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He Z, Wu J, Fu X, Li X, Xu H, Chen Y. CT and MRI Findings of Renal Angiomyolipoma With Lung Metastasis: A Case Report and Literature Review. THE CLINICAL RESPIRATORY JOURNAL 2024; 18:e13796. [PMID: 38982540 PMCID: PMC11233257 DOI: 10.1111/crj.13796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 06/02/2024] [Indexed: 07/11/2024]
Abstract
Renal angiomyolipoma has two histological variants: classical and epithelioid. Epithelioid angiomyolipoma is considered as a potential malignant tumor, often leading to recurrence and metastasis, with rapid progression in most of the cases. The lung is one of the most commonly reported sites of metastasis, and pulmonary metastasis of renal angiomyolipoma is usually diagnostic by computed tomography (CT) scans. Here, we report for the first time renal angiomyolipoma with lung metastasis by combining CT and magnetic resonance imaging (MRI).
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Affiliation(s)
- Zhiqiang He
- Department of RadiologyNanjing Gaochun People's HospitalNanjingChina
| | - Jing Wu
- Department of RadiologyNanjing First Hospital, Nanjing Medical UniversityNanjingChina
| | - Xiao ming Fu
- Department of RadiologyNanjing Gaochun People's HospitalNanjingChina
| | - Xiao ran Li
- Department of RadiologyNanjing Gaochun People's HospitalNanjingChina
| | - Hai Xu
- Department of RadiologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Yu‐Chen Chen
- Department of RadiologyNanjing First Hospital, Nanjing Medical UniversityNanjingChina
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2
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Campos MAG, Vasques LF, de Medeiros RG, Monteiro Cutrim ÉM, Favarin AJ, Silva SRM, Silva GEB, Moraes MPDT, Zanatta ML, Queiróz DAR. Malignant lung PEComa (clear cell tumor): rare case report and literature review. Front Oncol 2023; 13:1260844. [PMID: 37799476 PMCID: PMC10547894 DOI: 10.3389/fonc.2023.1260844] [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: 07/18/2023] [Accepted: 08/30/2023] [Indexed: 10/07/2023] Open
Abstract
Clear cell tumors of the lung (CCTL), or "sugar tumors" of lung, are very uncommon lesions and are mostly benign perivascular epithelioid cell (PEC) tumors with no specific morphologic features. Fewer than 100 cases have been reported; the aggressive nature demonstrated in sporadic reports has rarely been described in the literature. Although the course is generally described as benign, eight reported cases showed malignant behavior. We report a case of a PEC with a malignant presentation in a young man, correlating the main characteristics of the tumor with other cases reported in the literature to better elucidate this rare presentation. We also performed a literature review of reports on benign and malignant CCTL cases, with a focus on clinical, imaging, and immunohistochemical differentiation. CCTLs are rare tumors that require histopathological and immunohistochemical confirmation; to date, criteria that can predict malignant evolution are lacking.
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Affiliation(s)
| | | | | | | | - Ana Júlia Favarin
- Department of Internal Medicine, Hospital of Medical School of São Paulo State University, Botucatu, Brazil
| | | | - Gyl Eanes Barros Silva
- Laboratory of Immunofluorescence and Electron Microscopy, University Hospital of Federal University of Maranhão, São Luís, Brazil
| | | | - Mariana Lopes Zanatta
- Department of Internal Medicine, Hospital of Medical School of São Paulo State University, Botucatu, Brazil
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Pediatric Primary Ovarian PEComa: Morphological Approach and Diagnostic Challenges. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2023. [DOI: 10.1007/s40944-022-00676-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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4
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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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Muniraj F, Divyapriya C, Raghavan V, Radha RKN, Ramanujam S, Rajakumar SA. Cervical Angiomyolipoma Coexisting with Endometrial Carcinoma in the Absence of Tuberous Sclerosis: A Rare Case Report. Indian J Med Paediatr Oncol 2021. [DOI: 10.1055/s-0041-1733822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
AbstractAngiomyolipoma (AML) is a rare benign mesenchymal neoplasm composed of variable admixture of blood vessels, smooth muscle, and adipose tissue; most commonly located in kidney, and is usually associated with tuberous sclerosis. Extrarenal AML has been reported in various sites, although infrequently in female genital tract (FGT). AML in cervix is extremely rare and only six cases have been reported so far. A 46-year-old postmenopausal female presented with lower abdominal pain, bleeding for 4 days and a polypoidal mass protruding through the cervical os. Endometrial curettings were suggestive of endometrial adenocarcinoma—endometrioid type (World Health Organization [WHO]). The subsequent hysterectomy specimen confirmed the diagnosis and the histologic grade was International Federation of Obstetrics and Gynecology (FIGO) grade I and stage was pT1aN0 (American Joint Committee on Cancer [AJCC], 8th edition). Cervical polyp showed AML. CD34 and smooth muscle actin (SMA) showed diffuse positivity in blood vessels and smooth muscle cells, respectively. HMB-45 was negative. This is the first ever reported case of AML coexisting with endometrial carcinoma in the absence of tuberous sclerosis. CD34 is a good marker for delineating the blood vessels and SMA for both the smooth muscle and vascular components. S100 is generally not needed to prove the adipose tissue component. HMB-45 is not consistently expressed in AML of female genital tract.
