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PubMed2002

[Cavernous haemangioma in the Muscularis propria of the oesophagus and in the paraoesophageal tissue].

This is a case report of a 45-year-old woman who presented herself in our hospital with increasing retrosternal tenderness to pressure, dysphagia, and symptoms of reflux oesophagitis. The clinical examination and laboratory results showed no pathological findings. Oesophagogastroduodenoscopy revealed a bluish-livid, bulging mass from 32-38 cm aborally. A malignancy could not be excluded by biopsies with histological work-up, endoscopical ultrasound, nor CT-scan. By thoraco-abdominal surgery, a 5 cm large vascularised tumour of the outer layers of the oesophagus and the paraoesophageal tissue was resected. After intrathoracic oesophago-gastrostomy the patient could be discharged 17 days after surgery without further symptoms. Histology showed a benign tumour which was classified as cavernous haemangioma. To our knowledge, this is the first case of a haemangioma which involves the paraoesophageal tissue and the muscularis propria. The few published case reports of cavernous haemangioma of the oesophagus describe only an involvement of the mucosa and submucosa.

Diagnosis, Differential↗
PubMed2001

Hibernoma of the neck.

A hibernoma is a rare, benign, soft-tissue tumor composed of cells similar to those of brown adipose tissue. Only nine cases in the cervical area have been reported. Typically, hibernomas are asymptomatic and slow growing. Adequate treatment consists of complete excision. We describe an additional case of neck hibernoma and review the literature to clarify a pathologic condition rarely included in the differential diagnosis of cervical masses.

Adult↗
PubMed2004

Myofibromatosis: imaging characteristics.

BACKGROUND: Infantile myofibromatosis is the most common fibrous tumor of infancy. It can involve the skin, muscle, bone, and viscera. This uncommon entity is subdivided into solitary and multicentric forms, with or without visceral involvement. OBJECTIVE: To describe the imaging characteristics of extracranial myofibromatosis. MATERIALS AND METHODS: Six infants, aged 1 day-1 week, were evaluated by imaging. All six patients had evaluation of one of the masses by US; four patients had CT evaluation of at least one of the masses; and five patients had evaluation by MRI. RESULTS: The US appearance of the myofibromas included a mass with a purely anechoic center with a thick wall, a mass with a partially anechoic center, and a mass without anechoic components. On enhanced CT, the masses had lower or similar attenuation compared to adjacent muscle, with some masses exhibiting peripheral enhancement. The MR appearance consisted of low signal on T1-weighted imaging. On T2-weighted imaging, two had low signal of the center and the other three had high signal. All masses showed peripheral enhancement after gadolinium administration. CONCLUSIONS: Myofibromas have variable appearance on US, with a mass with an anechoic center being the most common feature. On CT, the mass can exhibit peripheral enhancement, calcifications, and erosion of adjacent bone. The MR appearance consisted of low signal on T1-weighted imaging and high or low signal of the center on T2-weighted imaging. All masses showed peripheral enhancement after gadolinium administration.

Back↗
PubMed2000

The role of electron microscopy in gynecological pathology.

Electron microscopy, as a diagnostic method, has been available to pathologists for about half a century. Its use in studying normal and abnormal gynecological tissues has been applied during the second half of that period, and many works on specific female genital topics have been published. Several of those subjects are worthy of citing in a review of the present type. Clear cell carcinoma has been revealed to be a mullerian, rather than a wolffian, derivative. Small cell carcinoma of the ovary with hypercalcemia is comprised of cells shown ultrastructurally to be epithelial, but unlike surface epithelial cells, germ cells, sex-cord cells, or neuroendocrine cells. Further electron microscopic studies provided evidence that these small cell tumors are not adult diffuse granulosa cell tumors, endometrioid stromal tumors, primitive neuroectodermal tumors, or numerous other primary and metastatic small cell tumors. Electron microscopy has also been useful in determining that not all signet-ring cell tumors of the ovary are stromal, and that there are multiple types of signet-ring (vacuolated) cells in ovarian tumors. Smooth muscle tumors are well known to have multiple light microscopic phenotypes, and electron microscopy has proven to be diagnostic in many of these cases, especially in epithelioid smooth muscle tumors. A number of other gynecological neoplasms that have been better defined by electron microscopic studies are described. Embryology and histogenesis are other areas of study in which electron microscopy has been a major contributor of new information at the subcellular level. Electron microscopy, solely or in harmony with clinical information, light microscopy, and immunohistochemistry, has been and is a valuable tool for the pathologist in the study of histogenesis and accurate diagnosis of gynecological lesions.

