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Taylor AT, Dason S, Zynger DL. Clinicopathologic Features of Scrotal Leiomyosarcoma: Single Institutional Experience of Ten Cases. Hum Pathol 2022; 124:96-102. [DOI: 10.1016/j.humpath.2022.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/21/2022] [Accepted: 04/25/2022] [Indexed: 11/29/2022]
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Gama J, Oliveira RC, Jarimba R, Sousa V. Leiomyoma with bizarre nuclei of the scrotum: a rare entity. BMJ Case Rep 2022; 15:e248423. [PMID: 35264392 PMCID: PMC8915319 DOI: 10.1136/bcr-2021-248423] [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] [Accepted: 02/06/2022] [Indexed: 11/04/2022] Open
Abstract
Leiomyomas of the paratesticular region are a rare entity. A subtype of leiomyomas called bizarre nuclei leiomyoma is even rarer and histologically present some interesting features that are important to recognise to make the differential diagnosis with its malignant counterpart-leiomyosarcoma. We present a case of a man in his 60s, who presented with a painless mass on the right testicle. The clinical diagnosis was of an epidermoid cyst. The mass was excised and a diagnosis of leiomyoma of bizarre nuclei was made.
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Affiliation(s)
- João Gama
- Pathology Department, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Rui Caetano Oliveira
- Pathology Department, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Roberto Jarimba
- Urology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Vítor Sousa
- Pathology Department, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
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Matoso A, Parimi V, Epstein JI. Noninvasive low-grade papillary urothelial carcinoma with degenerative nuclear atypia: a grading pitfall. Hum Pathol 2021; 113:1-8. [PMID: 33887303 DOI: 10.1016/j.humpath.2021.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/05/2021] [Accepted: 04/06/2021] [Indexed: 10/21/2022]
Abstract
Noninvasive low-grade papillary urothelial carcinoma is a papillary neoplasm with orderly appearance and mild nuclear pleomorphism. Some cases show significant nuclear pleomorphism with degenerative atypia leading to grading difficulties. A retrospective review of the pathology files identified 16 cases diagnosed as noninvasive low-grade papillary urothelial carcinoma with degenerative atypia. Fifteen cases were consults. The average age was 46 years (range 19-78). The average size was 1.7 cm (range: 0.3-3.5). The submitting diagnoses in consults were noninvasive high-grade papillary urothelial carcinoma (n = 6), condyloma (n = 1), atypical papillary lesion (n = 1), prominent umbrella cells (n = 1), and not given (n = 6). Ki-67 proliferation rate was <5% in 10 of 10 cases (100%), and the cells with large atypical nuclei were negative. Microscopically, there were scattered cells with nuclei larger than 5 times the size of stromal lymphocytes but displayed smudgy chromatin and occasional multinucleation and intranuclear vacuoles. Next-generation sequencing identified the following mutations: HRAS (n = 4), FGFR3 (n = 3), KRAS (n = 3), BRAF (n = 1), PDGFRA (n = 1), and PIK3CA (n = 1). Other deleterious mutations were identified, but none in genes characteristic of high-grade tumors. Follow-up was available in 6 patients (median 32 months). One patient recurred with a noninvasive low-grade papillary urothelial carcinoma 20 months after the index case. All the remaining patients had no evidence of disease at the last follow-up. No patient died or had disease progression. The combination of preservation of polarity, low mitotic activity, Ki-67 <5% with the larger atypical nuclei negative for Ki-67, along with nuclear atypia that is degenerative are features used to classify these tumors as low grade.
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Affiliation(s)
- Andres Matoso
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD, 21231, USA; Department of Urology, The Johns Hopkins Medical Institutions, Baltimore, MD, 21231, USA; Department of Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD, 21231, USA; Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, MD, 21231, USA
| | - Vamsi Parimi
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD, 21231, USA
| | - Jonathan I Epstein
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD, 21231, USA; Department of Urology, The Johns Hopkins Medical Institutions, Baltimore, MD, 21231, USA; Department of Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD, 21231, USA; Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, MD, 21231, USA.
