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Machuca-Aguado J, Rendón-García R, Miraglia A, Téllez-Cantero JC, Gutiérrez-Domingo Á. Rare primary cardiac myxofibrosarcoma in adolescence: Diagnostic challenges and surgical insights. Cardiovasc Pathol 2024; 70:107623. [PMID: 38373641 DOI: 10.1016/j.carpath.2024.107623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 02/13/2024] [Accepted: 02/14/2024] [Indexed: 02/21/2024] Open
Abstract
This article presents a unique case of primary myxofibrosarcoma, an exceptionally rare cardiac neoplasm, in a 16-year-old girl. With fewer than 40 documented cases, this tumor's occurrence in adolescence is particularly uncommon. The patient presented with right-sided paresthesia and subsequent right hemiparesis and dysarthria, along with bilateral pleural effusion. Imaging tests revealed a cerebral ischemic lesion and the presence of a left atrial mass. Initially suspected as a myxoma, the tumor exhibited significant infiltration. Despite prompt excision and cardiac intervention, the patient experienced rapid decompensation and succumbed to heart failure 2 days later. Histopathological analysis revealed an intermediate grade myxofibrosarcoma. This case underscores the diagnostic complexity, emphasizing the need for early identification given the grim prognosis associated with cardiac myxofibrosarcomas, requiring detailed imaging, surgical, and histopathological insights.
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Affiliation(s)
- Jesús Machuca-Aguado
- Pathology Department, Virgen Macarena University Hospital, Seville, Spain.; University of Seville, Seville, Spain..
| | - Rosa Rendón-García
- Pathology Department, Virgen Macarena University Hospital, Seville, Spain
| | - Alessia Miraglia
- Cardiovascular Surgery Department, Virgen Macarena University Hospital, Seville, Spain
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Machuca-Aguado J, McCluggage WG. "Deciduoid" Change in Uterine Leiomyomas in Pregnancy: Aberrant Expression of Sex Cord Markers Inhibin and Calretinin. Int J Gynecol Pathol 2024; 43:176-181. [PMID: 37562064 DOI: 10.1097/pgp.0000000000000969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
Leiomyomas are common hormone-responsive uterine neoplasms which can exhibit a variety of morphologic changes secondary to hormonal agents such as progestogens. They may increase in size during pregnancy as a result of hormonal stimulation but surprisingly the morphologic features of leiomyomas in pregnancy are not well described in the literature. In this report, we describe the morphologic features of a series of 29 uterine leiomyomas in pregnancy. The features include in decreasing order of frequency infarct-type necrosis, decidualization of the serosal surface, hyalinization, myxoid alteration of the stroma, edema (sometimes with cyst formation), and dystrophic calcification. We also report a feature which we term "deciduoid" change (seen in 10 of 29 leiomyomas) which takes the form of altered smooth muscle cells with an epithelioid morphology with abundant eosinophilic or clear cytoplasm. Furthermore, we show that the "deciduoid" cells commonly exhibit expression of sex cord markers inhibin and calretinin. We speculate on the pathogenesis of the "deciduoid" change which together with its "aberrant" immunophenotype may result in diagnostic problems and consideration of other neoplasms.
