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Requena DO, Velez-Torres JM, Diaz-Perez JA, Gomez-Fernandez C, Montgomery EA, Rosenberg AE. Mesenchymal Neoplasms of the Tongue: A Clinicopathologic Study of 93 Cases. Hum Pathol 2024:S0046-8177(24)00107-2. [PMID: 38876200 DOI: 10.1016/j.humpath.2024.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 06/06/2024] [Accepted: 06/11/2024] [Indexed: 06/16/2024]
Abstract
Neoplasms of the tongue are relatively common, and the vast majority are epithelial in phenotype. Although uncommon, a diverse and distinctive array of mesenchymal neoplasms arises in this anatomic site. To increase our understanding of these lesions, we reviewed our experience of MNs of the tongue and described their clinicopathologic features. The pathology archives from 2005-2021 and the consultation files of one of the authors were queried for all MNs of the tongue. We reviewed the histologic slides and ancillary studies and obtained clinical data from the available medical records. Ninety-three cases were identified, and they form the study cohort - to our knowledge, this is the largest series of mesenchymal neoplasms of the tongue. Forty-eight patients were female, and forty-five were male, with a mean age of 51 years (range: 1-94 years). The tumors included 43 (46.2%) hemangiomas, 14 (15%) granular cell tumors, 8 (9%) lipomas, 4 (4.3%) schwannomas, 4 (4.3%) solitary fibrous tumors - all with low risk of progression based on risk stratification criteria, 2 (2.2%) lymphangiomas, 3 (3.2%) Kaposi sarcomas, 2 (2.2%) chondromas, 2 (2.2%) myofibromas, 1 (1.1%) solitary circumscribed neuroma, 1 (1.1%) perineurioma, 1 (1.1%) neurofibroma, 1 (1.1%) ectomesenchymal chondromyxoid tumor, 1 (1.1%) atypical glomus tumor with a NOTCH2 rearrangement and TLL2 mutation, 1 (1.1%) spindle cell rhabdomyosarcoma, 1 (1.1%) pleomorphic fibroblastic sarcoma, 1 (1.1%) malignant rhabdoid tumor, 1 (1.1%) leiomyosarcoma, 1 (1.1%) angiosarcoma, and 1 (1.1%) alveolar soft part sarcoma. Most of the patients underwent surgical excision, and 1 patient (with hemangioma) underwent embolization. On follow-up, the patient with spindle cell rhabdomyosarcoma developed postoperative numbness at the surgical site and was disease-free through 17 months of follow-up. The patient with leiomyosarcoma declined adjuvant radiation and developed metastasis to the lung at 22 months. The patient with alveolar soft part sarcoma had metastases to the lung at the time of diagnosis and received adjuvant chemotherapy. The remaining patients had no local or distant recurrence. MNs of the tongue are usually benign and characterized by either endothelial, adipocytic, or schwannian differentiation. The mainstay of treatment is surgical excision with the extent of excision determined by tumor type. Adjuvant therapy is reserved for high-grade sarcomas.
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Affiliation(s)
- Domenika Ortiz Requena
- University of Miami Miller School of Medicine, Department of Pathology and Laboratory Medicine, Miami, Florida
| | - Jaylou M Velez-Torres
- University of Miami Miller School of Medicine, Department of Pathology and Laboratory Medicine, Miami, Florida
| | - Julio A Diaz-Perez
- Departments of Pathology, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Carmen Gomez-Fernandez
- University of Miami Miller School of Medicine, Department of Pathology and Laboratory Medicine, Miami, Florida
| | - Elizabeth A Montgomery
- University of Miami Miller School of Medicine, Department of Pathology and Laboratory Medicine, Miami, Florida
| | - Andrew E Rosenberg
- University of Miami Miller School of Medicine, Department of Pathology and Laboratory Medicine, Miami, Florida.
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2
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Hems T, Parafioriti A, Thomas BP, Di Bernardo A. An algorithmic approach to the management of peripheral nerve tumours. J Hand Surg Eur Vol 2024; 49:758-772. [PMID: 38534080 DOI: 10.1177/17531934241238739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
This article reviews the pathology and management of peripheral nerve tumours, including a framework for investigation and decision-making. Most tumours are benign, including schwannomas and neurofibromas, but malignant peripheral nerve sheath tumours can occur. The risk of malignant change is remote for schwannomas but higher for neurofibromas, particularly in neurofibromatosis type 1. Magnetic resonance imaging is useful for defining the relationship of a swelling with adjacent nerves but is not definitive for tissue diagnosis. Increasing size, pain and neurological deficit suggest malignant change and TruCut needle biopsy is indicated, although there is a risk of sampling error. Excision biopsy preserving nerve function may be carried out for benign tumours to relieve symptoms. Malignant tumours require a multidisciplinary approach. Complete surgical excision with clear margins is the only curative treatment and may be supplemented with radiotherapy and chemotherapy. However, prognosis remains poor, particularly for patients with neurofibromatosis.
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Affiliation(s)
- Tim Hems
- Scottish National Brachial Plexus Injury Service, Department of Orthopaedic Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| | | | - Binu P Thomas
- Paul Brand Centre for Hand Surgery, Christian Medical College Hospital, Vellore, Tamil Nadu, India
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Gavvala SN, Jenko N, Stevenson J, Shirodkar K, Vaiyapuri S, Botchu R. Test yourself answer: incidental hip lesion on PET-CT. Skeletal Radiol 2024; 53:1229-1231. [PMID: 38063891 DOI: 10.1007/s00256-023-04530-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 11/08/2023] [Accepted: 11/21/2023] [Indexed: 04/10/2024]
Affiliation(s)
- Sai Niharika Gavvala
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, UK
| | - N Jenko
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, UK
| | - J Stevenson
- Department of Orthopedic Oncology, Royal Orthopedic Hospital, Birmingham, UK
| | - K Shirodkar
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, UK
| | - S Vaiyapuri
- Department of Musculoskeletal Pathology, University Hospitals of Birmingham, Birmingham, UK
| | - R Botchu
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, UK.
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Kunugitani K, Ogiso S, Fujimoto M, Yoh T, Shirai H, Okumura S, Hirao H, Ishii T, Yoshida A, Hatano E. Malignant perineurioma derived from the retroperitoneum with an aggressive clinical course: a case report. Surg Case Rep 2024; 10:121. [PMID: 38739347 DOI: 10.1186/s40792-024-01915-9] [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: 04/02/2024] [Accepted: 04/29/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND Malignant perineurioma is a rare malignant counterpart of perineurioma derived from perineural cells. Resection is the primary option for the treatment of malignant perineuriomas; however, patients often develop recurrence after resection, and effective treatment for advanced or recurrent lesions needs to be established. This report describes a 51-year-old female with a rare malignant perineurioma in the retroperitoneum, which contributing valuable insights to the literature. CASE PRESENTATION The patient presented with abdominal distension and the imaging work-up revealed a huge hemorrhagic tumor in the retroperitoneum and obstruction of inferior vena cava by the tumor. The patient underwent surgery retrieving the tumor combined with left hemiliver and retrohepatic vena cava, which confirmed the diagnosis of a malignant perineurioma based on histopathological and immunohistochemical examination. Cancer gene panel testing identified mutations in NF2. Radiotherapy was administered for peritoneal dissemination 2 months after surgery, and the patient died from disease progression 6 months after surgery. CONCLUSIONS This rare case highlights the challenges in managing retroperitoneal malignant perineuriomas. The aggressive characteristics and limited treatment options for advanced malignant perineuriomas underscore the need for understanding the pathogenesis and developing effective systemic therapies. The identification of an NF2 mutation provides significant insights into potential therapeutic target.
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Affiliation(s)
- Ken Kunugitani
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogo-in Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Satoshi Ogiso
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogo-in Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan.
| | - Masakazu Fujimoto
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - Tomoaki Yoh
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogo-in Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Hisaya Shirai
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogo-in Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Shinya Okumura
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogo-in Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Hirofumi Hirao
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogo-in Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Takamichi Ishii
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogo-in Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
- Department of Surgery for Abdominal Oncology and Organ Regeneration, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Akihiko Yoshida
- Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Etsuro Hatano
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogo-in Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
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Giannini C, Righi A. Peripheral nerve tumors. HANDBOOK OF CLINICAL NEUROLOGY 2024; 201:251-271. [PMID: 38697744 DOI: 10.1016/b978-0-323-90108-6.00016-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
The chapter is focused on the neoplastic peripheral nerve lesions, which primarily involve "cranial and paraspinal nerves," as outlined in the CNS volume (WHO_Classification_of_Tumours_Editorial_Board, 2021). These include classic peripheral nerve sheath tumors such as schwannoma, neurofibroma, intraneural perineurioma, and malignant peripheral nerve sheath tumors, with their variants as well as new and more precisely defined entities, including hybrid nerve sheath tumors and malignant melanotic nerve sheath tumor (previously melanotic schwannoma).
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Affiliation(s)
- Caterina Giannini
- Division of Anatomic Pathology, Laboratory Medicine/Pathology and Neurosurgery, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, United States; Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, Bologna, Italy.
| | - Alberto Righi
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Suurmeijer AJH, Cleven AHG, Antonescu CR, Duckworth LA, Fritchie KJ, Billings SD, Dermawan JK. Novel EWSR1::GFI1B gene fusion in angiofibroma of soft tissue. Histopathology 2023; 83:959-966. [PMID: 37680034 DOI: 10.1111/his.15044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/09/2023]
Abstract
AIMS Angiofibroma of soft tissue is a benign soft tissue tumour characterised by bland spindle cells and a distinct branching vascular network. The majority of soft tissue angiofibromas harbour AHRR::NCOA2 gene fusions. Here we present three cases of EWSR1::GFI1B-fused soft tissue tumours that are morphologically most reminiscent of soft tissue angiofibroma. METHODS AND RESULTS All three cases presented in male patients with an age range of 35-78 years (median = 54 years). Two cases presented as subcutaneous nodules on the trunk (posterior neck and chest wall); one was an intramuscular foot mass. The tumours were unencapsulated nodules with infiltrative margins ranging from 2.2 to 3.4 cm in greatest dimension. Histologically, the tumours contained uniformly bland fibroblastic spindle cells with ovoid to fusiform nuclei and delicate cytoplasmic processes embedded in a myxoid to myxocollagenous stroma. All three cases were characterised by a thin-walled, branching vascular network evenly distributed throughout the tumour. Overt cytological atypia or conspicuous mitotic activity was absent. The spindle cells had an essentially null immunophenotype. By targeted RNA sequencing, an in-frame gene fusion between EWSR1 exons 1-7 and GFI1B exons 6-11 or 7-11 was detected in all three cases. The tumours were marginally excised. For all three cases, there were no documented local recurrence or distant metastases during a limited follow-up period of 6-10 months. CONCLUSIONS We propose that EWSR1::GFI1B may represent a novel fusion variant of soft tissue angiofibroma.
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Affiliation(s)
- Albert J H Suurmeijer
- Department of Pathology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Arjen H G Cleven
- Department of Pathology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Cristina R Antonescu
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lauren A Duckworth
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Karen J Fritchie
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Steven D Billings
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Josephine K Dermawan
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
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7
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Mittenzwei R, Yoda RA. Cytological features of cranial and paraspinal nerve Tumours. Cytopathology 2023. [PMID: 38041220 DOI: 10.1111/cyt.13339] [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: 09/16/2023] [Revised: 11/07/2023] [Accepted: 11/12/2023] [Indexed: 12/03/2023]
Abstract
The 2021 World Health Organization Classification of Central Nervous System Tumours introduced significant revisions to the categorization of paraspinal and nerve sheath tumours. This updated system encompasses seven tumour types: schwannoma, neurofibroma, perineurioma, hybrid nerve sheath tumours, malignant melanotic nerve sheath tumour, malignant peripheral nerve sheath tumour and cauda equina neuroendocrine tumour. This review provides an image-rich cytologic reference of these tumours, with particular emphasis on intraoperative smear preparations. Knowledge of the key cytological features of these tumours and their differential diagnoses will help guide classification of these challenging entities.
