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Moodley J, Chebib I. Emerging fusion-associated mesenchymal tumours: a tabular guide and appraisal of five 'novel' entities. J Clin Pathol 2024:jcp-2024-209460. [PMID: 39304199 DOI: 10.1136/jcp-2024-209460] [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: 02/03/2024] [Accepted: 08/08/2024] [Indexed: 09/22/2024]
Abstract
AIMS The field of molecular pathology has undergone significant advancements in the clinical impact of sarcoma diagnosis, resulting in challenges to nosology of bone and soft tissue tumours. The surge in molecular data has led to the identification of novel fusions and description of new 'entities'. To illustrate this, we have selected five emerging entities with novel fusions: clear cell stromal tumour of the lung with YAP1::TFE3 fusion, GAB1::ABL1 fusion spindle cell neoplasm, NUTM1-rearranged sarcomas, NR1D1-rearranged sarcomas and calcified chondroid mesenchymal neoplasms. METHODS Literature for the relevant case reports and case series of these five entities were reviewed and clinicopathological data was collected. Additionally, this review includes a table format of recently described fusion-associated mesenchymal neoplasms. RESULTS The morphological and immunohistochemical features, along with diagnostic challenges, are discussed for each entity. CONCLUSIONS Here, we have provided a review of selected emerging mesenchymal neoplasms, which of these neoplasms will meet the threshold to be 'new entities' remains to be determined.
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Affiliation(s)
- Jinesa Moodley
- Anatomical Pathology, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Ivan Chebib
- Department of Pathology, Harvard Medical School, Boston, Massachusetts, USA
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2
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Perez RL, Wu KJ, Nguyen BD. Extraneuraxial pancreatic hemangioblastoma in a patient with tuberous sclerosis. Jpn J Clin Oncol 2024; 54:735-736. [PMID: 38364442 DOI: 10.1093/jjco/hyae017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 01/25/2024] [Indexed: 02/18/2024] Open
Affiliation(s)
- Rachel L Perez
- Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Kevin J Wu
- Department of Laboratory Medicine and Pathology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Ba D Nguyen
- Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ, USA
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3
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Ye J, Yu M, Lin Y, Zhang D. Recurrent multiple central nervous system hemangioblastomas without von Hippel-Lindau disease: A rare case report. Asian J Surg 2023; 46:4995-4996. [PMID: 37414687 DOI: 10.1016/j.asjsur.2023.06.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 06/07/2023] [Indexed: 07/08/2023] Open
Affiliation(s)
- Jiangfeng Ye
- Department of Gastroenterology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, 441000, China
| | - Mengxing Yu
- Department of Pathology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, 441000, China
| | - Yong Lin
- Department of Gastroenterology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, 441000, China.
| | - Dongdong Zhang
- Department of Oncology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, 441000, China.
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4
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Chen Y, Chen J, Jiang Y, Lin X. Clinicopathological analysis of extraneural sporadic haemangioblastoma occurring in the tongue. BMJ Case Rep 2023; 16:16/5/e255581. [PMID: 37258051 DOI: 10.1136/bcr-2023-255581] [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: 06/02/2023] Open
Abstract
Haemangioblastoma is a morphologically distinctive tumour with uncertain histogenesis, typically occurring in the cerebellum, brain stem or spinal cord and less commonly in extraneural locations. Here, we present a case of haemangioblastoma occurring in the tongue, which is the first reported case in terms of the pathogenic site. The tumour was morphologically indistinguishable from central nervous system haemangioblastoma, that is, neoplastic stromal cells with cytoplasmic vacuolisation and abundant small vessels. Immunohistochemical studies revealed that the tumour cells were positive for S100, NSE, CD56, Syn, EMA, vimentin and α-inhibin, while negative for CK, SMA, factor Ⅷ, D2-40 and GFAP. Immunostainings for CD34 and CD31 outlined the rich and delicate vascular channels. Ki-67 expression was presented in approximately 3% of tumour cells. Primary haemangioblastoma has not been previously described at this site, and this case emphasises the need to consider haemangioblastoma in the differential diagnoses of neoplasms occurring in the tongue.