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Machuca-Aguado J, García-Trevijano CI, Orrego-Pereira C, Montaña-Ramírez AM, Ríos-Martín JJ. Unraveling PRAME Expression in Desmoplastic Melanocytic Neoplasms: Illuminating its Diagnostic Significance in Distinguishing Desmoplastic Spitz Nevi. Am J Dermatopathol 2024:00000372-990000000-00295. [PMID: 38354375 DOI: 10.1097/dad.0000000000002638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Affiliation(s)
- Jesús Machuca-Aguado
- Pathology Department, Virgen Macarena University Hospital, Seville, Spain
- University of Seville, Seville, Spain
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Machuca-Aguado J, González-Fernández J, Rodríguez-Zarco E, González-Cámpora R, García-Escudero A. Adenomyomatous Pulmonary Hamartoma: Regarding a Case. Int J Surg Pathol 2024; 32:209-211. [PMID: 37013272 DOI: 10.1177/10668969231166304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
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Rodríguez-Rodero A, Machuca-Aguado J, Aguilar-Vera F, García-Escudero A. Xanthogranuloma in the External Auditory Canal in Childhood, an Unexpected Lesion. Indian J Otolaryngol Head Neck Surg 2024; 76:1098-1100. [PMID: 38440505 PMCID: PMC10908902 DOI: 10.1007/s12070-023-04139-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 08/11/2023] [Indexed: 03/06/2024] Open
Abstract
Pedunculated lesions in the external auditory canal present a broad differential diagnosis. It is crucial to rule out malignant neoplasms and consider the possibility of xanthogranulomas, which are very rare in this location. Management is determined by associated complications, and otolaryngologists must consider this for appropriate treatment.
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Affiliation(s)
| | - Jesús Machuca-Aguado
- Pathology Department, Virgen Macarena University Hospital, 41009 Avda. Fedriani, 3, Seville, Spain
| | | | - Antonio García-Escudero
- Pathology Department, Virgen Macarena University Hospital, 41009 Avda. Fedriani, 3, Seville, Spain
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Machuca-Aguado J, Salto-Tellez M. [What is Modern Pathology? Notes for the training of a contemporary Anatomic Pathology resident]. Rev Esp Patol 2024; 57:1-2. [PMID: 38246705 DOI: 10.1016/j.patol.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Affiliation(s)
- Jesús Machuca-Aguado
- Hospital Universitario Virgen Macarena, Sevilla, España; Escuela Internacional de Doctorado Universidad de Sevilla (EIDUS), Sevilla, España
| | - Manuel Salto-Tellez
- Precision Medicine Centre, Queen's University Belfast, Belfast, UK; Integrated Pathology Unit, the Institute of Cancer Research & The Royal Marsden Hospital, London, UK.
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Machuca-Aguado J, Rendón-García R, Álvarez-Muñoz A, Gálvez-Criado JM, Rubio-Garrido FJ, Sánchez-Bernal ML. The value of preoperative histological confirmation in inconclusive biliary strictures: Biliary neurofibroma as a rare cause of icteric obstructive syndrome. Gastroenterol Hepatol 2023; 46:803-804. [PMID: 36584753 DOI: 10.1016/j.gastrohep.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 11/18/2022] [Accepted: 12/02/2022] [Indexed: 12/28/2022]
Affiliation(s)
- Jesús Machuca-Aguado
- Unidad de Gestión Clínica de Anatomía Patológica, Hospital Universitario Virgen Macarena, Sevilla, España.
| | - Rosa Rendón-García
- Unidad de Gestión Clínica de Anatomía Patológica, Hospital Universitario Virgen Macarena, Sevilla, España
| | - Alejandro Álvarez-Muñoz
- Unidad de Gestión Clínica de Anatomía Patológica, Hospital Universitario Virgen Macarena, Sevilla, España
| | - José Manuel Gálvez-Criado
- Unidad de Gestión Clínica del Aparato Digestivo, Hospital Universitario Virgen Macarena, Sevilla, España
| | | | - María Luisa Sánchez-Bernal
- Unidad de Gestión Clínica de Anatomía Patológica, Hospital Universitario Virgen Macarena, Sevilla, España