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Affiliation(s)
- Femela Muniraj
- Department of Pathology, Chettinad Hospital and Research Institute, Rajiv Gandhi Road, Kelambakkam, Chengalpattu District, Tamil Nadu, India
| | - C Divyapriya
- Department of Pathology, Chettinad Hospital and Research Institute, Rajiv Gandhi Road, Kelambakkam, Chengalpattu District, Tamil Nadu, India
| | - Vijayashree Raghavan
- Department of Pathology, Chettinad Hospital and Research Institute, Rajiv Gandhi Road, Kelambakkam, Chengalpattu District, Tamil Nadu, India
| | - Rajesh Kanna Nandhagopal Radha
- Department of Pathology, Chettinad Hospital and Research Institute, Rajiv Gandhi Road, Kelambakkam, Chengalpattu District, Tamil Nadu, India
| | - Sailatha Ramanujam
- Department of Obstetrics & Gynecology, Chettinad Hospital and Research Institute, Rajiv Gandhi Road, Kelambakkam, Chengalpattu District, Tamil Nadu, India
| | - Shery Angel Rajakumar
- Department of Obstetrics & Gynecology, Chettinad Hospital and Research Institute, Rajiv Gandhi Road, Kelambakkam, Chengalpattu District, Tamil Nadu, India
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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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Abstract
Perivascular epithelioid cell tumor (PEComa) is a rare mesenchymal neoplasm characterized by expression of both melanocytic and smooth muscle markers. PEComas are rarely encountered in the female genital tract. We report a case of malignant primary PEComa of the ovary, and discuss the differential diagnosis. This represents the first case of primary typical malignant PEComa of the ovary.
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Gemcitabine and docetaxel in a patient with primary ovarian leiomyosarcoma: a case report and review of literature. Int Cancer Conf J 2017; 7:11-15. [PMID: 31149505 DOI: 10.1007/s13691-017-0309-7] [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: 04/27/2017] [Accepted: 09/06/2017] [Indexed: 12/23/2022] Open
Abstract
Primary ovarian leiomyosarcoma (POLMS) is extremely rare, and optimal therapy for this disease is unknown. A 40-year-old woman presented at a local hospital with abdominal pain. Tumor resection of the left ovary was performed. The pathological diagnosis was leiomyoma of the left ovary. Nine months after surgery, she developed of severe back pain and a subcutaneous tumor on her left shoulder. Magnetic resonance imaging and computed tomography revealed left ovarian tumor recurrence, pelvic bone metastasis, and multiple liver masses. Biopsy of the subcutaneous tumor on her left shoulder demonstrated metastatic leiomyosarcoma. The previously resected left ovarian tumor was re-examined, and the tumor was found to be a leiomyosarcoma. The patient received gemcitabine 800 mg/m2 and docetaxel 60 mg/m2 (GD therapy), administered at 3-week intervals. After three cycles of GD therapy, the patient experienced dyspnea and was diagnosed with mild interstitial pneumonia. Oral corticosteroid therapy resulted in complete symptom improvement. Thereafter, the dosage of GD was decreased, and after 13 cycles of GD therapy, radiofrequency ablation was performed twice for liver metastases. The tumors have shrunk by 65.5% after 23 cycles of GD. She remains alive after undergoing 24 cycles of GD. GD therapy may be effective for POLMS.
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McCluggage WG, Boyde A. Uterine Angioleiomyomas: A Report of 3 Cases of a Distinctive Benign Leiomyoma Variant. Int J Surg Pathol 2016; 15:262-5. [PMID: 17652533 DOI: 10.1177/1066896907302226] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
We report 3 cases of a distinctive uterine leiomyoma containing numerous thick-walled vascular channels, which we term angioleiomyoma. The leiomyomas occurred in women aged 33, 44, and 49 and ranged from 1.5 to 6.0 cm. They were composed of bland, spindle-shaped cells with numerous evenly distributed, arteriole-like vessels with thick muscular walls throughout. The spindle cells often swirled around the vessels. In 1 case, fibrin was present within vessel walls. The spindle cells were positive with smooth-muscle markers and negative with HMB45. We believe angioleiomyoma should be recognized as a distinct entity and included in the World Health Organization classification of tumors of the female genital tract as a benign leiomyoma variant, similar to cellular and atypical leiomyoma. Uterine angioleiomyoma has a close morphological resemblance to the similarly named skin tumor. We review uterine smooth-muscle and other mesenchymal neoplasms in which prominent vascular channels are a feature.
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Affiliation(s)
- W Glenn McCluggage
- Department of Pathology, Royal Group of Hospitals Trust, Belfast, and University of Wales, Cardiff, UK.
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10
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Fitzpatrick M, Pulver T, Klein M, Murugan P, Khalifa M, Amin K. Perivascular Epithelioid Cell Tumor of the Uterus with Ovarian Involvement: A Case Report and Review of the Literature. AMERICAN JOURNAL OF CASE REPORTS 2016; 17:309-14. [PMID: 27150246 PMCID: PMC4913755 DOI: 10.12659/ajcr.896401] [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] [Indexed: 11/09/2022]
Abstract
Patient: Female, 61 Final Diagnosis: Uterine PEComa with ovarian involvement Symptoms: Palpable abdominal mass Medication: — Clinical Procedure: Hysterectomy and bilateral salpingo-oophorectomy Specialty: Obstetrics and Gynecology
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Affiliation(s)
- Megan Fitzpatrick
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Tanya Pulver
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, Minneapolis, MN, USA
| | - Molly Klein
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Paari Murugan
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Mahmoud Khalifa
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Khalid Amin
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
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11
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He M, Deng YJ, Zhao DY, Zhang Y, Wu T. Synchronous leiomyosarcoma and fibroma in a single ovary: A case report and review of the literature. Oncol Lett 2016; 11:2510-2514. [PMID: 27073508 DOI: 10.3892/ol.2016.4241] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 12/15/2015] [Indexed: 12/17/2022] Open
Abstract
Primary ovarian leiomyosarcoma (POLMS) is a rare disease. To the best of our knowledge, only 72 cases, including the present case, have been reported in the English literature, while synchronous POLMS and fibroma in a single ovary have not previously been reported at all. In the present study, a 46-year-old premenopausal woman was diagnosed with a mass in the left ovary in 2005. A total of 5 years after the diagnosis of this mass, the patient was admitted to hospital exhibiting lower abdominal pain, and two masses were observed in the left ovary. An exploratory laparoscopy was performed. Frozen section analysis led to a diagnosis of fibroma. Furthermore, the observed second mass was hypothesized to be a malignant form of the original fibroma. A hysterectomy and bilateral salpingo-oophorectomy were performed. Pathological reports following surgery revealed concurrent stage Ic POLMS and fibroma in the left ovary. A total of 13 months after the initial surgery, recurrent leiomyosarcoma was detected. Although the patient underwent multiple cytoreductive surgeries and chemotherapy cycles, as well as interstitial brachytherapy and conventional therapy, a poor state of health ensued. Due to the rarity of POLMS, particularly in combination with ovarian fibroma, the current report presents a detailed overview of the literature and discusses a number of histogenetic and clinical issues.