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Affiliation(s)
- Yacun Chen
- School of Chinese Medicine, The University of Hong Kong, Hong Kong, China
| | - Jie Chen
- School of Chinese Medicine, The University of Hong Kong, Hong Kong, China
- Department of Orthopedics, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ye Jiang
- Department of Pathology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Xiang Lin
- School of Chinese Medicine, The University of Hong Kong, Hong Kong, China
- Department of Chinese Medicine, the University of Hong Kong-Shenzhen Hospital (HKU-SZH), Shenzhen, China
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5
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Kojima F, Musangile FY, Matsuzaki I, Yorita K, Kuroda N, Nagashima Y, Murata SI. Current Knowledge and Prospects for Renal Hemangioblastoma and Renal Cell Carcinoma with Hemangioblastoma-like Features. Biomedicines 2023; 11:biomedicines11051467. [PMID: 37239138 DOI: 10.3390/biomedicines11051467] [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: 04/03/2023] [Revised: 05/08/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023] Open
Abstract
Tumors exhibiting histopathological findings similar to those of hemangioblastoma of the central nervous system (CNS-HB) rarely develop in the kidneys. Currently, renal hemangioblastoma (RHB) is considered analogous to CNS-HB; however, they differ in gross appearance, as well as immunohistochemical and molecular findings. In contrast, some renal cell carcinomas reportedly comprise distinct, clear cell renal cell carcinoma (CCRCC)- and hemangioblastoma (HB)-like areas. Initially, renal cell carcinomas with HB-like features (RCC-HBs) were considered a morphological variant of CCRCC owing to their diverse histological findings. However, the immunohistochemical and molecular findings of RCC-HBs suggest that RCC-HB is distinct from CCRCC. Additionally, one of the RCC-HBs had a focal leiomyomatous stroma and TSC2 variant, suggesting that RCC-HB and RCC with fibromyomatous stroma (RCC-FMS) might belong to the same disease entity. Therefore, we comprehensively reviewed the clinical, pathological, and molecular features of RHB, RCC-HB, and the related tumors and discussed the similarities, differences, and relationships between them. We believe that our review would serve as a foundation for further investigation on elucidating the relationship between CNS-HB, RHB, RCC-HB, and RCC-FMS.
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Affiliation(s)
- Fumiyoshi Kojima
- Department of Human Pathology, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8509, Japan
| | - Fidele Y Musangile
- Department of Human Pathology, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8509, Japan
| | - Ibu Matsuzaki
- Department of Human Pathology, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8509, Japan
| | - Kenji Yorita
- Department of Diagnostic Pathology, Japanese Red Cross Kochi Hospital, 1-4-63-11 Hataminami-cho, Kochi-shi, Kochi 780-8562, Japan
| | - Naoto Kuroda
- Department of Internal Medicine, Kinrou Hospital, 3-2-28 Azounokitamachi, Kochi 781-0011, Japan
| | - Yoji Nagashima
- Department of Surgical Pathology, Tokyo Women's Medical University Hospital, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Shin-Ichi Murata
- Department of Human Pathology, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8509, Japan
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6
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Brain and Spinal Cord Tumors Among the Life-Threatening Health Problems: An Introduction. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1394:1-18. [PMID: 36587378 DOI: 10.1007/978-3-031-14732-6_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
As one of the global concerns, cancers, including brain and spinal cord tumors, are responsible for mortalities and irreversible morbidities in the affected patients. Although advancements in molecular pathology and imaging of tumors may have influenced the incidence rate due to higher diagnosis in early stages, exposure to environmental risk factors could be another explanation for increased incidence of these tumors over the past decades. Similar to many other tumors, the CNS tumors begin in cellular dimension with activation of different molecular pathways. Several genetic, epigenetic, and immunologic pathways and processes are already discovered to play roles in pathophysiology of these tumors, which mostly will eventually become symptomatic. Each of these tumors may exhibit imaging characteristics, making it possible to list a series of differential diagnosis before histopathologic examination. Advances in molecular pathology have resulted in better understanding and categorization of CNS tumors, leading to better decision-making on the most appropriate therapeutic approach for each category, as well as proposing new therapeutic modalities to treat these tumors. As an introduction to the 2-volume book, this chapter addressed different types of human brain and spinal cord tumors based on the fifth version of WHO classification of CNS tumors.
