis. Clin Rheumatol 2003; 22:467-71. [PMID: 14677031 DOI: 10.1007/s10067-003-0779-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2002] [Accepted: 06/26/2003] [Indexed: 11/25/2022]
Abstract
Inflammatory pseudotumour (IPT) of the lymph nodes is an uncommon, self-limiting, non-neoplastic proliferation of spindle cells, associated with a polymorphous inflammatory cell infiltrate embedded in a collagen-rich stroma and a variable degree of fibrosis, arising in the nodal parenchyma. Its clinical picture is characterised by site-specific signs and the presence, in most cases, of constitutional symptoms. The pathogenesis of IPT is unknown, but it has been interpreted as an aberrant reactive condition of the nodal connective framework, possibly related to viral infections or chronic inflammatory conditions. Its prognosis is usually favourable. We here report the simultaneous onset of seronegative rheumatoid arthritis (RA) and nodal IPT in a 31-year-old woman. Notably, in the nodal biopsy the coexistence of rheumatoid nodules, as well as histological and immunohistochemical features of IPT, was observed. To our knowledge, such an association has not been previously reported and the hypothesis that IPT could represent an unusual epiphenomenon of an RA-related chronic inflammatory response is suggested.
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Affiliation(s)
- Paolo Manganelli
- Dipartimento Osteo-Articolare, Unità Operativa di Reumatologia e Medicina Interna, Azienda Ospedaliera di Parma, Via Gramsci 14, 43100 Parma, Italy.
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11
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Kutok JL, Pinkus GS, Dorfman DM, Fletcher CD. Inflammatory pseudotumor of lymph node and spleen: an entity biologically distinct from inflammatory myofibroblastic tumor. Hum Pathol 2001; 32:1382-7. [PMID: 11774173 DOI: 10.1053/hupa.2001.29679] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Inflammatory pseudotumors (IPTs) of the lymph node and spleen are an uncommon, benign cause of lymphadenopathy and/or splenomegaly that often bear striking clinicopathologic similarities to the inflammatory myofibroblastic tumors (IMTs) found in soft tissues. These tumors have classically been grouped together under the umbrella category of "inflammatory pseudotumor." Recent evidence shows that IMTs are in fact neoplastic processes that often harbor balanced chromosomal translocations involving the ALK kinase gene. These translocations result in expression of ALK kinase in IMTs as assessed by immunohistochemical studies. However, the relationship between IMT and IPT of the lymph node and spleen is uncertain. To determine if ALK tyrosine kinase expression is also present in IPT, 13 cases of IPT (9 involving lymph nodes, 4 splenic lesions) were examined for the presence of ALK tyrosine kinase by immunohistochemical staining on paraffin-embedded tissue. In addition, in situ hybridization studies for Epstein-Barr virus--encoded RNAs (EBER) and immunoperoxidase studies for human herpesvirus-8 (HHV8)--specific proteins were performed. All cases had clinical, morphologic, and immunophenotypic findings typical of IPT and had varying proportions of fibroblastic and inflammatory components. Age ranged from 11 to 75 (median, 40) years; 8 subjects were male, and 5 were female. None of the cases (0 of 13) had positive staining for ALK kinase or HHV8, and in 1 a lymph node (1 of 13) was focally positive for EBV (EBER) by in situ hybridization. The absence of ALK kinase as detected by immunohistochemical studies in IPT of the lymph node and spleen suggests that this entity is biologically distinct from the histologically similar IMT.
