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Zaidi A, Chatterjee D, Bhargav V, Gupta V, Das A. Clear cell myomelanocytic tumor of ligamentum teres. Autops Case Rep 2024; 14:e2024503. [PMID: 39021472 PMCID: PMC11253914 DOI: 10.4322/acr.2024.503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 05/03/2024] [Indexed: 07/20/2024]
Abstract
Clear cell myomelanocytic tumor (CCMMT) of the falciform ligament/ligamentum teres is a rare hepatic tumor, a variant of the perivascular epithelioid cell tumor (PEComa) family. CCMMT is the rarest variant of hepatic PEComas. Only a few cases of CCMMT have been reported in the English literature. Because of its rarity, less is known about its biological behavior. We present a case of a 31-year-old female who complained of abdominal pain, bilious vomiting, and abdominal fullness over two months. The radiological impression was of focal nodular hyperplasia. The histological examination of the resection specimen revealed a well-circumscribed tumor arranged in fascicles, sheets, and a whorling pattern. The tumor cells were spindle to epithelioid shaped with abundant clear to pale eosinophilic cytoplasm. The tumor cells expressed both myoid (smooth muscle actin) and melanocytic (MelanA and HMB45) markers, while they were negative for hepatocytic and vascular markers. Thus, based on histology and immunohistochemistry, a diagnosis of CCMMT was made. This case presents the diagnostic challenges of CCMMT and discusses the differential diagnosis with a literature review.
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Affiliation(s)
- Ariba Zaidi
- Dr Ram Manohar Lohia Institute of Medical Sciences, Department of Pathology, Lucknow, Uttar Pradesh, India
| | - Debajyoti Chatterjee
- Post Graduate Institute of Medical Education and Research, Department of Histopathology, Chandigarh, India
| | - Venu Bhargav
- Post Graduate Institute of Medical Education and Research, Department of General Surgery, Chandigarh, India
| | - Vikas Gupta
- Post Graduate Institute of Medical Education and Research, Department of General Surgery, Chandigarh, India
| | - Ashim Das
- Post Graduate Institute of Medical Education and Research, Department of Histopathology, Chandigarh, India
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Hammer PM, Tan SY. Soft Tissue Perivascular Epithelioid Cell Tumors. Surg Pathol Clin 2024; 17:105-118. [PMID: 38278600 DOI: 10.1016/j.path.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
Perivascular epithelioid cell tumors (PEComas) are a heterogenous group of mesenchymal neoplasms with a mixed myomelanocytic immunophenotype. PEComa-family tumors include angiomyolipoma, lymphangioleiomyomatosis, and a large category of rare neoplasms throughout the body that are now classified under the umbrella term "PEComa." This review focuses on recent advances in the clinicopathological and molecular features of PEComas, with an emphasis on PEComas that originate in soft tissue.
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Affiliation(s)
- Phoebe M Hammer
- Department of Pathology, Stanford University School of Medicine, 1291 Welch Road, Lane Building L235, Stanford, CA 94305, USA
| | - Serena Y Tan
- Department of Pathology, Stanford University School of Medicine, 1291 Welch Road, Lane Building L235, Stanford, CA 94305, USA.
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3
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Peker SK, Tevetoğlu F, Aliyeva C, Çevik H, Batur Ş, Yener HM. Perivascular Epitheloid Cell Tumor (PEComa) of the Neck. Indian J Otolaryngol Head Neck Surg 2023; 75:3858-3860. [PMID: 37974890 PMCID: PMC10645702 DOI: 10.1007/s12070-023-03918-8] [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: 03/21/2022] [Accepted: 05/28/2023] [Indexed: 11/19/2023] Open
Abstract
Perivascular epitheloid cell tumors (PEComas) are a family of neoplasms with distinctive perivascular epitheloid cells. 36 year old female patient admitted to our clinic with a mass on neck. Biopsy was reported as PEComa. PEComas are very rare, especially in neck region. Here, we present the second case in literature.
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Affiliation(s)
- Sinem Kara Peker
- Cerrahpaşa Medical Faculty Otorhinolaryngology-Head and Neck Surgery, Department, Istanbul University-Cerrahpaşa, Kocamustafapaşa Fatih, Istanbul, 34098 Turkey
| | - Fırat Tevetoğlu
- Cerrahpaşa Medical Faculty Otorhinolaryngology-Head and Neck Surgery, Department, Istanbul University-Cerrahpaşa, Kocamustafapaşa Fatih, Istanbul, 34098 Turkey
| | - Chinara Aliyeva
- Cerrahpaşa Medical Faculty Otorhinolaryngology-Head and Neck Surgery, Department, Istanbul University-Cerrahpaşa, Kocamustafapaşa Fatih, Istanbul, 34098 Turkey
| | - Haluk Çevik
- Cerrahpaşa Medical Faculty Otorhinolaryngology-Head and Neck Surgery, Department, Istanbul University-Cerrahpaşa, Kocamustafapaşa Fatih, Istanbul, 34098 Turkey
| | - Şebnem Batur
- Pathology Department, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - H. Murat Yener
- Pathology Department, Istanbul University-Cerrahpaşa, Istanbul, Turkey
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4
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Koufopoulos N, Pateras IS, Koratzanis C, Gouloumis AR, Ieronimaki AI, Fotiou A, Panayiotides IG, Vrachnis N. Uterine collision tumor (PEComa and endometrioid carcinoma) in a tuberous sclerosis patient: a case report. Front Oncol 2023; 13:1244261. [PMID: 37621679 PMCID: PMC10445650 DOI: 10.3389/fonc.2023.1244261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 07/21/2023] [Indexed: 08/26/2023] Open
Abstract
Perivascular epithelioid cell tumors are very rare mesenchymal neoplasms arising in various locations, such as the female genital tract, kidney, lung, prostate, bladder, pancreas, soft tissues, and bone. They possess a unique immunophenotype, co-expressing myogenic and melanocytic markers; molecular findings include mutations of tuberous sclerosis complex and translocations of transcription factor E3, a member of the microphthalmia transcription factor gene family. We herewith report a uterine collision tumor consisting of a perivascular epithelioid cell tumor and a moderately differentiated endometrial endometrioid carcinoma in a patient with genetically proven tuberous sclerosis; two leiomyomas were also found in contact with the tumor. Although two such cases one with a benign and another with a malignant perivascular epithelioid cell tumor have previously been reported, ours is, to our knowledge, the first reported in a tuberous sclerosis patient.
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Affiliation(s)
- Nektarios Koufopoulos
- Second Department of Pathology, National and Kapodistrian University of Athens School of Medicine, “Attikon” University Hospital, Haidari, Greece
| | - Ioannis S. Pateras
- Second Department of Pathology, National and Kapodistrian University of Athens School of Medicine, “Attikon” University Hospital, Haidari, Greece
| | - Christos Koratzanis
- Third Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens School of Medicine, “Attikon” University Hospital, Haidari, Greece
| | - Alina-Roxani Gouloumis
- Second Department of Pathology, National and Kapodistrian University of Athens School of Medicine, “Attikon” University Hospital, Haidari, Greece
| | - Argyro-Ioanna Ieronimaki
- Second Department of Pathology, National and Kapodistrian University of Athens School of Medicine, “Attikon” University Hospital, Haidari, Greece
| | - Alexandros Fotiou
- Third Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens School of Medicine, “Attikon” University Hospital, Haidari, Greece
| | - Ioannis G. Panayiotides
- Second Department of Pathology, National and Kapodistrian University of Athens School of Medicine, “Attikon” University Hospital, Haidari, Greece
| | - Nikolaos Vrachnis
- Third Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens School of Medicine, “Attikon” University Hospital, Haidari, Greece
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Apte SS, Mor E, Mitchell C, Gyorki DE. Practical Management of Adult Ultra-Rare Primary Retroperitoneal Soft Tissue Sarcoma: A Focus on Perivascular Epithelioid Tumours and Extraosseous Ewing Sarcoma. Curr Oncol 2023; 30:5953-5972. [PMID: 37504306 PMCID: PMC10377910 DOI: 10.3390/curroncol30070445] [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: 03/22/2023] [Revised: 06/16/2023] [Accepted: 06/20/2023] [Indexed: 07/29/2023] Open
Abstract
With the exception of well-differentiated liposarcoma, dedifferentiated liposarcoma, leiomyosarcoma, solitary fibrous tumour, malignant peripheral nerve sheath tumour, and undifferentiated pleomorphic sarcoma, the majority of the ≈70 histologic subtypes of retroperitoneal sarcoma are defined as 'ultra-rare' sarcomas, with an incidence of ≤1-5/1,000,000 persons/year. For most of these ultra-rare RPS subtypes, diagnosis and treatment follows international guidelines for the management of more common RPS histologies, with en bloc surgical resection as the mainstay of curative treatment, and enrolment in clinical trials where possible. Because the treatment of RPS is heavily driven by histology, the surgeon must be familiar with specific issues related to the diagnosis and management of ultra-rare sarcoma subtypes. Expert radiological and surgeon reviews are required to differentiate similarly presenting tumours where surgery can be avoided (e.g., angiomyolipoma), or where upfront systemic therapy is indicated (e.g., extraosseous Ewing's sarcoma). Thus, the management of all retroperitoneal sarcomas should occur at a sarcoma referral centre, with a multidisciplinary team of experts dedicated to the surgical and medical management of these rare tumours. In this focused review, we highlight how diagnosis and management of the ultra-rare primary RPS histologies of malignant perivascular epithelioid cell tumour (PEComa), extraosseous Ewing sarcoma (EES), extraosseous osteosarcoma (EOS), and rhabdomyosarcoma (RMS) critically diverge from the management of more common RPS subtypes.