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7
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Sporadic Nerve Root Hemangioblastoma: A Rare Neoplasm. Treatment Strategies. Neurol Sci 2023; 50:123-126. [PMID: 36752307 DOI: 10.1017/cjn.2021.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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8
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Li DF, Guo XJ, Song SP, Li HB. Rare massive hepatic hemangioblastoma: A case report. World J Gastrointest Oncol 2022; 14:2415-2421. [PMID: 36568941 PMCID: PMC9782622 DOI: 10.4251/wjgo.v14.i12.2415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/02/2022] [Accepted: 11/07/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Hepatic hemangioblastoma is an extremely rare disease; only three cases have been reported in the literature, and its magnetic resonance imaging (MRI) findings are unreported.
CASE SUMMARY We report a case of incidental hepatic hemangioblastoma. The patient had no history of von Hippel-Lindau disease or associated clinical signs. Computed tomography and MRI showed a large tumor occupying almost half of the right side of the liver with expansive growth, well-defined borders, heterogeneous mildly progressive enhancement, and visibly enlarged blood supply vessels. Flow voids were observed on T2-weighted imaging. Both diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) map findings of the mass were predominantly inhomogeneous. Postoperative pathology indicated a diagnosis of hemangioblastoma.
CONCLUSION Enlarged peripheral blood-supplying vessels and progressive enhancement seem to be typical imaging features of hepatic hemangioblastoma. However, a solid significantly enhanced mass with a low signal on DWI and a high signal on ADC may also be helpful for the diagnosis of hepatic hemangioblastoma.
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Affiliation(s)
- De-Fu Li
- Department of Radiology, Fuyong People’s Hospital of Shenzhen Baoan, Shenzhen 518103, Guangdong Province, China
| | - Xue-Jun Guo
- Department of Radiology, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong Province, China
| | - Shi-Peng Song
- Department of Hepatobiliary Surgery, Fuyong People’s Hospital of Shenzhen Baoan, Shenzhen 518103, Guangdong Province, China
| | - Hong-Bing Li
- Department of Radiology, Fuyong People’s Hospital of Shenzhen Baoan, Shenzhen 518103, Guangdong Province, China
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9
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Chung RT, Cheung YY, Henderson ER, Linos K, Kerr DA. Extraneuraxial Hemangioblastoma: An Unusual Soft Tissue Neoplasm that Mimics More Common Entities but Carries Distinct Clinical Implications. Int J Surg Pathol 2022; 31:419-426. [PMID: 35651303 DOI: 10.1177/10668969221102560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Hemangioblastoma, one of the characteristic tumors associated with Von Hippel-Lindau (VHL) disease, most often presents in the central nervous system (CNS) but can uncommonly arise in extraneuraxial, or previously referred to as peripheral, locations. Without the clinical context of known VHL disease, hemangioblastoma may not enter the differential for a soft tissue mass outside the CNS. Here, we present two patients with diagnostically challenging extraneuraxial hemangioblastoma to highlight the importance of considering this entity within the differential diagnosis of soft tissue neoplasms containing clear cells and delicate vasculature. We review the relevant diagnostic features, including a suggested immunohistochemical panel, along with the potential associated clinical implications of making this diagnosis. It is recommended that affected patients be offered genetic counseling to assess for underlying VHL disease.