Adenocarcinoma, Clear Cell↗
PubMed2004

Type-selective muscular degeneration promotes infiltrative growth of intramuscular lipoma.

BACKGROUND: Intramuscular lipoma is a relatively common benign neoplasm that is occasionally described as an infiltrating lipoma. Typical benign tumors show a clear margin, however, the infiltrative growth pattern of this lipoma mimics that of a malignant tumor. Although its growth has an effect on muscle bundles and it is known to never metastasize, the mechanism of infiltrative growth is not well understood. Previously, little attention has been paid to pathogenic features of muscle fibers around an intramuscular lipoma. METHODS: In the present study, we focused on pathologic changes of the surrounding skeletal muscles especially to the degenerative features of involving muscular types, and evaluate the role of type-selective muscular degeneration for the infiltrative growth of intramuscular lipomas. Following a review of the medical records in our institute, 17 lesions containing muscle tissues in their specimens (15 infiltrating lipomas, 2 well-circumscribed lipomas) were analyzed immunohistochemically. The tumor from the most recent case was also subjected to ultrastructural analysis. Two cases of the traumatic muscle damage were also evaluated as the control experiments. RESULTS: These analyses revealed type-selective muscle involution in 11 of 17 intramuscular lipomas and in 10 of 11 of the infiltrative type, with an involving pattern that resembled that of a neurogenic or myogenic disorder. Immunoreactivity to cathepsin-D, a lysosomal catabolic enzyme, was increased in the involved muscle fibers. Subsarcolemmal vacuoles in the muscle fibers of the peripheral areas were also positive for cathepsin-D, while degenerative findings were not visually apparent in these areas. Ultrastructural analysis revealed degenerative changes in those fibers. Neither positive staining for cathepsin-D nor type-selective atrophy was detected in the sections of traumatic muscle damage. CONCLUSIONS: Our findings suggest that type-selective muscular degeneration and endomysial fatty growth as a result of atrophy may modulate the infiltrating growth characteristic of intramuscular lipoma.

Adipocytes↗
PubMed1998

Mast cells in smooth muscle tumors of the uterus.

Mast cells (MCs) have been reported in the myometrium and uterine smooth muscle tumors. We examined the number of MCs in various uterine smooth muscle tumors (including leiomyosarcomas) and assessed whether this feature might be of value in their pathologic diagnosis. The number of MCs in 95 uterine smooth muscle tumors, including 55 ordinary leiomyomas, 17 cellular leiomyomas, 8 bizarre leiomyomas, and 15 leiomyosarcomas, was counted using toluidine blue and immunohistochemical staining. The number of MCs that stained for tryptase was lowest in leiomyosarcoma and next lowest in ordinary leiomyoma; the number in each of these two groups was significantly lower than in the myometrium (p < 0.001). In cellular and bizarre leiomyomas, the number of MCs was significantly higher than in ordinary leiomyoma (p < 0.001 and p < 0.001, respectively) and leiomyosarcoma (p < 0.001 and p < 0.005, respectively). Statistical analysis revealed that counting the number of MCs and using a cut-off value of 16 MCs per high-power-field is useful for the differential diagnosis of leiomyosarcomas from cellular leiomyoma and bizarre leiomyoma, yielding 100% sensitivity and 96% specificity. The number of MCs was significantly lower in leiomyosarcomas at TNM stages III and IV than in those at stages I and II (p < 0.05), but there was no significant correlation between the number of MCs and patient survival. These results suggest that the number of MCs might be useful as part of a multivariate approach to the differential diagnosis of leiomyosarcoma from bizarre or cellular leiomyoma.