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Zeng J, Pollock G, Addams J, Bracamonte E, Chipollini J. Leiomyosarcoma of the scrotum: a case report and literature review. Transl Androl Urol 2021; 10:1342-1346. [PMID: 33850768 PMCID: PMC8039593 DOI: 10.21037/tau-20-1184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Leiomyosarcoma (LMS) is one of the most common forms of soft tissue sarcoma with approximately 2,500 cases per year in the United States. The symptoms LMS vary depending upon the location, size, and spread of the tumor. In early stages, it may not be associated with any obvious symptoms so diagnosis and treatment may be delayed. In some cases, it can grow quickly and behave aggressively. Most types of LMS occur in the abdomen or in the uterus; although, scrotal LMS can be a very rare presentation of the disease. Here we present our case of a large, ulcerated scrotal LMS originating from subcutaneous tissue but not invading spermatic cord or tunica. Radical orchiectomy with high ligation of spermatic cord was performed, and patient had an uneventful postoperative course. This disease entity remains rare in the literature, and warrants larger studies in order to better understand treatment and oncologic outcomes. When LMS is identified early and is removed by surgical excision, prognosis can be good and full recovery quite likely. When LMS is already large or has spread to other parts of the body, treatment is relatively more complex and the prognosis poor. Hence, prompt diagnosis and treatment of genitourinary LMS require prompt attention, referral to tertiary, referral center should be strongly considered.
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Affiliation(s)
- Jiping Zeng
- Department of Urology, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Grant Pollock
- Department of Urology, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Joel Addams
- Department of Pathology, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Erika Bracamonte
- Department of Pathology, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Juan Chipollini
- Department of Urology, University of Arizona College of Medicine, Tucson, AZ, USA
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Chibuzo I, Adebayo S, Takure A, Ogun G, Nweke M, Shittu O, Olapade-Olaopa EO. Scrotal leiomyoma. HAMDAN MEDICAL JOURNAL 2019. [DOI: 10.4103/hmj.hmj_65_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Abstract
Smooth muscle tumors occur infrequently in the skin. They consist of a diverse group of lesions representing hamartomas as well as benign and malignant neoplasms. They may arise from arrector pili muscle, specialized smooth muscle of the genitalia, or vascular smooth muscle. Although rare, accurate diagnosis and classification of cutaneous smooth muscle proliferations is important as they can exhibit a range of clinical behavior and may be associated with underlying syndromes. This review summarizes the clinicopathologic spectrum of smooth muscle tumors involving the skin.
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Raghavendran M, Venugopal A, Kumar KG. Symplastic epididymal leiomyoma with bizarre cytology. Cytopathology 2017; 28:549-551. [PMID: 28868647 DOI: 10.1111/cyt.12464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2017] [Indexed: 11/29/2022]
Affiliation(s)
- M Raghavendran
- Department Of Urology, Apollo BGS Hospitals, Mysore, India
| | - A Venugopal
- Department Of Pathology, Apollo Hospitals, Mysore, India
| | - K G Kumar
- Department Of Urology, Apollo BGS Hospitals, Mysore, India
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Huang JH, Broggi M, Osunkoya AO, Master VA. Surgical Management of Primary Scrotal Cancer. Urol Clin North Am 2016; 43:531-544. [PMID: 27717439 DOI: 10.1016/j.ucl.2016.06.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Primary scrotal cancer is a rare urologic malignancy with various histologic subtypes. Management and outcomes are not designed optimally. Surgical excision is the recommended treatment for localized scrotal cancer, with assessment of the margins for disease. Closure of the defect can be performed with primary closure, skin grafts, flaps, or by secondary intention. Analysis of outcomes suggests that high-risk scrotal cancer may have a worse prognosis compared with penile cancer, and low-risk scrotal cancer may have a comparable prognosis. Understanding techniques for management and survival outcomes can help the urologist determine the appropriate course of treatment and improve patient care.
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Affiliation(s)
- Jonathan H Huang
- Department of Urology, Emory University, 1365 Clifton Road Northeast, Suite B6140, Atlanta, GA 30322, USA.