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Affiliation(s)
- Robert T Chung
- 12285Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Yvonne Y Cheung
- 12285Geisel School of Medicine at Dartmouth, Hanover, NH, USA.,Department of Radiology, 22916Dartmouth-Hitchcock Medical Center, NH, Lebanon
| | - Eric R Henderson
- 12285Geisel School of Medicine at Dartmouth, Hanover, NH, USA.,Department of Orthopaedics, 22916Dartmouth-Hitchcock Medical Center, NH, Lebanon
| | - Konstantinos Linos
- 12285Geisel School of Medicine at Dartmouth, Hanover, NH, USA.,Department of Pathology and Laboratory Medicine, 22916Dartmouth-Hitchcock Medical Center, NH, Lebanon
| | - Darcy A Kerr
- 12285Geisel School of Medicine at Dartmouth, Hanover, NH, USA.,Department of Pathology and Laboratory Medicine, 22916Dartmouth-Hitchcock Medical Center, NH, Lebanon
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10
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Zhang X, Huang B, Jiang H, Wei H. Case Report: Hemangioblastoma- Like Clear Cell Stromal Tumor of the Left Lower Lung. Front Med (Lausanne) 2022; 9:836012. [PMID: 35510252 PMCID: PMC9058074 DOI: 10.3389/fmed.2022.836012] [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: 12/15/2021] [Accepted: 03/03/2022] [Indexed: 11/23/2022] Open
Abstract
Background Hemangioblastoma-like clear cell stromal tumor (HLCCST) is a recently reported neoplasm of the lung. Only 13 cases have been reported in four recent studies. Because HLCCST is very rare, it has not been included in the 2021 WHO classification of lung tumors. Case Presentation We report a case of HLCCST of the left lower lung in a 40-year-old female who was admitted to our hospital after pulmonary nodules were discovered. A plain chest CT scan showed a nodular high-density shadow measuring approximately 8 mm in diameter in the left lower lung. The lesion had clear borders, uneven internal density, and a low-density central vacuolar area. The left lower lung was partially resected by video-assisted thoracic surgery. Post-operative histopathologic diagnosis “hemangioblastoma-like clear cell stromal tumor” of the left lower lung. Conclusion The HLCCST is an extremely rare tumor and needs long-term follow-up after operation. Clinically, it may be easily confused with other benign and malignant tumors of the lung, and diagnosis is solely determined by histopathologic examination. This case suggests that immunohistochemical CD34 can be a strong positive marker.
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Affiliation(s)
- Xiaowei Zhang
- Department of Pathology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, China
| | - Bifei Huang
- Department of Pathology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, China
- *Correspondence: Bifei Huang,
| | - Hongquan Jiang
- Department of Thoracic Surgery, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, China
| | - Hangping Wei
- Department of Medical Oncology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, China
- Hangping Wei,
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11
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Meredith DM, Alexandrescu S. Embryonal and non-meningothelial mesenchymal tumors of the central nervous system - Advances in diagnosis and prognostication. Brain Pathol 2022; 32:e13059. [PMID: 35266242 PMCID: PMC9245947 DOI: 10.1111/bpa.13059] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/08/2022] [Accepted: 02/16/2022] [Indexed: 12/31/2022] Open
Abstract
The 5th edition of the WHO Classification of Tumours of the Central Nervous System introduces new entities, and provides updated guidance regarding the diagnostic criteria for tumors of the central nervous system (CNS). CNS embryonal tumors and CNS non‐meningothelial mesenchymal tumors can be challenging for practicing pathologists, as the histologic features are not always specific to a particular entity, and integration of microscopic and molecular findings is necessary. This review on CNS embryonal and non‐meningothelial mesenchymal tumors is meant to provide an update with a focus on WHO changes and additions and on recent discoveries with diagnostic, prognostic, and therapeutic implications.
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Affiliation(s)
- David M Meredith
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sanda Alexandrescu
- Department of Pathology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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12
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Perumalsamy NK, Hemalatha C. Cis-regulatory elements (CREs) in spinal solitary fibrous tumours. Meta Gene 2022. [DOI: 10.1016/j.mgene.2022.101025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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13
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Freiburg Neuropathology Case Conference : An 89-year-old Patient with a History of Domestic Falls, Dysarthria and a slowly Progressive Cerebellar Mass Lesion. Clin Neuroradiol 2022; 32:313-319. [PMID: 35199211 PMCID: PMC8894187 DOI: 10.1007/s00062-022-01142-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2022] [Indexed: 11/30/2022]
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Roque D, Cabral D, Rodrigues C, Simas N. Extradural thoracic nerve root hemangioblastoma approached by a combined posterior thoracic spine and video-assisted thoracoscopic surgery: A case report. Surg Neurol Int 2022; 13:10. [PMID: 35127210 PMCID: PMC8813609 DOI: 10.25259/sni_1186_2021] [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: 11/28/2021] [Accepted: 12/31/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Hemangioblastomas commonly occur in the posterior fossa and are typically attributed to sporadic or familial Von Hippel–Lindau disease. Spinal hemangioblastomas, found in 7–10% of patients, are usually located within the cord (i.e., intramedullary). Here, a 58-year-old male presented with a purely extradural hemangioblastoma involving a spinal root that was surgically excised. Case Description: A 58-year-old male was admitted with a progressive paraparesis and incomplete sensory deficit. The magnetic resonance imaging documented a solid dumbbell-shaped lesion that extended through the left T3-T4 foramen resulting in nerve root and spinal cord compression. Following arterial embolization and lesion excision by both neurosurgeons and thoracic surgeons, the patient’s deficits improved. The postoperative computed tomography scan documented complete tumor removal, and the neuropathology revealed a hemangioblastoma. Conclusion: Here, we describe a 58-year-old male with a purely extradural thoracic foraminal T3-T4 dumbbell-shaped hemangioblastoma successfully treated by both embolization and surgical excision.