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MESH Headings
- Adult
- Aged
- Anaplastic Lymphoma Kinase
- Biomarkers, Tumor/analysis
- Child
- Epstein-Barr Virus Infections/complications
- Epstein-Barr Virus Infections/pathology
- Female
- Fibromatosis, Abdominal/enzymology
- Fibromatosis, Abdominal/pathology
- Granuloma, Plasma Cell/enzymology
- Granuloma, Plasma Cell/pathology
- Granuloma, Plasma Cell/virology
- Herpesviridae Infections/complications
- Herpesviridae Infections/pathology
- Herpesvirus 4, Human/genetics
- Herpesvirus 4, Human/isolation & purification
- Herpesvirus 8, Human/genetics
- Herpesvirus 8, Human/isolation & purification
- Humans
- Immunoenzyme Techniques
- Immunophenotyping
- In Situ Hybridization
- Lymph Nodes/enzymology
- Lymph Nodes/pathology
- Lymph Nodes/virology
- Lymphatic Diseases/enzymology
- Lymphatic Diseases/pathology
- Lymphatic Diseases/virology
- Male
- Middle Aged
- Protein-Tyrosine Kinases/metabolism
- RNA-Binding Proteins/analysis
- Receptor Protein-Tyrosine Kinases
- Ribosomal Proteins
- Splenic Diseases/enzymology
- Splenic Diseases/pathology
- Splenic Diseases/virology
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Affiliation(s)
- J L Kutok
- Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA 02115, USA
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12
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Kojima M, Nakamura S, Shimizu K, Hosomura Y, Ohno Y, Itoh H, Yamane N, Yoshida K, Masawa N. Inflammatory pseudotumor of lymph nodes: clinicopathologic and immunohistological study of 11 Japanese cases. Int J Surg Pathol 2001; 9:207-14. [PMID: 11584317 DOI: 10.1177/106689690100900306] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We report 11 Japanese cases of inflammatory pseudotumor (IPT) of the lymph node. There were 7 males and 4 females with ages ranging from 5 to 68 years (median; 48). Only 2 patients had systemic lymphadenopathy, and all others had involvement of only 1 lymph node group. Constitutional symptoms such as fever were present in 8 patients and laboratory abnormalities were detected in 5. All patients recovered and were alive and well after 2 to 180 months (median; 32 months). Histologically, the process mainly involved the connective tissue framework of the lymph node, secondarily spreading into the lymph node parenchyma and the perinodal tissue. It was characterized by a storiform growth pattern of myofibroblasts, marked vascularity with associated vascular lesions, and a polymorphous reactive cellular infiltrate in a collagen-rich stroma. An immunohistochemical study revealed numerous myofibroblasts, histiocytes, and vascular endothelial cells expressing vascular endothelial growth factor (VEGF) in 6 cases. It was suggested that VEGF may be involved, in part, in the induction of the angiogenesis of IPT. Moreover, the present study indicates that follicular dendritic cell sarcoma, nasal T/natural killer cell lymphoma, and anaplastic large cell lymphoma should be added to the differential diagnosis from IPT of the lymph node. Int J Surg Pathol 9(3):207-214, 2001
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Affiliation(s)
- M Kojima
- Department of Pathology, Dokkyo University School of Medicine, Mibu, Tochigi, Japan
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13
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Abstract
Anaplastic lymphoma kinase (ALK), a hallmark of anaplastic large cell lymphoma, has recently been implicated in the genesis of some inflammatory pseudotumors (inflammatory myofibroblastic tumors) in children and young adults. The aim of this study was to determine the frequency of its expression among inflammatory pseudotumors, and to characterize the clinicopathologic features of the positive cases. Sixty-one cases of inflammatory pseudotumors were retrieved from the surgical pathology archives and consultation files. Paraffin sections were immunostained with the antibody ALK1. The patients ranged in age from 0.5 to 79 years (median age, 50 years), with 10 patients (16.4%) younger than 20 years. Five cases (8.2%) were ALK+, including two of six urogenital inflammatory myofibroblastic tumors, none of eight pulmonary inflammatory pseudotumors, three (one adrenal, one small bowel, one liver) of 31 extrapulmonary inflammatory pseudotumors, none of nine hepatic/splenic inflammatory pseudotumors expressing follicular dendritic cell markers and harboring Epstein-Barr virus, and none of seven inflammatory pseudotumors of the lymph node. When only those patients 40 years or younger were considered, the ALK positivity rate became 21.7% (five of 23). All five ALK+ cases occurred in young patients aged 0.5 to 37 years, who were alive and well at 3.5 to 17 years. The tumors exhibited a spectrum of histologic features typical of inflammatory pseudotumors/myofibroblastic tumors, but there was at least focal nuclear atypia. Immunostaining for ALK produced fibrillary or granular cytoplasmic staining in the neoplastic cells, sometimes with cell membrane accentuation. This study confirms that ALK is implicated in a proportion of inflammatory pseudotumors, and is generally associated with a favorable outcome. The results also support the heterogeneity of inflammatory pseudotumors, with the follicular dendritic cell/Epstein-Barr virus-positive cases and those occurring in lymph nodes representing different biologic entities.
