Ectatic Vessels Research Articles

A French bulldog with rectal bleeding, anaemia and left hindlimb oedema due to arteriovenous malformations

AbstractA 2‐year‐10‐month‐old, male, neutered French bulldog presented with a rectal prolapse, rectal bleeding, weight loss and anaemia with left hindlimb oedema. Biopsies of the recto‐anal junction identified moderate neutrophilic and lymphoplasmacytic erosive proctitis, with moderate vascular hyperaemia and moderately ectatic vessels in the rectal submucosa. Abdominal computed tomography identified intra‐abdominal arteriovenous malformations involving the mesenteric arteries, colic arteries, the vertebral venous plexus and femoral veins causing concurrent left hindlimb oedema. The malformations were too extensive to allow for surgical resection of the affected area of intestine. The patient's clinical signs initially responded to immunosuppressive therapy with corticosteroids. However, the patient's clinical signs progressed, and the dog was euthanased 4 months after initial presentation. To the authors’ knowledge, this is the first report of such extensive arteriovenous anomalies also involving rectal prolapse and suspected colonic ectasia in a dog.

Ectatic Vessels on the Chest.

Ectatic Vessels on the Chest.

Dermoscopy and reflectance confocal microscopy finding of different anatomic sites of Langerhans cell histiocytosis.

Recognizing Langerhans cell histiocytosis (LCH) might be a challenge due to its rarity. Reflectance confocal microscopy (RCM) and dermoscopy were emergent promising non-invasive technique as auxiliary tools in diagnosis of different skin conditions. However, the RCM and dermoscopic features of LCH had been less investigated. To reveal the common RCM and dermoscopic features of LCH. Forty cases of LCH were retrospectively analyzed according to age, locations, clinical, RCM, and dermoscopic features from September 2016 to December 2022. To reveal the differences and common in clinical, RCM, and dermoscopic features that occur in different anatomic location. In the study, sites of predilection include the trunk 31/40 (77.5%), extremity 21/40 (52.5%), face 14/40 (35%), scalp 11/40 (27.5%), vulvar 4/40 (10%), and nail 2/40 (5%). All LCHs had the common RCM features. There were significant differences in clinical and dermoscopic features for age and lesion anatomic site. The common dermoscopic features for scalp, face, trunk, and extremity were the erythematous scaly rash, purplish-red globules or patches, scar-like streaks with ectatic vessels. While the features for nail LCH were purpuric striae, onycholysis and purulent scaly rash, and the erosive erythematous plaque and purulent scaly rash for vulvar LCH. The common RCM features of all LCH showed a focal highly reflective dense image in the surface keratin layer, epidermis architectural disarray, obscuration of dermo-epidermal junction, numerous polygonal, large, medium reflective, short dendrites cells in the epidermis, and dermis. All LCH involving the vulvar and nail did not manifest skin lesions. RCM and dermoscopy showed promising value for diagnosis and differentiation of LCH.

Pleomorphic Hyalinizing AngiectaticTumor: A Case Report and Literature Review

Pleomorphic hyalinizing angiectatictumor (PHAT), a rare low-grade non-metastasizing tumor, was first reported in 1996[1]. It affects patients with a mean age of 54.5 years and no predilection for gender[2], and has a preference for the subcutaneous soft tissue in the lower extremity. The main histology features are clusters of hyalinized ectatic blood vessels and scattered pleomorphic cells or spindle cells with nuclear pseudoinclusions. The clinical behavior is characterized by local recurrence in 30-50%, and no cases have been known to metastasize. A wide intralesional excision and long-term postoperative follow-up become the main therapeutic approach. So far, about 130 cases have been reported in the literature, and its manifestation on electron microscope and imaging has not yet been fully described. Here, we report a case of PHAT and describe its morphological and imaging performance.

Clinicopathological Survey of 204 Rosacea Patients Regarding Rosacea Subgroups and Severity.