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Affiliation(s)
- Diogo Roque
- Department of Neurosurgery, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Portugal
| | - Daniel Cabral
- Department of Thoracic Surgery, Hospital Pulido Valente, Alameda das Linhas de Torres, Lisbon, Portugal
| | - Cristina Rodrigues
- Department of Thoracic Surgery, Hospital Pulido Valente, Alameda das Linhas de Torres, Lisbon, Portugal
| | - Nuno Simas
- Department of Neurosurgery, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Portugal
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15
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Agaimy A, Stoehr R, Michal M, Christopoulos P, Winter H, Zhang L, Stenzinger A, Michal M, Mechtersheimer G, Antonescu CR. Recurrent YAP1-TFE3 Gene Fusions in Clear Cell Stromal Tumor of the Lung. Am J Surg Pathol 2021; 45:1541-1549. [PMID: 33899786 PMCID: PMC8516668 DOI: 10.1097/pas.0000000000001719] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Clear cell (hemangioblastoma-like) stromal tumor of the lung (CCST-L) is a recently described distinctive rare pulmonary neoplasm of unknown histogenesis and molecular pathogenesis. Only 7 cases have been reported in 2 recent studies, although additional cases might have been reported under the heading of extraneural pulmonary hemangioblastoma. We herein describe 4 CCST-L cases, 3 of them harboring a YAP1-TFE3 fusion. The fusion-positive tumors occurred in 3 women, aged 29, 56, and 69 years. All presented with solitary lung nodules measuring 2.3 to 9.5 cm. Histologically, all tumors showed similar features being composed of relatively uniform medium-sized epithelioid to ovoid cells with clear cytoplasm and small round monomorphic nuclei. Scattered larger cells with enlarged hyperchromatic nuclei and marked pleomorphism were noted in 2 cases. The tumors were associated with a hypervascularized stroma with variable but essentially subtle resemblance to capillary hemangioblastoma and perivascular epithelioid cell tumor (PEComa). Immunohistochemistry was negative for all lineage-specific markers. Targeted RNA sequencing showed a YAP1-TFE3 fusion in 3 of 4 cases. All 3 tumors showed homogeneous nuclear TFE3 immunoreactivity. Two patients were disease free at 36 and 12 months. The third patient had biopsy-proven synchronous renal and hepatic metastases, but extended follow-up is not available (recent case). The fourth case lacking the fusion affected a 66-year-old woman and showed subtle histologic differences from the fusion-positive cases, but had comparable TFE3 immunoreactivity. CCST-L represents a distinctive entity unrelated to hemangioblastoma and likely driven by recurrent YAP1-TFE3 fusions in most cases. The relationship of our cases to the recently reported "hemangioblastoma-like" CCST-L remains to be determined. Analysis of larger series is paramount to delineate the morphologic spectrum and biological behavior of this poorly characterized entity.