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Affiliation(s)
- J K Chan
- Department of Pathology, Queen Elizabeth Hospital, Hong Kong.
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14
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Liu TH, Consorti ET. Inflammatory Pseudotumor Presenting as a Cystic Tumor of the Pancreas. Am Surg 2000. [DOI: 10.1177/000313480006601101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Inflammatory pseudotumor (IPT) of the pancreas occurs rarely. Eighteen cases have been described in the English literature. In all previous patients IPT of the pancreas presented as solid pancreatic mass. We are reporting a case of IPT presenting as a cystic mass of the pancreas, which has not been described previously. A review of IPT of the pancreas and a discussion regarding the management of pancreatic cystic neoplasm is provided.
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Affiliation(s)
- Terrence H. Liu
- Department of Surgery, The University of Texas-Houston Health Science Center at Lyndon B. Johnson General Hospital, Houston, Texas
| | - Eileen T. Consorti
- Department of Surgery, The University of Texas-Houston Health Science Center at Lyndon B. Johnson General Hospital, Houston, Texas
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15
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Labat ML, Milhaud G, Pouchelet M, Boireau P. On the track of a human circulating mesenchymal stem cell of neural crest origin. Biomed Pharmacother 2000; 54:146-62. [PMID: 10840592 DOI: 10.1016/s0753-3322(00)89048-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The neural markers present in the normal circulating monocytoid cells able, in pathological situations, to trans-differentiate into different mesenchymal-type cells, confirm the hypothesis previously raised that these cells derive from the neural crest. In culture, the normal cells display a great plasticity very reminiscent of microglial cells in culture. Almost a quiescent cell in normal individuals, this monocytoid cell shows its division potentialities in pathological situations of fibrosis and cancer (chondrosarcoma) where it is found to spontaneously proliferate. While the normal neofibroblasts are rapidly recognized and destroyed by fibrophagic T-lymphocytes, the pathological cells escape this control and, as a result, they accumulate in vitro giving rise to a tissue sometimes organized as nodules. Although basically the transdifferentiation process is similar in all the pathological situations of fibrosis and cancer studied so far, the end-result phenotype evokes the pathology the patient is suffering from. It evokes osteoblasts in a case of osteomyelosclerosis, chondroïdocytes in a case of chondrosarcoma, myelofibroblasts in a case of fibrosis of lung and kidney in a patient under ciclosporine treatment. Hence, this circulating monocytoid cell is a multipotent cell with great division potentiality. These are characteristics of stem/preprogenitor cells. Since this circulating monocytoid cell also bears the neural markers we called it a monocytoid ectomesenchymal stem/preprogenitor cell. Therefore, the existence of an ectomesenchymal system is discussed here. The circulating monocytoid ectomesenchymal stem/preprogenitor cell might be involved in the normal cicatrisation process while the fibrophagic T lymphocytes might be involved in its termination. Impairment of this controlled mechanism might result in the development of fibrosis and/or cancer such as chondrosarcoma in vivo. Interestingly, at least in vitro, proliferation is restricted to the monocytoid cell before transdifferentiation takes place. In this model, fibrosis and cancer might share some common steps going from the proliferation of the monocytoid cells to their transdifferentiation into mesenchymal-type cells and the accumulation of these transdifferentiated cells in the tissues. Then, cancer might be distinguished from fibrosis by the additional acquisition of the ability to proliferate by the transdifferentiated cells. The monocytoid ectomesenchymal stem/preprogenitor cell might also be involved in brain neurodegenerative diseases characterized by an accumulation of microglia. The circulating monocytoid ectomesenchymal stem/preprogenitor cell appears as a target for gene therapy in pathological situations of fibrosis and/or cancer where it proliferates out of control. If the normal cell can be expanded and if its transdifferentiation can be directed, the circulating monocytoid ectomesenchymal stem/preprogenitor cell may become a useful tool for cellular therapy, in case of failure in wound healing and tissue regeneration.