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Affiliation(s)
- Sameer S Apte
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
- Division of General Surgery, The Ottawa Hospital, Ottawa, ON K1H 8L6, Canada
| | - Eyal Mor
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
| | - Catherine Mitchell
- Division of Pathology, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
| | - David E Gyorki
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
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Meredith L, Chao T, Nevler A, Basu Mallick A, Singla RK, McCue PA, Bowne WB, Jiang W. A rare metastatic mesenteric malignant PEComa with TSC2 mutation treated with palliative surgical resection and nab-sirolimus: a case report. Diagn Pathol 2023; 18:45. [PMID: 37041531 PMCID: PMC10088294 DOI: 10.1186/s13000-023-01323-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] [Received: 10/26/2022] [Accepted: 03/05/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND Malignant perivascular epithelioid cell tumors (PEComas) are exceedingly rare malignant mesenchymal neoplasms with characteristic morphological and immunohistochemical (IHC) patterns. However, some malignant PEComas are poorly differentiated with atypical histopathological features, making a definitive diagnosis difficult. PEComas are most commonly found in females and often show either TSC1 or TSC2 alterations, which result in the activation of the mTOR pathway, or TFE3 fusions. Given these molecular characteristics, mTOR inhibitors have recently been approved by the FDA in the treatment of malignant PEComas, particularly in those with TSC1/2 alterations. Therefore, molecular analyses may be helpful for both the diagnostic workup of and predicting response to mTOR inhibitors in cases of malignant PEComas. CASE PRESENTATION Here, we report a case of an aggressive, 23 cm mesenteric malignant PEComa with multiple peritoneal metastases in a young male patient. Pathological examination of the initial biopsy showed a malignant epithelioid neoplasm with high-grade morphology and atypical immunoprofile, which precluded a definitive diagnosis. Because of the patient's excessive transfusion requirements due to intra-tumoral hemorrhage, a palliative R2 resection was performed. Histopathological examination of the tumor revealed focal immunoreactivity for Melan-A, HMB-45, desmin, and CD117. Although a diagnosis of malignant PEComa was favored, other entities such as epithelioid gastrointestinal stromal tumor (GIST) or melanoma could not be definitively ruled out. Given the favored diagnosis, the patient was started on sirolimus, an mTOR inhibitor, rather than chemotherapy. Molecular analyses were performed and the tumor was found to harbor mutations in TP53 and TSC2, supporting a definitive diagnosis of malignant PEComa. The patient was then switched to nab-sirolimus, with initial stabilization of the disease. CONCLUSIONS This report details a multidisciplinary approach for the diagnosis and management of a highly aggressive, metastatic malignant PEComa in a young male patient. The basis for the treatment of malignant PEComas with the recently FDA-approved mTOR inhibitor, nab-sirolimus, is also reviewed. In summary, this case highlights the importance of molecular analysis, particularly TSC1/2 alterations, for both the definitive diagnosis of malignant PEComas and predicting their response to nab-sirolimus.
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Affiliation(s)
- Luke Meredith
- Department of Surgery, Sidney Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia, PA, 19107, USA
| | - Timothy Chao
- Department of Pathology and Genomic Medicine, Sidney Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia, PA, 19107, USA
| | - Avinoam Nevler
- Department of Surgery, Sidney Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia, PA, 19107, USA
| | - Atrayee Basu Mallick
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia, PA, 19107, USA
| | - Rajan K Singla
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia, PA, 19107, USA
| | - Peter A McCue
- Department of Pathology and Genomic Medicine, Sidney Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia, PA, 19107, USA
| | - Wilbur B Bowne
- Department of Surgery, Sidney Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia, PA, 19107, USA
| | - Wei Jiang
- Department of Pathology and Genomic Medicine, Sidney Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia, PA, 19107, USA.
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Wang B, Xu X, Zhao Z. Clear cell "sugar" tumor of the lung: Diagnostic characteristics of a rare pulmonary tumor: A case report and review of literature. Medicine (Baltimore) 2023; 102:e33035. [PMID: 36800595 PMCID: PMC9936011 DOI: 10.1097/md.0000000000033035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
INTRODUCTION Clear cell tumors of the lung (CCTLs), also known as "sugar tumors" for an abundant cellular glycogen concentration, are an extremely rare type pulmonary neoplasm. Often, they are incidentally found on chest roentgenogram or computed tomography scan during routine examination. CCTLs usually present with nonspecific symptoms that pose a diagnostic challenge to clinicians. Accordingly, histopathology remains the gold standard for diagnosing. Moreover, some of them can present with either appearances or histopathological features similar to other pulmonary neoplasms under the light microscope, including pulmonary malignancy, thereby causing misdiagnosis prior to or after surgery. Accordingly, herein, we describe a rare case of CCTL, review the literature has been published, and then discuss the benign versus malignant nature of this rare tumor. PATIENT CONCERNS A 59-year-old man presented due to a high-density chest nodule in the left diaphragm. The patient's medical history was unremarkable and he also denied smoking in the past. DIAGNOSIS Physical examination, there were no noted signs. A new chest contrast-enhanced computed tomography revealed a 3.2 × 2.5 cm, solitary, circular nodule with a smooth edge located in the beside of the left thoracic aorta. Postoperative pathological and immunohistochemical examinations of the surgical specimens revealed a final diagnosis of CCTLs. INTERVENTIONS The patient underwent video-assisted thoracoscopic surgery. A wedge resection of left lower lung lobe was carried out and the tumor node was successfully removed alongside normal surrounding parenchyma. OUTCOMES The operation was successful. Then the patient recovered completely and continued to do well on postsurgical thoracic surgical clinic visits. The tumor was a benign tumor, and the patient did not require any additional treatment. The patient had been followed-up regularly for 4 years after surgery; she did not experience any complications and remained disease-free. CONCLUSION CCTLs should be considered in the differential diagnosis if a patient shows a solitary, circular chest nodule with a smooth edge. They are extremely rare lung tumors that must be differentiated from other lung tumors, especially the malignant tumors. Although pathological and immunohistochemical findings are important for making the diagnosis, the varying histopathological features on microscope make diagnosis difficult. The current case highlights the importance of physicians being aware of and suspecting CCTLs in similar cases, along with knowing the characteristics of CCTLs for the diagnosis and differential diagnosis.
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Affiliation(s)
- Bo Wang
- Department of Pathology, Xingtai People’s Hospital Affiliated to Hebei Medical University, Xingtai, Hebei, P.R. China
- * Correspondence: Bo Wang, Department of Pathology, Xingtai People’s Hospital Affiliated to Hebei Medical University, 16 Red Star Street, Xingtai, Hebei 054001, P.R. China (e-mail: )
| | - Xin Xu
- Department of Pathology, Xingtai People’s Hospital Affiliated to Hebei Medical University, Xingtai, Hebei, P.R. China
| | - Zhenya Zhao
- Department of Pathology, Xingtai People’s Hospital Affiliated to Hebei Medical University, Xingtai, Hebei, P.R. China
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8
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Almousa MA, Alnashwan YA, Amr SS. Perivascular Epithelioid Cell Tumor (PEComa) of the Pancreas in a Patient with Ulcerative Colitis: A Case Report and Review of the Literature. Healthcare (Basel) 2023; 11:healthcare11040547. [PMID: 36833081 PMCID: PMC9956215 DOI: 10.3390/healthcare11040547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/08/2023] [Accepted: 02/09/2023] [Indexed: 02/16/2023] Open
Abstract
Perivascular epithelioid cell tumors (PEComas) are mesenchymal tumors of peculiar cells that are focally associated with blood vessels, and generally have a distinctive bi-phenotypic expression of both smooth muscle and melanocytic markers. There are several entities in the PEComa family, including tumors that arise in the soft tissues and viscera. Frequently affected organs include the lungs (sugar tumors), uterus, broad ligament, colon, small bowel, liver, and pancreas. Ulcerative colitis (UC) has been associated with the development of tumors, especially colorectal and hepatobiliary carcinomas. Rare cases of UC have been reported in the PEComa family of tumors, but none in the pancreas. Here, we present a case study of a 27-year-old female patient with a history of UC who developed PEComa of the pancreas, a unique association that has not been previously reported. We also review reported cases of PEComas in the pancreas, as well as PEComas at all anatomic sites associated with UC.
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Affiliation(s)
- Maryam A. Almousa
- Department of Pathology and Laboratory Medicine, King Fahad Specialist Hospital, Dammam 34258, Saudi Arabia
| | - Yara A. Alnashwan
- Department of Pathology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 1982, Saudi Arabia
- Correspondence:
| | - Samir S. Amr
- Department of Pathology and Laboratory Medicine, Istishari Hospital, Amman 840431, Jordan
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Sanchez NG, Ávila Romay AA, Martínez Luna E, Padilla Rodríguez AL. Cutaneous Angiomyolipoma-A Distinct Entity That Should Be Separated From Classic Angiomyolipoma: Complete Review of Existing Cases and Defining Fundamental Features. JMIR DERMATOLOGY 2022; 5:e40168. [PMID: 37632898 PMCID: PMC10334929 DOI: 10.2196/40168] [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: 06/09/2022] [Revised: 09/07/2022] [Accepted: 09/17/2022] [Indexed: 11/13/2022] Open
Abstract
Cutaneous angiomyolipoma is a rare mesenchymal tumor that is demographically, clinically, and immunohistochemically distinct from its renal and extrarenal counterparts. We present a case of cutaneous angiomyolipoma in the right retroauricular area of a 35-year-old male patient and provide a broad systematic review of the literature and the largest compilation of cutaneous angiomyolipomas reported to date. According to the findings presented in this review, we conclude that cutaneous angiomyolipoma should be completely separated from renal and extrarenal angiomyolipomas and therefore be considered a distinct entity in the classification of skin tumors.
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Affiliation(s)
- Natalia Gabriela Sanchez
- DIGIPATH: Digital Pathology Laboratory, Mexico City, Mexico
- Instituto Tecnológico y de Estudios Superiores De Monterrey Campus Ciudad de México, Mexico City, Mexico
| | | | | | - Alvaro Lezid Padilla Rodríguez
- DIGIPATH: Digital Pathology Laboratory, Mexico City, Mexico
- Instituto Tecnológico y de Estudios Superiores De Monterrey Campus Ciudad de México, Mexico City, Mexico
- Escuela de Medicina Universidad Panamericana Campus Ciudad de México, Mexico City, Mexico
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10
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Cazzato G, Colagrande A, Lospalluti L, Pacello L, Lettini T, Arezzo F, Loizzi V, Lupo C, Casatta N, Cormio G, Maiorano E, Ingravallo G, Resta L. Primitive Cutaneous (P)erivascular (E)pithelioid (C)ell Tumour (PEComa): A New Case Report of a Rare Cutaneous Tumor. Genes (Basel) 2022; 13:genes13071153. [PMID: 35885936 PMCID: PMC9317609 DOI: 10.3390/genes13071153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 02/04/2023] Open
Abstract
Perivascular epithelioid cell tumours (PEComas) are a growing family of tumours composed of histologically and immunohistochemically distinctive perivascular epithelioid cells. Cutaneous primitive PEComas (cPEComas) are very rare, with 65 cases described in the English literature, and occur as a painless lesion predominantly in female patients, with a wide age range. We present a new case of cPEComa found on the left thigh of a 53-year-old patient with histopathological, immunohistochemical, and molecular information. The lesion was positive for HMB-45 and focal for smooth muscle actin and desmin but negative for melan-A, S-100 protein, CD31, and CD34. Next generation sequencing (NGS) analysis demonstrated the presence of genomic aberration for baculoviral IAP repeats containing BIRC3 splice site 1622-27_1631del37. Although there are little molecular data regarding this entity, our case adds to this knowledge, considering the importance of detecting genomic aberrations in the context of specific therapies such as mTOR inhibitors.
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Affiliation(s)
- Gerardo Cazzato
- Section of Molecular Pathology, Department of Emergency and Organ Transplantation (DETO), University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.C.); (T.L.); (E.M.); (G.I.); (L.R.)