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Machuca-Aguado J, Conde-Martín AF, Alvarez-Muñoz A, Rodríguez-Zarco E, Polo-Velasco A, Rueda-Ramos A, Rendón-García R, Ríos-Martin JJ, Idoate MA. Machine Learning Quantification of Intraepithelial Tumor-Infiltrating Lymphocytes as a Significant Prognostic Factor in High-Grade Serous Ovarian Carcinomas. Int J Mol Sci 2023; 24:16060. [PMID: 38003250 PMCID: PMC10671555 DOI: 10.3390/ijms242216060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 10/26/2023] [Accepted: 11/01/2023] [Indexed: 11/26/2023] Open
Abstract
The prognostic and predictive role of tumor-infiltrating lymphocytes (TILs) has been demonstrated in various neoplasms. The few publications that have addressed this topic in high-grade serous ovarian carcinoma (HGSOC) have approached TIL quantification from a semiquantitative standpoint. Clinical correlation studies, therefore, need to be conducted based on more accurate TIL quantification. We created a machine learning system based on H&E-stained sections using 76 molecularly and clinically well-characterized advanced HGSOC. This system enabled immune cell classification. These immune parameters were subsequently correlated with overall survival (OS) and progression-free survival (PFI). An intense colonization of the tumor cords by TILs was associated with a better prognosis. Moreover, the multivariate analysis showed that the intraephitelial (ie) TILs concentration was an independent and favorable prognostic factor both for OS (p = 0.02) and PFI (p = 0.001). A synergistic effect between complete surgical cytoreduction and high levels of ieTILs was evidenced, both in terms of OS (p = 0.0005) and PFI (p = 0.0008). We consider that digital analysis with machine learning provided a more accurate TIL quantification in HGSOC. It has been demonstrated that ieTILs quantification in H&E-stained slides is an independent prognostic parameter. It is possible that intraepithelial TIL quantification could help identify candidate patients for immunotherapy.
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Affiliation(s)
- Jesús Machuca-Aguado
- Department of Pathology, Virgen Macarena University Hospital & School of Medicine, University of Seville, 41009 Seville, Spain; (J.M.-A.); (A.F.C.-M.); (A.A.-M.); (E.R.-Z.); (R.R.-G.); (J.J.R.-M.)
| | - Antonio Félix Conde-Martín
- Department of Pathology, Virgen Macarena University Hospital & School of Medicine, University of Seville, 41009 Seville, Spain; (J.M.-A.); (A.F.C.-M.); (A.A.-M.); (E.R.-Z.); (R.R.-G.); (J.J.R.-M.)
| | - Alejandro Alvarez-Muñoz
- Department of Pathology, Virgen Macarena University Hospital & School of Medicine, University of Seville, 41009 Seville, Spain; (J.M.-A.); (A.F.C.-M.); (A.A.-M.); (E.R.-Z.); (R.R.-G.); (J.J.R.-M.)
| | - Enrique Rodríguez-Zarco
- Department of Pathology, Virgen Macarena University Hospital & School of Medicine, University of Seville, 41009 Seville, Spain; (J.M.-A.); (A.F.C.-M.); (A.A.-M.); (E.R.-Z.); (R.R.-G.); (J.J.R.-M.)
| | - Alfredo Polo-Velasco
- Gynecology Department, Virgen Macarena University Hospital & School of Medicine, University of Seville, 41009 Seville, Spain;
| | - Antonio Rueda-Ramos
- Oncology Department, Virgen Macarena University Hospital & School of Medicine, University of Seville, 41009 Seville, Spain;
| | - Rosa Rendón-García
- Department of Pathology, Virgen Macarena University Hospital & School of Medicine, University of Seville, 41009 Seville, Spain; (J.M.-A.); (A.F.C.-M.); (A.A.-M.); (E.R.-Z.); (R.R.-G.); (J.J.R.-M.)
| | - Juan José Ríos-Martin
- Department of Pathology, Virgen Macarena University Hospital & School of Medicine, University of Seville, 41009 Seville, Spain; (J.M.-A.); (A.F.C.-M.); (A.A.-M.); (E.R.-Z.); (R.R.-G.); (J.J.R.-M.)
| | - Miguel A. Idoate
- Department of Pathology, Virgen Macarena University Hospital & School of Medicine, University of Seville, 41009 Seville, Spain; (J.M.-A.); (A.F.C.-M.); (A.A.-M.); (E.R.-Z.); (R.R.-G.); (J.J.R.-M.)
