Tissue differentiation in malignant synovial tumours.
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Becker's nevus (BN) has been reported in association with smooth-muscle hamartoma, and an acneiform eruption and underlying structural anomalies of bone and soft tissues. We report a case of BN coexistent with a large connective-tissue nevus (CTN) on the right shoulder of a 74-year-old man. Whether this phenomenon represents the mere chance occurrence of two distinct cutaneous hamartomatous processes coexistent in the same anatomic site, an exaggerated manifestation of minor dermal changes previously described, or an association heretofore unrecognized due to the often subtle clinical and histologic features of both BN and CTN, is conjectural.
Glomangiosarcoma (GS) is a very unusual but morphologically distinctive tumor of soft tissue. We report a case of GS which occurred in the subcutaneous tissue of a 56-year-old man. Microscopically, a typical glomus tumor surrounded a central area of sarcoma. Immunohistochemical stains were performed, and there was a strong positive reaction for vimentin, muscle-specific actin and smooth muscle actin. We also review the clinicopathologic findings of the 9 GS that have previously been reported.
Ameloblastomas are usually found in the bony tissues of the jaws, but have also been reported in the adjacent soft tissues. Here we report the unusual occurrence of an extraosseous ameloblastoma in the tissues of the cheek.
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We reviewed 197 body CT studies on 53 sequential patients who had a histologic diagnosis of malignant melanoma in order to determine the CT appearance, pattern of spread, and prevalence of subcutaneous melanoma metastases. Seventeen (38%) of 45 patients with CT evidence of metastatic melanoma had subcutaneous nodules shown on CT. Five patients (11%) had subcutaneous nodules as the only indication of metastatic disease on their CT scans. All patients who developed subcutaneous metastases had primary lesions classified as Clark level IV or V. (The Clark classification is based on the depth of tumor invasion and is rated I to V.) Metastases appeared as small, discrete rounded densities in the subcutaneous fat; lesions were occasionally subtle because of their small size and peripheral location. The location of subcutaneous nodules could not be predicted consistently on the basis of the site of the primary malignancy. We conclude that subcutaneous metastases are common with melanoma in patients with Clark level IV or V lesions. These subcutaneous nodules are readily detected on CT scans if the subcutaneous tissues are carefully examined. The detection of these lesions may affect management or prognosis of patients, especially in those cases where subcutaneous nodules are the only CT evidence of metastatic disease.
We report on a 51-year-old male patient showing a slowly growing, pedunculated, hairless tumor on the back of his head. The tumor grew up to the size of 4.2 cm in diameter, before it was removed by surgery. Histological examination revealed the typical picture of an ancient schwannoma (degenerated neurilemmoma). In spite of its highly atypical nuclei, the biological behavior of ancient schwannoma is benign, and it must be differentiated from malignant tumors of the nerve sheath.
First described as a pleural neoplasm, the solitary fibrous tumor has been reported in a number of extrapleural sites, including the upper respiratory tract. The neoplasm is of mesenchymal origin, exists in benign and malignant forms, and is a histopathologic diagnosis made after exclusion of other soft tissue neoplasms. None of the eight reported sinonasal and nasopharyngeal solitary fibrous tumors have been histologically or biologically malignant. Surgical excision appears to control the tumor at these sites.
A hemangiopericytoma (HPC) is an uncommon soft-tissue neoplasm that may arise in many body sites. The cytologic features of fine-needle aspirates (FNAs) of HPCs have only rarely been described in the literature. We examined FNAs of malignant HPCs from the head and neck region (three) and the retroperitoneum (one) in four adults (aged 38 to 83 years). All four FNAs yielded cellular specimens that consisted of uninuclear tumor cells with high nuclear-cytoplasmic ratios. The cytomorphological spectrum included nuclei that were oval to elongate and had very finely granular, evenly distributed chromatin with one or two small but distinct nucleoli. Hemangiopericytomas yield aspirates that may be considered malignant and may suggest sarcoma. Histologically, all four neoplasms manifested high mitotic activity. The ultrastructural features of all four tumors were supportive of the diagnosis of HPC. Although a specific primary diagnosis of HPC on FNA of a soft-tissue mass is unlikely, cytologic analysis may allow diagnosis of recurrent or metastatic HPC. We were able to perform flow cytometric determinations of tumor DNA content on three of the resected neoplasms. In two, an aneuploid pattern was found, including the neoplasm with the most marked pleomorphism in the FNA. The third was diploid.
In recent years whole lung tomography (WLT) has been considered mandatory in the staging of some neoplastic diseases, particularly of soft tissues and bone tumors. Since WLT is an exacting roentgen examination, its usefulness was evaluated by analysing 132 consecutive patients submitted to orthogonal chest roentgenograms and WLT, from January 1979 to October 1981 at the National Cancer Institute of Milan. A comparison between WLT and traditional chest X-ray examination was performed in order to evaluate how much tomography is significantly useful in improving diagnosis of lung metastases. From this analysis, the authors conclude that WLT is generally unnecessary when chest roentgenograms are negative, whereas it is useful when single or multiple lung metastases are already evident by traditional X-ray examination. In these cases WLT allows a more accurate identification of the metastases from the point of view of their number and site, which is important not only for the treatment choice but also for the check of its effectiveness.