Few studies have evaluated the histopathological characteristics of clinical rosacea subtypes in detail. To assess rosacea histopathological features in correspondence to clinical subgroups. The histopathological findings of 204 rosacea patients were analyzed retrospectively and were compared among clinical subtypes. Thirt-Two Percent of patients were male and 68% were female. Seventy-three patients had erythematotelangiectatic rosacea (ETR) and 110 had papulopustular rosacea (PPR), 12 were ETR + PPR, 4 ocular, 2 phymatous, and 3 had Morbihan's edema. Perivascular and perifollicular lymphohistiocytic infiltration, perifollicular exocytosis, follicular spongiosis, and ectatic vessels were almost found in all subtypes. Solar elastosis was higher in ETR. Spongiosis, exocytosis of inflammatory cells into epidermis, acanthosis, and granulomatous reaction were higher in PPR. Inflammatory cells exocytosis was more in PPR and phymatous. Demodex folliculorum was identified in 27% of ETR, 33.6% of PPR, 50% of phymatous, one ocular patient, and none of Morbihan edema. Demodex brevis were found in 5% of ETR, 3% of PPR, and 50% of phymatous. Demodex brevis not folliculorum was more in phymatous. Spongiosis was the most common finding in ocular rosacea. Spongiosis, exocytosis of inflammatory cells, and granulomatous reactions were more in PPR. Solar elastosis was more in ETR. Histopathological findings were compatible with clinical subgroups.

P135 A CASE OF RIGHT CORONARY ARTERY ANEURYSM COMPLICATED BY ENDOVASCULAR THROMBOSIS

Abstract Coronary artery aneurysm is a rare disorder with prevalence in male population. The most commonly involved vessel is the right coronary artery followed by the anterior descending artery. The most frequent etiologies are coronary atherosclerosis and Kawasaki disease. The treatment of coronary aneurysms with significant stenosis is often surgical, with implantation of covered stents in case of saccular aneurysms. In coronary artery aneurysms without significant stenosis, medical therapy is often the most suitable choice. Case report We present a case of a 68–year–old man with history of hypertension and dyslipidemia, who arrived to our ED with inferior STEMI. Left coronary angiography showed a 75% stenosis of the distal anterior descending artery and subocclusion of the first left marginal artery. Right coronary angiography revealed a severely ectatic vessel (7–8 mm diameter) with intraluminal thrombosis and markedly slowed flow (TIMI 1). Considering the regression of symptoms and ECG alterations, intracoronary bolus of Tirofiban was performed followed by i.v. infusion of 24 hours in association with DAPT. Blood tests did not detect any relevant alterations of coagulation profile but only an heterozygous mutation for MTHFR with slightly altered homocysteine values. Six days later, a second coronary angiography was performed which confirmed the persistence of thrombotic formation into the right coronary artery that was treated with rheolytic thromboaspiration and TIMI 2 final flow. In consideration of the angiographic findings, it was decided not to implant coronary stents. After multidisciplinary team discussion it was decided to associate DAPT with oral anticoagulant therapy (Warfarin 5 mg, INR 2–3) The patient was discharged with indication to continue the triple antithrombotic therapy for 6 months followed by double antithrombotic therapy with ASA and Warfarin. Conclusions Coronary aneurysms in the context of ACS are rare findings, often caused by endovascular thrombosis. Thrombolytic therapy, rheolytic thromboaspiration and anticoagulation therapy are valid tools for the successful treatment of such cases.

VIM::KMT2A-rearranged sarcomas: A report of two new cases confirming an entity with distinct histologic features.