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Affiliation(s)
- Meng He
- Department of Oncology, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116023, P.R. China
| | - Yan-Jie Deng
- Department of Gynecology, Dalian Women and Children's Health Hospital, Dalian, Liaoning 116033, P.R. China
| | - Dan-Yi Zhao
- Department of Oncology, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116023, P.R. China
| | - Yang Zhang
- Department of Oncology, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116023, P.R. China
| | - Tao Wu
- Department of Oncology, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116023, P.R. China
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Jones RG, Akande MY, Younes HK, Jagarpu J, Mba N, Savell VH, Almond SP. Yolk sac tumor of the ovary in a young girl with tuberous sclerosis: A case report and review of the literature. Gynecol Oncol Rep 2015; 10:9-12. [PMID: 26075992 PMCID: PMC4434146 DOI: 10.1016/j.gore.2014.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 07/28/2014] [Indexed: 11/30/2022] Open
Abstract
We reported the first tuberous sclerosis patient with an ovarian yolk sac tumor. Although angiomyolipoma is a common benign tumor in TS patients, abdominal malignancies must be considered.
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Affiliation(s)
- Riley G Jones
- Department of Surgery, Driscoll Children's Hospital, Corpus Christi, TX, USA
| | - Manzilat Y Akande
- Department of Pediatrics, Driscoll Children's Hospital, Corpus Christi, TX, USA
| | - Houssam K Younes
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Jawahar Jagarpu
- Deptartment of Pediatrics, Jackson Memorial Hospital, Miami, FL, USA
| | - Nkechi Mba
- Department of Pediatrics, Driscoll Children's Hospital, Corpus Christi, TX, USA
| | - Van H Savell
- Department of Pathology, Driscoll Children's Hospital, Corpus Christi, TX, USA
| | - Stephen P Almond
- Department of Surgery, Driscoll Children's Hospital, Corpus Christi, TX, USA
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13
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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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Conlon N, Soslow RA, Murali R. Perivascular epithelioid tumours (PEComas) of the gynaecological tract. J Clin Pathol 2015; 68:418-26. [PMID: 25750268 DOI: 10.1136/jclinpath-2015-202945] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 02/11/2015] [Indexed: 12/11/2022]
Abstract
Perivascular epithelioid tumours (PEComas) of the gynaecological tract are rare tumours which were first recognised and diagnosed within the last 20 years. They represent a unique diagnostic challenge with regard to their accurate and reproducible distinction from more common entities such as smooth muscle tumours of the uterine corpus. In this review article, we trace the development of the concept of the PEComa tumour family, highlight what is known about extra-gynaecological tract PEComa at an immunohistochemical, molecular and therapeutic level and then present a summary of all reported cases of gynaecological tract PEComa to date. In the summary, we highlight rare subtypes of gynaecological tract PEComa and compare the performances of extant prognostic classification systems for malignancy in these tumours.
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Affiliation(s)
- Niamh Conlon
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Robert A Soslow
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Rajmohan Murali
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Abstract
A wide variety of neoplasms of varying histogenesis occur within the ovary. We report the first case of a primary ovarian myoepithelioma, a diagnosis made on the basis of the morphologic features coupled with immunoreactivity with epithelial and myoid markers. The tumor had a lobulated appearance with variable architectural patterns including anastomosing cords, trabeculae, and nests of epithelioid to spindled tumor cells within a hyalinised and focally myxoid stroma. Fluorescence in situ hybridization for EWS gene rearrangement and reverse transcriptase polymerase chain reaction for EWSR1-POU5F1 and EWSR1-PBX1, molecular abnormalities which are found in some extrasalivary myoepitheliomas, were negative. In reporting this unique neoplasm, we discuss the wide differential diagnosis generated by the case.
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Shigenobu T, Kohno M, Emoto K, Hayashi Y. A Solitary Metastatic Lung Tumor Slow-Growing with Late Onset from Renal Epithelioid Angiomyolipoma. Ann Thorac Cardiovasc Surg 2014; 20 Suppl:445-8. [DOI: 10.5761/atcs.cr.13-00297] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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17
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Lee HY, Huang CW, Li CC, Wu WC, Liu TC, Wu CC, Tsai YF, Juan YS. Malignant renal epithelioid angiomyolipoma with an inferior vena cava and right atrium thrombus. UROLOGICAL SCIENCE 2012. [DOI: 10.1016/j.urols.2012.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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18
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Abstract
We describe a primary ovarian neoplasm, occurring in a 15-year-old female patient, with morphologic, immunohistochemical, and molecular genetic features identical to those of the very rare tumors of the kidney previously described as "melanotic Xp11 translocation renal cancer." This represents, to the best of our knowledge, the first report of a melanotic Xp11 translocation-associated neoplasm arising outside of the kidney. We discuss the relationship of these rare tumors to neoplasms showing perivascular epithelioid cell differentiation, in particular those showing TFE3 rearrangements.
