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Thangjam N, Dey B, Raphael V, Mishra J, Lynser D, Ghosh T, Kumar S, Bhattacharjee M. Adult Primary Central Nervous System Atypical Teratoid/Rhabdoid Tumor Metastasizing to the Cervical Lymph Node. Cureus 2024; 16:e73742. [PMID: 39677208 PMCID: PMC11646409 DOI: 10.7759/cureus.73742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2024] [Indexed: 12/17/2024] Open
Abstract
Atypical teratoid/rhabdoid tumors (AT/RTs) of the central nervous system (CNS) are rare and aggressive, typically occurring in early childhood or infancy, with adult cases being extremely rare. These tumors are associated with the inactivation of the integrase interactor 1 (INI1) gene. The prognosis is poor, worsening significantly if metastasis is detected at diagnosis. While CNS tumors rarely metastasize to cervical lymph nodes, recent findings have shown that such dissemination is possible, challenging the previously held belief that CNS malignancies do not spread via the lymphatic system. Awareness of this potential pathway is crucial for early diagnosis and avoiding unnecessary treatments. We present a case of a young adult male patient with a primary CNS AT/RT who had presented with cervical lymph node metastasis.
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Affiliation(s)
- Nirvana Thangjam
- Pathology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, IND
| | - Biswajit Dey
- Pathology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, IND
| | - Vandana Raphael
- Pathology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, IND
| | - Jaya Mishra
- Pathology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, IND
| | - Donboklang Lynser
- Radiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, IND
| | - Tamajyoti Ghosh
- Neurosurgery, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, IND
| | - Sumit Kumar
- Radiation Oncology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, IND
| | - Mainak Bhattacharjee
- Pathology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, IND
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Tahir M, Martin A, Madelaire C, Herrera GA, Maltese C, Shackelford RE. Primary Pulmonary Epithelioid Angiosarcoma Presenting in a 59-Year-Old Woman: A Report of a Rare Case. Cureus 2024; 16:e69191. [PMID: 39398746 PMCID: PMC11469199 DOI: 10.7759/cureus.69191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2024] [Indexed: 10/15/2024] Open
Abstract
Primary pulmonary angiosarcomas are rare malignancies, with aggressive clinical behavior and poor prognosis. Here we present a case of a rare primary pulmonary epithelioid angiosarcoma in a 59-year-old woman who initially presented with right-sided chest pain and shortness of breath. Chest X-ray revealed right lower lobe atelectasis, while a chest computed tomography angiography (CTA) showed a large right hydrothorax with collapse of most of the right lung. A right lower lobe resection was performed and histologic and immunohistochemical analyses were consistent with a primary pulmonary epithelioid angiosarcoma. The patient was discharged, given supportive care, and died 12 days following her last operation.
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Affiliation(s)
- Muhammad Tahir
- Pathology and Laboratory Medicine, University of South Alabama College of Medicine, Mobile, USA
| | - Ardenne Martin
- Pathology and Laboratory Medicine, University of South Alabama College of Medicine, Mobile, USA
| | - Carlina Madelaire
- Pathology and Laboratory Medicine, University of South Alabama College of Medicine, Mobile, USA
| | | | - Carl Maltese
- Cardiothoracic Surgery, University of South Alabama College of Medicine, Mobile, USA
| | - Rodney E Shackelford
- Pathology and Laboratory Medicine, University of South Alabama College of Medicine, Mobile, USA
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El Ouardani S, Chibani H, Rezzoug F, Kharkhach A, Al Jarroudi O, Brahmi SA, Afqir S. Neck Epithelioid Sarcoma at an Unusual Location Mimicking Lymph Node Metastases of Nasopharyngeal Carcinoma: A Case Report. Cureus 2024; 16:e56484. [PMID: 38638767 PMCID: PMC11026034 DOI: 10.7759/cureus.56484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 04/20/2024] Open
Abstract
Epithelioid sarcoma (ES) is an uncommon soft tissue sarcoma. It is usually located in the extremities and exceptionally in the neck. Its diagnosis constitutes a real challenge which is based on histology and immunohistochemistry staining that must be interpreted with caution given the anatomopathological similarities to other tumors. In this article, we report a case of a 37-year-old man admitted for a locally advanced ES of the neck. There were suspicions of lymph node metastases of nasopharyngeal carcinoma at the first pathological examination. The patient received palliative chemotherapy and was referred to the supportive care department. Through this case, we will discuss the clinical and anatomopathological characteristics and therapeutic options of this extremely rare tumor which poses a diagnostic challenge.