The recently described KMT2A-rearranged sarcomas are rare emerging entities where the KMT2A gene fuses with YAP1 and, less commonly, VIM, resulting in two distinct morphologies. Unlike the sclerosing epithelioid fibrosarcoma-like features that characterize tumors with KMT2A::YAP1 fusions, VIM::KMT2A-rearranged sarcomas are more uniformly cellular and lack the extensively sclerotic background seen in the former. Most tumors behave aggressively with metastases on presentation. Here, we describe the clinicopathologic and molecular findings in two additional cases of VIM::KMT2A rearranged sarcomas that arose in the deep soft tissues of adult males. Both tumors were composed of hypercellular fascicles of uniform spindle cells with pale eosinophilic cytoplasm and ovoid nuclei. The stroma had scant delicate collagen with occasional thin-walled ectatic blood vessels and perivascular hyalinization. Immunohistochemical studies showed an unspecific staining pattern with diffuse positivity for CD99 and BCL2 and variable staining for S100 protein. RNA-sequencing detected the presence of VIM::KMT2A gene fusion involving VIM exon 4 and KMT2A exon 2 in both cases. Sarcomas with VIM::KMT2A gene fusions seem to have sufficient morphologic features to warrant distinction from KMT2A-rearranged sarcomas with YAP1 partner. Without the benefit of molecular testing, these tumors pose a diagnostic challenge due to their lack of specific immunohistochemical profile and great morphologic overlap with other monomorphic spindle cell neoplasms.

Triglyceride-Glucose Index Could be Used to Predict Severity of Coronary Artery Ectasia

Introduction: Coronary artery ectasia (CAE) refers to a 1.5 fold increase in coronary artery diameter compared to the normal segment. Although the underlying pathophysiological mechanism is not fully elucidated, coronary atherosclerosis is thought to play a role in more than half of the cases. Triglyceride glucose (TyG) index is an indicator of insulin resistance. In the present study, aimed to evaluated TyG index values in CAE cases and find if a predictive value of TyG index existed. Patients and Methods: Sixty-one patients with CAE (study group) and 64 patients with normal coronary arteries (control group) were included in the study. TyG index was calculated as ln (fasting triglyceride × fasting glucose/2). Results: There were no differences between the two groups with respect to age, sex, diabetes mellitus prevalence, and biochemical parameters including, white blood cell, platelet, lymphocyte, monocyte counts, hemoglobin, hematocrit, urea, glucose, total cholesterol, high density lipoprotein-cholesterol, triglyceride levels and TyG index value. Twenty-five patients (41.0%) had one-vessel involvement, 24 (39.3%) patients had twovessel involvement and 12 (19.7%) patients had three-vessel involvement. Right coronary artery was the most commonly affected vessel (11, 44%), followed by left anterior descending artery (8, 35%), left main coronary artery (4, 16%) and circumflex artery (1, 4%). TyG index was statistically significantly higher in patients who had two/three vessel involvement (8.80 ± 0.48 vs 9.14 ± 0.62, p= 0.027). TyG index had statistically significant correlation with the number of ectatic vessels (r= 0.275, p= 0.032). ROC curve analysis showed that TyG index was useful for the prediction of ectasia severity (AUC= 0.653, 95% CI= 0.515-0.792, p= 0.043). TyG index value of 9.16 had 41.7% sensitivity and 84% specificity for prediction of CAE severity. Conclusion: TyG index, which is easily calculated from biochemical parameters, might be used for the assessment of CAE severity.

Recurrent PRDM10 Fusions in Superficial CD34-Positive Fibroblastic Tumors : A Clinicopathologic and Molecular Study of 10 Additional Cases of an Emerging Novel Entity.

Superficial CD34-positive fibroblastic tumor (SCD34FT) is a rare mesenchymal neoplasm. The genetic alterations of SCD34FT have yet to be determined. Recent studies suggest it overlaps with PRDM10-rearranged soft tissue tumor (PRDM10-STT). This study aimed to characterize a series of 10 cases of SCD34FT using fluorescence in situ hybridization (FISH) and targeted next-generation sequencing (NGS). The study recruited 7 men and 3 women aged between 26 and 64 years. The tumors were located in the superficial soft tissues of the thigh (8 cases), foot, and back (1 case each), ranging in size from 1.5 to 7 cm. The tumors were composed of sheets and fascicles of plump spindled to polygonal cells, with glassy cytoplasm and pleomorphic nuclei. Mitotic activity was absent or low. Common and uncommon stromal findings included foamy histiocytic infiltrates, myxoid changes, peripheral lymphoid aggregates, large ectatic vessels, arborizing capillary vasculature, and hemosiderin deposition. All tumors expressed CD34, and 4 demonstrated focal cytokeratin immunoexpression. In 7 of 9 (77.8%) cases analyzed, FISH identified PRDM10 rearrangement. Targeted NGS revealed a MED12::PRDM10 fusion in 4 of 7 cases tested. Follow-up showed no recurrence or metastasis. We demonstrate recurrent PRDM10 rearrangements in SCD34FT and provide additional evidence of a close relationship to PRDM10-STT.