- Correspondence: ; Tel.: +39-34-0520-3641
| | - Anna Colagrande
- Section of Molecular Pathology, Department of Emergency and Organ Transplantation (DETO), University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.C.); (T.L.); (E.M.); (G.I.); (L.R.)
| | - Lucia Lospalluti
- Section of Dermatology and Venereology, Department of Biomedical Sciences and Human Oncology (DIMO), University of Bari “Aldo Moro”, 70124 Bari, Italy; (L.L.); (L.P.)
| | - Lucia Pacello
- Section of Dermatology and Venereology, Department of Biomedical Sciences and Human Oncology (DIMO), University of Bari “Aldo Moro”, 70124 Bari, Italy; (L.L.); (L.P.)
| | - Teresa Lettini
- Section of Molecular Pathology, Department of Emergency and Organ Transplantation (DETO), University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.C.); (T.L.); (E.M.); (G.I.); (L.R.)
| | - Francesca Arezzo
- Section of Gynecology and Obstetrics, Department of Biomedical Sciences and Human Oncology (DIMO), University of Bari “Aldo Moro”, 70124 Bari, Italy; (F.A.); (V.L.)
| | - Vera Loizzi
- Section of Gynecology and Obstetrics, Department of Biomedical Sciences and Human Oncology (DIMO), University of Bari “Aldo Moro”, 70124 Bari, Italy; (F.A.); (V.L.)
| | - Carmelo Lupo
- Innovation Department, Diapath S.P.A., Via Savoldini n.71, 24057 Martinengo, Italy; (C.L.); (N.C.)
| | - Nadia Casatta
- Innovation Department, Diapath S.P.A., Via Savoldini n.71, 24057 Martinengo, Italy; (C.L.); (N.C.)
| | - Gennaro Cormio
- Gynecologic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy;
- Department of Interdisciplinary Medicine (DIM), University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Eugenio Maiorano
- Section of Molecular Pathology, Department of Emergency and Organ Transplantation (DETO), University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.C.); (T.L.); (E.M.); (G.I.); (L.R.)
| | - Giuseppe Ingravallo
- Section of Molecular Pathology, Department of Emergency and Organ Transplantation (DETO), University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.C.); (T.L.); (E.M.); (G.I.); (L.R.)
| | - Leonardo Resta
- Section of Molecular Pathology, Department of Emergency and Organ Transplantation (DETO), University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.C.); (T.L.); (E.M.); (G.I.); (L.R.)
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Salamo R, Fong TL, Patel D, Silva J, Chopra S, Kulkarni S, Tseng W, Grant E. Perivascular epithelioid cell tumor of the falciform ligament with recruitment of the paraumbilical vein. JOURNAL OF CANCER RESEARCH AND PRACTICE 2022. [DOI: 10.4103/jcrp.jcrp_2_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] Open
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12
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Malignant perivascular epithelioid cell neoplasm in the liver: report of a pediatric case. Surg Case Rep 2021; 7:212. [PMID: 34542724 PMCID: PMC8452810 DOI: 10.1186/s40792-021-01300-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 09/13/2021] [Indexed: 11/29/2022] Open
Abstract
Background Perivascular epithelioid cell neoplasm (PEComa) in a child is very rare. We herein report the first malignant case of PEComa developing in the liver of a pediatric patient.
Case presentation A 10-year-old boy visited a private clinic with prolonged fever of unknown etiology. Abdominal ultrasonography was performed to evaluate the fever’s origin, revealing a large tumor in the liver. He was thus referred to a nearby hospital to investigate the tumor further. Enhanced computed tomography (CT) showed a 6.8 × 5.9 × 10.5-cm solid lesion on S4 and S5. On magnetic resonance imaging (MRI), the tumor had a low signal intensity on T1 imaging and high signal intensity on T2 imaging, with partial diffusion restriction. 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) showed a marked uptake in the mass lesion with no evidence of metastasis. The patient was negative for all tumor markers, including AFP, CEA and PIVKA-II. The results of a needle biopsy suggested hepatocellular carcinoma. The tumor’s rapid growth suggested malignancy. Hepatic segmentectomy (S4 + S5 + S8) was performed. The tumor was resected en bloc with a margin. Microscopically, the tumor showed atypical spindle, polygonal or oval-shaped cells with a high nuclear grade, and vascular invasion. Immunohistochemistry was positive for alpha-smooth muscle antigen (α-SMA), human melanin black-45 (HMB-45) and melan A. The pathological diagnosis was malignant PEComa. In the 6 months after surgery, the patient complained of shoulder pain. MRI showed a dumbbell-shaped tumor at the 2nd thoracic vertebrae, which was confirmed to be bone metastasis of PEComa. After chemotherapy, including ifosfamide and doxorubicin, vertebrectomy was performed. Two years later, thoracoabdominal CT showed a 10-cm solid mass occupying the pelvis and a 15-mm nodule in the middle lobe of the right lung. Under a diagnosis of peritoneal and lung metastases, they were surgically removed and metastasis of PEComa was pathologically confirmed. Four months after the 2nd relapse, pelvic metastasis appeared again and mTOR (mammalian target of rapamycin) inhibitor was initiated. To our knowledge, this is the first report of malignant hepatic PEComa in a pediatric patient. Conclusion Although extremely rare, malignant hepatic PEComa can develop in a child.
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Wangsiricharoen S, Larman TC, Wakely PE, Siddiqui MT, Ali SZ. Cytopathology of extra-renal perivascular epithelioid cell tumor (PEComa): a series of 7 cases and review of the literature. J Am Soc Cytopathol 2020; 10:175-186. [PMID: 33162379 DOI: 10.1016/j.jasc.2020.09.006] [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: 08/31/2020] [Revised: 09/16/2020] [Accepted: 09/16/2020] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Perivascular epithelioid cell tumor (PEComa) is a family of rare mesenchymal tumors consisting of histologically and immunohistochemically distinctive perivascular epithelioid cells. Relatively little is known about the cytopathology of extra-renal PEComas. Because of a considerable range of morphology and their rarity, accurate cytologic classification can be challenging. We evaluated cytologic characteristics and diagnostic pitfalls of extra-renal PEComas on fine-needle aspiration (FNA). MATERIALS AND METHODS We performed a retrospective search in our cytopathology and surgical pathology database for cases diagnosed as PEComa that had corresponding cytology specimens from 3 medical institutions. All available cytopathology specimens were reviewed. We evaluated cytologic characteristics and recorded histologic diagnoses and immunohistochemical stains. RESULTS Seven FNA specimens from 6 patients were identified, and cytologic diagnoses were made in all cases as follows: PEComa (4 cases), most consistent with PEComa (1 case), malignant neoplasm (1 case), and hepatocellular carcinoma (1 case). Most specimens were moderately to highly cellular. Cell distribution occurred as tissue fragments with background proliferating capillaries. Most smears were composed of epithelioid cells showing mild to moderate anisonucleosis, abundant eosinophilic cytoplasm, well-defined borders, intranuclear pseudoinclusions, and prominent nucleoli. A combination of myoid and melanocytic markers was expressed in 6 cases except 1 case, which was called hepatocellular carcinoma. CONCLUSIONS This was the largest FNA series for extra-renal PEComas to date. Our study highlights some common cytomorphologic characteristics of PEComa with which cytopathologists should be familiar. In the right clinical and radiologic context, and with the aid of immunohistochemistry, a definitive diagnosis can be achieved.
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Affiliation(s)
| | - Tatianna C Larman
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Paul E Wakely
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Momin T Siddiqui
- Department of Pathology and Laboratory Medicine, Weil Cornell Medicine, New York Presbyterian Hospital, New York, New York
| | - Syed Z Ali
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Businello G, Dal Pozzo CA, Sbaraglia M, Mastracci L, Milione M, Saragoni L, Grillo F, Parente P, Remo A, Bellan E, Cappellesso R, Pennelli G, Michelotto M, Fassan M. Histopathological landscape of rare oesophageal neoplasms. World J Gastroenterol 2020; 26:3865-3888. [PMID: 32774063 PMCID: PMC7385561 DOI: 10.3748/wjg.v26.i27.3865] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 06/19/2020] [Accepted: 07/04/2020] [Indexed: 02/06/2023] Open
Abstract
The landscape of neoplastic pathology of the oesophagus is dominated by malignancies of epithelial origin, in particular by oesophageal adenocarcinoma and oesophageal squamous cell carcinoma. However, several other histopathological variants can be distinguished, some associated with peculiar histopathological profiles and prognostic behaviours and frequently underrecognized in clinical practice. The aim of this review is to provide a comprehensive characterization of the main morphological and clinical features of these rare variants of oesophageal neoplastic lesions.
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Affiliation(s)
- Gianluca Businello
- Department of Medicine (DIMED), Surgical Pathology and Cytopathology Unit, University of Padua, Padua 35121, Italy
| | - Carlo Alberto Dal Pozzo
- Department of Medicine (DIMED), Surgical Pathology and Cytopathology Unit, University of Padua, Padua 35121, Italy
| | - Marta Sbaraglia
- Department of Medicine (DIMED), Surgical Pathology and Cytopathology Unit, University of Padua, Padua 35121, Italy
| | - Luca Mastracci
- Department of Surgical and Diagnostic Sciences (DISC), Pathology Unit, University of Genova, Genova 16123, Italy
| | - Massimo Milione
- Department of Pathology and Laboratory Medicine, First Pathology Division, Fondazione IRCCS - Istituto Nazionale dei Tumori, Milan 20133, Italy
| | - Luca Saragoni
- Pathology Unit, Morgagni-Pierantoni Hospital, Forlì 47121, Italy
| | - Federica Grillo
- Department of Surgical and Diagnostic Sciences (DISC), Pathology Unit, University of Genova, Genova 16123, Italy
| | - Paola Parente
- Pathology Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo 71013, Italy
| | - Andrea Remo
- Department of Pathology, Ospedale Mater Salutis di Legnago, Legnago 37045, Italy
| | - Elena Bellan
- Department of Medicine (DIMED), Surgical Pathology and Cytopathology Unit, University of Padua, Padua 35121, Italy
| | - Rocco Cappellesso
- Department of Medicine (DIMED), Surgical Pathology and Cytopathology Unit, University of Padua, Padua 35121, Italy
| | - Gianmaria Pennelli
- Department of Medicine (DIMED), Surgical Pathology and Cytopathology Unit, University of Padua, Padua 35121, Italy
| | - Mauro Michelotto
- Department of Medicine (DIMED), Surgical Pathology and Cytopathology Unit, University of Padua, Padua 35121, Italy
| | - Matteo Fassan
- Department of Medicine (DIMED), Surgical Pathology and Cytopathology Unit, University of Padua, Padua 35121, Italy
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15
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Gadducci A, Zannoni GF. Perivascular epithelioid cell tumors (PEComa) of the female genital tract: A challenging question for gynaecologic oncologist and pathologist. Gynecol Oncol Rep 2020; 33:100603. [PMID: 32685651 PMCID: PMC7356199 DOI: 10.1016/j.gore.2020.100603] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/09/2020] [Accepted: 06/15/2020] [Indexed: 02/06/2023] Open
Abstract
Perivascular epithelioid cell tumors (PEComa)s are mesenchymal neoplasms composed of perivascular epithelioid cells, which express both melanocytic and myogenic markers. These neoplastic cells are thought to arise from undifferentiated cells of the neural crest, or from myoblastic cells harbouring a molecular alteration leading to expression of melanocytic markers, or from pericytic cells. The majority of cases are benign, but a small subset behaves in a malignant fashion. Unfortunately, given their rarity, reliable criteria for predicting malignancy have yet to be established. PEComas of the female genital tract account for nearly 25% of PEComas of all body sites, and the most common site of occurrence is the uterine corpus; less common sites include the cervix, adnexa, vagina/vulva or broad or round ligament exceptionally. The present review aims to elucidate the clinical, pathological and molecular features of gynecological PEComas. Moreover, prognostic and therapeutic implications are also discussed.