In obese patients, lymphodystrophic tissue can create large masses that are microscopically indistinguishable from chronic lymphedema. This tissue can be disabling, especially in the lower extremities. The tissue is refractory to conservative therapy and is prone to cellulitis and abscess formation. The patients are regarded as being at high risk for surgical complications due to obesity and related illnesses. We report two cases of patients with lesions severely limiting walking. The two patients weighed 490 and 520 lb, respectively. One patient had hypertension and asthma; the other had arrhythmias and chronic venous thrombosis. One patient had wedge resection of the right groin (23 lb) and knee (5 lb), and the second patient had resection of the right thigh (65 lb) and left thigh (84 lb). All procedures were done separately. Both patients reported improvement in walking. Simple wedge excision was an effective, minimally complicated treatment for these patients.
PURPOSE: To evaluate the use of MR imaging using standard sequences in the differentiation of common vascular birthmarks of soft tissues in childhood. MATERIAL AND METHODS: Forty-three lesions in 37 children (median age 33 months) with hemangiomas (n=25), venous (n=8) and lymphatic (n=10) malformations were retrospectively studied. Images were obtained with a 0.2 T and a 1.5 T MR unit, using T1-weighted spin-echo, T2-weighted turbo spin-echo and turbo STIR sequences. In addition, 19 contrast studies were evaluated. Signal intensities and morphological characteristics were analyzed. RESULTS: All hemangiomas were hyperintense in T2-weighted, and mostly (22/25) isointense compared to the surrounding skeletal muscle in T1-weighted images. The lesions were homogeneous or mildly inhomogeneous and well defined. Venous and lymphatic malformations showed similar patterns. Contrary to other lesions, no vessels or lobular architecture were detectable and contrast enhancement was absent in lymphatic malformations. CONCLUSION: A reliable differentiation between hemangiomas, venous and lymphatic malformations in childhood is not possible by standard MR sequences alone. Contrast media may be helpful as lymphatic malformations show no contrast enhancement. The main role of MR imaging is to determine the local extent or infiltration of deeper tissue layers and narrow the differential diagnosis of other soft tissue tumors.
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Widespread linear hamartoma of vascular, elastic, adipose, and connective tissue was observed in two girls with another and opposite defect, that of failure of development of focal areas of dermis. No abnormality in number or chromosones was found. Multiple associated defects of development of mesodermal and ectodermal tissues were present. The fat tissue appeared to be associated with vascular proliferation in the papillary bodies and to crowd out the corium by downward infiltration of newly developed fat. Elastic tissue fibers were demonstrable crossing between the fat cells and were prominent in the superficial dermis. There was a definite stratum of dermis dividing the superficial nevus fat and the normal subcutaneous fat. This evidence justifies the explanation of the superficial fat tumors as nevoid neoplasms rather than herniations of subcutaneous fat.
We report 2 cases of nasolabial cyst and a case of schwannoma beneath the alar base that required a differential diagnosis because of clinical features and MR images that resembled the nasolabial cyst. The morphologic analysis on MR images revealed the characteristic appearance of the nasolabial cyst, and the sagittal MR image may be most helpful for diagnosing this rare disease.
The clinical and pathologic features of four cases of benign mesenchymoma in which mature cartilage represented the predominant component are reported. The distinctive histologic feature in all four cases was a lobular proliferation of cartilaginous tissue exhibiting a spectrum of hyaline cartilage, fibrocartilage, myxoid cartilage, and cartilage with ossification and even bone marrow formation, intimately associated with mature adipose tissue and vascular elements. The localization of these tumors was in the proximity of a bone, but not attached to the periosteum or in continuity with a joint. Because these lesions may be mistaken for other cartilaginous neoplasms of soft tissue, recognition of this entity has potentially important diagnostic and therapeutic implications in that mutilating surgery may be avoided.
Malignant peripheral nerve sheath tumor (MPNST) commonly presents a diagnostic challenge and may resemble a variety of other soft tissue neoplasms microscopically. The authors have examined 62 examples of MPNST immunohistochemically, using antibodies to S-100 protein, myelin basic protein (MBP), and Leu-7, all of which are potential neural markers. Sixty-eight percent of all cases expressed at least one of these three determinants, representing a higher rate of immunoreactivity than that seen for single nervous system antigens in previous studies. Conjoint reactivity for S-100/Leu-7, S-100/MBP, and MBP/Leu-7 was seen in 34%, 34%, and 24% of cases, respectively. This coexpression of antigens is important, because none of them in isolation is immunospecific for nerve sheath tumors. In addition, stains for epithelial membrane antigen were reactive in two epithelioid tumors in this series, and eight spindle-cell neoplasms demonstrated desmin positivity. Analyses for cytokeratin, carcinoembryonic antigen, and Factor VIII-related antigen were negative in all cases. These results indicate an overlap between the immunocytochemical attributes of malignant peripheral nerve sheath tumors and other soft tissue sarcomas and emphasize the desirability of assessing multiple neural markers in such cases.