Blunt-ended Nuclei Research Articles

Gross and histopathological diagnosis of intra-luminal vaginal leiomyoma in an 8-year-old Caucasian bitch: case report

Vaginal leiomyomas are uncommon tumours and they may originate from vaginal smooth muscles, local arterial musculature, bladder or urethral smooth muscles. An 8-year-old Caucasian bitch was presented with a round pendulous smooth solid mass of about 5cm in diameter at the junction between the vestibule and vagina. Two other similar smaller masses were seen on the vaginal wall (0.4-0.6cm in diameter). Histopathologically, abundant densely packed spindle cells of uniform size, indistinct cellular borders, eosinophilic cytoplasm, and elongate, blunt-ended (cigar shaped) nuclei were seen. The cells appeared grouped in broad interlacing fibres at angles of 90 degree in a herringbone pattern, typical of smooth muscle tissue. In-depth examination of the reproductive tract should be carried out to avoid missing valuable diagnostic information that could help in proper intervention.

A RARE CASE OF A RECURRENT LEIOMYOSARCOMA OF THE BUCCAL MUCOSA

Leiomyosarcomas are rare malignant tumors that affect smooth muscle tissue. In the oral cavity, leiomyosarcomas are exceedingly rare. The diagnosis is challenging due to the overlap of morphologic findings with several spindle cell tumors. Herein, we reported a rare recurrent case of leiomyosarcoma in a 73-year-old woman presenting clinically as a painful nodule on the buccal mucosa. Microscopically, the tumor showed atypical spindle cells with elongated, blunt-ended nuclei and eosinophilic cytoplasm arranged in a fascicular pattern. Immunohistochemistry showed positivity for vimentin, α-SMA, HHF35, h-Caldesmon, and focal positivity for desmin. S-100 protein, CD34, myogenin, and pan-cytokeratin (AE1/AE3) were negative. Surgical excision followed by chemotherapy was performed. No recurrence was observed after 12 months of follow-up. Careful histopathologic analysis, supported by immunohistochemistry, is essential to ensure a correct diagnosis. Early wide surgical excision and prolonged follow-up is strongly recommended.

A subvulvar leiomyosarcoma in a Simmental cow - a case report

In this case, a mass located subcutaneously in the perineal subvulvar region of a six-year-old Simmental cow was examined clinically, pathomorphologically and immunohistochemically. Macroscopically, the solitary, whitishyellow-tumor mass was 19x15x6 cm in size, weighed 1610 grams, and had a lobular structure with a few small cystic formations in the section. Histopathological examination revealed that the tumor parenchyma had smooth muscle-like cells with abundant cytoplasm, pleomorphic cells with blunt-ended or cigar-shaped nuclei, anisocytosis, anisokaryosis and karyomegaly. Immunohistochemically, strong positive expression for α-SMA, vimentin, Ki67 and slight positive for desmin were found, while immulolabeling for pancytokeratin (AE1/AE3), S-100, CD31 and CD34 were negative. In conclusion, on the basis of these findings, the tumor was diagnosed as leiomyosarcoma.

Piloleiomyosarcoma in cats: Histological and immunohistochemical features.

This study describes the histomorphology and immunohistochemical profile of 9 cases of feline piloleiomyosarcoma. Cats ranged in age from 7 to 16 years (mean 10), and tumors were 7 to 24 mm in diameter (mean 15). Tumors were composed of fusiform cells that were haphazardly arranged or in variably sized interwoven bundles. Neoplastic cells had eosinophilic and fibrillar cytoplasm, and elongated blunt-ended nuclei. Entrapment of hair follicles and absence of vascular components support an origin from the smooth muscle cells of the arrector pili. Additional findings included bizarre nuclei and giant cells (7/9 cases), atypical mitoses (7/9 cases), ulceration (3/9 cases), and intratumoral necrosis (6/9 cases). Neoplastic cells expressed calponin, desmin, α-smooth muscle actin, and vimentin, but not CD18, CD31, cytokeratins, glial fibrillary acidic protein, neuron-specific enolase, Melan A, p63, or S-100 protein. Surgical excision was curative in 6/9 cases, with local recurrence in 2/9 cases and metastasis to local lymph nodes in 1/9 case. Clinical outcome was influenced by mitotic count, infiltration of subcutaneous tissue, and intensity of nuclear immunolabeling for p53.