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Affiliation(s)
- Angiolo Gadducci
- Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Italy
| | - Gian Franco Zannoni
- Division of Anatomic Pathology and Histology - Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore School of Medicine, Rome, Italy
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16
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Hamza A, Guo CC. Perivascular Epithelioid Cell Tumor of the Urinary Bladder: A Systematic Review. Int J Surg Pathol 2019; 28:393-400. [PMID: 31865807 DOI: 10.1177/1066896919895810] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Perivascular epithelioid cell tumor (PEComa) of the urinary bladder is a rare neoplasm showing distinct melanocytic and smooth muscle differentiation. We aimed to review the clinicopathologic features of bladder PEComa using all the available cases in the literature, along with 2 new cases from our database. The patients included 15 females and 15 males with a mean age of 39.2 ± 15.3 years. Painless hematuria was the most common clinical presentation. The tumors were usually well circumscribed with a mean tumor size of 4.4 ± 2.7 cm. Bladder PEComas demonstrated nests, trabeculae, or sheets of epithelioid cells with intermixed spindled cells and numerous thin-walled vessels. Immunohistochemical studies showed that the tumors were positive for HMB45 (27/27), cathepsin (4/4), SMA (20/22), and caldesmon (3/3) and were negative for pan cytokeratin (0/18) and EMA (0/4). Molecular studies revealed that PEComa was associated with the TFE3 (n = 3) and EWSR1 (n = 1) gene rearrangements. Treatment included partial cystectomy (n = 18), transurethral resection (n = 8), and radical cystectomy (n = 4). Twenty patients had no evidence of disease during a mean follow-up time of 19.4 ± 17.2 months. Two patients had recurrence, and 1 patient died of metastatic disease. In conclusion, bladder PEComas demonstrate distinct morphologic and immunohistochemical features. Although most tumors follow a benign course, a small subset may develop metastasis and cause death.
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Affiliation(s)
- Ameer Hamza
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Charles C Guo
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
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17
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Marano A, Maione F, Woo Y, Pellegrino L, Geretto P, Sasia D, Fortunato M, Orcioni GF, Priotto R, Fasoli R, Borghi F. Robotic wedge resection of a rare gastric perivascular epithelioid cell tumor: A case report. World J Clin Cases 2019; 7:4011-4019. [PMID: 31832403 PMCID: PMC6906564 DOI: 10.12998/wjcc.v7.i23.4011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/31/2019] [Accepted: 11/13/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Perivascular epithelioid cell tumor (PEComa) is a rare mesenchymal neoplasm that can arise in many different organs with a broad spectrum of biological behavior, from indolent to aggressive progression. Only ten cases of gastric PEComas have been reported in the English literature, which were treated with endoscopic, laparoscopic, or open resections. Due to its rarity, the optimal surgical management and prognosis of this tumor are still uncertain.
CASE SUMMARY We present a case of robotic wedge resection of a 6.5 cm bleeding lesion of the gastric fundus located 3 cm below the esophago-gastric junction in a 55-year-old man. Biopsy revealed a malignant tumor with epithelioid cells focally positive for muscle markers desmin and smooth muscle actin. In addition, histology revealed that the tumor was positive for HMB-45, melan-A (MART-1), microphthalmia transcription factor and negative for pan-cytokeratin AE1/AE3, CD34, p40, DOG-1, CD117 (c-kit), S100, CD3, CD79a, caldesmon and myogenin. These markers suggested the possibility of a PEComa. The patient underwent a diagnostic laparoscopy via the da Vinci® Si™ system and robotic wedge resection. Final pathology confirmed a malignant gastric PEComa with negative margins. At his 11-mo follow-up visit, the patient remained disease-free.
CONCLUSION Gastric PEComa can be treated with a robotic R0 resection with acceptable postoperative and short-term oncological outcomes.
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Affiliation(s)
- Alessandra Marano
- Department of Surgery, General and Oncologic Surgery Unit, Santa Croce e Carle Hospital, Cuneo 12100, Italy
| | - Francesca Maione
- Department of Surgery, General and Oncologic Surgery Unit, Santa Croce e Carle Hospital, Cuneo 12100, Italy
| | - Yanghee Woo
- Department of Surgery, City of Hope, Duarte, CA 91010, United States
| | - Luca Pellegrino
- Department of Surgery, General and Oncologic Surgery Unit, Santa Croce e Carle Hospital, Cuneo 12100, Italy
| | - Paolo Geretto
- Department of Surgery, General and Oncologic Surgery Unit, Santa Croce e Carle Hospital, Cuneo 12100, Italy
| | - Diego Sasia
- Department of Surgery, General and Oncologic Surgery Unit, Santa Croce e Carle Hospital, Cuneo 12100, Italy
| | - Mirella Fortunato
- Department of Pathology, Santa Croce e Carle Hospital, Cuneo 12100, Italy
| | | | - Roberto Priotto
- Department of Radiology, Santa Croce e Carle Hospital, Cuneo 12100, Italy
| | - Renato Fasoli
- Department of Gastroenterology and Digestive Endoscopy, Santa Croce e Carle Hospital, Cuneo 12100, Italy
| | - Felice Borghi
- Department of Surgery, General and Oncologic Surgery Unit, Santa Croce e Carle Hospital, Cuneo 12100, Italy
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18
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Hung YP, Hornick JL. Immunohistochemical Biomarkers of Mesenchymal Neoplasms in Endocrine Organs: Diagnostic Pitfalls and Recent Discoveries. Endocr Pathol 2018; 29:189-198. [PMID: 29340997 DOI: 10.1007/s12022-018-9513-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Mesenchymal neoplasms rarely present in or adjacent to endocrine organs. In this context, the recognition of these rare tumor types can be challenging, with significant potential for misdiagnosis as sarcomatoid carcinomas (i.e., anaplastic thyroid carcinoma and sarcomatoid adrenal cortical carcinoma) or neuroendocrine carcinomas, depending upon the dominant histologic patterns. In this review, we address potential pitfalls in diagnosing selected mesenchymal neoplasms arising within or near endocrine organs, including dedifferentiated liposarcoma, synovial sarcoma, angiosarcoma, PEComa, proximal-type epithelioid sarcoma, Ewing sarcoma, and neuroblastoma. For each of these tumor types, we review clinical and pathologic features, histologic clues to distinguish them from endocrine neoplasms, and recently developed immunohistochemical markers that can be particularly useful for establishing the correct diagnosis.
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Affiliation(s)
- Yin P Hung
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Jason L Hornick
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
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19
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20
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Hekimoglu K, Haberal M. Liver Perivascular Epithelioid Cell Tumor with an Unusual Location: Diagnostic Characteristics with Multidetector Computed Tomography and Magnetic Resonance Imaging. J Clin Imaging Sci 2017; 7:36. [PMID: 28975043 PMCID: PMC5615861 DOI: 10.4103/jcis.jcis_43_17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 07/25/2017] [Indexed: 12/17/2022] Open
Abstract
Primary perivascular epithelioid cell tumor (PEComa) of the liver is a very rare tumor that originates from mesenchyma. Gastrointestinal tract with perivascular distribution is the most common anatomic sites of these tumors. Only few cases of hepatic PEComa have been described so far. Malignant PEComas exhibit aggressive behavior with poor prognosis, making early diagnosis crucial. Hereby, we report a 79-year-old female with unusually located mass in the liver. A partial curative hepatectomy has been done, and PEComa was diagnosed histopathologically. No evidence of recurrence was observed during the 6-month follow-up.
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Affiliation(s)
- Koray Hekimoglu
- Department of Radiology, School of Medicine, Baskent University, Ankara, Turkey
| | - Murat Haberal
- Department of Radiology, School of Medicine, Baskent University, Ankara, Turkey
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21
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Varan A, Bayhan T, Kiratli H, Özoğul E, Kösemehmetoğlu K, Bulut E, Akyüz C. An orbital perivascular epithelioid cell tumor in a 7-year-old boy: case report and review of the literature. J AAPOS 2017; 21:325-328.e1. [PMID: 28576480 DOI: 10.1016/j.jaapos.2017.05.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 01/08/2017] [Indexed: 11/16/2022]
Abstract
We report the case of a 7-year-old boy who presented with a swollen right eye. Magnetic resonance imaging revealed a right intraconal orbital mass with intense contrast enhancement. Incisional biopsy led to a diagnosis of perivascular epithelioid cell tumor (PEComa). Sirolimus was initiated but discontinued at the third week of treatment because the tumor had progressed. A minor regression of the tumor was seen after six cycles of systemic chemotherapy. Previously reported cases of PEComa were benign in nature, and full remission was achieved with surgical excision. In the present case the tumor was malignant and responded only slightly to systemic chemotherapy.
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Affiliation(s)
- Ali Varan
- Department of Pediatric Oncology, Hacettepe University, Cancer Institute, Ankara, Turkey.
| | - Turan Bayhan
- Department of Pediatric Oncology, Hacettepe University, Cancer Institute, Ankara, Turkey
| | - Hayyam Kiratli
- Department of Ocular Oncology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Ece Özoğul
- Department of Pathology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Kemal Kösemehmetoğlu
- Department of Pathology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Elif Bulut
- Department of Radiology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Canan Akyüz
- Department of Pediatric Oncology, Hacettepe University, Cancer Institute, Ankara, Turkey
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22
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Shin SA, Choi J, Moon KC, Kim WH. Perivascular Epithelioid Cell Tumor in the Stomach. J Pathol Transl Med 2017; 51:428-432. [PMID: 28372349 PMCID: PMC5525029 DOI: 10.4132/jptm.2016.09.16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 09/16/2016] [Indexed: 02/06/2023] Open
Abstract
Perivascular epithelioid cell tumors or PEComas can arise in any location in the body. However, a limited number of cases of gastric PEComa have been reported. We present two cases of gastric PEComas. The first case involved a 62-year-old woman who presented with a 4.2 cm gastric subepithelial mass in the prepyloric antrum, and the second case involved a 67-year-old man with a 5.0 cm mass slightly below the gastroesophageal junction. Microscopic examination revealed that both tumors were composed of perivascular epithelioid cells that were immunoreactive for melanocytic and smooth muscle markers. Prior to surgery, the clinical impression of both tumors was gastrointestinal stromal tumor (GIST), and the second case was erroneously diagnosed as GIST even after microscopic examination. Although gastric PEComa is a very rare neoplasm, it should be considered in the differential diagnosis of gastric submucosal lesions.