Cell Count↗
PubMed2005

Usefulness and limitations of ultrasound-guided core biopsy in the diagnosis of musculoskeletal tumours.

Ultrasound-guided needle biopsy is a safe and efficient diagnostic method increasingly used in the initial approach to superficial and deep musculoskeletal tumours. However, so far no general consensus has been reached regarding its reliability. During a 6-year period (1999-2004), biopsies were taken from 188 patients (100 females, 88 males; age average 55.8 years) with musculoskeletal tumours under ultrasound guidance using 18G BioPince or 14G ProMag 2.2 true-cut type needles. Cytological (imprints and cytocentrifugates) and histological material was obtained for diagnosis in every case. The lower extremity (59 cases) and the abdominal wall (29 cases) were the most commonly affected sites. Benign/reactive tumours (77 cases), metastatic epithelial malignancies (40 cases), and sarcomas (36 cases) were most frequently diagnosed. In 180 (95.75%) cases, core needle results were concordant with the definitive diagnosis (97 true positives and 83 true negatives). Relevant diagnostic discordance was seen in 8 (4.25%) cases (8 false negatives and 0 false positives). Sensitivity, specificity and positive and negative predictive values were 92%, 100%, 100%, and 91%, respectively. Ultrasound-guided core biopsy is thus a useful method in the initial approach to musculoskeletal tumours that allows correct patient management in the vast majority of cases.

Adolescent↗
PubMed1993

[Extension of an epidermoid carcinoma of the tongue to the infratemporal fossa].

Based on an atypical case of squamous carcinoma of the tongue in a young non-alcoholic, non-smoking woman, the authors review the anatomy of the tongue and adjacent spaces. The features of extension and the CT and MRI diagnosis of the tumour are analysed. Extension beyond the oropharynx to the pharyngolarynx and intratemporal fossa and bony involvement changed the stage and modified the treatment.

Adult↗
PubMed1987

Intermediate filament proteins and actin isoforms as markers for soft tissue tumor differentiation and origin. I. Smooth muscle tumors.

A series of 3 benign and 10 malignant smooth muscle (SM) neoplasms and of 2 malignant fibrous histiocytomas was examined by light microscopy, transmission electron microscopy, two-dimensional gel electrophoresis (2D-GE) and indirect immunofluorescence, using polyclonal monospecific or monoclonal antibodies to desmin, vimentin, cytokeratin, alpha-SM and alpha-sarcomeric (alpha-SR) actins. Benign neoplasms displayed typical light-microscopic features of SM, whereas leiomyosarcomas demonstrated variations in their histologic pattern. In 6 sarcomas, light microscopy suggested a SM differentiation, whereas in the other 4, a predominant nondistinctive spindle-cell pattern was observed. By transmission electron microscopy, all 13 neoplasms showed the minimal essential features of SM differentiation. Immunofluorescence disclosed heterogeneity of cytoskeletal protein expression: 5 neoplasms (3 benign and 2 malignant well-differentiated) expressed desmin, vimentin, and alpha-SM-actin; 2 malignant neoplasms expressed desmin and vimentin; 1 malignant neoplasm expressed desmin, vimentin and alpha-SR actin; 1 malignant neoplasm expressed vimentin and alpha-SR actin; and 4 malignant neoplasms expressed vimentin alone. By 2D-GE, 3 benign and 4 malignant SM neoplasms expressed alpha, beta, and gamma actins, and the remaining expressed only beta and gamma actins. The presence of alpha-SM actin in all benign neoplasms and in 2 well-differentiated leiomyosarcomas suggests that this actin isoform reflects a high degree of cellular differentiation. In 2 leiomyosarcomas, alpha-SR actin was detected by immunofluorescence, which suggested a skeletal muscle differentiation of these neoplasms. This study supports the assumption that leiomyosarcomas represent a heterogeneous group of neoplasms and furnishes new criteria for their characterization.

Actins↗