LEIOMYOSARCOMA IN THE LATERAL BORDER OF THE TONGUE: A RARE CASE REPORT

Leiomyosarcoma is a rare mesenchymal malignant neoplasm, of which 3% to 10% of cases occur in the head and neck region. The leiomyosarcoma of the tongue is a very rare tumor with only 10 cases described in the literature. This work reports a case of oral leiomyosarcoma arising in the lateral border of the tongue of a 78-year-old man. Clinical examination showed a well-demarcated, firm and painful nodule measuring about 3 cm in diameter. After incisional biopsy, microscopic analysis showed the spindle-shaped tumor cells were arranged in an interlacing fascicular pattern and contained oval to elongated blunt-ended (cigar-shaped) nuclei. More than 10 mitoses per high-power field were counted. Immunohistochemical examination displayed that tumor cells were strongly positive to H-caldesmon, actin, and vimentin and negative to S100, establishing the final diagnosis of leiomyosarcoma. The patient was referred for oncologic treatment.

GINGIVAL ANGIOLEIOMYOMA IN CHILD

Male patient, 10 years old, was referred to evaluate symptomatic lesion with duration of 2 months. There were no systemic diseases. Extraoral and intraoral examinations revealed nodular soft tissue mass located in the upper gingival, between 63 and 24, covered for normal oral mucosa with ulceration area. Periapical and panoramic radiography showed smaller radiopacity of the alveolar bone around the root of 63. Diagnostic hypothesis were pyogenic granuloma and giant cells peripheral lesion. Excisional biopsies and root planning of associated teeth were performed. Histologic analysis revealed spindle-shaped cells with eosinophilic cytoplasm and elongated blunt-ended cigar-shaped nuclei to large dilated vascular channels. Masson's trichrome stain and immunohistochemistry were performed nuclear vacuole to differentiate angioleiomyoma and myofibroma. Diagnosis was angioleiomyoma. The patient developed no recurrence in the thirty months after surgical treatment. In this case, Masson's trichrome stain demonstrated to be an important method to differentiate angioleiomyoma and myofibroma. (CNPq #309322/2015-4; FAPEMIG).

Primary vaginal leiomyosarcoma, a rare tumour: case report and review

Primary vaginal leiomyosarcomas (pvLMS) are rare, recurrent tumours accounting for ca. 2% of all vaginal cancers. The etiology is still unknown, the prognosis is poor and there is no consensus guideline on its management. Diagnosis is usually made during the 5th decade due to the presence of a vaginal mass or nodule [1-2]. Current medical literature reports about 200 cases (PubMed®); only 3 studies have considered the ultrastructure [2-4]. Herein a pvLMS is presented and discussed. A nodular, 25 x 23 x 28 mm-mass, infiltrating the urethra but not the rectovaginal septum, was widely excised from the superior vaginal wall of a 58-year-old previously hysterectomized woman. Macroscopic images and MRI were performed. Iliac lymph nodes and HMB-45 were negative. The sample was fixed and prepared for light microscopy, transmission (TEM) and scanning (SEM) electron microscopy. Semithin sections showed a storiform pattern of spindle shaped cells with blunt-ended nuclei. Cells arranged in interwoven fascicles within a dense and richly vascularised stroma (neoangiogenesis). Some atypic mitotic figures and focal necrosis were seen. SEM evidenced a dense collagenous stroma with numerous microvessels. TEM showed neoplastic and pleomorphic cells with complex cytoplasm projections containing paranuclear crowds of dilated mitochondria, free ribosomes and a well-developed rough endoplasmic reticulum. Nuclei were large, mostly hyperchromatic, usually indented, with prominent nucleoli and nucleolonema. The dense intercellular space contained dense bundles of collagen fibers. A high and reactive endothelium lined blood vessels. After 4 follow-ups, the patient is fine and without recurrence. Best outcomes occur when the tumour is small, localized, and can be removed surgically with wide, clear margins, as it was for this case. As there are different kinds of LMS, biopsy followed by immunohistochemistry and electron microscopy still represents a good diagnostic choice.

Successful treatment of multiple cutaneous leiomyomas with carbon dioxide laser ablation.