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Affiliation(s)
- Rhonda Mittenzwei
- King County Medical Examiner's Office, Seattle, Washington, USA
- Division of Neuropathology, Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Rebecca A Yoda
- Division of Neuropathology, Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
- Division of Cytopathology, Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
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8
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Lenartowicz KA, Smith BW, Jack MM, Wilson TJ, Klein CJ, Amrami KK, Spinner RJ. What is new in intraneural perineurioma? Acta Neurochir (Wien) 2023; 165:3539-3547. [PMID: 37684428 DOI: 10.1007/s00701-023-05765-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/18/2023] [Indexed: 09/10/2023]
Abstract
Since the initial description of intraneural (IN) perineurioma in 1964, advances in the understanding of the clinical presentation, diagnostic imaging, pathologic features, and genetic underpinnings have changed how this pathology is managed. IN perineuriomas are rare, benign peripheral nerve sheath tumors, most frequently coming to clinical attention when patients present with painless, progressive weakness or sensory loss in adolescence or young adulthood. The gold standard of diagnosis has traditionally been with targeted tissue biopsy demonstrating "pseudo-onion bulb" formation with positive epithelial membrane antigen (EMA) staining. However, modern magnetic resonance imaging is allowing some patients to forgo biopsy. Recent genetic studies of IN perineuriomas have demonstrated common TRAF7 point mutations and rare NF2 mutations, which may present targets for diagnosis or therapy in the future. Current advances have allowed for us to provide improved patient counseling with informed understanding for various clinical scenarios. With the workup and diagnosis now clearly defined, the next frontier is for improving the lives of patients with IN perineuriomas through the interaction between restoration of functional deficits and advances in our understanding of the genetics of this entity.
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Affiliation(s)
| | - Brandon W Smith
- Department of Neurosurgery, Duke University, Durham, NC, USA
| | - Megan M Jack
- Department of Neurosurgery, Cleveland Clinic, Cleveland, OH, USA
| | - Thomas J Wilson
- Department of Neurosurgery, Stanford University Medical Center, Stanford, CA, USA
| | | | | | - Robert J Spinner
- Departement of Neurologic Surgery, Mayo Clinic, Gonda 8-214, Rochester, MN, 55905, USA.
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Wangsiricharoen S, Gjeorgjievski SG, Bahrami A, Torres-Mora J, Zou YS, Michal M, Charville GW, Gross JM. Non-cutaneous syncytial myoepitheliomas are identical to cutaneous counterparts: a clinicopathologic study of 24 tumors occurring at diverse locations. Virchows Arch 2023; 483:665-675. [PMID: 37548750 DOI: 10.1007/s00428-023-03609-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/13/2023] [Accepted: 07/21/2023] [Indexed: 08/08/2023]
Abstract
AIMS Cutaneous syncytial myoepithelioma (CSM) is a rare myoepithelioma variant of skin, characterized by intradermal syncytial growth of spindle cells with a distinct immunophenotype of EMA and S100 positivity and infrequent keratin expression. While CSM was first described as a cutaneous tumor, singular non-cutaneous cases have since been reported in bone. We aimed to investigate the clinicopathological features of this variant across all anatomic sites through a large multi-institutional study. METHODS AND RESULTS We complied a total of 24 myoepitheliomas with syncytial growth from our files. The tumors occurred in 12 male and 12 female patients (M:F = 1:1), with a median age of 31 years (range, 9-69 years). While the majority of tumors (75%, n = 18) occurred in skin, a significant subset (25%, n = 6) arose in non-cutaneous sites, including bone (n = 3), bronchus/trachea (n = 2), and interosseous membrane of tibia/fibula (n = 1). Tumor size ranged from 0.4 to 5.9 cm. Clinical follow-up (7 patients; range 14-202 months; median 56.5 months) showed a single local recurrence 8 years after incomplete skin excision but no metastases; all patients were alive at the time of last follow-up without evidence of disease. Histologically, all tumors were pink at low-power and characterized by a syncytial growth of bland ovoid, spindled, or histiocytoid cells with eosinophilic cytoplasm and prominent perivascular lymphoplasmacytic inflammation. One-third displayed adipocytic metaplasia (8/24). Rare cytologic atypia was seen but was not associated with increased mitotic activity. All tumors expressed S100, SMA, and/or EMA. Keratin expression was absent in most cases. Molecular analysis was performed in 16 cases, all showing EWSR1-rearrangments. In total, 15/15 (100%) harbored an EWSR1::PBX3 fusion, whereas 1 case EWSR1 FISH was the only molecular study performed. CONCLUSION Syncytial myoepithelioma is a rare but recognizable morphologic variant of myoepithelioma which may have a predilection for skin but also occurs in diverse non-cutaneous sites. Our series provides evidence supporting a reappraisal of the term "cutaneous syncytial myoepithelioma," as 25% of patients in our series presented with non-cutaneous tumors; thus, we propose the term "syncytial myoepithelioma" to aid pathologist recognition and avoidance of potentially confusing terminology when referring to non-cutaneous examples. The behavior of syncytial myoepithelioma, whether it arises in cutaneous or non-cutaneous sites, is indolent and perhaps benign with a small capacity for local recurrence.
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Affiliation(s)
| | | | - Armita Bahrami
- Department of Pathology, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Ying S Zou
- Department of Pathology, Johns Hopkins University School of Medicine, 401 N Broadway, Weinberg Building 2245, Baltimore, MD, 21231, USA
| | - Michael Michal
- Department of Pathology, Faculty of Medicine in Plzen, Charles University, Pilsen, Czech Republic
- Bioptical Laboratory, Ltd., Pilsen, Czech Republic
| | - Gregory W Charville
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - John M Gross
- Department of Pathology, Johns Hopkins University School of Medicine, 401 N Broadway, Weinberg Building 2245, Baltimore, MD, 21231, USA.
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10
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Sharma AE, Kerr DA, Cipriani NA. Small biopsies in the head and neck: Bone and soft tissue. Semin Diagn Pathol 2023; 40:353-370. [PMID: 37453847 DOI: 10.1053/j.semdp.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 04/30/2023] [Accepted: 06/21/2023] [Indexed: 07/18/2023]
Abstract
Bone and soft tissue lesions in the head and neck encompass not only a broad morphologic spectrum but also significant inherent clinicopathologic overlap. Epidemiology, radiology, and location - similar to the diagnostic assessment in other sites - are especially important considerations in the context of an established mesenchymal proliferation. Herein, the approach towards diagnosis is stratified by morphology (spindle, sarcomatoid, epithelioid, round cell), cellular lineage (fibroblastic, nerve sheath, rhabdomyogenic), and tumor grade (benign, low- to high-grade malignant) as the basis of further immunohistochemical or molecular investigation.
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Affiliation(s)
- Aarti E Sharma
- Hospital for Special Surgery, New York, NY, United States
| | - Darcy A Kerr
- Dartmouth Hitchcock Medical Center, Lebanon, NH, United States
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11
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Agaimy A, Perret R, Demicco EG, Gross J, Liu YJ, Azmani R, Engelmann C, Schubart C, Seppet J, Stoehr R, Le Loarer F, Dickson BC. GAB1::ABL1 fusions define a distinctive soft tissue neoplasm, with variable perineurial differentiation, and a predilection for children and young adults. Genes Chromosomes Cancer 2023; 62:449-459. [PMID: 36744864 DOI: 10.1002/gcc.23131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/14/2023] [Accepted: 02/01/2023] [Indexed: 02/07/2023] Open
Abstract
Although well known as a fusion partner in hematological malignancies, fusion genes involving the ABL proto-oncogene 1 (ABL1), mapping to chromosomal region 9q34.12, have only been anecdotally reported in five soft tissue tumors. These neoplasms have been variously reported as perineurioma, angiofibroma, and solitary fibrous tumor, and all have harbored a GAB1::ABL1 gene fusion; however, the nosology and clinicopathological characteristics of soft tissue tumors carrying this rare fusion have not been delineated. We herein describe eight tumors containing the GAB1::ABL1 fusion and review previously reported cases in a series to define their morphological spectrum, address immunohistochemical evidence for a line of differentiation, with special reference to the presence or absence of a perineurial immunophenotype, and gather insight into their behavior. The patients included four females and four males, aged 13-37 years (median, 24 years). Two cases each originated in the shoulder area, trunk, hands, and lower extremities, with a size range of 1.5-8 cm (median, 3.4 cm). Four tumors were deep and four superficial. All tumors were morphologically similar, being composed of bland fibroblast-like spindle to ovoid cells diffusely arranged in a paucivascular fibrous to fibromyxoid stroma with variable resemblance to soft tissue perineurioma. Mitotic activity was generally low (0-8 mitoses in 10 high-power fields [HPFs]; median, 1). All lesions had at least focally infiltrative margins, but they otherwise lacked pleomorphism and necrosis. Immunohistochemistry showed focal reactivity for CD34 (5/7), epithelial membrane antigen (EMA) (3/8), claudin1 (2/3), GLUT1 (4/6), and S100 (2/7); other markers, including MUC4 (0/7), desmin (0/9), and smooth muscle actin (SMA) (0/4), were negative. RNA sequencing revealed a GAB1::ABL1 fusion in all cases with exon 6 of GAB1 fused to exon 2 of ABL1. Treatments included various forms of surgical intervention in seven cases; one tumor was biopsied only. Limited follow-up was available for five patients. One tumor regrew rapidly within 1 month to 1.5 cm after an initial marginal excision and was re-excised with close margins. Four patients were disease-free at 1, 3, 14, and 25 months of follow-up. Metastases have not, to date, been observed. This series characterizes "GAB1::ABL1 fusion-positive spindle cell neoplasm" as a distinct entity, with overlapping features with soft tissue perineurioma and predilection for children and young adults.