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Affiliation(s)
- M L Labat
- UMR 956 INRA/AFSSA/INRA, Ecole nationale vétérinaire d'Alfort, Maisons-Alfort, France
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16
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Fanburg-Smith JC, Miettinen M. Angiomatoid "malignant" fibrous histiocytoma: a clinicopathologic study of 158 cases and further exploration of the myoid phenotype. Hum Pathol 1999; 30:1336-43. [PMID: 10571514 DOI: 10.1016/s0046-8177(99)90065-5] [Citation(s) in RCA: 140] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Angiomatoid "malignant" fibrous histiocytoma (AMFH) has been considered to be a low-grade sarcoma of childhood, and, with its fibrous pseudocapsule, angiomatoid change, dense lymphoplasmacytic response, and proliferation of spindled or round cells, has been classified as a fibrohistiocytic neoplasm. We wanted to study the clinicopathologic and immunophenotypic features of a large number of these tumors and to especially further explore their myoid differentiation. Cases coded as AMFH from 1979 to 1995 were retrieved from the Soft Tissue Registry of the AFIP. Only cases that met the criteria for AMFH by light microscopy were included, a total of 158 cases. Immunohistochemistry was obtained on 98 cases. Clinical history on 92% of all cases revealed a gender ratio of 1.3 females: males, age range of 2 to 71 years, median size of 2.0 cm, and a distribution of extremities > trunk > head and neck, with 66% lesions occurring in areas of normal lymphoid tissue. All tumors with available margins were well-circumscribed. Eighty percent of cases had some degree of lymphoplasmacytic infiltration; 50% cases had pseudovascular spaces filled with blood. Fifty-two percent had predominantly round cell morphology; 48% had a predominantly spindle cell pattern. Desmin positivity was noted in 51% cases and occurred in both predominantly round cell and spindle cell tumors. Most of the desmin-positive cases with adjacent lymphoid infiltrate (67%) showed scattered similar, desmin-positive cells in the surrounding lymphoid infiltrate, adjacent to the tumor. Muscle-specific and smooth-muscle actins were seen in 14% cases. Heavy-caldesmon was strongly positive in 3%, and calponin was focally positive in 73% and extensively positive in 12% cases. MyoD1, myoglobin, and myogenin (myf4) were negative in all tumors studied. Forty-five percent of cases were positive for CD99; 52% of these had round cell morphology. Fifteen percent of cases were positive for KP-1. All tumors were positive for vimentin and negative for CD21, CD35, S100 protein, CD34, keratins 8/18, and lysozyme. Clinical follow-up on 86 patients indicated that only 1 patient was alive with a local nodal metastasis (1% frequency of metastasis) within 1 year, and 2 others had local recurrence, all over a mean follow-up period of 6 years. The myoid, primarily myofibroblastic, phenotype of these lesions is supported by desmin, calponin, and occasional actin positivity. The occasional heavy-caldesmon and smooth muscle actin additionally suggest rare smooth muscle phenotype; however, lack of skeletal muscle markers indicate no relationship of AMFH to skeletal muscle tumors. The resemblance of these lesions to lymph nodes, clinically and morphologically, the finding of similar desmin positive cells in the adjacent lymphoid infiltrate, and the fact that 66% cases were found in sites of normal lymphoid tissue raise the possibility that some of these lesions may arise from or be related to myoid cells of lymphoid tissue. AMFH has an almost invariably benign behavior, but the 1% metastatic rate warrants its classification as low-grade "malignant." The predominantly round cell, CD99-positive and desmin positive AMFH cases, respectively, should not be confused with Ewing's sarcoma/PNET or rhabdomyosarcoma, respectively.
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Affiliation(s)
- J C Fanburg-Smith
- Soft Tissue Pathology Department, Armed Forces Institute of Pathology, Washington, DC 20306-6000, USA
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17
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Abstract
Idiopathic retroperitoneal fibrosis (IRF) is an inflammatory and fibrosing process that can be complicated by periureteral encasement, ureteral obstruction, and subsequent renal failure if left untreated. Unfortunately, treatment is often delayed due to the nonspecific nature of the presenting signs and symptoms. Clinical, radiologic, and microscopic findings in IRF, if examined independently, are all nonspecific for its diagnosis. Rendering a diagnosis of IRF by fine-needle aspiration (FNA) requires supportive clinical and radiologic data and systematic evaluation of entities in the differential diagnosis. Herein we report 2 cases of IRF diagnosed by FNA with subsequent histologic confirmation. Smears prepared from the aspirates revealed a combination of inflammatory cells and fibrous tissue. The inflammatory component was comprised of a mixture of lymphocytes, plasma cells, and rare eosinophils and mast cells. These 2 cases represent, to our knowledge, only the second report of IRF diagnosed by FNA.