Successful treatment of multiple cutaneous leiomyomas with carbon dioxide laser ablation.

Leiomyoma of the thyroid gland with psammoma bodies.

We report a rare case of leiomyoma of the thyroid gland associated with psammoma bodies. The patient was a 9-year-old black African boy. Prior to this, only five cases of primary thyroid leiomyoma have been reported. Histologically, thyroid leiomyoma was characterised by bundles of spindle smooth muscle cells with blunt-ended nuclei. Psammoma bodies were widely distributed within the tumour. Immunohistochemistry showed positive immunoreactivity for smooth muscle actin, vimentin and desmin, but was negative for a cytokeratin cocktail. Further reports of similar cases is required to ascertain the clinical significance of this lesion.

Epithelioid Leiomyosarcoma Arising in the Subcutis—A New Case Report of a Rare Variant

Epithelioid Leiomyosarcoma Arising in the Subcutis—A New Case Report of a Rare Variant

Primary leiomyoma of the ovaries in a dog

We would like to report a case of leiomyoma of the ovaries in a dog. Leiomyoma is commonly seen in the vagina in dogs. However, it is a very rare neoplasm in the ovaries. As there have only been a few reported cases, this report provides valuable information on veterinary medicine and pathology. Masses found in the ovaries need to be differentiated from other ovarian tumors. Therefore, we describe the gross, histopathological, and immunohistochemical features of a case of ovarian leiomyoma in a 10-year-old female Yorkshire Terrier dog. The mass on the right of the uterus was found accidentally by pelvic ultrasonography. Laparatomy revealed a large multi-nodulated ovarian mass. Grossly, cut surfaces of the mass showed multiple firm whitish nodules in the cortex and bloody loose connective tissue in the medulla. Histopathologically, the cortex of the mass was composed of spindle cells forming interlacing fascicles. The cells had elongated, blunt-ended nuclei and eosinophilic cytoplasm as detected by hematoxylin and eosin staining. Immunohistochemical stained sections were immunoreactive for α-smooth muscle actin and desmin but negative for vimentin and S-100. Therefore, differential diagnosis confirmed leiomyoma based on morphology and positive staining for α-smooth muscle actin and desmin.

Role of oxidative stress in concomitant occurrence of Fasciola gigantica and leiomyoma in cattle

Fasciola gigantica is a parasitic helminth that predominantly infects the liver and bile ducts of cattle and causes great losses of cattle production in the southwestern regions of Iran. The purpose of the present study was to find out the possible relationship between the extent of liver destruction and oxidative stress by estimating the level of MDA, and SOD and GPX enzymes in the liver of cattle infected with F. gigantica. Studies were carried out on 49 infected and 20 healthy livers. Based on the results, the SOD activity of the infected livers was substantially lower than those of the healthy ones. As in the livers with more damage, a significant decrease was observed in the SOD activity. Although the GPX activity of the control livers and the livers with low damage showed no statistically significant variation this value was significantly different between the livers with high injury and the control ones. The MDA level of the infected animals was significantly higher than the non-infected animals. In addition, the level of MDA production showed a parallel correlation with the severity of infection. By histological examination, the lesions in infected livers were varied from tortuous, organized fibrotic areas in or around the hepatic lobules, cirrhosis, and chronic catarrhal cholangitis to fresh migratory tunnels filled with RBC and eosinophils. Multifocal and relatively homogenous populations of densely packed spindle cells with blunt-ended nuclei, arranged in broad interlacing fascicles were noted in samples of 10 infected livers. Based on the histological features by routine and special staining and the results of the immune labeling, the tumors were diagnosed as hepatic leiomyoma. To the best of our knowledge, this is the first report on the concomitant occurrence of Fasciola gigantica infection and leiomyoma in cattle. Therefore, there is considerable evidence indicating that the severity of hepatic damage in fasciolosis is causally associated with the extent of intrahepatic oxidative stress. Future research is necessary in order to clarify the complex host–parasite interactions and to better define the oncogenic implications of F. gigantica infection.