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Machuca-Aguado J, Benítez Fernández T, Ríos-Martín JJ. Melanocytic Nevus in Subacute Lupus Erythematosus: An Unexpected Association. Actas Dermosifiliogr 2023; 114:830. [PMID: 36206814 DOI: 10.1016/j.ad.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/05/2022] [Accepted: 09/16/2022] [Indexed: 11/05/2022] Open
Affiliation(s)
- J Machuca-Aguado
- Departamento de Anatomía Patológica, Hospital Universitario Virgen Macarena, Sevilla, España
| | - T Benítez Fernández
- Departamento de Dermatología, Hospital Universitario Virgen Macarena, Sevilla, España
| | - J J Ríos-Martín
- Departamento de Anatomía Patológica, Hospital Universitario Virgen Macarena, Sevilla, España.
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Machuca-Aguado J, Cózar-Bernal F, Rodríguez-Zarco E, Ríos-Martin JJ, Idoate Gastearena MÁ. Clinicopathological Characteristics and Pathogenesis of Granular Cell Tumours of the Airways: A Plausible Neural Origin Through Chronic Tobacco Mucosa Irritation. J Bronchology Interv Pulmonol 2023; 30:390-392. [PMID: 37067992 DOI: 10.1097/lbr.0000000000000924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 03/21/2023] [Indexed: 04/18/2023]
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Machuca-Aguado J, López-Cano R, Triviño-Ramírez A, Villar-Rodríguez JL. Multiple Pulmonary and Hepatic Cavernous Hemangiomas, Simulating a Disseminated Malignant Neoplasm. J Bronchology Interv Pulmonol 2023; 30:382-384. [PMID: 36991543 DOI: 10.1097/lbr.0000000000000915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 02/07/2023] [Indexed: 03/31/2023]
Affiliation(s)
| | - Rafael López-Cano
- Thoracic Surgery Department, Virgen Macarena University Hospital, Seville, Spain
| | - Ana Triviño-Ramírez
- Thoracic Surgery Department, Virgen Macarena University Hospital, Seville, Spain
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Machuca-Aguado J, Benítez Fernández T, Ríos-Martín JJ. [Translated article] Melanocytic Nevus in Subacute Lupus Erythematosus: An Unexpected Association. Actas Dermosifiliogr 2023; 114:T830. [PMID: 37506829 DOI: 10.1016/j.ad.2022.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/16/2022] [Indexed: 07/30/2023] Open
Affiliation(s)
- J Machuca-Aguado
- Departamento de Anatomía Patológica, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - T Benítez Fernández
- Departamento de Dermatología, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - J J Ríos-Martín
- Departamento de Anatomía Patológica, Hospital Universitario Virgen Macarena, Sevilla, Spain.
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Machuca-Aguado J, McCluggage WG. 'STIC-like' lesions in ovarian low-grade serous carcinoma: a diagnostic pitfall. Histopathology 2023; 83:489-492. [PMID: 37356967 DOI: 10.1111/his.14967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/12/2023] [Accepted: 05/23/2023] [Indexed: 06/27/2023]
Affiliation(s)
| | - W Glenn McCluggage
- Department of Pathology, Belfast Health and Social Care Trust, Belfast, UK
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Machuca-Aguado J, Umbría-Jiménez S, García-Escudero A, Giráldez-Puig J, González-Cámpora R. Mixed Epithelial-stromal Tumor: Another Example of Confusing Subclassifications. Urology 2023; 178:192-193. [PMID: 37343681 DOI: 10.1016/j.urology.2023.05.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 05/15/2023] [Indexed: 06/23/2023]