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Affiliation(s)
- R C Dash
- Department of Pathology, Duke University Medical Center, Durham, North Carolina 27710, USA
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18
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Sabo E, Naschitz JE, Misselevich I, Boss JH. The fasciitis-panniculitis syndromes: histomorphometric assessment of the inflammatory and sclerosing processes affecting the subcutaneous and fascial tissues. Skin Res Technol 1998; 4:180-7. [PMID: 27332685 DOI: 10.1111/j.1600-0846.1998.tb00107.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND/AIMS The fasciitis-panniculitis syndromes include several disorders characterized by skin induration due to fibrotic thickening of the septa of the subcutis and muscular fascia associated with chronic inflammation. Representative of the idiopathic form, eosinophilic fasciitis, is the prototype of the fasciitis-panniculitis syndromes. Secondary forms of the syndromes are causally related to a variety of diseases, such as infections, circulatory disorders, physical injuries and neoplasms. METHODS Histological sections of 10 idiopathic and 20 secondary cases of the fasciitis-panniculitis syndromes were assessed by means of computer-assisted image analysis. The percent of fibrous tissue, referred to as "extent of fibrosis", and the number of lymphocytes, macrophages, eosinophils, plasma cells, and mast cells within the subcutaneous-fascial complex were assessed. RESULTS The "extent of fibrosis" varied from 1% to 2% in the control cases and from 4% to 98% in the index cases. The number of inflammatory cells per high power field varied from 0 to 33 in the control cases and from 9 to 323 in the index cases. CONCLUSIONS There is a direct and positive correlation between the "extent of fibrosis" and the number of inflammatory cells. The "extent of fibrosis" and intensity of the inflammatory infiltration do not correlate with the nature of the underlying diseases, the patients'demographic data, the anatomic location of the subcutaneous induration or the duration of the lesion. It is suggested that the fasciitis-panniculitis syndromes are the morphological expression of a chronic, relapsing, inflammatory-sclerosing reaction pattern that is essentially identical in the idiopathic and the secondary forms of the disorder.
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Affiliation(s)
- E Sabo
- Departments of Pathology, The Bnai-Zion Medical Center and The Bruce Rapapport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, IsraelDepartment of Internal Medicine A, The Bnai-Zion Medical Center and The Bruce Rapapport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - J E Naschitz
- Departments of Pathology, The Bnai-Zion Medical Center and The Bruce Rapapport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, IsraelDepartment of Internal Medicine A, The Bnai-Zion Medical Center and The Bruce Rapapport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - I Misselevich
- Departments of Pathology, The Bnai-Zion Medical Center and The Bruce Rapapport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, IsraelDepartment of Internal Medicine A, The Bnai-Zion Medical Center and The Bruce Rapapport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - J H Boss
- Departments of Pathology, The Bnai-Zion Medical Center and The Bruce Rapapport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, IsraelDepartment of Internal Medicine A, The Bnai-Zion Medical Center and The Bruce Rapapport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
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Petter LM, Martin JK, Menke DM. Localized lymphoplasmacellular pancreatitis forming a pancreatic inflammatory pseudotumor. Mayo Clin Proc 1998; 73:447-50. [PMID: 9581586 DOI: 10.1016/s0025-6196(11)63728-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Inflammatory pseudotumors (IPTs) of the pancreas are rare. To our knowledge, we report the first case of a pancreatic IPT composed of dense lymphocytic and plasmacellular infiltrates that histologically resembled a primary lymphoplasmacytic lymphoma of the pancreas. In addition, it is the first pancreatic IPT analyzed for latent Epstein-Barr virus, an agent implicated in the pathogenesis of IPTs of the liver and spleen.
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Affiliation(s)
- L M Petter
- Department of Surgery, Mayo Clinic Jacksonville, Florida 32224, USA
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