Angioleiomyoma of The Oral Cavity: Case Report

Leiomyomas are benign neoplasms originating from smooth muscles that rarely affect oral tissues. Woman, 34, was referred to the Oral Diagnosis Center of Faculty of Dentistry, University of São Paulo for evaluation of an asymptomatic submucous nodule discovered during a dental visit. Intraoral examination revealed a well-demarcated nodule located on the left buccal mucosa measuring 2 cm. Punch biopsy showed a bloody component. An excisional biopsy was performed, and the histological aspects revealed proliferating spindle and oval-shaped cells with elongated, pale staining, blunt-ended nuclei. Multiple blood vessels with thickened walls were also seen. The neoplastic cells were strongly positive for smooth muscle actin. Both histological and immunohistochemical features were consistent with angioleiomyoma. After 17 months of follow-up, no recurrence was observed. Leiomyomas affecting oral cavity are almost exclusively related to the endothelium. Immunohistochemical studies are helpful in the differential diagnosis between neurofibroma, schwannoma, fibromatosis, and myofibroma.

Extragastrointestinal stromal tumor originating from the vulva

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. They have gain-of-function mutations of the c-kit receptor tyrosine kinase gene and have been suggested to originate from the interstitial cells of Cajal. A small percentage of GISTs form extragastrointestinal masses. We report a rare case of a GIST originating from the vulva. A 55-year-old woman presented with a vulvar tumor. The tumor was initially diagnosed as a leiomyosarcoma following the first resection. Following a second recurrence the patient was administered chemotherapy. A third recurrence occurred and the patient underwent a third resection. Histology revealed that a bundle of fibrous tumor cells had invaded the connected tissue and muscular coat, and some spindle-shaped and blunt-ended nuclei were detected. Furthermore, immunohistochemical evaluation revealed that the tumor cells exhibited strong and diffuse staining for c-kit and CD34. The recurrent tumor was diagnosed as a GIST and a reevaluation of the original specimens also revealed a GIST. The patient was treated with imatinib, and is currently healthy with no evidence of recurrence at 20 months after the last surgery.

Primary leiomyosarcoma of the prostate with lung metastasis: Report of a case diagnosed by fine‐needle aspiration cytology

Prostate leiomyosarcoma is an extremely rare and highly aggressive neoplasm that accounts for less than 0.1% of primary prostate malignancies. Herein, we present a patient with primary leiomyosarcoma of the prostate with lung metastasis diagnosed primarily on fine-needle aspiration cytology. Characteristic cytological features such as small fascicles of spindle cells with blunt-ended nuclei, positivity for desmin and smooth muscle actin along with the radiological features are helpful in the correct diagnosis.

Congenital myofibroma of the skin mimicking a piloleiomyoma

Myofibroma is an uncommon benign soft tissue disorder, which is usually congenital or present in early infancy. Myofibroma usually manifests as a single mass. When there are multiple lesions, the term myofibromatosis is used. The characteristic histopathological feature of the myofibroma is the coexistence of two distinct areas. One area mainly contains plump spindle cells with thin blunt-ended nuclei and eosinophilic cytoplasm, thus indicating myoid characteristics. The other area contains either round or polygonal cells with slightly pleomorphic, hyperchromatic nuclei or small spindle cells typically arranged around a distinct hemangiopericytoma-like vascular pattern. In the present case, the majority of the tumor was composed of the plump myoid spindle cells. This led to an initial diagnosis of a piloleiomyoma. However, the tumor cells were not immunohistochemically positive for desmin. Moreover, careful examination revealed a hemangiopericytoma-like vascular pattern characterized by the presence of high cellular areas with irregular vascular spaces. These features led to the final diagnosis of the myofibroma. It is therefore important to recognize the leiomyoma-like variants of myofibromas.