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Affiliation(s)
- Abbas Agaimy
- Institute of Pathology, Erlangen University Hospital, Comprehensive Cancer Center, European Metropolitan Area Erlangen-Nuremberg (CCC ER-EMN), Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Raul Perret
- Department of Biopathology, Institut Bergonié, Comprehensive Cancer Center, Bordeaux, France
| | - Elizabeth G Demicco
- Department of Pathology & Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - John Gross
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Yajuan J Liu
- Department of Laboratory Medicine and Pathology, Clinical Genomics Laboratory, University of Washington School of Medicine, Seattle, Washington, USA
| | - Rihab Azmani
- Bioinformatics, Data and Digital Health Department, Institut Bergonié, Comprehensive Cancer Center, Bordeaux, France
| | - Carsten Engelmann
- Department of Pediatric Surgery, Brandenburg Clinic Center, Berlin, Germany
| | - Christoph Schubart
- Institute of Pathology, Erlangen University Hospital, Comprehensive Cancer Center, European Metropolitan Area Erlangen-Nuremberg (CCC ER-EMN), Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Joosep Seppet
- Pathology Department, Tartu University Hospital, Tartu, Estonia
| | - Robert Stoehr
- Institute of Pathology, Erlangen University Hospital, Comprehensive Cancer Center, European Metropolitan Area Erlangen-Nuremberg (CCC ER-EMN), Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - François Le Loarer
- Department of Biopathology, Institut Bergonié, Comprehensive Cancer Center, Bordeaux, France
- Bordeaux Institute of Oncology, BRIC U1312, INSERM, Université de Bordeaux, Institut Bergonié, Bordeaux, France
| | - Brendan C Dickson
- Department of Pathology & Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
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12
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Uchimura K, Anan T, Fukumoto T. Epithelioid perineurioma of the vulva: A case report. J Dermatol 2023; 50:e226-e227. [PMID: 36794566 DOI: 10.1111/1346-8138.16748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 01/17/2023] [Accepted: 01/31/2023] [Indexed: 02/17/2023]
Affiliation(s)
| | - Takashi Anan
- Sapporo Dermatopathology Institute, Hokkaido, Japan
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Kasago I, Aypar U, Sukhadia P, Vanderbilt C, Ladanyi M, Hurd T, Pulitzer M. A novel case of cutaneous myxoid spindle cell neoplasm with FMR1-ALK gene fusion and CD34/S100 co-expression. J Cutan Pathol 2023; 50:505-510. [PMID: 36325885 PMCID: PMC10154434 DOI: 10.1111/cup.14354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 10/29/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022]
Abstract
A novel class of superficial CD34+ and S100+ cutaneous spindle cell neoplasm harboring ALK rearrangements has recently been described. Morphologically, these neoplasms have been characterized by bland spindled cells organized in whorls and cords against myxoid stroma, eventuating in the designation "superficial ALK-rearranged myxoid spindle cell neoplasm." Here, we report a 78-year-old male with a 3-mm pink papule on the chest, clinically concerning for cutaneous carcinoma. Biopsy of the specimen showed a biphasic tumor with hypercellular and hypocellular zones consisting of epithelioid cells and monomorphic, bland spindled cells. The spindled cells were arranged in perineurial-like concentric whorls and cords embedded in a myxo-collagenous stroma. Neoplastic cells were diffusely positive for CD34, S100, and D5F3-ALK, without SOX10 expression. Negative markers included GLUT1, EMA, factor XIIIa, desmin, actin, and SMA. ALK-rearrangement was identified on fluorescence in situ hybridization break-apart assay. A corresponding novel FMR1-ALK fusion was found by next-generation sequencing (NGS) based RNA sequencing. Identification of this new FMR1-ALK fusion signature adds to the spectrum of diagnostic genomic alterations in this newly described class of tumors.
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Affiliation(s)
- Israel Kasago
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Umut Aypar
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Purvil Sukhadia
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Chad Vanderbilt
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marc Ladanyi
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tierra Hurd
- Department of Medicine, Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Melissa Pulitzer
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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14
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Andrei V, Haefliger S, Baumhoer D. Superficial mesenchymal tumours expressing epithelial markers on immunohistochemistry: Diagnostic clues and pitfalls. Semin Diagn Pathol 2023:S0740-2570(23)00044-8. [PMID: 37147159 DOI: 10.1053/j.semdp.2023.04.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 04/24/2023] [Indexed: 05/07/2023]
Abstract
The diagnosis of mesenchymal neoplasms arising in the superficial soft tissue can be challenging as some entities are rare and show overlapping features. Moreover, the spectrum of mesenchymal tumours has expanded recently to include potential new entities, some of which have been described after the 5th edition of the World Health Organisation (WHO) classification of soft tissue and bone tumours published in 2020. In the skin and superficial soft tissue, tumours of epidermal, melanocytic and appendageal origin are more commonly encountered than mesenchymal neoplasms. However, specific entities from the latter category can occasionally express epithelial markers on immunohistochemistry, some of them in a strong and diffuse manner. It is therefore crucial to be aware of diagnostic pitfalls when encountering cytokeratin positivity in superficial soft tissue neoplasms. This article provides an overview on the differential diagnosis of these mesenchymal tumours that can sporadically occur also in the skin, including myoepithelial neoplasms, epithelioid sarcoma, keratin positive giant cell tumour of soft tissue / xanthogranulomatous epithelial tumour, superficial CD34-positive fibroblastic tumour / PRDM10-rearranged soft tissue tumour, and perineurioma.
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Affiliation(s)
- Vanghelita Andrei
- Bone Tumour Reference Centre, Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Schoenbeinstrasse 40, 4031 Basel, Switzerland
| | - Simon Haefliger
- Bone Tumour Reference Centre, Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Schoenbeinstrasse 40, 4031 Basel, Switzerland
| | - Daniel Baumhoer
- Bone Tumour Reference Centre, Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Schoenbeinstrasse 40, 4031 Basel, Switzerland.
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15
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Lenartowicz KA, Monie DD, Amrami KK, Klein CJ, Giannini C, Spinner RJ. Hybrid tumors with perineurioma components: a systematic review of the literature and illustrative case. Acta Neurochir (Wien) 2023; 165:935-945. [PMID: 36396843 PMCID: PMC10073291 DOI: 10.1007/s00701-022-05413-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 10/26/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE Hybrid peripheral nerve sheath tumors (HPNST) are a newly recognized class of peripheral nerve sheath tumor, composed of at least two areas characteristic of perineurioma, schwannoma, or neurofibroma. The literature consists only of case reports and small series; therefore, we present an illustrative case and an analysis of all reported cases of HPNST with a perineurioma component in the literature. METHODS A systematic search of the literature was performed to identify all reported cases of hybrid perineurioma-schwannoma or perineurioma-neurofibroma in the world's literature. Individual cases were analyzed for demographics, clinical features, imaging, and outcomes. RESULTS A total of 159 cases were identified across 41 studies. Hybrid tumors tended to present in mid-adulthood (median 38.5 years), predominantly affected females (57%, 89/156), as a painless (63%, 63/100) mass, or swelling. Ten patients (10/74, 14%) had a history of neurofibromatosis 1, and 2 patients a history of neurofibromatosis 2 (2/74, 3%). The majority (78%, 122/157) of cases occurred superficially, most commonly in the lower extremity (25%, 39/157). Perineurioma-schwannoma was the most reported (86%, 137/159) pathologic diagnosis, with 3 cases presenting with malignant features. Two cases reocurred after resection. CONCLUSION HPNST tend to occur in mid-adulthood and present as slowly progressive, painless, superficial masses, with a heterogeneous appearance on imaging. These entities pose a unique diagnostic challenge and likely remain under-recognized in the literature and current clinical practice. They pose low risk of recurrence or malignant transformation, and future work regarding the association with neurofibromatosis and genetic profiles is needed.
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Affiliation(s)
- Karina A Lenartowicz
- Mayo Clinic Alix School of Medicine, Mayo Clinic, 200 First St SW, MN, 55905, Rochester, USA
| | - Dileep D Monie
- Mayo Clinic Alix School of Medicine, Mayo Clinic, 200 First St SW, MN, 55905, Rochester, USA
| | - Kimberly K Amrami
- Department of Radiology, Mayo Clinic, 200 First St SW, MN, 55905, Rochester, USA
| | - Christopher J Klein
- Department of Neurology, Mayo Clinic, 200 First St SW, MN, 55905, Rochester, USA
| | - Caterina Giannini
- Department of Anatomic Pathology, Mayo Clinic, 200 First St SW, MN, 55905, Rochester, USA
| | - Robert J Spinner
- Department of Neurologic Surgery, Mayo Clinic, 200 First St SW, MN, 55905, Rochester, USA.
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16
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Capitanio JF, Mortini P. Other Less Prevalent Tumors of the Central Nervous System. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1405:607-643. [PMID: 37452956 DOI: 10.1007/978-3-031-23705-8_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
The presented tumors in this chapter are somewhat very rare, and their management is still debated due to the scarcity of information about their cell of origin, behavior, and biology. Treatment options are still limited, but we are confident that in the near future by discovering the genetic and biological mechanisms that drive tumor growth we will be able to offer new target therapies that should be flanked by surgery, radiotherapy, and chemotherapeutic agents actually in use. The purpose of this chapter is to highlight the most important known characteristics of these tumors offering the chance to recognize the disease and then offer the best opportunity for treatment to patients. The 5th WHO Classification Central Nervous System features substantial changes by moving further to advance the role of molecular diagnostics in CNS tumor classification, but remaining rooted in other established approaches to tumor characterization, including histology and immunohistochemistry, and probably, the category of many tumors will change. Here, the most important characteristics of each neoplasm are summarized focusing on genetic mechanisms and molecular pathways, their histopathologic footprints, signs and symptoms, radiologic features, therapeutic approaches, and prognosis as well as follow-up protocols. Schematic classifications are also presented to offer a better understanding of the pathology.
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Affiliation(s)
- Jody Filippo Capitanio
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, Milan, Italy
| | - Pietro Mortini
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, Milan, Italy.
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17
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Jha S, Mohanty SK, Sampat NY, Naik S, Baisakh MR, Pattnaik N, Lobo A, Rauta S, Sharma S, Munjal G, Jain D, Arora S, Malik V, Jain E, Sahoo B, Bhardwaj M, Mishra SK, Jaiswal S, Barik LM, Balzer BL, Chakrabarti I, Parwani AV. Solitary Fibrous Tumor of the Adrenal Gland. Am J Clin Pathol 2022; 158:546-554. [PMID: 35993354 DOI: 10.1093/ajcp/aqac088] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/06/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Solitary fibrous tumor (SFT) is a mesenchymal neoplasm that can arise at various anatomic locations. It is characterized by inv12(q13q13)-derived NAB2::STAT6 fusion, resulting in the nuclear expression of STAT6. Primary SFT of the adrenal gland is rare. We launched a multi-institutional collaboration to comprehend the overarching demographics, clinical and follow-up, macroscopic, microscopic, IHC, and FISH features of 9 patients with SFT of the adrenal gland. METHODS We added a series of 9 patients to the collection of adrenal SFTs where the clinicopathologic parameters, including clinical presentation, imaging, histopathology, IHC, molecular profiles, and management and follow-up data, were analyzed comprehensively. A modified 4-variable risk stratification model, including age, tumor size, and necrosis, was applied. RESULTS Our series consisted of 6 male and 3 female patients, ranging in age from 19 to 64 years (mean, 49.3 years). Abdominal pain (4) and fever with abdominal pain (1) were the presenting symptoms in 5 patients. In the remaining 4 patients, the tumors were detected by abdominal imaging for hypertension and diabetes. The size of the tumor ranged from 2 cm to 10.5 cm in maximum dimension. All tumors exhibited the morphology of a spindle cell SFT with a patternless architecture; 3 had a focal storiform arrangement. STAT6 positivity was observed in all tumors, and 7 were positive for CD34. Surgical resection was the primary modality of treatment. No adjuvant therapy was administered. Follow-up ranging from 7 months to 23 months was available for 7 patients. All were alive without disease recurrence or metastasis. Risk stratification placed 8 (88.9%) patients into a low-risk category and 1 into an intermediate-risk category. CONCLUSIONS This series is the largest of adrenal SFTs to date. These tumors of the adrenal gland are predominantly spindle cell neoplasms with indolent behavior, with a wide age distribution and a slight male preponderance. Combining our cohort with the previously published cases, the majority of tumors fall into the low-risk category for the propensity to develop metastases. Owing to the rarity and age distribution associated with these tumors, the differential diagnosis is wide and requires a systematic approach for ruling out key differential diagnoses aided by STAT6 IHC.