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Cardiac Epithelioid PEComa: Report of Two Cases and Review of the Literature. Case Rep Med 2012; 2012:521678. [PMID: 22973317 PMCID: PMC3438758 DOI: 10.1155/2012/521678] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 07/28/2012] [Indexed: 02/06/2023] Open
Abstract
Cardiac PEComa is very rare. We reported two cases of epithelioid PEComas, one in an adult and one in a 2-year-old child. Both tumors were composed of sheets of epithelioid cells with coagulation necrosis. In addition, the adult case showed marked nuclear atypia and high mitotic activity with atypical mitosis and the pediatric case showed unusual clear cell features. Immunohistochemically, both tumors were positive for HMB-45 and SMA and negative for S100 and cytokeratin. Electron microscopy was performed in the pediatric case and showed premelanosomes. The adult patient developed extensive metastasis indicating malignant behavior. Prior to the two cases, only 5 other cases of cardiac PEComa were reported and the literatures are reviewed.
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20
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P N S, M S, S G, Sharma SK. Acute abdomen as an unusual presentation of broad ligament angiomyolipoma. A case report and review of literature. Indian J Surg Oncol 2012; 3:276-8. [PMID: 24293961 DOI: 10.1007/s13193-012-0169-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Accepted: 06/08/2012] [Indexed: 11/28/2022] Open
Affiliation(s)
- Shakuntala P N
- Department of Obstetrics and Gynaecology, St. Martha's Hospital, Bengaluru, India
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21
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Ovarian perivascular epithelioid cell tumor not otherwise specified with transcription factor E3 gene rearrangement: a case report and review of the literature. Hum Pathol 2012; 43:1126-30. [DOI: 10.1016/j.humpath.2011.10.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Revised: 10/19/2011] [Accepted: 10/21/2011] [Indexed: 11/21/2022]
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22
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Perivascular migration: a clue to the histogenesis of PEComas? Am J Dermatopathol 2011; 33:528-9. [PMID: 21587036 DOI: 10.1097/dad.0b013e3181f87d52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Epithelioid Clear Cell Smooth Muscle Tumor of the Ovary Presenting as a Mural Nodule in an Endometrioid Adenocarcinoma With Clear Cell Changes. Int J Gynecol Pathol 2011; 30:58-61. [DOI: 10.1097/pgp.0b013e3181f0c4fb] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Malignant Variant of Sclerosing Perivascular Epithelioid Cell Tumor Arising in the Adnexa. Int J Gynecol Pathol 2009; 28:589-93. [DOI: 10.1097/pgp.0b013e3181a3a4de] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Phongnarisorn C, Khunamornpong S, Pattamapaspong N, Srisomboon J. Laparoscopic Radical Excision of Primary Round Ligament Perivascular Epithelioid Cell Tumor Mimicking Leiomyoma. J Minim Invasive Gynecol 2009; 16:626-9. [DOI: 10.1016/j.jmig.2009.04.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Accepted: 04/30/2009] [Indexed: 10/20/2022]
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Zekry N, Rettenmaier MA, Abaid LN, John CR, Micha JP, Brown JV, Goldstein BH. Perivascular epithelioid cell neoplasms: a systematic review of prognostic factors. J Minim Invasive Gynecol 2009; 16:527-32. [PMID: 19596216 DOI: 10.1016/j.jmig.2009.04.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2009] [Revised: 04/22/2009] [Accepted: 04/30/2009] [Indexed: 10/20/2022]
Abstract
Perivascular epithelioid cell tumors (PEComas) are rare, soft tissue tumors characterized by epithelioid cells with clear or eosinophilic cytoplasm and a perivascular disbursement. We compiled the treatment and follow-up results from an extensive collection of reported gynecologic PEComa cases and statistically analyzed their respective therapy modalities and corresponding patient outcomes. In the group of patients with PEComa who received surgical management alone, there was a tendency for them to exhibit a lower disease recurrence rate. Conversely, patients with PEComa who initially received surgery and chemotherapy or radiation therapy were associated with a higher disease recurrence rate (P =.024). Metastatic involvement was related to higher patient mortality rates (P =.0001), although this finding was unrelated to treatment type. Surgical management alone may suffice for nonaggressive lesions, but chemotherapy and radiotherapy appear necessary for patients who present with high-risk histologic condition or metastatic disease. Because PEComas exhibit varying biologic behavior and an ill-defined presentation, the treatment for these lesions necessitates further evaluation.