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Affiliation(s)
- Abbas Agaimy
- Institute of Pathology, Friedrich Alexander University Erlangen-Nürnberg, University Hospital, Erlangen, Germany
| | - Robert Stoehr
- Institute of Pathology, Friedrich Alexander University Erlangen-Nürnberg, University Hospital, Erlangen, Germany
| | - Michael Michal
- Department of Pathology, Charles University, Faculty of Medicine in Plzen, Czech Republic
- Bioptical Laboratory, Ltd., Plzen, Czech Republic
| | - Petros Christopoulos
- Department of Thoracic Oncology, Thoraxklinik, National Center for Tumor Diseases at Heidelberg University Hospital, Heidelberg, Germany, and Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Hauke Winter
- Department of Thoracic Surgery, Thoraxklinik, Heidelberg University Hospital, Heidelberg, Germany, and Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Lei Zhang
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | - Michal Michal
- Department of Pathology, Charles University, Faculty of Medicine in Plzen, Czech Republic
- Bioptical Laboratory, Ltd., Plzen, Czech Republic
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16
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Choi JH, Ro JY. Mesenchymal Tumors of the Mediastinum: An Update on Diagnostic Approach. Adv Anat Pathol 2021; 28:351-381. [PMID: 34050062 DOI: 10.1097/pap.0000000000000306] [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
Mesenchymal tumors of the mediastinum are a heterogenous group of rare tumors with divergent lineages. Mediastinal mesenchymal tumors are diagnostically challenging due to their diversity and morphologic overlap with nonmesenchymal lesions arising in the mediastinum. Accurate histologic diagnosis is critical for appropriate patient management and prognostication. Many mediastinal mesenchymal tumors affect distinct age groups or occur at specific mediastinal compartments. Neurogenic tumors, liposarcoma, solitary fibrous tumor, and synovial sarcoma are common mesenchymal tumors in the mediastinum. Herein, we provide an update on the diagnostic approach to mediastinal mesenchymal tumors and a review of the histologic features and differential diagnosis of common benign and malignant mesenchymal tumors of the mediastinum.
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Affiliation(s)
- Joon Hyuk Choi
- Department of Pathology, Yeungnam University College of Medicine, Daegu, South Korea
| | - Jae Y Ro
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, TX
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17
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Hemangioblastoma of the Peripheral Nervous System: A Critical Analysis of Its Rarity in Von Hippel-Lindau Disease. World Neurosurg 2021; 154:e707-e709. [PMID: 34343683 DOI: 10.1016/j.wneu.2021.07.123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/25/2021] [Accepted: 07/26/2021] [Indexed: 12/30/2022]
Abstract
Von Hippel-Lindau (VHL) disease is a multisystem disease cause by germline mutations of the VHL tumor suppressor gene. Hemangioblastomas are the most common manifestation of VHL disease and can occur in the central nervous system in up to 90% of these patients. By contrast, we found only one true case of a peripheral nervous system (PNS) hemangioblastoma in the setting of VHL. We explore the possible reasons behind the lack of PNS hemangioblastomas in VHL disease.
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18
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Xu Y, Ma X, Ma Y, Li J, Zhang R, Li X. Sporadic hemangioblastoma of the kidney: a clinicopathologic study of three cases and a literature review. J Int Med Res 2021; 49:3000605211027774. [PMID: 34256639 PMCID: PMC8283055 DOI: 10.1177/03000605211027774] [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] [Indexed: 11/15/2022] Open
Abstract
Much attention has been paid to renal hemangioblastoma, but there are still challenges in its differential diagnosis. Three cases (2 men, 1 woman; age: 40–56 years) presented with renal tumors. The tumors were surrounded by a thick fibrous capsule, well-demarcated from the surrounding renal parenchyma, and composed of sheets or nests of polygonal to short spindle-shaped tumor cells with a rich capillary network. In cases 1 and 3, the large polygonal tumor cells contained abundant pale or eosinophilic cytoplasm, and some possessed intracytoplasmic lipid vacuoles. In case 2, tumor cells were characterized by a uniform size, mild, clear, or lightly stained cytoplasm, and typical "clear cell" appearance. Immunohistochemistry revealed that the polygonal stromal cells were strongly and diffusely positive for α-inhibin, neuron-specific enolase (NSE), S100 protein, and vimentin. Cluster of differentiation (CD)10 and paired box gene (PAX)8 were positive, while epithelial membrane antigen (EMA) and cytokeratin (CK) were focally positive in case 3. CD34 and CD31 outlined the contours and distribution of the vascular networks. Renal hemangioblastoma is rare and prone to misdiagnosis; more attention should be paid to the morphological features and reasonable application of immunohistochemistry in the diagnosis of hemangioblastoma.