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Affiliation(s)
- Shilpy Jha
- Department of Pathology and Laboratory Medicine, Prolife Diagnostics, Bhubaneswar, India.,Department of Pathology and Laboratory Medicine, Advanced Medical Research Institute, Bhubaneswar, India
| | - Sambit K Mohanty
- Department of Pathology and Laboratory Medicine, Prolife Diagnostics, Bhubaneswar, India.,Department of Pathology and Laboratory Medicine, Advanced Medical Research Institute, Bhubaneswar, India.,Department of Pathology and Laboratory Medicine, CORE Diagnostics, Haryana, India
| | - Nakul Y Sampat
- Department of Pathology and Laboratory Medicine, Advanced Medical Research Institute, Bhubaneswar, India
| | - Subhasini Naik
- Department of Pathology and Laboratory Medicine, Prolife Diagnostics, Bhubaneswar, India
| | - Manas R Baisakh
- Department of Pathology and Laboratory Medicine, Prolife Diagnostics, Bhubaneswar, India.,Department of Pathology and Laboratory Medicine, Apollo Hospital and Apollo Cancer Institute, Bhubaneswar, India
| | - Niharika Pattnaik
- Department of Pathology and Laboratory Medicine, Advanced Medical Research Institute, Bhubaneswar, India
| | - Anandi Lobo
- Department of Pathology and Laboratory Medicine, Advanced Medical Research Institute, Bhubaneswar, India
| | - Sudhasmita Rauta
- Department of Pathology and Laboratory Medicine, Prolife Diagnostics, Bhubaneswar, India
| | - Shivani Sharma
- Department of Pathology and Laboratory Medicine, CORE Diagnostics, Haryana, India
| | - Gauri Munjal
- Department of Pathology and Laboratory Medicine, CORE Diagnostics, Haryana, India
| | - Deepika Jain
- Department of Pathology and Laboratory Medicine, CORE Diagnostics, Haryana, India
| | - Samriti Arora
- Department of Pathology and Laboratory Medicine, CORE Diagnostics, Haryana, India
| | - Vipra Malik
- Department of Pathology and Laboratory Medicine, CORE Diagnostics, Haryana, India
| | - Ekta Jain
- Department of Pathology and Laboratory Medicine, CORE Diagnostics, Haryana, India
| | - Biswajit Sahoo
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Mohit Bhardwaj
- Department of Pathology and Laboratory Medicine, CORE Diagnostics, Haryana, India
| | - Saurav K Mishra
- Department of Medical Oncology, Apollo Cancer Institute, Bhubaneswar, India
| | - Sunil Jaiswal
- Department of Surgical Oncology, Apollo Cancer Institute, Bhubaneswar, India
| | - Lalit M Barik
- Department of Pathology and Laboratory Medicine, Advanced Medical Research Institute, Bhubaneswar, India
| | - Bonnie L Balzer
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA,USA
| | - Indranil Chakrabarti
- Department of Pathology and Laboratory Medicine, North Bengal Medical College, Siliguri, India
| | - Anil V Parwani
- Department of Pathology, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
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18
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Practical Approach to Histological Diagnosis of Peripheral Nerve Sheath Tumors: An Update. Diagnostics (Basel) 2022; 12:diagnostics12061463. [PMID: 35741273 PMCID: PMC9222088 DOI: 10.3390/diagnostics12061463] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 06/01/2022] [Accepted: 06/02/2022] [Indexed: 12/01/2022] Open
Abstract
Peripheral nerve sheath tumors encompass a wide spectrum of lesions with different biological behavior, including both benign and malignant neoplasms as well as the recent diagnostic category, i.e., “atypical neurofibromatous neoplasm with uncertain biologic potential” to be used only for NF1 patients. Neurofibromas and schwannomas are benign Schwann-cell-derived peripheral nerve sheath tumors arising as isolated lesions or within the context of classical neurofibromatosis or schwannomatoses. Multiple tumors are a hallmark of neurofibromatosis type 1(NF1) and related forms, NF2-related-schwannomatosis (formerly NF2) or SMARCB1/LZTR1-related schwannomatoses. Perineuriomas are benign, mostly sporadic, peripheral nerve sheath tumors that show morphological, immunohistochemical, and ultrastructural features reminiscent of perineurial differentiation. Hybrid tumors exist, with the most common lesions represented by a variable mixture of neurofibromas, schwannomas, and perineuriomas. Conversely, malignant peripheral nerve sheath tumors are soft tissue sarcomas that may arise from a peripheral nerve or a pre-existing neurofibroma, and in about 50% of cases, these tumors are associated with NF1. The present review emphasizes the main clinicopathologic features of each pathological entity, focusing on the diagnostic clues and unusual morphological variants.
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19
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Huber AR, DeRoche TC. Gastric Perineurioma: A Case Report and Review of the Literature. Int J Surg Pathol 2022; 31:301-306. [PMID: 35635199 DOI: 10.1177/10668969221101872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Perineuriomas of the gastrointestinal tract, formerly known as benign fibroblastic polyps, most commonly occur as polyps on screening colonoscopy, particularly in the distal colon. Gastric examples are exceedingly rare. We report the sixth patient with a gastric perineurioma in a 57-year-old female. Histologically, the lesion was composed of bland spindle cells without cytologic atypia or mitotic activity located in the gastric lamina propria. The spindled cells were strongly positive for GLUT1 and focally reactive for epithelial membrane antigen (EMA). The morphologic and immunophenotypic findings were those of gastric perineurioma.
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Affiliation(s)
- Aaron R. Huber
- University of Rochester Medical Center, Rochester, NY, USA
| | - Tom C. DeRoche
- Kaiser Airport Way Regional Laboratory, Portland, OR, USA
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20
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Characterization of a Novel Aspect of Tissue Scarring Following Experimental Spinal Cord Injury and the Implantation of Bioengineered Type-I Collagen Scaffolds in the Adult Rat: Involvement of Perineurial-like Cells? Int J Mol Sci 2022; 23:ijms23063221. [PMID: 35328642 PMCID: PMC8954100 DOI: 10.3390/ijms23063221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 03/04/2022] [Accepted: 03/15/2022] [Indexed: 11/17/2022] Open
Abstract
Numerous intervention strategies have been developed to promote functional tissue repair following experimental spinal cord injury (SCI), including the bridging of lesion-induced cystic cavities with bioengineered scaffolds. Integration between such implanted scaffolds and the lesioned host spinal cord is critical for supporting regenerative growth, but only moderate-to-low degrees of success have been reported. Light and electron microscopy were employed to better characterise the fibroadhesive scarring process taking place after implantation of a longitudinally microstructured type-I collagen scaffold into unilateral mid-cervical resection injuries of the adult rat spinal cord. At long survival times (10 weeks post-surgery), sheets of tightly packed cells (of uniform morphology) could be seen lining the inner surface of the repaired dura mater of lesion-only control animals, as well as forming a barrier along the implant–host interface of the scaffold-implanted animals. The highly uniform ultrastructural features of these scarring cells and their anatomical continuity with the local, reactive spinal nerve roots strongly suggest their identity to be perineurial-like cells. This novel aspect of the cellular composition of reactive spinal cord tissue highlights the increasingly complex nature of fibroadhesive scarring involved in traumatic injury, and particularly in response to the implantation of bioengineered collagen scaffolds.
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21
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Sun K, Ru GQ, Zhao M. BRAF-rearranged spindle cell mesenchymal neoplasm with a predominant lipofibromatosis-like neural tumor pattern and co-expression of CD34, S100 protein, and markers associated with perineurial differentiation: A rare case with potential diagnostic pitfall. J Cutan Pathol 2021; 49:278-283. [PMID: 34632612 DOI: 10.1111/cup.14149] [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: 08/09/2021] [Revised: 09/18/2021] [Accepted: 10/05/2021] [Indexed: 11/28/2022]
Abstract
Recently, a distinctive group of S100 protein/CD34-positive spindle cell mesenchymal neoplasms characterized by a predominant lipofibromatosis-like neural pattern harboring recurrent gene rearrangements involving NTRK1-3, RAF1, RET, ROS1, ALK, and MET has been identified. BRAF rearrangements have been rarely documented in this group of neoplasms. Herein, we report a 54-year-old man with a 1.3-cm painless mass located in the subcutis of left back. The tumor was composed of mildly atypical, short-spindle shaped to ovoid cells with fascicles and whorls intervening between and admixed with the subcutaneous adipose tissues and nerve bundles. Focally abundant thick, band-like stromal hyalinization was also noted. The neoplastic cells showed diffuse reactivity for S100 protein and CD34 and multifocal immunopositivity for markers associated with perineurial differentiation including epithelial membrane antigen, GLUT1, and claudin-1. Fluorescence in situ hybridization analyses showed positive for BRAF rearrangement and negative for rearrangements involving NTRK1, RET, and ROS1. The tumor was narrowly excised and recurred after 24 months of follow-up. To our knowledge, we report the second case of BRAF-rearranged spindle cell mesenchymal tumor with predominant lipofibromatosis-like neural tumor pattern. Expression of markers associated with perineurial differentiation is exceptional and represents a potential diagnostic pitfall, which may cause significant diagnostic confusion with a peripheral nerve sheath tumor.
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Affiliation(s)
- Ke Sun
- Department of Pathology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Guo-Qing Ru
- Department of Pathology, Laboratory Medicine Center, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Ming Zhao
- Department of Pathology, Laboratory Medicine Center, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
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22
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Suster D, Miller JA, Pihan G, Mackinnon AC, Suster S. Expression patterns for Bcl-2, EMA, β-catenin, E-cadherin, PAX8, and MIB1 in thymomas. Mod Pathol 2021; 34:1831-1838. [PMID: 34135467 DOI: 10.1038/s41379-021-00839-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/11/2021] [Accepted: 05/11/2021] [Indexed: 11/09/2022]
Abstract
The expression of immunohistochemical markers has been extensively investigated in thymomas to assist in the differential diagnosis. We have studied six select markers to determine their utility in the evaluation of these tumors. A series of 126 thymomas including 33 type A, 27 type AB, 20 type B1, 22 type B2, and 24 type B3, were examined utilizing a tissue microarray (TMA) technique with antibodies to e-cadherin, β-catenin, PAX8, bcl-2, EMA, and MIB-1. Keratin AE1/AE3 and p63 were used for quality control. A significant finding was strong and consistent positivity for bcl-2 in type A (90%) and type AB (88.8%) thymoma, while 100% of B1, B2, and B3 were negative. The distribution of e-cadherin and β-catenin was not useful for differential diagnosis. E-cadherin and β-catenin were expressed in a high proportion of all the tumors (92-100%), except for B2 thymoma which showed only 45% expression. A significant increase in the expression of the MIB-1 proliferation marker (mean: 12.8% nuclear positivity) was also observed in B3 thymoma compared with the other histologic types. Statistical significance was confirmed using Kruskal's non-parameterized test for distribution. EMA was generally negative except for spindle cells in the fibrous septa in types A and AB thymoma. PAX8 showed less consistent nuclear staining than p63 and was only widely expressed in 55.7% of cases. Bcl-2 may serve as a useful marker to separate spindle cell thymomas (Type A and AB) from the other types, and the MIB1 proliferation index may be of use to differentiate type B2 from type B3 thymoma.
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Affiliation(s)
- David Suster
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - James A Miller
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - German Pihan
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - A Craig Mackinnon
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Saul Suster
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA.
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23
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Ma TS, Zhou L, Zhou Q, He XL, Zhao M. Soft tissue perineurioma involving the kidney: a report of two cases with an emphasis on differential diagnosis. Diagn Pathol 2021; 16:87. [PMID: 34592995 PMCID: PMC8482618 DOI: 10.1186/s13000-021-01149-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 09/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Soft tissue perineurioma of the kidney is rare, with only a few reported cases. We report two additional cases with histologic, immunohistochemical and genetic analyses. CASE PRESENTATION Both tumors were from adults (1 female aged 49 years and 1 male aged 42 years) and grossly had maximum diameters of 6.5 and 10 cm, respectively. The tumors were overall well circumscribed but unencapsulated, with focally entrapped benign native renal tubules in one case; both tumors seemed to arise in the capsular areas. The tumors had histologic and immunohistochemical profiles consistent with soft tissue perineurioma. Fluorescence in situ hybridization analyses demonstrated that the tumors were negative for amplification of MDM2 and rearrangements of ESWR1, FUS, and KMT2A. Targeted next-generation sequencing revealed a low tumor mutation burden and likely pathogenic mutations (CYP2B6 and FLT1 mutations for 1 each). Follow-up data were available for both patients; neither had tumor recurrence or metastasis. CONCLUSIONS In conclusion, renal perineurioma is rare, usually arises in the capsular areas, and is cured by resection. Low-grade dedifferentiated liposarcoma and low-grade fibromyxoid sarcoma as well as other spindle cell lesions should be considered in the differential diagnosis.