Gastric Antral Vascular Ectasia as a Reversible Cause of Upper Gastrointestinal Bleeding in the Oldest Old

Abstract Gastric antral vascular ectasia (GAVE) is a rare condition which accounts for 4% of the nonvariceal acute upper gastrointestinal (GI) bleeding. The mean age of diagnosis is 70 years. This condition is often misdiagnosed as hemorrhagic antral gastritis or portal hypertensive gastropathy. In this case report, we report the oldest person to date in the South Asian population with upper GI bleeding caused by GAVE. An 87-year-old, female, known case of chronic obstructive pulmonary disorder and systemic hypertension under medication for 2 years, current smoker, previous alcohol consumer presented to the emergency department with complaints of hematemesis, melena, and easy fatigability. On general physical examination, pallor was present. A provisional diagnosis of chronic anemia secondary to upper GI bleeding was made. Upper GI endoscopy revealed ectatic vessels radiating from the gastric antrum which was diagnosed as GAVE. Blood transfusion was done, and three sessions of argon plasma coagulation were done. In the oldest old, GAVE is an overlooked cause of GI bleeding and persistent severe anemia. It might also mimic the signs and symptoms of GI malignancy. However, the frail older adult and their caretakers must be counseled about its reversibility, good prognosis, and nonmalignant nature. Simple intervention can improve the quality of life in the frail oldest old.

Case Report of Dermoscopic Aspects and Reflectance Confocal Microscopy Description of Segmental Leiomyoma and Relative Management

Cutaneous leiomyoma is a benign tumor, mainly composed of smooth muscle cells and arising from the arrector pili muscle of hair follicles. The diagnosis of leiomyomas is of paramount importance, as they can often be associated with underlying malignancies (e.g., renal cell carcinoma, leiomyosarcoma) and specific genetic mutations. We report the case of a 27-year-old Caucasian male patient that presented to our attention with a rare segmental and Zoosteriform type II leiomyoma. We performed an analysis of the cutaneous lesions using dermoscopy, reflectance confocal microscopy (RCM) and histology. We found that, using dermoscopy, the leiomyomas showed a dermatofibroma-like appearance with a central hypopigmented area, peripheral delicate hyperpigmentation and also erythematous areas and ectatic vessels. RCM, although not specific, showed groups of hypo-reflective areas distributed in the most superficial papillary dermis, which in histology and immunohistochemistry corresponded to the most superficial protrusions in the papillary dermis of the tumoral bundles. Finally, we discuss the management of patients with multiple leiomyomas and stress the fact that, in the cases of multiple leiomyomas, an annual sonography of the kidneys associated with dermatological and (in women) gynecological consultations are needed to ensure the early identification of an underlying tumor. A genetic consultation to detect an eventual FH mutation is recommended, but since in some cases the FH result may be negative, the above recommended controls remain always of paramount importance.

Conjunctival Lymphangiectasia Simulating Loa Loa.