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Affiliation(s)
- Yanmei Xu
- Department of Pathology, Shanxian Central Hospital, Heze, China
| | - Xuehua Ma
- Department of Ultrasound, Shanxian Central Hospital, Heze, China
| | - Yong Ma
- Department of Urinary Surgery, Shanxian Central Hospital, Heze, China
| | - Juan Li
- Department of Pathology, the Fourth Hospital of Jinan, Jinan, China
| | - Renya Zhang
- Department of Pathology, Affiliated Hospital of Jining Medical University, Jining, China
| | - Xiaomei Li
- Department of Pathology, Tai'an Central Hospital, Tai'an, China
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19
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He J, Liu N, Liu W, Zhou W, Wang Q, Hu H. CT and MRI characteristic findings of sporadic renal hemangioblastoma: Two case reports. Medicine (Baltimore) 2021; 100:e24629. [PMID: 33578578 PMCID: PMC7886462 DOI: 10.1097/md.0000000000024629] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 01/15/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Hemangioblastomas in the kidney are rare. Although a few cases of renal hemangioblastoma (RH) have been reported, the content of these articles mainly focused on clinical and pathological research, with minimal descriptions of radiologic findings. Moreover, there are no descriptions of magnetic resonance imaging (MRI) with enhancement of this condition. Herein, we report 2 cases of RH with computed tomography (CT) and MRI findings. PATIENT CONCERNS Two patients presented to our institution because of dull pain in the left abdomen, and a mass in the left kidney was found by ultrasound examination in each case. The patient had no special family history. Physical examination revealed no obvious tenderness or percussion pain in the renal and ureteral walking areas, and there was no obvious mass. Routine blood and urine tests were normal, and the serum tumor markers were negative. No obvious lesions were found on imaging of the other body parts. DIAGNOSIS Similar radiologic findings were observed in both cases and mimicked those of cavernous hemangiomas of the liver, including peripheral nodular enhancement in the corticomedullary phase, progressive centripetal enhancement in the nephrographic and delayed phases, and occasional complete "filling in" in the delayed phase. We made a radiologic diagnosis of renal clear cell carcinoma for patient 1 and suspected renal clear cell carcinoma for patient 2, but the pathological results showed RH. INTERVENTIONS Given the suspicion of renal cell carcinoma, both patients underwent partial nephrectomy. OUTCOME The recovery of the two patients was uneventful, and there was no evidence of local recurrence or metastasis many years after surgery. LESSONS RH is a rare benign tumor that can be easily misdiagnosed as clear cell carcinoma. Characteristic CT and MRI manifestations may improve preoperative diagnostic accuracy to avoid surgery or indicate nephron-sparing surgery.
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Affiliation(s)
| | - Nan Liu
- Department of Critical Care Medicine
| | - Wangwang Liu
- Department of Pathology, Sir Run Run Shaw Hospital
| | | | - Qiangfeng Wang
- Department of Oncology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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20
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Setia A, Kumar D, Bains L, Sharma P, Tempe A, Mallya V. Renal Hemangioblastoma with Mixed Mullerian tumour of endometrium: A tale of two rare primary tumours. World J Surg Oncol 2020; 18:154. [PMID: 32631354 PMCID: PMC7339407 DOI: 10.1186/s12957-020-01929-1] [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: 02/19/2020] [Accepted: 06/22/2020] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Renal hemangioblastoma (RH) is a very rare benign tumour. Hemangioblastoma most commonly occurs in the central nervous system (CNS), and only few cases of RH have been reported as they occur most commonly as asymptomatic masses found incidentally. Mixed Mullerian tumour (MMT) of the uterus is a rarer and aggressive form of uterine malignancy. The detection of two primary rare tumours incidentally is a rare entity. CASE PRESENTATION A 50-year-old female presented with abnormal uterine bleeding which on endometrial sampling was diagnosed as a rare variety of endometrial cancer, i.e. MMT or uterine carcinosarcoma. On preoperative imaging, a renal mass was also detected which was highly vascular and was mimicking renal cell carcinoma (RCC). Fine needle aspiration cytology (FNAC) was done from the renal mass to differentiate between RCC and metastasis, but it showed only blood cells. Patient underwent staging laparotomy for endometrial cancer and frozen section examination of the renal mass which was inconclusive with few atypical cells, and thus, patient underwent radical nephrectomy too. Histopathological examination revealed it to be a RH which is a very rare benign tumour. DISCUSSION RH is a rare benign tumour which does not require any treatment in majority of the patients. Only 26 cases of RH outside the CNS have been reported till date. MMT is a rare aggressive uterine tumour with an incidence of 1-2 % of all uterine neoplasms, which metastasizes early, and thus, early identification and treatment is the key. RH needs to be differentiated from RCC to avoid over treatment. Morphological findings are similar in RCC and RH; preoperative FNAC, PET scan, and intraoperative frozen section can be utilized to differentiate the two, in well-circumcised tumours and high index of suspicion. Occurrence of renal mass as an incidental finding in the preoperative work up of uterine malignancy directed us to the differentials of metastasis or another histologically distinct primary tumour. The presence of two rare primary tumours, i.e. RH and MMT in the same patient which are unrelated, is a rare entity.