Malignant solitary fibrous tumor

Malignant solitary fibrous tumors (SFTs) are extremely uncommon and poorly understood mesenchymal neoplasms. There are only rare published accounts of the cytopathologic features of these tumors, prompting the current study. All cases of malignant SFT with preoperative fine-needle aspirations (FNAs) from 1999 to 2008 were retrieved from the archives of 3 large teaching hospitals. FNA smears and cell block material including immunoperoxidase stains were reviewed, and the cytologic characteristics were described. Thirteen cases of malignant SFT were identified in 11 patients. Mean age was 58 years, with a men:women ratio of 1:2.6. The tumors were generally large, with a mean size of 13.4 cm. Cytomorphologic features included mostly hypercellular smears with tissue fragments of monotonous, plump spindled cells with blunt-ended and indented nuclei and fragile, wispy cytoplasm. Also seen were bare nuclei, occasional mitoses, and rare necrosis. Some cases showed a predominance of epithelioid cells, whereas others displayed a loose myxomatous matrix. There was a general lack of single cells. None of the cases was diagnosed accurately as malignant SFT on FNA, and only 6 cases were called malignant or suspicious for malignancy. The FNA diagnosis of malignant SFT is extremely difficult and needs histologic material for accurate interpretation. Predominant FNA diagnoses were SFT or spindle cell neoplasm. Malignant SFT must be included in the differential diagnosis of a spindle cell neoplasm of any anatomic site, particularly if it displays features not typical of benign SFT. Immunoperoxidase staining has some utility, mainly in ruling out other neoplasms in the differential diagnosis.

Postoperative spindle cell nodule of the breast: Pseudosarcomatous myofibroblastic proliferation following endo‐surgery

Despite the frequent use of fine-needle aspiration, core biopsy and surgery, postoperative spindle cell nodule (PSCN) is a rare pathological complication that may be diagnostically treacherous. Presented herein is the case of a 52-year-old woman who developed a 7 mm mammary nodular lesion 66 days after removal of an area of columnar cell hyperplasia involving cellular and architectural atypia, performed with the Mammotome Breast Biopsy System. The lesion was highly cellular and composed of intersecting fascicles of plump spindle cells with blunt-ended elongated nuclei and nucleoli easily visible. Interspersed mononuclear cells and hemosiderin-laden macrophages were evident. PSCN is a reactive, benign myofibroblastic proliferation. Differential diagnosis includes benign and malignant spindle cell lesions of the breast. Recognition of this reactive lesion will avoid overdiagnosis of spindle cell malignant tumor. Attention to clinicopathological and histological features should result in accurate recognition of this lesion.

Nonfunctional Right Kidney in a 50-Year-Old Woman

Nonfunctional Right Kidney in a 50-Year-Old Woman

Multiple hepatic masses in a 38-year-old male 10 years after renal transplantation

The patient is a 38-year-old male, diagnosed with IgA nephropathy at age 24, who underwent renal allograft transplantation 10 years ago. He presented with complaints of fever and non-productive cough. Clinical examination was notable for a low grade temperature (99.5 F), bibasilar crackles and a distended abdomen with overlying varices. Laboratory studies showed anaemia of chronic disease and normal liver function tests, except for a mildly depressed serum albumin level. Serum creatinine was elevated from his baseline of 2.5mg/dl to 4.2mg/dl. Additional past medical history includes former heavy use of alcohol, with none following his transplant. A right sided pulmonary infiltrate was detected on chest X-ray. Following antibiotic therapy for presumed pneumonia, his clinical symptoms resolved and his creatinine reverted to baseline level. An out-patient computed tomography (CT) scan was performed to evaluate the abdominal findings. Massive liver nodules in the lobes were present, replacing the hepatic parenchyma. The largest measured 13.5 cm in the left lobe, with a separate 12.5 cm mass in the right lobe (Figure 1). Radiologically, the lesions were perplexing, with a broad differential diagnosis including abscesses, haemangiomas, benign cystic lesions, metastases or hepatocellular carcinoma. Percutaneous core needle biopsy yielded a moderately cellular spindle cell neoplasm with minimal cellular pleomorphism and no mitotic activity (Figure 2). The spindle cells contained elongated, blunt-ended nuclei with finely stippled chromatin. Immunohistochemistry by the standard avidin–biotin–peroxidase complex method demonstrated myogenic differentiation of the tumour cells, which were immunoreactive to smooth muscle actin. In situ hybridization for EBV virus was strongly positive in >90% of the spindle cell nuclei (Figure 3). These findings are indicative of an EBV-associated myogenic tumour. A reduction of the immunosuppressive agents was recommended to the patient, who declined for fear of impending rejection. Currently he is being followed, with slow expansion in the size of the liver nodules. Six months following diagnosis of the liver lesions, a palpable 4 cm nodule in the right gluteal region developed. Additional smaller nodules in the same region were noted by imaging studies. Percutaneous needle core biopsy illustrated a histologically identical EBV-associated myogenic tumour.