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Flores JLR, de Ceballos EPG, Hernández-Cruz B, Muñoz AHA, Machuca-Aguado J, Gallardo SR, Venegas JJP. Refractory multisystemic sarcoidosis, a diagnosis and treatment challenge: a case report. J Med Case Rep 2023; 17:303. [PMID: 37386509 DOI: 10.1186/s13256-023-03996-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 05/21/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Sarcoidosis is a multisystemic granulomatous disease of unknown origin. It is characterized by abnormal activation of lymphocytes and macrophages with the formation of granulomas. Most cases have asymptomatic pulmonary involvement. In case of symptoms, they have an excellent response to glucocorticoid therapy. We present a case of sarcoidosis with multi-organ involvement, refractory to multiple treatments including biological. Partial remission was achieved in it. CASE PRESENTATION We report an interesting case of a 38-years-old Spanish woman treated by Heerfordt's syndrome (uveitis, parotiditis, fever and facial palsy) plus pulmonary hiliar adenopathy. A sarcoidosis diagnosis was confirmed by lung biopsy. She was initially treated with an 8 weeks course of medium dose oral glucocorticoids and tapered over 8 weeks with improvement. After the suspension of glucocorticoids a relapse occurs with severe ocular involvement and suspicion of neurological involvement. The patient received multiple lines of treatment with poor response. Finally, after the combination of cyclophosphamide with infliximab, the uveitis resolved, improving the neurological symptoms. CONCLUSIONS Sarcoidosis is a benign disease in most cases. In a small percentage of cases behaves aggressively, requiring early diagnosis and immunosuppressive treatment to avoid sequelae. An adequate immunosuppressive therapy based on Anti TNF drugs should be started to minimize damage and improve the quality of life.The choice of treatment depends on the type and severity of the disease.
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Affiliation(s)
- Jorge Luis Rodas Flores
- Rheumatology Department, Virgen Macarena University Hospital, Av Dr. Fedriani 3, 41009, Seville, Spain.
| | | | - Blanca Hernández-Cruz
- Rheumatology Department, Virgen Macarena University Hospital, Av Dr. Fedriani 3, 41009, Seville, Spain
| | | | - Jesús Machuca-Aguado
- Pathological Anatomy Department, Virgen Macarena University Hospital, Av Dr. Fedriani 3, 41009, Seville, Spain
| | - Salvador Recio Gallardo
- Radiology Department, Virgen Macarena University Hospital, Av Dr. Fedriani 3, 41009, Seville, Spain
| | - José Javier Perez Venegas
- Rheumatology Department, Virgen Macarena University Hospital, Av Dr. Fedriani 3, 41009, Seville, Spain
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Rodríguez-Zarco E, Machuca-Aguado J, Macías-García L, Vallejo-Benítez A, Ríos-Martín JJ. Metanephric adenoma: molecular study and review of the literature. Oncotarget 2022; 13:387-392. [PMID: 35198098 PMCID: PMC8852360 DOI: 10.18632/oncotarget.28192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 01/17/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction: Metanephric adenoma (MA) is an uncommon benign tumor accounting for 0.2–0.7% of adult renal epithelial neoplasms. The clinical course is often indolent, but diagnosis should not be delayed since clinical symptoms (hematuria, fever, palpable abdominal mass, and flank pain) may be non-specific and overlap with those of a malign renal neoplasm. We report on 4 cases of AM, for which morphological and mutational analysis were performed. Material and Methods: Immunohistochemical staining was performed on sections cut from paraffin blocks to assess expression of WT1, vimentin, racemase, CK7, CD10 and RCC. Testing for the BRAF gene mutation V600 was carried out using real-time PCR (Cobas® 4800). Results: In all four cases, tumors were visible as well-circumscribed, non-encapsulated masses located in the renal cortex and extending towards the medulla. At immunohistochemical examination, tumor cells stained negative for CK7, CD10 and RCC and positive for both WT1 (nuclear, intense) and vimentin (cytoplasmic, intense, and diffuse). Molecular analysis revealed the BRAF gene mutation V600E in three cases and wild-type BRAF in the fourth. Conclusions: BRAF molecular mutation analysis may aid diagnosis in cases with atypical histological features, especially in small incisional biopsies when reassessment of surgical treatment may be considered.
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