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Affiliation(s)
- Tian-Shi Ma
- Department of Pathology, Laboratory Medicine Center, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, 310014, Hangzhou, Zhejiang, China
| | - Ling Zhou
- Department of Pathology, People's Hospital of Lichuan, 445499, Lichuan, Hubei, China
| | - Quan Zhou
- Department of Pathology, Jiaxing Second Hospital, 314099, Jiaxing, Zhejiang, China
| | - Xiang-Lei He
- Department of Pathology, Laboratory Medicine Center, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, 310014, Hangzhou, Zhejiang, China
| | - Ming Zhao
- Department of Pathology, Laboratory Medicine Center, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, 310014, Hangzhou, Zhejiang, China. .,Department of Pathology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, 158 Shangtang Road, 310014, Hangzhou, Zhejiang, China.
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24
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Zhao LD, Jarrar FS, Hussain AA, Hyrcza MD, Harvey JT. Eyelid-Cheek Junction Soft-Tissue Perineurioma: Case Report and Controversies. Ophthalmic Plast Reconstr Surg 2021; 37:e181-e184. [PMID: 33927170 DOI: 10.1097/iop.0000000000001986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Perineurioma is a rare soft-tissue tumor with characteristic histologic and immunohistochemical features. The diagnosis; however, can be met with certain challenges. A 71-year-old woman presented with an enlarging painless mass in the right lower eyelid-cheek junction. The lesion presented as a raised overhanging trunk-shaped mass. An excisional biopsy and local reconstruction were performed. The overall morphology and immunohistochemical findings were most supportive of a cellular soft-tissue perineurioma, with differential diagnoses including dermatofibroma. To the authors' knowledge, this is the first histopathologically reported case of a superficially occurring soft-tissue perineurioma in the eyelid-cheek junction. The authors discuss the presentation, relevant literature, and controversies associated with this diagnosis.
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Affiliation(s)
- Lily D Zhao
- Division of Ophthalmology, McMaster University, Hamilton
| | | | - Ahsen A Hussain
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax
| | - Martin D Hyrcza
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Canada
| | - John T Harvey
- Division of Ophthalmology, McMaster University, Hamilton
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Dermawan JK, Azzato EM, Goldblum JR, Rubin BP, Billings SD, Ko JS. Superficial ALK-rearranged myxoid spindle cell neoplasm: a cutaneous soft tissue tumor with distinctive morphology and immunophenotypic profile. Mod Pathol 2021; 34:1710-1718. [PMID: 34088997 DOI: 10.1038/s41379-021-00830-w] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 12/12/2022]
Abstract
Gene rearrangements involving the anaplastic lymphoma kinase (ALK) receptor tyrosine kinase gene have been identified in various neoplasms, including inflammatory myofibroblastic tumor and epithelioid fibrous histiocytoma. We present an ALK-rearranged cutaneous soft tissue tumor with unique morphologic and immunophenotypic features that are not shared by other entities with ALK rearrangements. The six cases involved two females and four males, aged 18-84 (mean 51) years old. Three tumors were on the back and three on the lower extremities (thigh, knee, shin); ranging from 0.5 to 5.6 (mean 2.1) cm. Four were confined to the dermis; two involved the subcutis. All six cases were characterized by the presence of spindled to ovoid cells arranged in concentric whorls and cords against a myxoid to myxohyaline stroma and relatively cellular aggregates of plump ovoid to epithelioid cells. Four cases showed distinct hyalinized blood vessels. Both cases that involved the subcutis showed peripheral lipofibromatosis-like areas. Tumor-infiltrating lymphocytes were absent to moderate. Severe cytologic atypia or conspicuous mitotic activity was not identified. Immunohistochemically, all tumors diffusely expressed ALK (D5F3) and CD34. All but one tumor was diffusely positive for S100 protein. All tumors were negative for EMA, AE1/AE3, SMA, and SOX10. Next-generation sequencing revealed ALK fusions with FLNA (3 cases), MYH10 (2 cases), and HMBOX1 (1 case) as the partner genes. In all six cases, the breakpoints involved exon 20 of ALK, which preserves the receptor tyrosine kinase domains of ALK in the fusion product. Of the four cases with limited follow-up information (2-18 months), none recurred. In conclusion, we report an ALK-rearranged cutaneous soft tissue tumor characterized by the presence of myxoid spindle cell whorls and cords, and co-expression of ALK, CD34, and frequently S100 protein, we term "superficial ALK-rearranged myxoid spindle cell neoplasm".
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Affiliation(s)
- Josephine K Dermawan
- Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Elizabeth M Azzato
- Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - John R Goldblum
- Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Brian P Rubin
- Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Steven D Billings
- Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jennifer S Ko
- Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA.
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Haghayeghi K, Telang G, Chen S, Bevivino J, Mangray S, Hui Y, Robinson-Bostom L. A Rare Perineurioma/Granular Cell Tumor Hybrid Peripheral Nerve Sheath Tumor. Am J Dermatopathol 2021; 42:762-765. [PMID: 31977319 DOI: 10.1097/dad.0000000000001606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Hybrid peripheral nerve sheath tumors (PNSTs) are rare benign composite neoplasms demonstrating features of multiple endogenous nerve sheath cell types. Hybrid PNSTs with granular cell components are exceedingly rare. Only a handful number of hybrid PNSTs composed of granular cell tumor and perineurioma have been described to date. We present a rare hybrid of perineurioma and granular cell tumor and review the literature.
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Affiliation(s)
- Koorosh Haghayeghi
- Department of Pathology and Laboratory Medicine, Warren Alpert Medical School of Brown/Rhode Island Hospital, Providence, RI. Dr. Mangray is now with the Nationwide Children's Hospital, Columbus, OH. Dr. Hui is now with the Memorial Sloan Kattering Institude; and
| | | | - Sonja Chen
- Department of Pathology and Laboratory Medicine, Warren Alpert Medical School of Brown/Rhode Island Hospital, Providence, RI. Dr. Mangray is now with the Nationwide Children's Hospital, Columbus, OH. Dr. Hui is now with the Memorial Sloan Kattering Institude; and
| | - Jack Bevivino
- Surgery, Warren Alpert Medical School of Brown/Rhode Island Hospital, Providence, RI
| | - Shamlal Mangray
- Department of Pathology and Laboratory Medicine, Warren Alpert Medical School of Brown/Rhode Island Hospital, Providence, RI. Dr. Mangray is now with the Nationwide Children's Hospital, Columbus, OH. Dr. Hui is now with the Memorial Sloan Kattering Institude; and
| | - Yiang Hui
- Department of Pathology and Laboratory Medicine, Warren Alpert Medical School of Brown/Rhode Island Hospital, Providence, RI. Dr. Mangray is now with the Nationwide Children's Hospital, Columbus, OH. Dr. Hui is now with the Memorial Sloan Kattering Institude; and
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27
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Abstract
This article focuses on various recently described or emerging cutaneous soft tissue neoplasms. These entities encompass a wide range of clinical and histologic characteristics. Emphasis is placed on their distinguishing morphologic and immunophenotypic features compared with entities that enter into their differential diagnosis, as well as novel immunophenotypic and molecular tests that are often necessary for accurate diagnosis of these entities. Entities discussed include EWSR1-SMAD3-rearranged fibroblastic tumor, superficial CD34-positive fibroblastic tumor, epithelioid fibrous histiocytoma, CIC-rearranged sarcomas, and NTRK-rearranged spindle cell tumors.
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Affiliation(s)
- Josephine K Dermawan
- Soft Tissue and Bone Pathology Section, Department of Pathology, Cleveland Clinic, 9500 Euclid Avenue, L25, Cleveland, OH 44195, USA
| | - Jennifer S Ko
- Dermatopathology Section, Department of Pathology, Cleveland Clinic, 9500 Euclid Avenue, L25, Cleveland, OH 44195, USA
| | - Steven D Billings
- Dermatopathology Section, Department of Pathology, Cleveland Clinic, 9500 Euclid Avenue, L25, Cleveland, OH 44195, USA.
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Abstract
PURPOSE OF REVIEW Although tumors with nerve sheath differentiation are vast, the main clinically significant problems faced by the pathologist are the separation of malignant peripheral nerve sheath tumors (MPNSTs) from histologic mimics, the diagnosis of neurofibromatous neoplasms with atypical features, and the separation of cutaneous neurofibromatous neoplasms from melanoma. This review briefly discusses a variety of common nerve sheath tumors and summarizes recent advances on these diagnostic fronts. RECENT FINDINGS Much of recent work has focused on abnormalities in polycomb repressive complex 2, and the ways in which these abnormalities may be exploited in the diagnosis of MPNSTs. Progress has been made in the diagnostic and clinical understanding of atypical neurofibromatous neoplasms and low-grade MPNSTs. A number of reports have explored the diagnostic distinction between cutaneous neurofibroma and melanoma. SUMMARY New discoveries show promise in the diagnosis of peripheral nerve sheath tumors, but challenges - old and new - remain.
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29
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Panagopoulos I, Gorunova L, Andersen K, Tafjord S, Lund-Iversen M, Lobmaier I, Micci F, Heim S. Recurrent Fusion of the GRB2 Associated Binding Protein 1 ( GAB1) Gene With ABL Proto-oncogene 1 ( ABL1) in Benign Pediatric Soft Tissue Tumors. Cancer Genomics Proteomics 2021; 17:499-508. [PMID: 32859628 DOI: 10.21873/cgp.20206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/22/2020] [Accepted: 06/01/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND/AIM Fusions of the ABL proto-oncogene 1 gene (ABL1 in 9q34) are common in leukemias but rare in solid tumors. The most notable is the t(9;22)(q34;q11)/BCR-ABL1 coding for a chimeric tyrosine kinase. We herein report an ABL1-fusion in a pediatric tumor. MATERIALS AND METHODS G-banding, fluorescence in situ hybridization, reverse transcription polymerase chain reaction and Sanger sequencing were performed on a soft tissue perineurioma found in the left musculus erector spinae of a child. RESULTS A der(4)t(4;9)(q31;q34) and a fusion of the GRB2 associated binding protein 1 (GAB1 in 4q31) gene with ABL1 were found. A literature search revealed 3 more cases with similar genetic and clinicopathological characteristics: a soft tissue perineurioma with t(2;9;4)(p23;q34;q31) and ABL1 rearrangement, a soft tissue angiofibroma with a GAB1-ABL1 chimeric gene, and a solitary fibrous tumor carrying a der(4)t(4;9)(q31.1;q34). CONCLUSION GAB1-ABL1 is a recurrent fusion gene in benign pediatric tumors.