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Affiliation(s)
- Sun Ah Shin
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| | - Jiwoon Choi
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| | - Kyung Chul Moon
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| | - Woo Ho Kim
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
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23
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Kubo H, Yamazaki H, Okada T, Takahashi Y, Nishi Y, Yokomori H. Primary hepatic angiomyolipoma: immunohistochemistry and electron microscopic observations: a case report. J Med Case Rep 2017; 11:76. [PMID: 28327196 PMCID: PMC5361786 DOI: 10.1186/s13256-017-1235-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 02/03/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Hepatic angiomyolipomas are a rare, benign group of mesenchymal tumors in the liver. Hepatic angiomyolipoma is sometimes misdiagnosed as hepatocellular carcinoma, and there is the possibility of a malignant transformation. Hence, the accurate diagnosis of this disorder is necessary. CASE PRESENTATION A 64-year-old Japanese man was observed to have a space-occupying lesion of 15-mm diameter in the liver during a follow-up examination for a previously resected cecal carcinoma. He underwent lateral segmentectomy of the liver with a provisional diagnosis of hepatic metastatic recurrence of the carcinoma based on gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging and diffusion-weighted imaging. CONCLUSIONS We have explored the combination of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging and histological examination to confirm our diagnosis of hepatic angiomyolipoma comprising an intimate mixture of numerous abnormal blood vessels, adipocytes, and epithelioid spindle cells of various sizes. Immunohistochemical examination revealed characteristic pathological findings associated with positive qualitative immunoreactions for human melanoma black 45 and desmin. Electron microscopic findings revealed the presence of melanosomes in the epithelioid cells. Diffusion-weighted imaging provides a more accurate diagnostic image with the characteristic macroscopic appearance of hepatic angiomyolipoma. Through immunohistochemistry and electron microscopy, we also show that this benign tumor comprises tissue elements.
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Affiliation(s)
- Hidefumi Kubo
- Department of Surgery, Kitasato University Medical Center, Kitamoto, Saitama, Japan
| | - Hitoshi Yamazaki
- Department of Pathology, Kitasato University Medical Center, Kitamoto-Saitama, Japan
| | - Takemichi Okada
- Department of Radiology, Kitasato University Medical Center, Kitamoto, Saitama, Japan
| | - Yoshihito Takahashi
- Department of Surgery, Kitasato University Medical Center, Kitamoto, Saitama, Japan
| | - Yatsushi Nishi
- Department of Surgery, Kitasato University Medical Center, Kitamoto, Saitama, Japan
| | - Hiroaki Yokomori
- Department of Internal Medicine, Kitasato University Medical Center, Saitama, Japan.
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24
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Son HJ, Kang DW, Kim JH, Han HY, Lee MK. Hepatic perivascular epithelioid cell tumor (PEComa): a case report with a review of literatures. Clin Mol Hepatol 2017; 23:80-86. [PMID: 28288506 PMCID: PMC5381835 DOI: 10.3350/cmh.2016.0034] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 06/30/2016] [Accepted: 07/13/2016] [Indexed: 01/02/2023] Open
Abstract
Hepatic perivascular epithelioid cell tumors (PEComas) are very rare. We report a primary hepatic PEComa with a review of the literature. A 56-year-old women presented with a nodular mass detected during the management of chronic renal failure and chronic hepatitis C. Diagnostic imaging studies suggested a nodular hepatocellular carcinoma in segment 5 of the liver. The patient underwent partial hepatectomy. A brown-colored expansile mass measuring 3.2×3.0 cm was relatively demarcated from the surrounding liver parenchyma. The tumor was mainly composed of epithelioid cells that were arranged in a trabecular growth pattern. Adipose tissue and thick-walled blood vessels were minimally identified. A small amount of extramedullary hematopoiesis was observed in the sinusoidal spaces between tumor cells. Tumor cells were diffusely immunoreactive for human melanoma black 45 (HMB45) and Melan A, focally immunoreactive for smooth muscle actin, but not for hepatocyte specific antigen (HSA).
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Affiliation(s)
- Hyun-Jin Son
- Department of Pathology, Eulji University School of Medicine, Daejeon, Korea
| | - Dong Wook Kang
- Department of Pathology, Eulji University School of Medicine, Daejeon, Korea
| | - Joo Heon Kim
- Department of Pathology, Eulji University School of Medicine, Daejeon, Korea
| | - Hyun Young Han
- Department of Radiology, Eulji University School of Medicine, Daejeon, Korea
| | - Min Koo Lee
- Department of Surgery, Cheju Halla General Hospital, Jeju, Korea
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25
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Melloul S, El Hajjam M, Julié C. A Subhepatic Calcified Cyst. Gastroenterology 2017; 152:488-489. [PMID: 28056349 DOI: 10.1053/j.gastro.2016.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 09/05/2016] [Indexed: 12/02/2022]
Affiliation(s)
- Sarah Melloul
- Department of Pathology, Ambroise Paré, Boulogne-Billancourt, France
| | - Mostafa El Hajjam
- Department of Radiology, Ambroise Paré, Boulogne-Billancourt, France
| | - Catherine Julié
- Department of Pathology, Ambroise Paré, Boulogne-Billancourt, France
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26
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Affiliation(s)
- David F Schaeffer
- Division of Anatomic Pathology, Vancouver General Hospital, Vancouver, BC Canada
| | - Michael P Poulin
- Division of Anatomic Pathology, Vancouver General Hospital, Vancouver, BC Canada
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27
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Tang D, Wang J, Tian Y, Li Q, Yan H, Wang B, Xiong L, Li Q. Hepatic perivascular epithelioid cell tumor: Case report and brief literature review. Medicine (Baltimore) 2016; 95:e5572. [PMID: 28002331 PMCID: PMC5181815 DOI: 10.1097/md.0000000000005572] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
RATIONAL Perivascular epithelioid cell tumor (PEComa) is a rare mesenchymal neoplasm which expresses both myogenic and melanocytic markers. PEComas are found in a variety locations in the body, but up to now only approximately 30 cases about hepatic perivascular epithelioid cell tumor are reported in English language worldwide. PATIENT CONCERNS A 32-year-old woman was admitted in our hospital with intermittent right upper quadrant pain for 1 month and recent (1 day) progressive deterioration. DIAGNOSES Based on the results of the laboratory examinations and the findings of the computed tomography, the diagnosis of hepatic hamartoma or the hepatocecullar carcinoma with hemorrhage was made. INTERVENTIONS The patient underwent a segmentectomy of the liver, and the finally diagnosis of hepatic PEComa was made with immunohistochemical confirmation with HMB-45 and SMA. OUTCOMES There is no clinical or radiographic evidence of recurrence 9 months after surgery. LESSONS This kind of tumor is extremely rare and the natural history of PEComa is uncertain, as the treatment protocol for hepatic PEComa has not reached a consensus. But the main treatment of the disease may be surgical resection. Only after long term follow-up can we know whether the tumor is benign or malignant. It appears that longer clinical follow-up is necessary in all patients with hepatic PEComas.
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Affiliation(s)
- Da Tang
- Department of General Surgery, Second Xiangya Hospital, Central South University
| | - Jianmin Wang
- Department of General Surgery, Second Xiangya Hospital, Central South University
| | - Yuepeng Tian
- Department of General Surgery, Second Xiangya Hospital, Central South University
| | - Qiuguo Li
- Department of General Surgery, the First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, P.R. China
| | - Haixiong Yan
- Department of General Surgery, Second Xiangya Hospital, Central South University
| | - Biao Wang
- Department of General Surgery, Second Xiangya Hospital, Central South University
| | - Li Xiong
- Department of General Surgery, Second Xiangya Hospital, Central South University
| | - Qinglong Li
- Department of General Surgery, Second Xiangya Hospital, Central South University
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Abstract
The authors present a first case of pigmented perivascular epithelioid cell tumor (PEComa) of the skin, which was misdiagnosed histopathologically as metastatic melanoma. PEComa are exceedingly rare neoplasms, and only a few cases have been reported in kidney, liver, and pelvis. Herein, we describe this very rare entity in the subcutaneous tissue of the flank with very similar if not identical morphology of renal clear cell carcinoma. Because of the presence of focal melanin pigmentation and strong positivity for HMB-45, the lesion was mistaken for metastatic melanoma. To the best of authors' knowledge, this is the first case of cutaneous PEComa with melanin pigmentation. Awareness about occurrence of the lesion in the subcutaneous tissue and its unique immunoprofile would be helpful to reach correct diagnosis and to distinguish this lesion from melanoma or metastatic renal clear cell carcinoma.
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29
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Choi YJ, Hong JH, Kim A, Kim H, Chang H. A Case of Malignant PEComa of the Uterus Associated with Intramural Leiomyoma and Endometrial Carcinoma. J Pathol Transl Med 2016; 50:469-473. [PMID: 27452081 PMCID: PMC5122724 DOI: 10.4132/jptm.2016.04.20] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 03/24/2016] [Accepted: 04/20/2016] [Indexed: 02/05/2023] Open
Abstract
Perivascular epithelioid cell tumors (PEComas) refers to a family of mesenchymal neoplasms composed of angiomyolipomas, clear cell “sugar” tumors of the lung, and lymphangioleiomyomatoses. These tumors have a distinctive and common component of perivascular epithelioid cells that show an association with blood vessel walls and immunohistochemically display myomelanocytic differentiation. The unique neoplasms have been shown to have an expanded range through a variety of case reports, including visceral, intra-abdominal, soft tissue, and bone tumors. The retroperitoneum, abdominopelvic region, and uterus have been reported to be the most common sites. Most PEComas follow a benign course. However, reports of malignant PEComas are increasing. Many papers have described uterine PEComas, but to our knowledge, there have not yet been any reports of a malignant PEComa arising concomitant with another epithelial tumor and mesenchymal tumor. We report herein the case of a 67-year-old woman who experienced a malignant uterine PEComa infiltrating a preexisting intramural leiomyoma with synchronous well differentiated endometrial carcinoma and multiple liver and lung metastases.
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Affiliation(s)
- Yoo Jin Choi
- Department of Pathology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jin Hwa Hong
- Department of Obsterics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Aeree Kim
- Department of Pathology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hankyeom Kim
- Department of Pathology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hyeyoon Chang
- Department of Pathology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
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30
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Handa A, Fujita K, Kono T, Komori K, Hirobe S, Fukuzawa R. Radiological findings of perivascular epithelioid cell tumour (PEComa) of the falciform ligament. J Med Imaging Radiat Oncol 2016; 60:741-743. [PMID: 27094767 DOI: 10.1111/1754-9485.12460] [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: 02/22/2016] [Accepted: 03/12/2016] [Indexed: 11/30/2022]
Abstract
Perivascular epithelioid cell tumour (PEComa) encompasses a group of mesenchymal tumours composed of histologically and immunohistochemically distinctive perivascular epithelioid cells. A subset of PEComa that typically arises from the falciform ligament and/or ligamentum teres is termed clear cell myomelanocytic tumour of the falciform ligament/ligamentum teres. To date, its imaging findings have not been described. Here, we report the first radiological description of a pathologically confirmed tumour. The patient was a 5-year-old girl with a palpable abdominal mass. US, CT, MR and FDG-PET revealed a midline, well-defined, solid anterior abdominal wall tumour below the rectus abdominis and contiguous with the umbilicus that was hypervascular and FDG avid. Awareness of these imaging findings facilitates the diagnosis of this distinctive tumour.