A 46-year-old woman presented with complaints of irritation in the OS for 1 year. Her ocular examination revealed normal vision and anterior segment except for an incidental finding of a worm-like lesion in the temporal conjunctiva. The lesion was transparent, linear in shape forming a complete loop, extending from the superotemporal conjunctiva to the inferior conjunctiva (Panel A). The plane of the lesion was conjunctival. The lesion showed no mobility with exposure to light or when touched with a cotton-tip applicator. Differential diagnosis of dead loa loa versus lymphangiectasia was made. Her peripheral blood smear did not reveal any microfilariae and had a normal cell count. Surgical excision revealed the lesion to be embedded within the conjunctiva and no worm came out. Only a segment of the lesion was sent for biopsy as there was no worm. Histopathology revealed hyperplastic conjunctival epithelium (Panel B; ×200) showing diffuse and intense expression with pan-cytokeratin antibody (Panel C; ×200). Subepithelial stroma showed thickened, dilated, and ectatic vessels (Panel D; ×400). The endothelial lining of vessels showed strong and intense expression with CD34 and podoplanin antibodies (Panels E and F; ×400) indicating lymphatic origin. The final diagnosis of conjunctival lymphangiectasia was made. Isolated conjunctival lymphangiectasia can be an incidental finding or associated with chemosis or persistent irritation. A trial of topical steroids can be given in symptomatic patients. Surgical excision with or without amniotic membrane graft or conjunctival autograft can be performed in nonresponsive cases. Anterior segment optical coherence tomography of conjunctival lymphangiectasia shows multiple subepithelial cystic spaces within the conjunctiva.

Managing pregnancy after myocardial infarction and ectatic coronary vessels.

Managing pregnancy after myocardial infarction and ectatic coronary vessels.

Atypical PIK3CA Positive Hemangioma Refractory to Propranolol

A newborn presented with a lateral right eye proliferating vascular tumor, with characteristics consistent with infantile hemangioma by examination and imaging. The lesion was refractory to therapeutic dosing of oral propranolol, with worsening mass effect in the upper eyelid threatening hemianopsia. A near total surgical resection was completed. Histologic findings were mostly consistent with infantile hemangioma with some atypical areas of larger serpiginous, ectatic vessels identified. Immunostaining demonstrated strong CD34+, CD31+, and glucose transporter type 1 immunoreactivity and D2-40 immuno-negativity. Genetic sequencing revealed a pathogenic somatic PIK3CA (phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha) variant (p.His1047Gln) at 8.3% allele frequency. Despite continued postoperative propranolol therapy, the lesion produced new mass effect over the right cheek. Alternative therapy with the mammalian target of rapamycin inhibitor, sirolimus, was initiated based on the novel genetic finding and lack of clinical response to standard therapy. The case demonstrates mosaic PIK3CA variant expression within a benign vascular tumor histologically and clinically sharing features of an infantile hemangioma.

The classification of gastric antral vascular ectasia in cirrhotic patients by Versatile Intelligent Staining Technology

BackgroundPortal hypertensive gastropathy (PHG) and gastric antral vascular ectasia (GAVE) are two different pathologies that cause bleeding in cirrhotic patients. These two pathologies are still difficult to be distinguished by white light endoscopy (conventional), as they both appear as red spots in the gastric antral mucosa in the case of severe PHG. The aim of our study was to assess the efficacy of Versatile Intelligent Staining Technology (VIST) in comparison to histopathology in the diagnosis and classification of GAVE.MethodsA cross-sectional study included 50 patients with liver cirrhosis recruited from Alexandria Main University Hospital. Patients with connective tissue diseases and chronic kidney disease were excluded. All patients were examined by both conventional white light endoscopy (WLE) and image enhancement technology (VIST) using Sonoscape HD500 endoscope. GAVE was diagnosed as tortuous columns of ectatic vessels in the gastric antrum. Histopathological examination was used as the standard tool for the diagnosis of GAVE.ResultsA total of 50 patients were included, 28 patients (56 %) were diagnosed as GAVE by pathology vs 22 (44 %) as non-GAVE. Twenty-three of 28 (78.6 %) cases of GAVE were detected by VIST. VIST had superior sensitivity than WLE in the detection of GAVE, 82.1 % vs 7.1 %, while WLE had higher specificity 95.5 % vs 59.1 % by VIST. There was statistical significance between VIST and pathology in the diagnosis of GAVE, p<0.035, but no statistical significance between WLE and pathology. VIST has identified two types of GAVE: focal in 12/28 cases and diffuse in 11/28, and five were not diagnosed by VIST.ConclusionsVersatile Intelligent Staining Technology could be used as an alternative tool to histopathological diagnosis of GAVE. GAVE can present as a focal group of ectatic vessels which adds a new class to GAVE classification that was previously misdiagnosed.