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Affiliation(s)
- Aparna Setia
- Department of Obstetrics and Gynaecology, Maulana Azad Medical College, New Delhi, India
| | - Devender Kumar
- Department of Obstetrics and Gynaecology, Maulana Azad Medical College, New Delhi, India
| | - Lovenish Bains
- Department of Surgery, Maulana Azad Medical College, New Delhi, India.
| | - Pallavi Sharma
- Department of Obstetrics and Gynaecology, Maulana Azad Medical College, New Delhi, India
| | - Anjali Tempe
- Department of Obstetrics and Gynaecology, Maulana Azad Medical College, New Delhi, India
| | - Varuna Mallya
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
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21
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Segawa K, Sugita S, Aoyama T, Minami S, Nagashima K, Tsuda M, Tanaka S, Hasegawa T. Detection of VHL deletion by fluorescence in situ hybridization in extraneuraxial hemangioblastoma of soft tissue. Pathol Int 2020; 70:473-475. [PMID: 32304124 DOI: 10.1111/pin.12935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/16/2020] [Accepted: 04/01/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Keiko Segawa
- Department of Surgical Pathology, Kushiro City General Hospital, Hokkaido, Japan
| | - Shintaro Sugita
- Department of Surgical Pathology, School of Medicine, Sapporo Medical University, Hokkaido, Japan
| | - Tomoyuki Aoyama
- Department of Surgical Pathology, School of Medicine, Sapporo Medical University, Hokkaido, Japan
| | - Seiichi Minami
- Department of Breast Surgery, Sapporo Higashi Tokushukai Hospital, Hokkaidō, Japan
| | - Kazuo Nagashima
- Department of Diagnostic Pathology, Sapporo Higashi Tokushukai Hospital, Hokkaidō, Japan
| | - Masumi Tsuda
- Faculty of Cancer Pathology, Hokkaido University Graduate School of Medicine, Hokkaido, Japan
| | - Shinya Tanaka
- Faculty of Cancer Pathology, Hokkaido University Graduate School of Medicine, Hokkaido, Japan
| | - Tadashi Hasegawa
- Department of Surgical Pathology, School of Medicine, Sapporo Medical University, Hokkaido, Japan
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22
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Kim EK, Jang M, Choi YJ, Cho NH. Renal Cell Carcinoma With Hemangioma-Like Features: Diagnostic Implications and Review of the Literature. Int J Surg Pathol 2019; 27:631-638. [DOI: 10.1177/1066896919840435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Renal cell carcinoma (RCC) with clear cell morphology may show a prominent delicate vascularity. In this article, we report the morphologic and immunohistochemical features of a clear cell papillary RCC mimicking hemangioblastoma and a clear cell RCC mimicking hemangioma. Case 1 showed tubular and papillary growth of clear cells with distinctive areas of capillary proliferation and admixed stromal-like cells resembling a hemangioblastoma. Case 2 consisted of homogeneously delicate microvascular proliferations resembling a capillary hemangioma with scattered inconspicuous clear cells. The clear cells of Case 1 were PAX8(+), CK7(diffuse+), CA9(diffuse+, cup-shaped), and inhibin A(−). The hemangioblastoma-like areas were PAX8(+), CK7(−), CA9(diffuse+), and inhibin A(diffuse+). Case 2 showed PAX8(+), CK7(−), and CA9(diffuse+). They can be diagnostically challenging, and it is important to recognize that a pure hemangioma or hemangioblastoma of the kidneys is very rare, and that RCCs with clear cell morphology rarely exhibit hemangioma-like characteristics.
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Affiliation(s)
- Eun Kyung Kim
- National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Mi Jang
- Yonsei University, Seoul, Republic of Korea
| | - Yoon Jung Choi
- National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
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