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Affiliation(s)
- Ioannis Panagopoulos
- Section for Cancer Cytogenetics, Institute for Cancer Genetics and Informatics, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Ludmila Gorunova
- Section for Cancer Cytogenetics, Institute for Cancer Genetics and Informatics, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Kristin Andersen
- Section for Cancer Cytogenetics, Institute for Cancer Genetics and Informatics, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Svetlana Tafjord
- Department of Pathology, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Marius Lund-Iversen
- Department of Pathology, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Ingvild Lobmaier
- Department of Pathology, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Francesca Micci
- Section for Cancer Cytogenetics, Institute for Cancer Genetics and Informatics, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Sverre Heim
- Section for Cancer Cytogenetics, Institute for Cancer Genetics and Informatics, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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30
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Belakhoua SM, Rodriguez FJ. Diagnostic Pathology of Tumors of Peripheral Nerve. Neurosurgery 2021; 88:443-456. [PMID: 33588442 DOI: 10.1093/neuros/nyab021] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 09/09/2021] [Indexed: 02/07/2023] Open
Abstract
Neoplasms of the peripheral nervous system represent a heterogenous group with a wide spectrum of morphological features and biological potential. They range from benign and curable by complete excision (schwannoma and soft tissue perineurioma) to benign but potentially aggressive at the local level (plexiform neurofibroma) to the highly malignant (malignant peripheral nerve sheath tumors [MPNST]). In this review, we discuss the diagnostic and pathologic features of common peripheral nerve sheath tumors, particularly those that may be encountered in the intracranial compartment or in the spine and paraspinal region. The discussion will cover schwannoma, neurofibroma, atypical neurofibromatous neoplasms of uncertain biological potential, intraneural and soft tissue perineurioma, hybrid nerve sheath tumors, MPNST, and the recently renamed enigmatic tumor, malignant melanotic nerve sheath tumor, formerly referred to as melanotic schwannoma. We also discuss the diagnostic relevance of these neoplasms to specific genetic and familial syndromes of nerve, including neurofibromatosis 1, neurofibromatosis 2, and schwannomatosis. In addition, we discuss updates in our understanding of the molecular alterations that represent key drivers of these neoplasms, including neurofibromatosis type 1 and type 2, SMARCB1, LZTR1, and PRKAR1A loss, as well as the acquisition of CDKN2A/B mutations and alterations in the polycomb repressor complex members (SUZ12 and EED) in the malignant progression to MPNST. In summary, this review covers practical aspects of pathologic diagnosis with updates relevant to neurosurgical practice.
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Affiliation(s)
- Sarra M Belakhoua
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- School of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Fausto J Rodriguez
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Sydney Kimmel Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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31
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McAfee JL, Dermawan JK, Billings SD, Ko JS. Perineuriomatous nevi: A series of eight cases highlighting unifying pathologic features to avoid misdiagnosis. J Cutan Pathol 2021; 48:1223-1230. [PMID: 33745212 DOI: 10.1111/cup.14014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/26/2021] [Accepted: 03/15/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Perineuriomatous nevi are rare and diagnostically problematic. We report a series of eight perineuriomatous nevi to highlight the diagnostic features. METHODS Cases were retrospectively reviewed and characterized. RESULTS Median age was 42.5 years (range 25-64), with equal sex distribution. Lesions occurred on the arm (n = 4), trunk (n = 2), and head/neck (n = 2). Median size was 7.5 mm (range 5-12 mm). Clinical differential diagnoses included atypical nevus (3), blue nevus (1), neurofibroma (1), and dermatofibroma (1). Lesions were circumscribed, dome-shaped (5/8), and biphasic (8/8) with nested epithelioid cells and wavy spindled cells arranged in whorled fascicles in a myxocollagenous stroma. When present, junctional growth was lentiginous (4/8). No cases displayed pleomorphism or mitotic figures. The perineuriomatous component stained positively for epithelial membrane antigen (8/8 focal to diffuse) and CD34 (4/5 focal to diffuse). SOX10 and S100 protein stained all nevoid cells and in some cases a subset of intermingled spindled cells in perineuriomatous areas, where other melanocytic markers were negative. p16 protein expression was uniformly retained (3/3), and p53 negative (0/2). Nevoid cells in most lesions were positive for BRAFV600E (5/7). Ki67 was mildly elevated (~5%) in 3/3 cases. CONCLUSIONS Recognizing the histopathologic and immunophenotypic features in these unusual nevi helps avoid overdiagnosis.
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Affiliation(s)
- John L McAfee
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio, USA
| | | | | | - Jennifer S Ko
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio, USA
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32
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Domínguez-Malagón HR, Serrano-Arévalo ML, Maldonado J, Chávez J, Toussaint-Caire S, de Almeida OPD, Lino-Silva LS. Perineurioma versus meningioma. A multi-institutional immunohistochemical and ultrastructural studY. Ultrastruct Pathol 2020; 45:71-77. [PMID: 33320025 DOI: 10.1080/01913123.2020.1858212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The differential diagnosis between perineurioma (PN) and meningioma (MEN) can be difficult by histology and immunohistochemistry (IHC) because the perineurium and arachnoid have the same embryological origin. However, there are no comparative studies determining conclusive parameters for the differential diagnosis. The aim of this study is to compare IHC of PN and MEN and their ultra-structural characteristics to elucidate which are the useful data that allow differentiate both entities. Thirty-five MEN were analyzed, and 15 PN, (11 skin and soft tissues and four oral cavity). IHC for epithelial membrane antigen (EMA), Claudin-1, GLUT-1, somatostatin-2 receptor (SSTR-2), and progesterone receptor (RP) was performed. Ultrastructural studies were performed on 8 MEN and 15 PN. Only in PN Claudin-1 was positive in 9/11 (90%) cases and GLUT-1 in 7/11 (63%) cases. In MEN, the progesterone receptor was expressed in 21/35 (60%) cases and no case expressed Claudin-1 and GLUT-1; EMA was expressed in all MEN cases and 93% of PN. SSTR-2 was expressed weakly in six cases of MEN (17%), and it was not considered useful for differential diagnosis. On ultrastructure, PN showed thin and parallel processes, some caveolae, and lacked cell junctions. The cellular processes were surrounded by a collagenous stroma in 94% of the cases. MEN were characterized by curved cytoplasmic cell processes showing desmosomes in 75% of cases. Ultrastructural findings aid in the differential diagnosis between PN and MEN, especially if molecular studies are not available.
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Affiliation(s)
| | | | - J Maldonado
- Unit of Biomedical Research in Cancer, Institute of Biomedical Research - National Autonomous University of Mexico; National Cancer Institute, Mexico City, México
| | - J Chávez
- Unit of Biomedical Research in Cancer, Institute of Biomedical Research - National Autonomous University of Mexico; National Cancer Institute, Mexico City, México
| | - S Toussaint-Caire
- Dermatopathology Department, Manuel Gea González Hospital, Mexico City, Mexico
| | - O P D de Almeida
- Oral Diagnosis Department, Semiology and Oral Pathology Areas, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
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33
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Habeeb O, Korty KE, Azzato EM, Astbury C, Farkas DH, Ko JS, Billings SD. EWSR1-SMAD3 rearranged fibroblastic tumor: Case series and review. J Cutan Pathol 2020; 48:255-262. [PMID: 32901982 DOI: 10.1111/cup.13870] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/23/2020] [Accepted: 08/31/2020] [Indexed: 11/29/2022]
Abstract
We report the largest series to date (N = 6) of EWSR1-SMAD3 rearranged fibroblastic tumor. Initially described in 2018, the tumor features a marked female predominance (F:M, 5:1, mean age 44-years, median age 45.5 years; range 27-57), with most cases (5/6, 83%) arising in acral locations (4 on foot/toe, 1 on hand). One case presented on the lower extremity. The lesions presented as nodules and were composed of short, variably cellular, intersecting fascicles of uniform spindled cells in a collagenous to myxoid stroma. In four cases, the tumor abutted the epidermis without a grenz zone. In one case, there was an abrupt transition to a central, acellular hyalinized area. Two other cases had admixed smaller collagenous areas, reminiscent of collagen rosettes. One had a concentric arrangement of tumor cells around blood vessels. Mitotic activity was low (<1/10 HPFs). All were positive for ERG by immunohistochemistry and negative for CD34 (6/6). An EWSR1-SMAD3 fusion was identified in three cases tested by next-generation sequencing (3/3). Rearrangement of EWSR1 by fluorescence in situ hybridization was showed in 1/1 case. Our series reaffirms prior findings and expands the known histopathologic spectrum of this emerging entity.
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Affiliation(s)
- Omar Habeeb
- Department of Anatomic Pathology, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand
| | - Katelen E Korty
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio, USA
| | | | | | - Daniel H Farkas
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jennifer S Ko
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio, USA
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Zhou HY, Jiang S, Ma FX, Lu H. Peripheral nerve tumors of the hand: Clinical features, diagnosis, and treatment. World J Clin Cases 2020; 8:5086-5098. [PMID: 33269245 PMCID: PMC7674743 DOI: 10.12998/wjcc.v8.i21.5086] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 09/15/2020] [Accepted: 09/25/2020] [Indexed: 02/05/2023] Open
Abstract
The majority of the tumors arising from the peripheral nerves of the hand are relatively benign. However, a tumor diagnosed as malignant peripheral nerve sheath tumor (MPNST) has destructive consequences. Clinical signs and symptoms are usually caused by direct and indirect effects of the tumor, such as nerve invasion or compression and infiltration of surrounding tissues. Definitive diagnosis is made by tumor biopsy. Complete surgical removal with maximum reservation of residual neurologic function is the most appropriate intervention for most symptomatic benign peripheral nerve tumors (PNTs) of the hand; however, MPNSTs require surgical resection with a sufficiently wide margin or even amputation to improve prognosis. In this article, we review the clinical presentation and radiographic features, summarize the evidence for an accurate diagnosis, and discuss the available treatment options for PNTs of the hand.
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Affiliation(s)
- Hai-Ying Zhou
- Department of Orthopedics, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Shuai Jiang
- Department of Orthopedics, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Fei-Xia Ma
- Department of Breast Surgery, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310000, Zhejiang Province, China
| | - Hui Lu
- Department of Orthopedics, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
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35
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Bergamini ML, Noberto LPM, Torres GBMDA, Soares HA, Martins F, Costa ALF, de Souza SOCM, Braz-Silva PH. Primary intra-osseous Hybrid Schwannoma-Perineurioma in the mandible. J Clin Exp Dent 2020; 12:e888-e891. [PMID: 32994880 PMCID: PMC7511049 DOI: 10.4317/jced.57035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 05/14/2020] [Indexed: 11/05/2022] Open
Abstract
Benign nerve sheath tumours include perineuriomas, schwannomas and neurofibromas. Hybrid schwannoma-perineurioma represents a cutaneous, subcutaneous or occasionally intra-osseous tumour with schwannian cytomorphology and perineurioma-like architecture consisting of a mixture of both types of cells. These tumours can develop at any age and there is no gender-predilection. Tongue is the most frequently affected site, followed by palate, mouth floor, jugal mucosa, lips and, more rarely, mandible. We present a case of hybrid tumour with schwannoma-perineurioma morphology located on the right mandibular body (intra-osseous) of a 54-year-old female patient. The tumour was symptomatic and evolving for six months. Microscopically, it was encapsulated and highly cellularised, presenting fascicular aspect and exhibiting scant mitotic activity. The tumour consisted of distinct cellular populations involving fusiform cells, cells with wavy and hyperchromatic nucleus or even epithelioid cells. Positive immunostaining for S-100 and epithelial membrane antigen (EMA) was observed. The lesion was completely removed under general anaesthesia, with the patient showing no clinical or radiographic sign of relapse after two-year follow-up. Despite the limited knowledge on the pathogenesis of Hybrid Schwannoma-Perineurioma, these tumours seem to present a non-aggressive biological behaviour. Conservative surgery provides adequate solution without recurrence, even after a long-term follow-up. Key words:Nerve sheath tumours, Schwannoma, Perineurioma, Immunohistochemistry.