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Affiliation(s)
- Nazila Zekry
- Hoag Memorial Hospital, Department of Pathology, Newport Beach, CA, USA
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Uterine perivascular epithelioid cell tumor coexisting with pulmonary lymphangioleiomyomatosis and renal angiomyolipoma: a case report. Appl Immunohistochem Mol Morphol 2008; 16:405-9. [PMID: 18528274 DOI: 10.1097/pai.0b013e318137a9c2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
We present a case of uterine perivascular epithelioid cell tumor (PEComa) coexisting with both pulmonary lymphangioleiomyomatosis and renal angiomyolipoma. The patient was a 42-year-old woman, suffering from massive abnormal uterine bleeding, progressive dyspnea, and arterial hypertension. Her clinical history included diagnoses of bilateral renal angiomyolipoma and pulmonary lymphangioleiomyomatosis. The patient underwent a subtotal hysterectomy and the specimen contained a subserosal tumor with irregular outlines in addition to uterine leiomyomata. The uterine tumor was histologically composed of solid sheets and tonguelike infiltration and lymphangioleiomyomalike structures within the myometrium, formed by epithelioid cells with ovoid to round nuclei and clear to light eosinophilic cytoplasms. The tumor did not display any morphologic sign of malignancy. The tumor cells showed expression of HMB-45 and smooth muscle markers. Ultrastructural analysis revealed abundant cytoplasmic microfilaments and rare small cytoplasmic bodies with a gridlike lining. We conclude that identification of lymphangioleiomyomalike growth pattern may aid in the differential diagnosis of uterine PEComa and suggest using both PEComa and smooth muscle tumor terminology.
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Froio E, Piana S, Cavazza A, Valli R, Abrate M, Gardini G. Multifocal PEComa (PEComatosis) of the Female Genital Tract Associated With Endometriosis, Diffuse Adenomyosis, and Endometrial Atypical Hyperplasia. Int J Surg Pathol 2008; 16:443-6. [DOI: 10.1177/1066896908316067] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The authors describe a case of multifocal perivascular epithelioid cell tumor (PEComa) arising in the pelvis of a 39-year-old woman affected by tuberous sclerosis. The tumor presented in the form of multiple fascicular, focally cystic nodules involving the uterine corpus, both ovaries, and the omentum. Microscopically, the nodules were composed of foci of adenomyosis and endometriosis (with focal atypical complex hyperplasia) associated with a stromal spindle cell population immunoreactive for HMB-45, smooth muscle actin, and estrogen and progesterone receptors. We interpret these foci as the result of a widespread proliferation of perivascular epithelioid cells (PEC). Because of the diffuse quality of the process, the designation of PEComatosis seems warranted.
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Affiliation(s)
- Elisabetta Froio
- Department of Pathology, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Simonetta Piana
- Department of Pathology, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy,
| | - Alberto Cavazza
- Department of Pathology, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Riccardo Valli
- Department of Pathology, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Martino Abrate
- Department of Obstetrics and Gynecology, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Giorgio Gardini
- Department of Pathology, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
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Perivascular epithelioid cell tumor (PEComa) of the uterus: an outcome-based clinicopathologic analysis of 41 reported cases. Adv Anat Pathol 2008; 15:63-75. [PMID: 18418088 DOI: 10.1097/pap.0b013e31816613b0] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The uterus and retroperitoneum have emerged as the most frequently reported anatomic sites of origin of perivascular epithelioid cell tumors (PEComas), a poorly defined neoplasm that is characterized by varying amounts of spindle and epithelioid cells with clear to eosinophilic cytoplasm that display immunoreactivity for melanocytic markers, most frequently HMB-45. Published reports on 41 previously reported uterine PEComas are reviewed in this report. Of these 41 cases, 31 originating in the corpus and for which there was adequate follow-up information (or clinical malignancy) were categorized into 2 groups: (1) a malignant group that was comprised of cases associated with patient death of disease and/or clinical malignancy as evidenced by local and/or distant extension outside of the uterus (n=13, group 1) and (2) a "nonmalignant" group of cases in which neither of the above features were present (n=18, group 2). Groups 1 and 2 did not significantly differ regarding duration of follow-up (25 mo vs. 24.3 mo, respectively, P=0.9) or patient age (45.61 y vs. 43.46 y, respectively, P=0.7). Five of the group 1 patients experienced distant (extra-abdominal) metastases. The group 1 tumors were significantly larger than the group 2 tumors (averages 9.6 cm vs. 4.67 cm respectively, P=0.04); however, there were no size thresholds that, in of themselves, reliably classified 75% or more of the cases in both groups. Coagulative necrosis was highly associated with group 1, being present in 82% of cases as compared with only 11.8% of group 2 cases (P=0.0002). Eighty-eight percent of the group 2 cases had a mitotic rate of <or=1/10 high power fields (HPF) as compared with 40% of group 1 cases (P=0.01). However, the absence of mitotic activity did not rule out malignancy, as 2 of the group 1 cases lacked mitotic activity and displayed metastases. Twenty-five percent, 49%, 56%, 73%, and 100% of tested cases displayed immunoreactivity for CD10, desmin, vimentin, smooth muscle actin, and caldesmon, respectively. PEComas are tumors of uncertain histogenesis and malignant potential that seem to display some morphologic and immunophenotypic overlap with smooth muscle neoplasia. A mitotic count of >1/10 HPF and/or coagulative necrosis are features that, if present, raise the definite potential for aggressive behavior.
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31
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Martignoni G, Pea M, Reghellin D, Zamboni G, Bonetti F. PEComas: the past, the present and the future. Virchows Arch 2007; 452:119-32. [PMID: 18080139 PMCID: PMC2234444 DOI: 10.1007/s00428-007-0509-1] [Citation(s) in RCA: 344] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2007] [Accepted: 09/06/2007] [Indexed: 01/04/2023]
Abstract
The perivascular epithelioid cell (PEC) is a cell type constantly present in a group of tumors called PEComas. PEC expresses myogenic and melanocytic markers, such as HMB45 and actin. Recently, recurrent chromosomal alterations have been demonstrated in PEC. At present, PEComa is a widely accepted entity. In the past 10 years, the use of this term has allowed to report and describe numerous cases permitting to start highlighting the biology of this group of lesions. PEComas are related to the genetic alterations of tuberous sclerosis complex (TSC), an autosomal dominant genetic disease due to losses of TSC1 (9q34) or TSC2 (16p13.3) genes which seem to have a role in the regulation of the Rheb/mTOR/p70S6K pathway. There are some open questions about PEComas regarding its histogenesis, the definition of epithelioid angiomyolipoma and the identification of the histological criteria of malignancy. An innovative therapeutic trial using rapamycin is under way for tumors occurring in TSC such as renal angiomyolipoma and lymphangioleiomyomatosis. Its success could provide the rationale for the use of the same drug in other lesions composed of PECs, especially in the malignant ones.