Fetal Vascular Ectasia Can be an Artifact of Placental Fixation.

Placentas from outlying hospitals are formalin-fixed en route to our laboratory. We identified that chorionic, stem villus, and umbilical vessels in these fixed placentas are ectatic with greater frequency than in our in-house fresh placentas. We searched our LIS for third trimester placentas using keywords "ectasia" or "ectatic" over a 12-month period. We fixed incoming in-house placentas over a 2-week period for 24-72hours and tabulated the presence or absence of vascular ectasia as defined by Parast et al, 2008. The LIS search identified 61% of placental cases from outlying hospitals that had ectatic vessels vs 3% of in-house placentas (P < .001). Of 38 placentas fixed in a 2-week period, 45% had ectatic chorionic or stem villus vessels and 21% had umbilical vessel ectasia. In comparison, in the 2 subsequent weeks, 3.8% (P < .001) of fresh placentas had vascular ectasia. These data suggest that large fetal vessels in the placenta become engorged with blood at delivery and, if fixed soon after delivery, remain ectatic and congested when processed for pathology. The identification of artifactual ectasia is important because fetal vessel ectasia can suggest the presence of fetal vascular malperfusion (FVM) if diagnostic signs of FVM are present.

ALK rearrangements in infantile fibrosarcoma-like spindle cell tumours of soft tissue and kidney.

Recurrent alterations in receptor tyrosine kinase (RTK) and downstream effectors are described in infantile fibrosarcoma (IFS)/cellular congenital mesoblastic nephroma (cCMN) and a subset of spindle cell sarcomas, provisionally designated 'NTRK-rearranged' spindle cell neoplasms. These two groups of tumours demonstrate overlapping morphologies and harbour alterations in NTRK1/2/3, RET, MET, ABL1, ROS1, RAF1 and BRAF, although their relationship is not fully elucidated. We describe herein a cohort of paediatric tumours with clinicopathological features not typical for inflammatory myofibroblastic tumour, but rather with similarities to cCMN/IFS harbouring ALK fusions. Clinicopathological features were assessed and partner agnostic targeted RNA sequencing on clinically validated platforms were performed. Tumours occurred in patients aged from 2 to 10 years (median age 2 years) with a 2:2 male to female ratio and an average size of 8.4 cm. Two tumours arose in soft tissues and two in the kidney. Morphological features included spindle to ovoid cells arranged in long fascicles or haphazardly within a myxoid to collagenised stroma; a subset of cases had either dilated, ectatic vessels or focal perivascular hyalinosis. By immunohistochemistry, all cases tested showed cytoplasmic expression of anaplastic lymphoma kinase (ALK) and one case demonstrated co-expression of CD34 and S100. This series of ALK-rearranged IFS-like tumours expands the spectrum of targetable kinases altered in these tumours and reinforces the potential overlap between IFS/cCMN-like tumours and the provisional entity of 'NTRK-rearranged' spindle cell neoplasms.

Pleomorphic hyalinizing angiectatic tumor of the vulva: literature review based on a rare presentation.