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Affiliation(s)
- Mariana-Lobo Bergamini
- Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | | | | | - Haroldo-Arid Soares
- Division of Odontology, Municipal Hospital Carmino Caricchio, São Paulo, Brazil
| | - Fabiana Martins
- Department of Dentistry, University of Santo Amaro, São Paulo, Brazil
| | | | | | - Paulo-Henrique Braz-Silva
- Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil.,Laboratory of Virology, Institute of Tropical Medicine of São Paulo, School of Medicine, University of São Paulo, São Paulo, Brazil
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36
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Ko E, McNamara K, Ditty D, Alawi F. Intraneural perineurioma of the mandible: case series of a rare entity. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 130:428-432. [PMID: 32868253 DOI: 10.1016/j.oooo.2020.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 07/10/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Eugene Ko
- University of Pennsylvania, School of Dental Medicine, Philadelphia, PA, USA.
| | - Kristin McNamara
- The Ohio State University College of Dentistry, Columbus, OH, USA
| | - Douglas Ditty
- First State Oral and Maxillofacial Surgery, Dover, DE, USA
| | - Faizan Alawi
- University of Pennsylvania, School of Dental Medicine, Philadelphia, PA, USA
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37
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Association of intraneural perineurioma with neurofibromatosis type 2. Acta Neurochir (Wien) 2020; 162:1891-1897. [PMID: 32529330 DOI: 10.1007/s00701-020-04439-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 05/27/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Neurofibromatosis type 2 (NF2) is a genetic disorder characterized by mutations of the NF2 tumor suppressor gene that predisposes patients to develop multiple tumors in the peripheral and central nervous system. The most common neoplasms associated with the disease are schwannomas and meningiomas. Both have been shown to contain abnormalities in chromosome 22 and the NF2 gene, suggesting a genetic component to their pathogenesis. Perineuriomas are rare benign tumors arising from the perineural cells. They are commonly classified as intraneural and soft tissue perineuriomas. Several studies have reported mutations in genes on chromosome 22 in both types of perineuriomas, and there are reports of soft tissue perineuriomas associated with NF2 gene mutations. Despite this, perineuriomas are not considered as part of the NF2 constellation of tumors. METHOD The electronic medical records were searched for patients with a radiologic or pathologic diagnosis of intraneural perineurioma. Patients with clinical signs and genetic testing consistent with a diagnosis of NF2 were further evaluated. RESULTS Of 112 patients meeting inclusion criteria, there were two cases of intraneural perineurioma in patients with NF2 treated at our institution (1.8%). We include a third patient treated at another facility for whom we performed a virtual consultation. CONCLUSIONS The rarity of both NF2 and perineuriomas could explain the rarity of perineuriomas in the setting of NF2. Furthermore, there is divergent intraneural and soft tissue perineurioma somatic mutation pathogenesis, and there may be cytogenetic overlap between perineuriomas and multiple tumor syndromes. Our observed occurrence of intraneural perineurioma in the setting of NF2 in several patients provides further evidence of a potential link between the NF2 gene and the development of intraneural perineurioma.
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Rodriguez EF, Jones R, Miller D, Rodriguez FJ. Neurogenic Tumors of the Mediastinum. Semin Diagn Pathol 2020; 37:179-186. [PMID: 32448592 DOI: 10.1053/j.semdp.2020.04.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 04/02/2020] [Indexed: 12/15/2022]
Abstract
Neurogenic tumors represent a broad ill-defined category of neoplasms that includes tumors of Schwann cell and/or neuroblastic derivation, as well as neoplasms that typically develop in the central nervous system, but rarely present in ectopic sites including the mediastinum. Neurogenic tumors may occur at many different anatomic sites, but the mediastinum represents a uniquely challenging site given the complex anatomy. Additionally, some of these neoplasms may present with multicentric involvement in the context of genetic syndromes, including NF1, NF2 and schwanomatosis. Most of these develop in posterior structures, often in association with paraspinal structures. Fine needle biopsy/small biopsies play an important role in the diagnosis of these neoplasms, given its record of safety and the increased applicability of ancillary testing to these smaller samples at the present time. In this review we focus on the major categories of neurogenic tumors that may be encountered in the mediastinum, including schwannoma, neurofibroma, malignant peripheral nerve sheath tumors, ganglioneuroma and ganglioneuroblastoma, as well as rarer members of this category. We discuss diagnostic approaches applicable to small cytologic and tissue samples and relevant differential diagnoses.
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Affiliation(s)
- Erika F Rodriguez
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Robert Jones
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Daniel Miller
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Fausto J Rodriguez
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
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Meningioma-like Tumor of the Skin Revisited: A Distinct CD34+ Dermal Tumor With an Expanded Histologic Spectrum. Am J Surg Pathol 2020; 43:1518-1525. [PMID: 31490235 DOI: 10.1097/pas.0000000000001357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The term meningioma-like tumor of the skin (MLTS) was coined in 1993 to designate a particular whorled spindle cell superficial cutaneous tumor. No additional confirmed cases of this entity have been reported to date. Some authors have speculated that these cases might be cellular neurothekeomas. In order to delineate the histologic spectrum and the immunophenotype of this unusual tumor, we studied 5 cases, 2 previously unreported and the 3 original cases. The immunohistochemical findings of case 5, however, were limited to those from the original study. Clinically, the tumor presented as a reddish papule, plaque, or nodule, located in the extremities or trunk. The patient often referred to a recent growth of a longstanding lesion. Histologically, the characteristic whorled spindle and stellate dendritic cell population, commonly in a perivascular arrangement, and variable myxoid component, were consistently found in all cases. A prominent microvasculature was also a constant finding. The presence of large deciduoid cells was conspicuous in one case. A reticular pattern of multivacuolated cells giving a chordoma-like appearance was evident in another case. Tumor cells were diffusely positive for CD34 in all 4 cases studied, and negative for S-100, EMA, NKI-C3, CD68, and smooth muscle markers. No complete loss of retinoblastoma protein was found. No brachyury immunostaining was found in the case with chordoid features. No EWSR1 or NAB2-STAT6 gene fusions were found. From these findings, we demonstrate that MLTS is a distinct CD34 spindle cell benign dermal tumor, unrelated to cellular neurothekeoma, and exhibiting myxoid, deciduoid, or chordoma-like features.
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Rumayor Piña A, Flores Rodríguez O, Barbosa Rodríguez E, Vértiz Félix K, Flores Flores D. A 48-year-old female with an exophytic nodule in the buccal mucosa. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 129:95-99. [DOI: 10.1016/j.oooo.2018.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 07/24/2018] [Accepted: 08/14/2018] [Indexed: 10/28/2022]
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Mohan A, Pai H V, Menon R G, V G. Perineurioma -a rare cause of proptosis. Orbit 2020; 39:446-449. [PMID: 31910678 DOI: 10.1080/01676830.2019.1704799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Perineurioma is a rare benign soft tissue tumor arising from the peripheral nerve sheath. To date only two cases of orbital perineurioma have been reported in literature. A 45-year-old, with no comorbidities, presented with protrusion of the right eye since one-year. Examination revealed 8mm proptosis of the right eye. Dilated fundoscopy of the right eye showed a pale optic disc with choroidal folds temporal to it. Computerised Tomogram (CT) of the orbit showed a well-defined intraconal mass in the inferotemporal part of the orbit. A trans conjunctival orbitotomy with lateral canthotomy was performed and the tumor was removed en bloc. On immunohistochemistry, the tumour was negative for S-100 and showed patchy weak Epithelial Membrane Antigen positivity which was suggestive of a soft tissue perineurioma.
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Affiliation(s)
- Athul Mohan
- Department of Ophthalmology, Kasturba Medical College, Manipal Academy of Higher Education , Manipal, India
| | - Vijaya Pai H
- Department of Ophthalmology, Kasturba Medical College, Manipal Academy of Higher Education , Manipal, India
| | - Girish Menon R
- Department of Neurosurgery, Kasturba Medical College and Hospital, Manipal Academy of Higher Education , Manipal, India
| | - Geetha V
- Department of Pathology, Kasturba Medical College, Manipal Academy of Higher Education , Manipal, India
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Extraneural perineurioma: CT and MRI imaging characteristics. Skeletal Radiol 2020; 49:109-114. [PMID: 31267178 DOI: 10.1007/s00256-019-03264-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/13/2019] [Accepted: 06/17/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine the CT and MRI characteristics of extraneural perineuriomas. MATERIALS AND METHODS With IRB approval, our institutional imaging database was retrospectively reviewed for cases of pathologically proven extraneural perineuriomas. CT and MRI features were recorded, correlative imaging analyzed, and the electronic medical record cross-referenced. RESULTS We identified ten patients [(seven males, three females, mean age 49.4 ± 18.3 years (range, 16-70 years)]. All cases were pathologically confirmed. Nine cases were conventional soft tissue extraneural perineuriomas, including one with "reticular" features and one with histologic features of malignancy; the tenth case contained admixed Schwann cells (hybrid perineurioma/schwannoma). Six out of ten patients underwent CT and ten of ten MRI evaluation. Nine out of ten MRIs were performed with IV contrast. Five lesions were subcutaneous, four intermuscular, and one intramuscular. Mean lesion diameter was 4.3 ± 2.7 cm (range, 0.9-10.2 cm). Nine out of ten lesions were well circumscribed; one had irregular margins. On CT, five of six were hypodense and one isodense compared to skeletal muscle. Most lesions were T1 isointense (5/10) or hypointense (4/10) and T2 hyperintense (7/10) relative to skeletal muscle, and demonstrated solid enhancement (6/9). There was no evidence of muscular denervation on any MRI exam, and a nerve of origin was identified in two out of ten cases. CONCLUSIONS Extraneural perineuriomas have a distinctly different imaging appearance from intraneural perineuriomas, manifesting as rounded or ovoid soft tissue masses, without evidence of muscular denervation, and usually without an apparent nerve of origin. Because these features mimic other benign and malignant soft tissue lesions, including sarcomas, biopsy or excision is needed for definitive diagnosis.
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Hornick JL. Cutaneous soft tissue tumors: how do we make sense of fibrous and "fibrohistiocytic" tumors with confusing names and similar appearances? Mod Pathol 2020; 33:56-65. [PMID: 31653978 DOI: 10.1038/s41379-019-0388-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 10/01/2019] [Accepted: 10/01/2019] [Indexed: 12/26/2022]
Abstract
In the 2018 World Health Organization Classification of Skin Tumors, a wide range of predominantly benign mesenchymal neoplasms are included in the fibroblastic, myofibroblastic, and "fibrohistiocytic" categories. By far the most common of these tumors is dermatofibroma (fibrous histiocytoma). There are many histologic variants of dermatofibroma, some of which (cellular, aneurysmal, and atypical) are associated with a higher risk of local recurrence; these variants may be mistaken for more aggressive tumor types, including sarcomas. Furthermore, distinguishing among the fibrous and "fibrohistiocytic" tumors can be a diagnostic challenge, given their sometimes-similar histologic appearances and confusing nomenclature. Immunohistochemistry and molecular genetic assays play a relatively limited role in the diagnosis of these tumor types, with notable exceptions (i.e., epithelioid fibrous histiocytoma and dermatofibrosarcoma protuberans). Proper recognition of dermatofibrosarcoma protuberans is critical, since this tumor type is associated with locally aggressive behavior; transformation to the fibrosarcomatous variant brings metastatic potential. In recent years, understanding of the molecular pathogenetic basis for cutaneous mesenchymal neoplasms has increased dramatically, with the discovery of gene rearrangements in some of these tumor types. In this review, the histologic features of the most common fibrous and "fibrohistiocytic" cutaneous mesenchymal neoplasms will be discussed, as well as recently identified molecular genetic alterations.
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Affiliation(s)
- Jason L Hornick
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.