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Prasad SR, Sahani DV, Mino-Kenudson M, Narra VR, Humphrey PA, Menias CO, Chintapalli KN. Neoplasms of the Perivascular Epithelioid Cell Involving the Abdomen and the Pelvis. J Comput Assist Tomogr 2007; 31:688-96. [PMID: 17895778 DOI: 10.1097/rct.0b013e318031912f] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Neoplasms of the perivascular epithelioid cell (PEComas) represent a recently described heterogeneous group of mesenchymal tumors characterized by the presence of specific histological, immunohistochemical, and ultrastructural findings. The PEComas encompass a family of neoplasms that include angiomyolipomas, clear cell sugar tumors, and lymphangioleiomyomatosis. The PEComas demonstrate a wide spectrum of clinicobiological behavior and imaging findings. Perivascular epithelioid cell, as the name implies, is a unique cell that is characterized by perivascular distribution and epithelioid morphology. Perivascular epithelioid cell consistently shows immunoreactivity to melanocytic and smooth muscle markers including HMB-45 and actin. Abdominopelvic PEComas are found at a variety of somatic and visceral locations including kidney, liver, pancreas, gastrointestinal tract, genitourinary tract, peritoneum, and retroperitoneum. A subset of patients with abdominopelvic PEComas manifests tuberous sclerosis complex. In this paper, we review the histological spectrum and discuss the imaging findings of the PEComas that involve the abdomen and pelvis.
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Affiliation(s)
- Srinivasa R Prasad
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA.
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McClymont K, Brown I, Hussey D. Test and teach. 53. Diagnosis: An interesting retroperitoneal mass. Pathology 2007; 39:164-7. [PMID: 17365832 DOI: 10.1080/00313020601123847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Kelly McClymont
- Queensland Health Pathology Service, Royal Brisbane Hospital, Australia.
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Martignoni G, Pea M, Reghellin D, Zamboni G, Bonetti F. Perivascular epithelioid cell tumor (PEComa) in the genitourinary tract. Adv Anat Pathol 2007; 14:36-41. [PMID: 17198309 DOI: 10.1097/pap.0b013e31802e0dc4] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Perivascular epithelioid cell tumors (PEComas) are mesenchymal tumors composed of histologically, immunohistochemically, ultrastructurally, and genetically distinctive cells. PEComas have been described in different organs and are considered ubiquitous tumors. In this review we discuss recent informations related to PEComas in the genitourinary tract.
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Abstract
AIMS PEComa is a rare tumour developing from perivascular epithelioid cells (PEC) and is characterised by positive immunoreactivity for HMB45. Since PEComas are tumours having both a spindle cell component and an epithelioid and giant cell component, as seen in many sarcomas, as well as having a wide distribution in various organs and soft tissue, we reviewed cases originally diagnosed as sarcomas of the soft tissue in our institution and screened them by immunostaining for HMB45. METHODS Consecutive soft tissue sarcomas (31 tumours) retrieved from the Surgical Pathology file at our institution for a period of 3 years were submitted for immunostaining for HMB45. Cases with positive HMB45 immunostaining were submitted for further immunostaining for MART1, CD68, S100 protein, cytokeratin AE1/3, EMA, vimentin, MSA and CD117. RESULTS Of 31 sarcomas, three tumours in the group of 11 malignant fibrous histiocytomas (MFH) and unclassified sarcomas showed positive immunoreactivity for HMB45 and MART1 in 1-25% of tumour cells. The three tumours were located in the lower extremities and measured 8, 11 and 12 cm in diameter. Patient gender male:female was 2:1 and ages were 46, 56 and 60 years. Microscopically, the tumours were composed of a variable proportion of spindled cells, multinucleated cells and epithelioid cells disposed in diffuse sheets or nests. Mitotic figures and necrosis were frequent. The immunoreactivity was diffuse for CD68, focal for AE3 and EMA, negative or focal for MSA and CD117, and negative for S100 and AE1. All three patients developed lymph node or distant metastases and died of the disease within 1-2 years. CONCLUSIONS PEComa re-screened from the group of high grade sarcomas without definite differentiation range from pleomorphic to monomorphic cytohistopathological features. Immunostaining for HMB45 of unclassified sarcomas is useful for the classification of these tumours. They occur preferentially in the lower extremities and have a high malignant potential when associated with large size, tumoural necrosis and high mitotic activity.
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Affiliation(s)
- Kien T Mai
- Division of Anatomical Pathology, Department of Pathology and Laboratory Medicine, The Ottawa Hospital, Civic Campus, and University of Ottawa, Ottawa, Ontario, Canada.