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Affiliation(s)
- Atsuhiko Handa
- Department of Radiology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Kazutoshi Fujita
- Department of Radiology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Tatsuo Kono
- Department of Radiology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Koji Komori
- Department of Surgery, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Seiichi Hirobe
- Department of Surgery, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Ryuji Fukuzawa
- Department of Pathology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
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31
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Rampisela D, Grossmann P, Donner LR. Rhabdoid Myomelanocytic Tumor (PEComa) of the Ovary. Int J Surg Pathol 2016; 24:431-5. [DOI: 10.1177/1066896916635815] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A 3.0 × 2.5 cm rhabdoid myomelanocytic tumor was incidentally found in the left ovary of a 43-year-old black woman. The tumor cells were cytologically bland with minimal proliferation rate, multifocally weakly or moderately expressed TFE3, strongly expressed smooth muscle markers and SMARCB1/INI1, and focally expressed HMB45. They contained numerous paranuclear whorls of intermediate filaments that were verified by ultrastructure. No other lines of differentiation were detected within the tumor. Neither translocation nor increased number of copies of the TFE3 gene at Xp11.22 was detected by fluorescence in situ hybridization. The patient remains well, free of tumor, 7 years after surgery. A rhabdoid variant of myomelanocytic tumor is a rarity, with only a single case described previously.
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Affiliation(s)
- Debby Rampisela
- Baylor Scott & White Health/Texas A&M Health Science Center College of Medicine, Temple, TX, USA
| | | | - Ludvik R. Donner
- Baylor Scott & White Health/Texas A&M Health Science Center College of Medicine, Temple, TX, USA
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32
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Angiomyolipoma and Malignant PEComa: Discussion of Two Rare Adrenal Tumors. Case Rep Oncol Med 2016; 2016:5204092. [PMID: 26998374 PMCID: PMC4779821 DOI: 10.1155/2016/5204092] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 01/26/2016] [Accepted: 01/31/2016] [Indexed: 12/26/2022] Open
Abstract
Angiomyolipoma and PEComa are rare tumors descending from perivascular epithelial cells (PECs), with distinctive IHC, morphological, and ultrastructural features. The kidney is the most frequent site of origin, but not the only one; however, adrenal gland angiomyolipomas are extremely rare. We describe two cases being found in the adrenal glands. Given the paucity of literature on the subject, more information on this disease is necessary for diagnosis and treatment. Here, we describe two complete case reports, from presentation to treatment and follow-up, along with imaging and microscopic pathology samples, and provide a comprehensive review as to the history and current literature available regarding these extremely rare tumors.
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33
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Phillips CH, Keraliya AR, Shinagare AB, Ramaiya NH, Tirumani SH. Update on the imaging of malignant perivascular epithelioid cell tumors (PEComas). Abdom Radiol (NY) 2016; 41:368-76. [PMID: 26867923 DOI: 10.1007/s00261-015-0568-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Malignant perivascular epithelioid cell tumors (PEComas) are a histologic group of mesenchymal neoplasms that share a distinctive histological phenotype, the perivascular epithelioid cell. These tumors are known for their perivascular distribution. Malignant PEComas have a female predominance and are associated with aggressive disease and poor prognosis, making timely diagnosis critical to management. Imaging features of malignant PEComas are nonspecific and mimic other benign and malignant neoplasms. Surgery is the mainstay in the management of malignant PEComas. Promising novel molecular targeted therapies like m-TOR inhibitors have been shown to be effective in the metastatic setting. The aim of this review is to familiarize radiologists with the imaging appearances of and potential therapies for primary and metastatic malignant PEComa.
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Affiliation(s)
- Catherine H Phillips
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Abhishek R Keraliya
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
- Department of Imaging, Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Atul B Shinagare
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
- Department of Imaging, Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Nikhil H Ramaiya
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
- Department of Imaging, Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Sree Harsha Tirumani
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
- Department of Imaging, Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA.
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34
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Hasan H, Howard AF, Alassiri AH, Ng TL, McGregor G, Goddard K. PEComa of the terminal ileum mesentery as a secondary tumour in an adult survivor of embryonal rhabdomyosarcoma. ACTA ACUST UNITED AC 2015; 22:e383-6. [PMID: 26628881 DOI: 10.3747/co.22.2265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Perivascular epithelioid cell tumours (pecomas) are rare mesenchymal tumours that are characterized by perivascular epithelioid cell differentiation and immunoreactivity to myogenic and melanocytic markers. These tumours can be classified as benign, uncertain malignant potential, or malignant. Because of the rarity of pecomas, their cause and clinical prognosis remain unclear. To the best of our knowledge, no reports in the literature describe a pecoma of the terminal ileum mesentery as a secondary tumour in an adult survivor of childhood embryonal rhabdomyosarcoma, let alone any childhood cancer. Here, we present the case of a 27-year-old man with a pecoma involving the mesentery of the terminal ileum. At the age of 5, he had been treated with a combination of chemotherapy and high-dose pelvic radiation therapy for embryonal rhabdomyosarcoma, most likely arising from the posterior bladder wall. During routine follow-up 22 years after this patient's initial treatment, computed tomography imaging revealed a mass within the terminal ileum mesentery. The tumour was successfully treated with surgical resection, and pathology examination determined the mass to be a pecoma with uncertain malignant potential. This first case of a pecoma of the terminal ileum mesentery arising within a high-dose radiation therapy field as a secondary tumour in an adult survivor of childhood cancer highlights the importance of screening and surveillance in high-risk childhood cancer survivors treated with high-dose radiation therapy. Further research to build a better understanding of this remarkably rare tumour is warranted.
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Affiliation(s)
- H Hasan
- Department of Radiation Oncology, BC Cancer Agency-Vancouver Centre, Vancouver, BC; ; Pediatric Oncology Group of Ontario, Toronto, ON
| | - A F Howard
- Department of Radiation Oncology, BC Cancer Agency-Vancouver Centre, Vancouver, BC; ; School of Population and Public Health, University of British Columbia, Vancouver, BC
| | - A H Alassiri
- Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, BC
| | - T L Ng
- Department of Anatomical Pathology, Vancouver General Hospital, Vancouver, BC
| | - G McGregor
- Division of Surgical Oncology, BC Cancer Agency, Vancouver, BC; ; Division of Surgical Oncology, Vancouver General Hospital, Vancouver, BC; ; Division of General Surgery, University of British Columbia, Vancouver, BC
| | - K Goddard
- Department of Radiation Oncology, BC Cancer Agency-Vancouver Centre, Vancouver, BC; ; Department of Surgery, University of British Columbia, Vancouver, BC
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35
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Abstract
Perivascular epitheloid cell tumors (PEComas) are rare tumors of malignant potential. There is no normal cell variant to these cells. The family is large and includes angiomyolipoma, clear cell “sugar” tumor amongst others. Imaging modalities are not very diagnostic. The diagnosis hence is often postoperative. A 55-year old female presented to us with ultrasonographic diagnosis of solid mass in the right infrarenal region. Contrast-enhanced computerized sonography (CECT) suggested paraganglioma or a soft tissue retroperitoneal tumor. Laparoscopic excision was successful. The rarity of this pathology and laparoscopic modality of excision prompted us to publish this report.
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Affiliation(s)
- Amol H Bhanushali
- Department of Surgery and Minimal Access surgery, Kaushalya Hospital, Thane, Maharashtra, India
| | - Abhay N Dalvi
- Department of Surgery and Minimal Access surgery, Kaushalya Hospital, Thane, Maharashtra, India
| | - Harikant S Bhanushali
- Department of Surgery and Minimal Access surgery, Kaushalya Hospital, Thane, Maharashtra, India
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36
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Abhirup B, Kaushal K, Sanket M, Ganesh N. Malignant hepatic perivascular epithelioid cell tumor (PEComa) - Case report and a brief review. J Egypt Natl Canc Inst 2015; 27:239-42. [PMID: 26071321 DOI: 10.1016/j.jnci.2015.05.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Revised: 05/21/2015] [Accepted: 05/22/2015] [Indexed: 01/12/2023] Open
Abstract
Perivascular epithelioid cell tumors (PEComas) are rare mesenchymal neoplasms which can arise from almost any location in the body. Diagnosing them pre-operatively is difficult as they mimic features of other hepatic neoplasms including hepatocellular carcinoma (HCC), fibrolamellar HCC, and focal nodular hyperplasia (FNH) among others. The unique feature of these tumors is the coexpression of muscle and melanocytic markers. These are identified immunohistochemically by the expression of Human Melanin Black-45 (HMB-45), Melan-A and Smooth Muscle Antigen (SMA) which are seen in the majority of tumors. The liver is uncommonly associated with a PEComa and the approach to a patient with hepatic PEComa is not well described. There is no consensus regarding the neo-adjuvant/adjuvant therapy in these patients. The natural history of this condition is not well documented making it an unpredictable disease. Here we have discussed a case and reviewed the literature concerning these rare tumors.
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Affiliation(s)
- Banerjee Abhirup
- P.D. Hinduja National Hospital and Medical Research Centre, Veer Savarkar Marg, Mahim, Mumbai, Maharashtra 400016, India.
| | - Kundalia Kaushal
- P.D. Hinduja National Hospital and Medical Research Centre, Veer Savarkar Marg, Mahim, Mumbai, Maharashtra 400016, India
| | - Mehta Sanket
- Saifee Hospital, No. 15/17, Maharshi Karve Road, Opp Charni Road Railway Station, Mumbai, Maharashtra 400004, India
| | - Nagarajan Ganesh
- P.D. Hinduja National Hospital and Medical Research Centre, Veer Savarkar Marg, Mahim, Mumbai, Maharashtra 400016, India
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37
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PEComa: morphology and genetics of a complex tumor family. Ann Diagn Pathol 2015; 19:359-68. [PMID: 26144278 DOI: 10.1016/j.anndiagpath.2015.06.003] [Citation(s) in RCA: 134] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Accepted: 06/04/2015] [Indexed: 12/20/2022]
Abstract
Perivascular epithelioid cell tumors, or PEComas, are mesenchymal neoplasms composed of histologically and immunohistochemically distinctive epithelioid or spindle cells, which are immunoreactive for both smooth muscle and melanocytic markers. The cells in PEComas are typically arranged around blood vessels and appear to form the vessel wall, often infiltrating the smooth muscle of small- to medium-sized vessels. Periluminal cells are usually epithelioid and the more peripheral cells are spindle shaped. The cells have small, round to oval nuclei, sometimes with focal nuclear atypia, and clear to eosinophilic cytoplasm, and no counterpart normal cell has been identified. The PEComa "family" now includes angiomyolipoma, pulmonary clear cell "sugar" tumor and lymphangioleiomyomatosis, primary extrapulmonary sugar tumor, clear cell myomelanocytic tumor of the falciform ligament/ligamentum teres, abdominopelvic sarcoma of perivascular epithelioid cells, and other tumors with similar features at various sites that are simply termed PEComa. Some PEComas occur in patients with tuberous sclerosis complex and share the genetic abnormalities. There is a behavioral spectrum from benign to frankly malignant, and histologic criteria have been proposed for assessing malignant potential. The differential diagnosis can include carcinomas, smooth muscle tumors, other clear cell neoplasms, and adipocytic tumors. PEComas constitute a genetically diverse group that includes neoplasms harboring TFE3 gene rearrangements and those with TSC2 mutations, indicating alternative tumorigenic pathways. Recent advances in therapy of malignant PEComas relate to increased knowledge of specific genetic changes and their effects on metabolic pathways that are susceptible to specific interventions. We review PEComas, emphasizing the diagnostic spectrum and recent immunohistochemical and genetic findings.