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Affiliation(s)
- Soufia El Ouardani
- Medical Oncology, Mohammed VI University Hospital, Oujda, MAR
- Medical Oncology, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, MAR
| | - Hind Chibani
- Medical Oncology, Mohammed VI University Hospital, Oujda, MAR
- Medical Oncology, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, MAR
| | - Fatima Rezzoug
- Medical Oncology, Mohammed VI University Hospital, Oujda, MAR
- Medical Oncology, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, MAR
| | - Ayoub Kharkhach
- Surgical Oncology, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, MAR
- Surgical Oncology, Mohammed VI University Hospital, Oujda, MAR
| | - Ouissam Al Jarroudi
- Medical Oncology, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, MAR
- Medical Oncology, Mohammed VI University Hospital, Oujda, MAR
| | - Sami Aziz Brahmi
- Medical Oncology, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, MAR
- Medical Oncology, Mohammed VI University Hospital, Oujda, MAR
| | - Said Afqir
- Medical Oncology, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, MAR
- Medical Oncology, Mohammed VI University Hospital, Oujda, MAR
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Haseeb M, Sachdev P, Sravani M, Tadigotla C, Sunkara NABS, Gadyalpatil N. Malignant Perivascular Epithelioid Cell Neoplasm of Left Kidney Treated With Targeted Therapy: A Rare Case Report. Cureus 2023; 15:e43097. [PMID: 37692712 PMCID: PMC10483028 DOI: 10.7759/cureus.43097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2023] [Indexed: 09/12/2023] Open
Abstract
Perivascular epithelioid cell neoplasm (PEComa) is one of the rare entities which is challenging to diagnose clinically. These tumors occur due to tuberous sclerosis complex gene mutations leading to upregulation and overexpression of the mammalian target of rapamycin (mTOR). Malignant PEComas are rare, and we report a peculiar case of PEComa treated with mTOR inhibitors. A 43-year-old woman presented with complaints of back pain, intermittent fever, dysuria, and cough with expectoration for one month. Abdominal computed tomography (CT) revealed heterogeneously enhancing exophytic mass of the left kidney. A positron emission tomography CT whole body showed a primary malignancy in the left kidney, sclerotic lesions in the bony skeleton, and lymphangitis carcinomatosis in both lungs. A biopsy of the left renal mass revealed PEComa, focally positive for melanocytic and muscle markers. She was commenced on treatment with intravenous temsirolimus, and there was a complete tumor regression by the end of the completion of six cycles.
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Affiliation(s)
- Muhammad Haseeb
- Internal Medicine, Allama Iqbal Medical College, Lahore, PAK
| | - Priyanka Sachdev
- Internal Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, PAK
| | - Mary Sravani
- Internal Medicine, SVS Medical College, Hyderabad, IND
| | - Chandana Tadigotla
- Internal Medicine, P.E.S Institute of Medical Science and Research, Kuppam, IND
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Do Q, Farooqui ZA, Parajuli D. Primary Epithelioid Angiosarcoma of the Colon With Peritoneal Carcinomatosis. Cureus 2023; 15:e36709. [PMID: 37113364 PMCID: PMC10129070 DOI: 10.7759/cureus.36709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2023] [Indexed: 03/28/2023] Open
Abstract
Angiosarcoma is a rare mesenchymal tissue neoplasm, typically involving lymphatic or vascular endothelial cells. The tumor can arise anywhere in the body, though it is most often found as cutaneous lesions in the head and neck region. Due to its rarity, a diagnosis can sometimes be missed, especially when the sarcoma involves an uncommon site like the gastrointestinal tract. In this case, we describe a male patient who was found to have primary epithelioid angiosarcoma of the colon. Initial biopsies with immunohistochemistry staining were weakly positive for anti-cytokeratin (CAM 5.2) and negative for SRY-Box transcription factor 10 (SOX-10) and B-cell-specific activator protein (PAX-5). He was misdiagnosed as having poorly differentiated carcinoma as a result. However, a more in-depth look at the colon specimen after tumor resection revealed CD-31 and factor VIII positivity, which established the diagnosis of epithelioid angiosarcoma of the colon. This case suggests the use of rare histopathology markers as part of the workup for colonic lesions to confirm the diagnosis, especially when tissue biopsy is limited.
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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: 30] [Impact Index Per Article: 10.0] [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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Ramkumar S. Epithelioid Haemangioma of Bone: A Case Series and Comprehensive Literature Review Reappraising the Diagnostic Classification of All Epithelioid Vascular Neoplasms of Bone. Cureus 2021; 13:e15371. [PMID: 34094789 PMCID: PMC8168629 DOI: 10.7759/cureus.15371] [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: 11/05/2022] Open
Abstract
Epithelioid vascular neoplasms of the bone are classified by the World Health Organization (WHO) into only two tiers: low-grade epithelioid hemangioma (EH) and a more malignant category including both epithelioid hemangioendothelioma and epithelioid angiosarcoma. The World Health Organization defines bone EH as a locally aggressive neoplasm with no connotation of benign or intermediate malignancy. We reviewed three cases of EH in our lab archives with the perspective of appraising their histomorphological approach toward diagnosis. Patients were in the age range of 15-25 years. The site of the neoplasms ranged from the carpal bones to the metatarsal bones. Histomorphological examination of the lesions showed a nodular growth pattern of a vascular neoplasm without demonstrable vessel origin. The vasoformative area increased from the center to the periphery, with prominent epithelioid morphology of the endothelial cells at the periphery and an associated inflammatory infiltrate comprising eosinophils, lymphocytes, and plasma cells. The growth pattern was diffuse, with extension into the deeper dermis of overlying skin.
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