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Elmore SA, Cesta MF, Crabbs TA, Janardhan KS, Krane GA, Mahapatra D, Quist EM, Rinke M, Schaaf GW, Travlos GS, Wang H, Willson CJ, Wolf JC. Proceedings of the 2019 National Toxicology Program Satellite Symposium. Toxicol Pathol 2019; 47:913-953. [PMID: 31645210 PMCID: PMC6911009 DOI: 10.1177/0192623319876929] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The 2019 annual National Toxicology Program Satellite Symposium, entitled "Pathology Potpourri," was held in Raleigh, North Carolina, at the Society of Toxicologic Pathology's 38th annual meeting. The goal of this symposium was to present and discuss challenging diagnostic pathology and/or nomenclature issues. This article presents summaries of the speakers' talks along with select images that were used by the audience for voting and discussion. Various lesions and topics covered during the symposium included aging mouse lesions from various strains, as well as the following lesions from various rat strains: rete testis sperm granuloma/fibrosis, ovarian cystadenocarcinoma, retro-orbital schwannoma, periductal cholangiofibrosis of the liver and pancreas, pars distalis hypertrophy, chronic progressive nephropathy, and renal tubule regeneration. Other cases included polyovular follicles in young beagle dogs and a fungal blood smear contaminant. One series of cases challenged the audience to consider how immunohistochemistry may improve the diagnosis of some tumors. Interesting retinal lesions from a rhesus macaque emphasized the difficulty in determining the etiology of any particular retinal lesion due to the retina's similar response to vascular injury. Finally, a series of lesions from the International Harmonization of Nomenclature and Diagnostic Criteria Non-Rodent Fish Working Group were presented.
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Affiliation(s)
- Susan A. Elmore
- Cellular and Molecular Pathology Branch, National Toxicology Program, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina, USA
| | - Mark F. Cesta
- Cellular and Molecular Pathology Branch, National Toxicology Program, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina, USA
| | - Torrie A Crabbs
- Experimental Pathology Laboratories, Inc., Research Triangle Park, North Carolina, USA
| | | | - Gregory A. Krane
- Cellular and Molecular Pathology Branch, National Toxicology Program, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina, USA
| | - Debabrata Mahapatra
- Integrated Laboratory Systems, Inc., Research Triangle Park, North Carolina, USA
| | - Erin M. Quist
- Experimental Pathology Laboratories, Inc., Research Triangle Park, North Carolina, USA
| | | | - George W. Schaaf
- Wake Forest University School of Medicine, Winston Salem, North Carolina, USA
| | - Gregory S. Travlos
- Cellular and Molecular Pathology Branch, National Toxicology Program, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina, USA
| | - Haoan Wang
- West China-Frontier Pharma Tech Co., Ltd., Chengdu, Sichuan, China
| | - Cynthia J. Willson
- Integrated Laboratory Systems, Inc., Research Triangle Park, North Carolina, USA
| | - Jeffrey C. Wolf
- Experimental Pathology Laboratories, Inc., Sterling, Virginia, USA
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Abstract
Benign peripheral nerve tumors encompass a wide range of neoplasms and non-neoplastic tumor like lesions. Some of these lesions if not encountered in the setting of genetic syndromes, are occurring sporadically. The principles of oncology should be respectfully followed in every step of diagnostic approach and surgical management. Albeit, classified as benign, some of them do have different level of malignant potential, thus the treating physicians should be aware of that to avoid possible pitfalls with devastating outcomes. This article reviews the most common benign peripheral nerve tumors discussing the clinicopathological findings, imaging appearance and the current trend in their approach.
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Affiliation(s)
- Zinon T Kokkalis
- University of Patras, School of Medicine, University Hospital of Patras, Department of Orthopaedics, Rio-Patras, Greece.
| | - Nikolaos A Stavropoulos
- Second Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Konstantopouleio General Hospital, Athens, Greece
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece
| | - Andreas Panagopoulos
- University of Patras, School of Medicine, University Hospital of Patras, Department of Orthopaedics, Rio-Patras, Greece
| | - Panayotis N Soucacos
- "Panayotis N. Soucacos" Orthopaedic Research & Education Center (OREC), National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece
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Bourque PR, Sampaio ML, Warman-Chardon J, Samaan S, Torres C. Neurolymphomatosis of the lumbosacral plexus and its branches: case series and literature review. BMC Cancer 2019; 19:1149. [PMID: 31775683 PMCID: PMC6882218 DOI: 10.1186/s12885-019-6365-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 11/15/2019] [Indexed: 12/12/2022] Open
Abstract
Background Neurolymphomatosis (NL) is a direct process of invasion of peripheral nerves by lymphoma. It occurs in roughly 5% of patients with lymphoma and represents a particularly difficult diagnostic dilemma when it is the presenting focal manifestation of occult lymphoma. Case presentation We present 3 examples of invasion of the lumbosacral plexus and its branches. These cases demonstrate a protean clinical picture with regards to the time relationship to the clinical course of lymphoma and the neuroanatomical extent of lumbosacral plexus invasion. We demonstrate the complementary role of different imaging modalities. A review of the literature summarizes 23 reports where lumbosacral plexus invasion was the index manifestation, at the time of first diagnosis or recurrence of lymphoma. This series confirms the strong preponderance of B-cell type (92%). There is a marked predilection for involvement of the sciatic nerve (74%), either focally or in a longitudinally extensive fashion, from the ischium to the popliteal fossa. There can also be restricted and discrete involvement of tibial and fibular branches. In recent years, ultrasound and CT have been given a more limited role, as screening tools or as a guide for biopsy. MRI neurography and PET-CT have become leading diagnostic modalities for diagnosis, staging and assessment of treatment response. Conclusion The diagnosis of NL may be challenging, and it was once only reached at autopsy. Improved diagnostic imaging of focal or even asymptomatic disease offers new hope for earlier diagnosis and successful targeted therapy.
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Affiliation(s)
- Pierre R Bourque
- Department of Medicine (Neurology), University of Ottawa, Ottawa, Canada.,The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Marcos Loreto Sampaio
- The Ottawa Hospital Research Institute, Ottawa, Canada. .,Department of Radiology, University of Ottawa, Ottawa, Canada.
| | - Jodi Warman-Chardon
- Department of Medicine (Neurology), University of Ottawa, Ottawa, Canada.,The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Sam Samaan
- Division of Nuclear Medicine, The Ottawa Hospital, Ottawa, Canada
| | - Carlos Torres
- The Ottawa Hospital Research Institute, Ottawa, Canada.,Department of Radiology, University of Ottawa, Ottawa, Canada
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Araki Y, Yoshida A, Tanzawa Y, Endo M, Kobayashi E, Kawai A. Reconstruction of the Shoulder Joint with a Custom-Made Ceramic Implant After a Total Scapulectomy: A Case Report. JBJS Case Connect 2019; 8:e12. [PMID: 29489523 DOI: 10.2106/jbjs.cc.17.00061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We describe a 22-year-old woman who underwent total scapulectomy and shoulder joint reconstruction with use of a custom-made ceramic implant composed of hydroxyapatite and beta-tricalcium phosphate (β-TCP) for a recurrent atypical perineurioma that had arisen from the scapula. CONCLUSION To our knowledge, there have been no previous reports of shoulder joint reconstruction with use of a custom-made ceramic implant after a total scapulectomy. The patient showed excellent function of the new shoulder joint and good range of motion without pain or dislocation at 18 months postsurgery. This new method of reconstructing the shoulder joint after a total scapulectomy appears useful and promising.
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Affiliation(s)
- Yoshihiro Araki
- Divisions of Musculoskeletal Oncology (Y.A., Y.T., M.E., E.K., and A.K.) and Pathology and Clinical Laboratories (A.Y.), National Cancer Center Hospital, Tokyo, Japan.,Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Akihiko Yoshida
- Divisions of Musculoskeletal Oncology (Y.A., Y.T., M.E., E.K., and A.K.) and Pathology and Clinical Laboratories (A.Y.), National Cancer Center Hospital, Tokyo, Japan
| | - Yoshikazu Tanzawa
- Divisions of Musculoskeletal Oncology (Y.A., Y.T., M.E., E.K., and A.K.) and Pathology and Clinical Laboratories (A.Y.), National Cancer Center Hospital, Tokyo, Japan.,Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Makoto Endo
- Divisions of Musculoskeletal Oncology (Y.A., Y.T., M.E., E.K., and A.K.) and Pathology and Clinical Laboratories (A.Y.), National Cancer Center Hospital, Tokyo, Japan
| | - Eisuke Kobayashi
- Divisions of Musculoskeletal Oncology (Y.A., Y.T., M.E., E.K., and A.K.) and Pathology and Clinical Laboratories (A.Y.), National Cancer Center Hospital, Tokyo, Japan
| | - Akira Kawai
- Divisions of Musculoskeletal Oncology (Y.A., Y.T., M.E., E.K., and A.K.) and Pathology and Clinical Laboratories (A.Y.), National Cancer Center Hospital, Tokyo, Japan
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48
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Meyer A, Billings SD. What's new in nerve sheath tumors. Virchows Arch 2019; 476:65-80. [PMID: 31707590 DOI: 10.1007/s00428-019-02671-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/22/2019] [Accepted: 09/22/2019] [Indexed: 12/16/2022]
Abstract
Peripheral nerve sheath tumors are commonly encountered and frequently pose challenges to the pathologist and the clinician. This review discusses the wide range of entities with an emphasis on new discoveries in the past decade. Clinical, histologic, immunohistochemical, and pathogenetic findings are discussed with an emphasis on clinical implications and differential diagnosis.
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49
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Krivošíková L, Janega P, Babala J, Babál P. Pacinian collagenoma: A distinct form of sclerotic fibroma. J Cutan Pathol 2019; 47:291-294. [PMID: 31606915 DOI: 10.1111/cup.13595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 10/03/2019] [Accepted: 10/07/2019] [Indexed: 11/29/2022]
Abstract
Sclerotic fibroma (storiform collagenoma) is a rare benign skin tumor. A solitary tumor, as well as multifocal lesions, are found either sporadically, or associated with Cowden syndrome. The tumor usually presents as clinically asymptomatic, slowly growing papule or nodule on the skin of the head, neck, and upper extremities. Microscopically the lesion is sharply demarcated, composed of hyalinized bands of collagen with low cellularity and a distinctive irregularly whorled or storiform pattern. We describe a case of a unique variant of this tumor in the scalp of a 33-year-old male. The tumor was microscopically composed of concentrically arranged collagen bundles with prevailing type III collagen, which resembled an enlarged Vater-Pacini corpuscle, with low density of CD34-positive and glucose transporter 1-negative spindle shaped cells. The specific microscopic appearance is suggestive of the term "Pacinian collagenoma" for this unique benign tumor.
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Affiliation(s)
- Lucia Krivošíková
- Institute of Pathological Anatomy, Comenius University in Bratislava Faculty of Medicine, Bratislava, Slovakia
| | - Pavol Janega
- Institute of Pathological Anatomy, Comenius University in Bratislava Faculty of Medicine, Bratislava, Slovakia.,Institute of Normal and Pathological Physiology, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Jozef Babala
- Department of Pediatric Surgery, Comenius University in Bratislava Faculty of Medicine, Bratislava, Slovakia
| | - Pavel Babál
- Institute of Pathological Anatomy, Comenius University in Bratislava Faculty of Medicine, Bratislava, Slovakia.,Medirex Group Academy n.o., Bratislava, Slovakia
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Kilic Bagir E, Acikalin A, Gonlusen G, Zorludemir S, Deveci MA. Hibrid periferik sinir kılıfı tümörleri. CUKUROVA MEDICAL JOURNAL 2019. [DOI: 10.17826/cumj.491823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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