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38
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Liang W, Xu C, Chen F. Primary retroperitoneal perivascular epithelioid cell neoplasm: A case report. Oncol Lett 2015; 10:469-472. [PMID: 26171053 DOI: 10.3892/ol.2015.3210] [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] [Received: 08/12/2014] [Accepted: 04/27/2015] [Indexed: 12/21/2022] Open
Abstract
Perivascular epithelioid cell neoplasm (PEComa) is a rare type of tumor, and primary retroperitoneal PEComa is rarer still. The present report discusses the case of a 51-year-old woman who was admitted to hospital following stiffness and discomfort in the upper right abdomen for longer than one month. Computed tomography identified a soft tissue mass in the rear right kidney, accompanied by clear cystic degeneration and bleeding. The borderline between the mass and the right kidney was not distinct. An enhanced scan revealed that the solid section of the mass was progressively enhanced. Following excision of the mass and the affected right kidney, the patient was pathologically diagnosed with retroperitoneal PEComa involving the right kidney. Short-term reexamination did not detect any recurrence.
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Affiliation(s)
- Wenjie Liang
- Department of Radiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Chang Xu
- Department of Radiology, Hospital Affiliated to Binzhou Medical University, Binzhou, Shandong 256603, P.R. China
| | - Feng Chen
- Department of Radiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
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39
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Magnetic resonance imaging of less common pancreatic malignancies and pancreatic tumors with malignant potential. Eur J Radiol Open 2014; 1:49-59. [PMID: 26937427 PMCID: PMC4750607 DOI: 10.1016/j.ejro.2014.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 09/16/2014] [Accepted: 09/17/2014] [Indexed: 02/07/2023] Open
Abstract
Pancreatic tumors are an increasingly common finding in abdominal imaging. Various kinds of pathologies of the pancreas are well known, but it often remains difficult to classify the lesions radiologically in respect of type and grade of malignancy. Magnetic resonance imaging (MRI) is the method of choice for the evaluation of pancreatic pathologies due to its superior soft tissue contrast. In this article we present a selection of less common malignant and potentially malignant pancreatic neoplasms with their characteristic appearance on established MRI sequences with and without contrast enhancement.
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40
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A 6-year-old girl with vaginal spotting who was diagnosed with perivascular epithelioid cell neoplasm after vaginoscopic resection. Obstet Gynecol Sci 2014; 57:409-11. [PMID: 25264534 PMCID: PMC4175604 DOI: 10.5468/ogs.2014.57.5.409] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 04/08/2014] [Accepted: 04/09/2014] [Indexed: 12/18/2022] Open
Abstract
Perivascular epithelioid cell neoplasm (PEComa) is a rare tumor with unknown malignant potential. We report a case of a 6-year-old child with history of brain tumor (pineoblastoma), who presented with intermittent vaginal spotting for 6 months. A vaginoscopy revealed a 1.5×1.0-cm mass on the vaginal wall. Pathological examination demonstrated that the tumor was composed of clear cells with organoid patterns, which were immunohistochemically positive for HMB-45 and TFE3, and negative for CK, HNF1-B, SOX10, Melan A, and S-100 protein. These findings were consistent with PEComa arising from the vagina. Regular follow-up with magnetic resonance imaging has shown no signs of recurrence. This case shows that early detection of PEComa and subsequent regular follow-ups are important because of the neoplasm's unknown malignant potential.
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41
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Pizzi M, di Lorenzo I, d'Amore ES, D'Angelo P, Alaggio R. Pediatric gastrointestinal PEComas: a diagnostic challenge. Pediatr Dev Pathol 2014; 17:406-8. [PMID: 25020044 DOI: 10.2350/14-06-1501-cr.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Perivascular epithelioid cell tumors (PEComas) in the pediatric population are very rare and frequently arise in the gastrointestinal tract. These tumors are characterized by variable morphological and immunohistochemical features, which may pose significant problems in differential diagnosis with other gastrointestinal mesenchymal tumors in pediatric patients. In presenting an unusual pediatric case of gastrointestinal PEComa, we also discuss the possible differential diagnosis of this rare entity.
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Affiliation(s)
- Marco Pizzi
- 1 Department of Medicine-DIMED, General Pathology & Cytopathology Unit, University of Padova, Padova, Italy
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42
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Eken A, Saglican Y. Primary perivascular epithelioid cell tumour (PEComa) of the prostate. Can Urol Assoc J 2014; 8:E455-7. [PMID: 25024807 DOI: 10.5489/cuaj.1752] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Perivascular epithelioid cell tumours (PEComas) are a family of rare mesenchymal tumours arising in various anatomic locations. PEComas are defined by the presence of perivascular epithelioid cells that coexpress muscle and melanotic markers, especially HMB-45. They have unpredictable biological behaviour and are mostly benign, but some tumours can become unresectable or metastatic. Surgical resection, when possible, is the best treatment option. Radiation therapy, cytotoxic chemotherapy or immunotherapy have been reported as treatment options, either alone or in combination therapy. Prostatic PEComa is extremely rare, with only 1 malignant case reported. We report the first case of prostatic PEComa, which was benign and treated with transurethral resection.
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Affiliation(s)
- Alper Eken
- Acibadem Adana Hastanesi Urology Department, Adana, Turkey
| | - Yesim Saglican
- Acıbadem Maslak Hastanesi, Pathology Department, Istanbul, Turkey
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43
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Du S, Li Y, Mao Y, Sang X, Lu X, Wang W, Zhang Q, Xue H, Yang X, Li S, Chi T, Zhong S, Huang J. Diagnosis and treatment of hepatic angiomyolipoma. Hepatobiliary Surg Nutr 2014; 1:19-24. [PMID: 24570900 DOI: 10.3978/j.issn.2304-3881.2012.07.02] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 07/20/2012] [Indexed: 11/14/2022]
Abstract
BACKGROUND Hepatic angiomyolipoma (HAML) is a rare liver tumor. This paper summarized the clinical, radiological and pathological features of HAML. METHODS Seventeen cases of HAML were analyzed retrospectively. All patients were subjected to surgical resection of tumor, one of which was performed emergency surgery because of hemorrhage of tumor. RESULTS There are 13 females and 4 males, most of whom were asymptotic except 4 had minimal abdominal discomfort. US, CT and/or MRI were taken and corresponding data was comprehensively analyzed with other clinical signs and symptoms. Correct preoperative diagnosis was able to be achieved in 9 patients. Pathological analysis and immunohistochemistry of HMB-45 was used as final diagnosis. All patients were followed up and survived without recurrence. CONCLUSIONS Preoperative diagnosis of HAML can be benefited from comprehensive analysis of clinical manifestations. The malignant potential and fast growth of tumor suggested surgical removal of tumor while it was diagnosed.
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Affiliation(s)
- Shunda Du
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Ying Li
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Yilei Mao
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Xinting Sang
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Xin Lu
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Wenze Wang
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Qing Zhang
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Huadan Xue
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Xiaobo Yang
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Shaohua Li
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Tianyi Chi
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Shouxian Zhong
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Jiefu Huang
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
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PEComa: A Perivascular Epithelioid Cell Tumor in the Liver-A Case Report and Review of the Literature. Case Rep Med 2013; 2013:904126. [PMID: 24489554 PMCID: PMC3891746 DOI: 10.1155/2013/904126] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 11/07/2013] [Accepted: 11/21/2013] [Indexed: 12/30/2022] Open
Abstract
Perivascular epithelioid cell tumors are soft tissue tumors that can occur in various locations in the body whose incidence is rising. Hepatic PEComas are quite rare and diagnosis involves positivity of Melan-A and HMB45 on immunohistochemistry. Usual treatment is surgery for benign tumors and chemotherapy including mTOR inhibitors for malignant tumors. Here we discuss the radiological and pathological diagnosis, evaluation, and management of a hepatic PEComa. We describe a 51-year-old patient who was diagnosed incidentally after unusual physical exam findings.
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Abstract
BACKGROUND Trigeminal neuralgia was defined by the International Association for the Study of Pain as a sudden, usually unilateral, severe, brief, stabbing recurrent pain in the distribution of one or more branches of the fifth cranial nerve. Standard treatment is with anti-epileptic drugs. Non-antiepileptic drugs have been used in the management of trigeminal neuralgia since the 1970s. This is an update of a review first published in 2006 and previously updated in 2011. OBJECTIVES To systematically review the efficacy and tolerability of non-antiepileptic drugs for trigeminal neuralgia. SEARCH METHODS On 20 May 2013, for this updated review, we searched the Cochrane Neuromuscular Disease Group Specialized Register, CENTRAL (2013, Issue 4), MEDLINE (January 1966 to May 2013), EMBASE (January 1980 to May 2013), LILACS (January 1982 to May 2013) and the Chinese Biomedical Retrieval System (1978 to May 2013). We searched clinical trials registries for ongoing trials. SELECTION CRITERIA We included double-blind, randomised controlled trials in which the active drug was used either alone or in combination with other non-antiepileptic drugs for at least two weeks. DATA COLLECTION AND ANALYSIS Two authors decided which trials fitted the inclusion criteria and independently graded risk of bias. We assessed the quality of the evidence according to the GRADE criteria for this update. MAIN RESULTS In this 2013 update, we updated the searches, but identified only two new ongoing studies. The review includes four trials involving 139 participants. The primary outcome measure in each was pain relief. Three trials compared one of the oral non-antiepileptic drugs tizanidine, tocainide or pimozide with carbamazepine. The quality of evidence for all outcomes for which data were available was low. In a trial of tizanidine involving 12 participants (one dropped out due to unrelated disease), one of five participants treated with tizanidine and four of six treated with carbamazepine improved (risk ratio (RR) 0.30, 95% confidence interval (CI) 0.05 to 1.89). Few side effects were noted with tizanidine. For pimozide, there was evidence of greater efficacy than carbamazepine at six weeks. Up to 83% of participants reported adverse effects but these did not lead to withdrawal; the report did not provide comparable data for carbamazepine. Limited data meant that we could not assess the effects of tocainide; however, data from non-randomised studies (not included in this review) indicate that serious haematological adverse events can occur. A trial involving 47 participants compared 0.5% proparacaine hydrochloride eyedrops with placebo but did not show any significant benefits, again according to low-quality evidence. The report did not mention adverse events. The proparacaine trial was at low risk of bias; the other trials were at unclear risk of bias overall. AUTHORS' CONCLUSIONS There is low-quality evidence that the effect of tizanidine is not significantly different than that of carbamazepine in treating trigeminal neuralgia. Pimozide is more effective than carbamazepine, although the evidence is of low quality and the data did not allow comparison of adverse event rates. There is also low-quality evidence that 0.5% proparacaine hydrochloride eye drops have no benefit over placebo. Limitations in the data for tocainide prevent any conclusions being drawn. There is insufficient evidence from randomised controlled trials to show significant benefit from non-antiepileptic drugs in trigeminal neuralgia. More research is needed.