ABSTRACTPleomorphic hyalinizing angiectatic tumor (PHAT) of soft tissues is a rare, non-metastatic tumor of unknown etiology and uncertain behavior, which may recur locally. There are few reports on this condition, and due to the rarity of the disease, its lineage has not yet been fully elucidated. The present study aims to report the case of an unusual entity observed for the first time in vulval topography. A female patient, 83 years old, presented with a tumor in the vulvar region that had evolved for approximately 4 months. Magnetic resonance imaging showed an expansive perineal formation of 8.5 × 3.5 cm, and a hemivulvectomy with a flap rotation was performed. The review of the slides revealed a mesenchymal lesion without significant atypia, which was richly vascularized. In the areas of interest, the immunohistochemical (IHC) study demonstrated positivity for CD34, estrogen, and progesterone receptors; it was negative for the other tested markers. Morphological findings associated with the IHC staining panel supported the diagnosis of PHAT. The main morphological features of PHAT are clusters of ectatic vessels of different sizes that show deposits of subendothelial and intraluminal fibrin. Fusiform and pleomorphic cells randomly arranged in leaves or long fascicles intermingle these vessels. It is essential to recognize this entity and consider it among the differential diagnoses of a mesenchymal lesion, given the wide variety of entities that comprise this group of lesions.

Optical coherence tomography and coronary artery ectasia: the critical role of intracoronary imaging for optimal results of percutaneous coronary intervention

Percutaneous coronary intervention (PCI) in coronary artery ectasia is technically challenging, particularly regarding appropriate stent sizing, and it is associated with a higher incidence of adverse events. In this case report, a 63-year-old male patient, heart transplant recipient, underwent elective follow-up coronary angiography in the absence of clinical symptoms. Five years previously the patient was treated with coronary angioplasty and drug-eluting stent implantation for critical lesions of the left anterior descending coronary artery. Angiographic images showed a focal in-stent haziness at the level of an ectatic segment. To elucidate this finding, optical coherence tomography (OCT) was performed. Intracoronary imaging showed severe malapposition of the proximal end of the stent, with an intraluminal signal-rich structure, suggestive of organized stent thrombosis. Stent dilation was performed to maximal recommended diameter, with significant reduction of the malapposed area, as shown by repeated OCT pullbacks. Intracoronary imaging is particularly valuable in PCI of ectatic vessels to guide appropriate stent sizing and avoid stent malapposition. OCT, thanks to its superior spatial resolution in comparison with other intravascular imaging techniques, provides advantages for stent optimization and evaluation of stent failure causes. However, its limited imaging area and possible incomplete blood clearance may limit its usefulness in severely ectatic vessels.

Sclerosing stromal tumour: a clinicopathological study of 100 cases of a distinctive benign ovarian stromal tumour typically occurring in the young.

Since the sclerosing stromal tumour (SST) of the ovary was first described in 1973, few studies have expanded upon its histological features or overlap with other tumours. We thus investigate these aspects based on our experience with 100 cases. The patients, 14 of whom were pregnant, ranged from 12 to 63 years (median = 26 years). Ten patients had hormonal manifestations (seven oestrogenic, three androgenic). Bilateral ovarian involvement was present in two cases. Size ranged from 1 to 23 cm (mean = 8.4 cm). Most tumours were solid and white with focal yellow areas; oedema with cystic degeneration (seen in 25 cases) resulted in eight being predominantly cystic. On microscopic examination, alternating cellular and paucicellular areas (pseudolobulation) were prominent in 94 cases but seen to a limited degree in the remaining neoplasms. Admixed spindled and luteinised cells were present in all tumours, but 13 demonstrated mainly spindled cells and 19 demonstrated mainly lutein cells; 14 of the latter were from pregnant patients. The stroma was typically oedematous or collagenous, but in 14 cases was prominently hyalinised and, in four, myxoid. Prominent vascularity was present in most cases. The mitotic rate ranged from 0 to 8/10 high-power fields (HPF), but most demonstrated <1/10 HPF. The differential diagnosis of SST is broad, including fibromas, thecomas, solitary fibrous tumours, pregnancy luteomas, myxomas, other ovarian sex cord-stromal tumours with sclerosis and, rarely, Krukenberg tumours. Strict adherence to the requirement of pseudolobulation, prominent (usually ectatic) vessels, and lutein cells and fibroblasts admixed in a jumbled manner, will distinguish the neoplasm from others in the differential.