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Jozwiak J, Jozwiak S. Giant Cells: Contradiction to Two-Hit Model of Tuber Formation? Cell Mol Neurobiol 2006; 27:251-61. [PMID: 16897363 DOI: 10.1007/s10571-006-9106-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2005] [Accepted: 03/08/2005] [Indexed: 12/25/2022]
Abstract
Tuberous sclerosis (TSC) is an autosomal dominant disease characterized by the formation of hamartomatous lesions in many organs, including brain, heart or kidneys. It has been found that TSC is caused by the mutation in one of the two tumor suppressor genes: TSC1 or TSC2, encoding hamartin and tuberin, respectively. According to Knudson's two-hit model of tumorigenesis, second-hit mutation and resulting loss of heterozygosity (LOH) of a tumor suppressor gene is necessary for tumor formation. In fact, LOH is commonly found in several types of hamartomas formed in the process of tuberous sclerosis, but, interestingly, not in brain lesions, containing characteristic giant cells. In this paper, we review literature covering origination of giant cells and present several hypotheses explaining why in spite of the presence of hamartin and tuberin, brain lesions form in TSC patients.
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Affiliation(s)
- Jaroslaw Jozwiak
- Department of Histology and Embryology, Center for Biostructure Research, Medical University of Warsaw ul., Chalubinskiego, Warsaw, Poland.
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Guo H, Keefe KA, Kohler MF, Chan JK. Juvenile granulosa cell tumor of the ovary associated with tuberous sclerosis. Gynecol Oncol 2006; 102:118-20. [PMID: 16516278 DOI: 10.1016/j.ygyno.2006.01.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2005] [Revised: 12/28/2005] [Accepted: 01/03/2006] [Indexed: 12/01/2022]
Abstract
BACKGROUND Tuberous sclerosis is a neurocutaneous syndrome characterized by benign tumors that can affect many organs. Juvenile granulosa cell tumors of the ovary are rare neoplasms that typically occur in the first three decades of life and have excellent prognosis for early-staged disease. CASE REPORT We report the first case of an 8-year-old white female with tuberous sclerosis and juvenile granulosa cell tumor of the ovary. She presented with a 20 x 22 cm pelvic mass and received a right salpingo-oophorectomy. Three months later, she recurred and underwent a left salpingo-oophorectomy, lymphadenectomy, and omentectomy followed by four cycles of Bleomycin, Etoposide, and Cisplatin chemotherapy. She is currently free of disease 8 years after her recurrence. CONCLUSION Treatment options and a review of the literature pertaining to juvenile ovarian granulosa cell tumors and tuberous sclerosis are discussed.
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Affiliation(s)
- Hongyan Guo
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Stanford University School of Medicine, 300 Pasteur Drive HH333, CA 94305, USA
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38
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Abstract
PEComas (tumours showing perivascular epithelioid cell differentiation) are a family of related mesenchymal neoplasms that include angiomyolipoma, lymphangiomyomatosis, clear cell "sugar" tumour of the lung, and a group of rare, morphologically and immunophenotypically similar lesions arising at a variety of visceral and soft tissue sites. These tumours all share a distinctive cell type, the perivascular epithelioid cell or "PEC' (which has no known normal tissue counterpart). PEComas show a marked female predominance and are composed of nests and sheets of usually epithelioid but occasionally spindled cells with clear to granular eosinophilic cytoplasm and a focal association with blood vessel walls. PEComas appear to arise most commonly at visceral (especially gastrointestinal and uterine), retroperitoneal, and abdominopelvic sites, with a subset occurring in somatic soft tissue and skin. Nearly all PEComas show immunoreactivity for both melanocytic (HMB-45 and/or melan-A) and smooth muscle (actin and/or desmin) markers. A subset of PEComas behave in a malignant fashion. This review examines the members of the PEComa family, with an emphasis on lesions arising outside of the kidney, lung and liver, and discusses preliminary evidence for pathological features that might predict malignant behaviour.
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Affiliation(s)
- J 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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39
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Bosincu L, Rocca PC, Martignoni G, Nogales FF, Longa L, Maccioni A, Massarelli G. Perivascular epithelioid cell (PEC) tumors of the uterus: a clinicopathologic study of two cases with aggressive features. Mod Pathol 2005; 18:1336-42. [PMID: 15920549 DOI: 10.1038/modpathol.3800433] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We report the clinicopathologic, immunohistochemical and ultrastructural features of two unusual tumors of the uterus composed of spindle and epithelioid cells strongly positive for HMB45. The two patients of 56 and 48 years of age had, respectively, hemoperitoneum and abnormal uterine bleeding. Morphologically, both tumors showed atypia and extensive necrosis. The neoplastic cells express immunohistochemically both melanogenesis (HMB45) and smooth muscle markers (actin). Ultrastructural analysis showed the presence of intracytoplasmic membrane-bound granules. We viewed these neoplasms as perivascular epithelioid cell (PEC) tumors with aggressive features. Follow-up has shown the death of one patient whereas the other is alive without disease 36 months after the surgery. The two patients were evaluated for signs of tuberous sclerosis complex, and findings were negative.
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40
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Jozwiak J, Jozwiak S. Giant Cells: Contradiction to Two-Hit Model of Tuber Formation? Cell Mol Neurobiol 2005; 25:795-805. [PMID: 16133934 DOI: 10.1007/s10571-005-4932-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2005] [Accepted: 03/08/2005] [Indexed: 12/20/2022]
Abstract
1. Tuberous sclerosis (TSC) is an autosomal dominant disease characterized by the formation of hamartomatous lesions in many organs, including brain, heart or kidneys. It has been found that TSC is caused by the mutation in one of two tumor suppressor genes: TSC1 or TSC2, encoding hamartin and tuberin, respectively. 2. According to Knudson's two-hit model of tumorigenesis, second-hit mutation and resulting loss of heterozygosity (LOH) of a tumor suppressor gene is necessary for tumor formation. In fact, LOH is commonly found in several types of hamartomas formed in the process of tuberous sclerosis, but, interestingly, not in brain lesions, containing characteristic giant cells. 3. In the present paper we review literature covering origination of giant cells and present several hypotheses explaining why in spite of the presence of hamartin and tuberin, brain lesions form in TSC patients.