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Affiliation(s)
- Jingjing Zhang
- Department of Neurology, West China Hospital, Sichuan University, Wai Nan Guo Xue Xiang 37#, Chengdu, Sichuan, China, 610041
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Esheba GES, Esheba NES. Angiomyolipoma of the kidney: clinicopathological and immunohistochemical study. J Egypt Natl Canc Inst 2013; 25:125-34. [PMID: 23932749 DOI: 10.1016/j.jnci.2013.05.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 05/03/2013] [Accepted: 05/14/2013] [Indexed: 11/29/2022] Open
Abstract
OVERVIEW Although angiomyolipoma (AML) is a relatively rare entity, it is the most common benign mesenchymal neoplasm of the kidney. THE AIM OF THIS STUDY To highlight the clinicopathological characteristics of AML and to assess the role of Human Melanoma Black-45 (HMB-45), Melan-A, smooth muscle actin (SMA), S-100 and cytokeratin in its diagnosis. MATERIALS AND METHODS The study included 15 cases of AML. Clinical and radiological data were retrieved from the archival files and all cases were subjected to a histopathological evaluation as well as immunohistochemical staining for HMB-45, Melan-A, SMA, S-100, and cytokeratin. RESULTS AML was more common in females (female:male = 4:1), the mean age was 53.9 ± 6.45 years. 60% of patients were symptomatic while the remaining 40% were asymptomatic. A statistically significant relationship was found between size of the tumor and the presence of the symptoms (P = 0.02). Patients with tumor size less than 4 cm were asymptomatic, while those with tumor size larger than 4 cm had different symptoms. Thirteen cases were classic AML, while 2 cases were epithelioid AML. Classic AML demonstrated admixture of fatty tissue, thick-walled blood vessels, and smooth muscle, while epithelioid AML was composed mainly of epithelioid cells and contained no fat. HMB-45 was positive in all cases of AML (100%), Melan-A was positive in 13/15 (87%) while SMA was positive in 11/15 (73%) of AML with variable staining intensity. All cases of AML were negative for S-100 and cytokeratin. CONCLUSION AMLs have characteristic clinicopathological and immunohistochemical features and their recognition is crucial for proper diagnosis and treatment.
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Fisher C. Unusual myoid, perivascular, and postradiation lesions, with emphasis on atypical vascular lesion, postradiation cutaneous angiosarcoma, myoepithelial tumors, myopericytoma, and perivascular epithelioid cell tumor. Semin Diagn Pathol 2013; 30:73-84. [PMID: 23327731 DOI: 10.1053/j.semdp.2012.01.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
In recent years, a number of new soft tissue tumor entities have been described that occur in the skin only, or that also occur in other sites but form clinically and pathologically distinct subsets when arising in the skin and subcutaneous tissue. These include a variety of mesenchymal lineages and have variable malignant potential, although superficial malignant soft tissue tumors generally have a more favorable outcome than their more deeply located counterparts. This article reviews the clinical and pathologic features and differential diagnoses of atypical vascular lesion, postradiation cutaneous angiosarcoma, myoepithelioma, myopericytoma, and perivascular epithelioid cell tumor.
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Affiliation(s)
- Cyril Fisher
- Department of Histopathology, Royal Marsden Hospital, London, UK.
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Rao Q, Cheng L, Xia QY, Liu B, Li L, Shi QL, Shi SS, Yu B, Zhang RS, Ma HH, Lu ZF, Tu P, Zhou XJ. Cathepsin K expression in a wide spectrum of perivascular epithelioid cell neoplasms (PEComas): a clinicopathological study emphasizing extrarenal PEComas. Histopathology 2013; 62:642-50. [PMID: 23379905 DOI: 10.1111/his.12059] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 10/31/2012] [Indexed: 12/17/2022]
Abstract
AIMS Recent studies have demonstrated that cathepsin K seems to be a powerful marker in identifying renal perivascular epithelioid cell neoplasms (PEComas). However, the expression in extrarenal PEComas has not been well characterized due to their rare incidence. Our aim was to investigate the expression of cathepsin K in a wide spectrum of extrarenal PEComas and evaluate its potential diagnostic usefulness in comparison with other commonly used markers. METHODS AND RESULTS Twenty-three cases of PEComa (liver, n = 9; lung, n = 1; broad ligament of uterus, n = 1; vertex subcutaneous soft tissue, n = 1; abdominal wall, n = 1; and kidney, n = 10) were selected for study. All displayed a high percentage of cells with moderately to strongly positive reactions for cathepsin K (mean 91%; range 80-100%). HMB45, Melan-A and smooth muscle actin (SMA) were expressed in 78, 87 and 87% of cases, respectively, with various percentages of positive cells (mean, 34, 40 and 38%; range 0-80, 0-90 and 0-90%). Transcription factor E3 (TFE3) was expressed strongly in only three cases; none exhibited evidence of TFE3 gene fusion or amplification. CONCLUSIONS Cathepsin K appears to be more powerful than other commonly used markers in diagnosing a wide spectrum of PEComas and distinguishing them from the majority of human cancers.
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Affiliation(s)
- Qiu Rao
- Department of Pathology, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
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Yoo C, Kang CS, Choi YL, Kang HY, Kim JM, Koh YH, Lee JH, Lee SS, Kim IS, Kim DH, Park YK, Sohn JH. A proposal for creating a guideline for cancer registration of the fibromatosis, PEComa group, malignant lymphoma In Situ and dendritic cell tumors (III). KOREAN JOURNAL OF PATHOLOGY 2012; 46:436-42. [PMID: 23136570 PMCID: PMC3490119 DOI: 10.4132/koreanjpathol.2012.46.5.436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Revised: 08/10/2012] [Accepted: 08/20/2012] [Indexed: 11/17/2022]
Abstract
BACKGROUND Understanding the biologic behavior of a tumor is a prerequisite for tumor registration code assignment. The aim of this report was to propose appropriate behavior codes of the International Classification of Disease Oncology 3 (ICD-O3) to rare, yet pathologically interesting hematopoietic and soft tissue tumors. METHODS The Study Group for Hematopathology, the Bone and Soft Tissue Pathology Study Group, and the Cancer Registration Committee prepared the questionnaire containing provisional behavior codes of selected diseases. RESULTS In situ lesions of mantle cell and follicular lymphomas, dendritic cell tumors, and neoplasms with perivascular epithelioid cell differentiation (PEComa), not otherwise specified were classified as malignant (-/3). The fibromatosis group, with the exception of lipofibromatosis, was proposed as benign (-/0). Lipofibromatosis and several diseases that belong to the PEComa group were proposed as uncertain malignant potential (-/1). For the hematologic and soft tissue tumors, 274 and 288 members of the Korean Society of Pathologists, respectively, provided opinions through questionnaire, and most responders showed agreement with the provisional behavior code proposed. CONCLUSIONS The determination of behavior codes for the rare diseases described in this study, especially those of the PEComa group or malignant lymphoma, could be viewed as impractical and premature, but this study provides the basis for future research on this topic.
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Affiliation(s)
- Changyoung Yoo
- Department of Pathology, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea
- The Society of Bone and Soft Tissue Study Group, Seoul, Korea
| | - Chang Suk Kang
- Department of Pathology, Yeouido St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
- The Korean Study Group of Hematopathology, Seoul, Korea
| | - Yoon La Choi
- The Society of Bone and Soft Tissue Study Group, Seoul, Korea
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hye Yoon Kang
- The Society of Bone and Soft Tissue Study Group, Seoul, Korea
- Department of Pathology, Bundang CHA Hospital, CHA University College of Medicine, Seongnam, Korea
| | - Jin Man Kim
- The Korean Study Group of Hematopathology, Seoul, Korea
- Department of Pathology, Chungnam National University School of Medicine, Daejeon, Korea
- The Cancer Registration Committee of the Korean Society of Pathologist, Seoul, Korea
| | - Young Hye Koh
- The Korean Study Group of Hematopathology, Seoul, Korea
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joo Hee Lee
- The Korean Study Group of Hematopathology, Seoul, Korea
- Department of Pathology, Kyung Hee University School of Medicine, Seoul, Korea
| | - Seung Sook Lee
- The Korean Study Group of Hematopathology, Seoul, Korea
- Department of Pathology, Korea Cancer Center Hospital, Seoul, Korea
| | - In Sun Kim
- The Korean Study Group of Hematopathology, Seoul, Korea
- Department of Pathology, Korea University School of Medicine, Seoul, Korea
| | - Dong Hoon Kim
- The Society of Bone and Soft Tissue Study Group, Seoul, Korea
- Department of Pathology, Kangbuk Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong Ku Park
- The Society of Bone and Soft Tissue Study Group, Seoul, Korea
- Department of Pathology, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jin Hee Sohn
- The Cancer Registration Committee of the Korean Society of Pathologist, Seoul, Korea
- Department of Pathology, Kangbuk Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Fang CL, Lin YH, Chen WY. Microscopic endometrial perivascular epithelioid cell nodules: a case report with the earliest presentation of a uterine perivascular epithelioid cell tumor. Diagn Pathol 2012; 7:117. [PMID: 22937790 PMCID: PMC3487803 DOI: 10.1186/1746-1596-7-117] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2012] [Accepted: 08/29/2012] [Indexed: 12/24/2022] Open
Abstract
Abstract Perivascular epithelioid cell (PEC) tumors (PEComas) are a family of related mesenchymal tumors composed of PECs which co-express melanocytic and smooth muscle markers. Although their distinctive histologic, immunohistochemical, ultrastructural, and genetic features have been clearly demonstrated, their histogenesis and normal counterpart remain largely unknown. Precursor lesions of PEComas have rarely been reported. We herein describe a tuberous sclerosis patient with microscopic PEC nodules in the endometrium of adenomyosis, pelvic endometriosis, an ovarian endometriotic cyst, and the endometrium of the uterine cavity. The nodules showed a mixture of spindle-shaped and epithelioid cells concentrically arranged around small arteries. The cells exhibited uniform nuclei, light eosinophilic cytoplasm, and immunoreactivity with HMB-45 and CD10. Some nodules revealed continuity with a PEComa in the myometrium. These findings support microscopic endometrial PEC nodules possibly being precursor lesions of uterine PEComas. The wide distribution of the nodules in the pelvis may be related to the multicentricity of PEComas in tuberous sclerosis patients. Owing to the immunoreactivity with CD10, microscopic endometrial PEC nodules may be misinterpreted as endothelial stromal cells unless melanocytic markers are stained. To the best of our knowledge, this is a case with the earliest manifestation of PEC lesions occurring in the endometrium. Virtual Slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/9658280017862643
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Affiliation(s)
- Chia-Lang Fang
- Department of Pathology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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