| | - Matt Broggi
- Department of Urology, Emory University, 1365 Clifton Road Northeast, Suite B6140, Atlanta, GA 30322, USA
| | - Adeboye O Osunkoya
- Department of Urology, Emory University, 1365 Clifton Road Northeast, Suite B6140, Atlanta, GA 30322, USA
| | - Viraj A Master
- Department of Urology, Emory University, 1365 Clifton Road Northeast, Suite B6140, Atlanta, GA 30322, USA
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Rare Leiomyoma of the Tunica Dartos: A Case Report with Clinical Relevance for Malignant Transformation and HLRCC. Case Rep Pathol 2016; 2016:6471520. [PMID: 27529047 PMCID: PMC4978837 DOI: 10.1155/2016/6471520] [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: 05/25/2016] [Revised: 06/24/2016] [Accepted: 06/30/2016] [Indexed: 11/17/2022] Open
Abstract
Background. Genital leiomyomas fall under the broader category of cutaneous leiomyomas, which are rare smooth muscle neoplasms accounting for 5% of all leiomyomas. Genital leiomyomas arising from the dartos muscle are exceedingly rare with fewer than 30 cases reported in the literature. They are typically benign and adequately treated with simple surgical excision; however, previously reported cases of malignant transformation and a possible link to the hereditary leiomyomatosis and renal cell cancer (HLRCC) syndrome warrant closer follow-up. Case Presentation. We report a case of a 47-year-old male refugee from Rwanda found to have a mobile, pea-sized, mildly painful scrotal lesion near the left penoscrotal junction and 1.5 cm indeterminate vascular mass in the right kidney. Surgical excision of the scrotal nodule was performed and the diagnosis of a dartoic leiomyoma was rendered. The presence of moderate nuclear atypia, rare mitotic activity, and close surgical margins prompted a wide reexcision. We report the surgical approach, pathologic findings, and clinical follow-up related to this scrotal lesion. Conclusion. Scrotal leiomyomas demonstrate a high rate of recurrence and pose a risk for malignant transformation. They may also indicate an underlying autosomal dominant syndrome associated with increased risk for development of an aggressive form of renal cell carcinoma. When discovered, management should include surgical excision, screening for syndromic features, and routine follow-up.
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Azimpouran M, Vazifekhah S, Moslemi F, Piri R, Naghavi-Behzad M. Immunohistochemical profile of uterine leiomyomas; a comparison between different subtypes. Niger Med J 2016; 57:54-8. [PMID: 27185980 PMCID: PMC4859115 DOI: 10.4103/0300-1652.180567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Of all Smooth muscle tumours originating from uterus are leiomyomas are the most common ones. Benign nature and smooth muscle origination of leiomyomas can be easily documented via histological examination. In present study it was tried to examine immunohistochemical profile of leiomyomas with different subtypes. MATERIAL AND METHODS In this cross-sectional study 64 cases of smooth muscle tumors originating from uterus were included in study. As a control group 12 cases of conventional leiomyomas were selected. Then estrogen receptor, progesterone receptor, p53 and ki-67 were assessed. Statistical analysis was conducted using SPSS 16.0. RESULTS P 53 and ki-67 antibody status was diffusely positive in 12 out of 24 cases (50%) of leiomyosarcomas. Leiomyomas with bizzare nuclei were stained with Ki67 proliferative marker less than those in obviously malignant cases (P < 0.001). Estrogen and progesterone receptors had a reverse correlation with tumours malignancy potential. CONCLUSION Since p53 is known as an important inhibitory trigger for proliferative cycle of cells, in current study it was concluded that p53 inhibitory role decreases as malignancy potential increases, also tumors dependence on steroids via steroid receptors decreases as malignancy potential increases.
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Affiliation(s)
- Mahzad Azimpouran
- Department of Pathology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shabnam Vazifekhah
- Department of Obstetrics and Gynecology, Urmia University of Medical Sciences, Urmia, Iran
| | - Farnaz Moslemi
- Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reza Piri
- Medical Philosophy and History Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Naghavi-Behzad
- Students' Research Committee, Tabriz, Iran; Medical Education Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Schoolmeester JK, Fritchie KJ. Genital soft tissue tumors. J Cutan Pathol 2015; 42:441-51. [PMID: 25925211 DOI: 10.1111/cup.12507] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Revised: 03/01/2015] [Accepted: 04/04/2015] [Indexed: 01/12/2023]
Abstract
Mesenchymal neoplasms of the vulvovaginal and inguinoscrotal regions are among the most diagnostically challenging specimens in the pathology laboratory owing largely to their unique intersection between general soft tissue tumors and relatively genital-specific mesenchymal tumors. Genital stromal tumors are a unique subset of soft tissue tumors encountered at this location, and this group includes fibroepithelial stromal polyp, superficial (cervicovaginal) myofibroblastoma, cellular angiofibroma, mammary-type myofibroblastoma, angiomyofibroblastoma and aggressive angiomyxoma. Aside from the striking morphologic and immunophenotypic similarity that is seen with these entities, there is evidence that a subset of genital stromal tumors may be linked genetically. This review will focus on simplifying this group of tumors and provide the pathologist or dermatopathologist with practical management information. Smooth muscle tumors of the external genitalia will also be discussed.
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Affiliation(s)
- John K Schoolmeester
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.,Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | - Karen J Fritchie
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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