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Affiliation(s)
- Jaroslaw Jozwiak
- Department of Histology and Embryology, Center for Biostructure Research, Medical University of Warsaw, and Department of Pediatric Neurology, Children's Memorial Hospital, Warsaw, Poland.
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41
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Jaffe JS, Chambers JT. Endometrial adenocarcinoma presenting in a premenopausal patient with tuberous sclerosis. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2005; 49:463-5. [PMID: 15882396 DOI: 10.1111/j.1365-2788.2005.00685.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND Endometrial adenocarcinoma is very uncommon in women under 40 years of age. CASE A 39-year-old woman with tuberous sclerosis and severe intellectual disability presented with irregular bleeding unresponsive to oral contraceptive therapy. She was subsequently found to have a deeply invasive endometrial adenocarcinoma. CONCLUSION Caregivers must pay particular attention to signs and symptoms in non-verbal patients. Persistent irregular bleeding on oral contraceptive therapy warrants additional evaluation.
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Affiliation(s)
- J S Jaffe
- Sharon Hospital, Sharon, CT 06069, USA.
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Abstract
Angiomyolipoma is a benign mesenchymal neoplasm that typically occurs in the kidney sporadically or in patients with tuberous sclerosis complex. Extrarenal angiomyolipomas are uncommon, and the liver is the most common extrarenal site. Other sites reported include the bone, colon, heart, lung, parotid gland, skin, spermatic cord, gynecologic regions, and retroperitoneum. A case of an angiomyolipoma involving the right adrenal gland in a 49-year-old female patient with tuberous sclerosis is reported. The magnetic resonance (MR) imaging features are also discussed. Only 2 cases describing adrenal angiomyolipoma were found in the English literature. Neither of these 2 cases was documented in the radiology literature or discussed the MR features of adrenal angiomyolipoma.
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Affiliation(s)
- Khaled M Elsayes
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA.
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Gronchi A, Diment J, Colecchia M, Fiore M, Santinami M. Atypical pleomorphic epithelioid angiomyolipoma localized to the pelvis: a case report and review of the literature. Histopathology 2004; 44:292-5. [PMID: 14987234 DOI: 10.1111/j.0309-0167.2004.01801.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
AIMS Angiomyolipoma is the most common mesenchymal tumour of the kidney. It has been reported in several other sites outside the kidney, mainly in the liver. We report the first case of atypical pleomorphic angiomyolipoma in a man, arising from the pouch of Douglas and extending to the entire abdominal cavity. METHODS A 17-year-old man underwent a complete resection of a giant abdominopelvic mass. The tissue was formalin fixed and paraffin embedded and 4 micro m thick histological sections were stained with haematoxylin-eosin. Immunohistochemical stains for HMB-45, smooth muscle actin, vimentin, calponin, S100 and desmin were performed. Sections for electron microscopy were also prepared. RESULTS Microscopic examination revealed a neoplasm composed of pleomorphic epithelioid cells with atypical features, immunoreactive for HMB-45, MART-1, actin, vimentin and calponin, while S100 protein and desmin stains were negative. Ultrastructurally, the tumour cells showed prominent nucleoli, vacuolated cytoplasm, and some premelanosomes. A diagnosis of atypical pleomorphic epithelioid angiomyolipoma was then made. CONCLUSIONS To date five patients with abdominal epithelioid angiomyolipoma have been described in the literature. All were women. Three of the five patients reported developed metastasis, while our patient is still free of disease at 16 months of follow-up. Clear prognostic pathological features have not been identified.
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Affiliation(s)
- A Gronchi
- Department of Surgery, National Cancer Institute of Milan, Milan, Italy.
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44
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Abstract
Renal angiomyolipomata can exist as an imaging curiosity or represent a life-threatening condition. There are likely over 10 million people world-wide who have a renal angiomyolipomata and approximately one tenth of these people also have tuberous sclerosis complex. The optimum treatment of angiomyolipomata is focused on sparing renal tissue and has included no intervention, both total and partial nephrectomy, and embolization. As basic science investigation into the biology of angiomyolipomata progresses, there is even hope for successful drug therapy. Because these renal lesions can be associated with other organ system dysfunction, a number of medical specialists become involved in the care of affected patients. The purpose of this article is to update the nephrologist on the molecular understanding of renal angiomyolipomata and for the possibilities of pharmacologic therapy in the future.
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Affiliation(s)
- John J Bissler
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229-3039, USA.
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45
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Tseng CA, Pan YS, Su YC, Wu DC, Jan CM, Wang WM. Extrarenal retroperitoneal angiomyolipoma: case report and review of the literature. ACTA ACUST UNITED AC 2004; 29:721-3. [PMID: 15185030 DOI: 10.1007/s00261-004-0179-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2003] [Accepted: 01/15/2004] [Indexed: 12/31/2022]
Abstract
Angiomyolipomas are rare benign tumors that usually occur in the kidneys. Extrarenal angiomyolipomas are extremely uncommon. We describe a case of angiomyolipoma arising in the retroperitoneum that was successfully treated by arterial embolization and surgical excision. The literature on retroperitoneal extrarenal angiomyolipoma and its differential diagnoses is briefly reviewed.
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Affiliation(s)
- C-A Tseng
- Division of Gastroenterology, Department of Internal Medicine, Buddhist Tzu Chi General Hospital, Dalin, Chia-Yi, Taiwan, People's Republic of China
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