Loose Myxoid Stroma Research Articles

Monophasic pericardial synovial sarcoma in a turkish female patient: a very rare case with cyto-histopathological findings

BackgroundThe aim was to present a 35-year-old female patient with diagnosis of monophasic primary pericardial synovial sarcoma (PSS) with cytopathological findings.Case PresentationThe case with back pain, palpitation and weakness, was diagnosed with pericardial effusion and suspicious mass adjacent to right heart in ultrasonography. Computerized tomography showed mass 12 × 11 × 6.5 cm in size, located in right mid-anterior pericardial area, with heterogeneous internal structure, heterogeneously contrasting right heart and prominent pressure on superior vena cava. Cytopathology of pericardial effusion showed monotonous cells with oval-spindle vesicular nuclei, less amphophilic cytoplasm, evenly distributed chromatin and inconspicuous nucleoli. The pericardial mass was resected incompletely, spindle cell mesenchymal tumor with hypercellular fascicular structure and with infiltrative margins, containing a small amount of loose myxoid stroma, occasionally necrotic areas was observed histopathologically. Immunohistochemical positive reaction was for vimentin, Bcl-2, TLE-1. Accordingly, the case was diagnosed with monophasic PSS.ConclusionsThis case of monophasic primary PSS was an extremely rare malignancy diagnosed with the cytopathological findings.

Ameloblastic Fibro-Odontoma

Introduction: Ameloblastic fibro-odontoma (AFO) is a benign odontogentic tumor without an aggressive behavior, unlike the similar ameloblastic fibroma. Case Presentation: A 9-year-old boy, with tooth eruption failure, underwent enucleation and curettage of a well-defined variable radiolucent and radio-opaque right mandible lesion. There was odontogenic epithelium with peripheral palisading in a loose myxoid stroma as well as a disorganized component of dentin, enamel, and cementum, features of an AFO. Conclusion: AFO is an odontogenic mixed tumor of epithelium and mesenchyme.

Cardiac myxomas: A narrative review

Cardiac myxomas are common primary neoplasms of the heart. They are biologically benign but “functionally malignant” because of the potential for embolization. They arise most commonly from the left atrium, but no chambers of the heart are immune. They may be sporadic in the majority but also familial as a part of the Carney complex. Two morphological forms exist: polypoid and papillary. Polypoid myxomas often present with obstructive features, while the papillary forms are more prone to embolization. Histogenesis is still controversial; the current view centres around origin from the primitive pluripotent mesenchymal cells. They may be of giant proportion, be calcified or get infected. Clinical presentation typically involves the triad of intracardiac obstruction, embolic events and constitutional symptoms. Precordial examination findings may simulate those of mitral or tricuspid stenosis. The presence of tumour plop and change of the physical findings with changing position may help differentiation between the two. Echocardiography is the investigation of choice. Echogenic polypoid or papillary mobile mass within the atrial cavity remaining attached to the interatrial septum through a stalk are the tell-tale echocardiographic features. Cardiac magnetic resonance and computed tomographic scanning may have incremental diagnostic value. Histopathological examination reveals abundant loose myxoid stroma with scattered round, polygonal or stellate cells with dense irregular nuclei. Genetic testing may detect mutations in the PRKAR1A gene in the familial form of cardiac myxoma, i.e. the Carney complex. Surgical excision is the mainstay of treatment with low operative mortality, excellent postoperative survival and low recurrence rate. The current trend favours minimal-access surgery with or without robotic assistance. Physicians should have appropriate preparedness to make a timely diagnosis and enthusiastic treatment to avoid potentially fatal complications.

Collision Tumor Composed of Renal Oncocytoma and Mucinous Tubular and Spindle Cell Carcinoma: Not a Rare Occurrence

Abstract Primary renal collision tumors have been rarely reported in the literature. Our institution reported the first case of a renal collision tumor that comprised oncocytoma and mucinous tubular and spindle cell carcinoma (MTSCC). In this study, upon review of this index case and a second case encountered in our practice, we performed molecular characterization of each component using next-generation sequencing, which did not detect any somatic mutations. In addition, we reviewed resection cases of oncocytomas for previously undetected MTSCC components. While no additional definitive oncocytoma-MTSCC collision tumor cases were identified, 2 cases with entrapped tubules within the central scar of the oncocytoma that possessed some features of MTSCC were encountered, raising the differential diagnosis of oncocytoma-MTSCC collision tumors versus entrapped renal tubules. We propose the following histomorphologic criteria to distinguish a true MTSCC component: (1) expansile mass lesion greater than 0.5 cm; (2) dense proliferation of tubules lined by plump cells; and (3) background of loose myxoid collagenous stroma. In contrast, entrapped tubules tend to form a smaller, stellate-shaped area with atrophic tubules within a dense collagenous stroma. Nevertheless, the occurrence of the 2 described cases provides evidence that the incidence of this collision tumor may not be extremely rare. Therefore, we recommend careful examination and generous sampling of oncocytomas, particularly from the central scarred region or in cases exhibiting atypical gross appearance. Further studies with additional cases are required to better document the relationship and molecular pathogenesis of MTSCC from the central scars of oncocytomas.

Abdominal Inflammatory Myofibroblastic Tumor: Minimal Inflammatory Infiltrate and Diffuse Immunoreactivity for Caldesmon are Potential Diagnostic Pitfalls

Abstract Introduction/Objective Inflammatory myofibroblastic tumor (IMT) is an uncommon spindle cell lesion that can involve various organs and occurs in multiple body sites. While older terminology (i.e. inflammatory pseudotumor) suggested otherwise, recent molecular studies point toward a neoplastic pathogenesis for IMTs. Herein, we report a case of an abdominal IMT and discuss the morphologic and immunohistochemical pitfalls pertaining to this entity. Methods A 75-year-old woman presented with complaints of generalized abdominal pain and distention. An abdominal CT scan showed multiple peritoneal masses, the largest of which measured 23 cm. Biopsy revealed compact fascicles of bland spindle cells exhibiting diffuse actin and caldesmon immunoreactivity, consistent with a spindle cell tumor with smooth muscle differentiation. Mitotic activity was low-to-unapparent. Surgical excision was performed. The cut surface of the tumor was tan-white with hemorrhagic foci. Histopathologic examination of the tumor showed elongated spindle cells set in a loose myxoid stroma rich in blood vessels and a mixed inflammatory infiltrate. Deeper sections of the tumor were more cellular, showing a similar morphology to that seen in the original biopsy, which was virtually devoid of inflammatory cells. Immunohistochemistry showed diffuse staining for desmin, caldesmon, smooth muscle actin, and ALK. FISH analysis showed ALK gene rearrangement in 52% of tumor cells, confirming the diagnosis of IMT. Results Studies in the literature show that IMTs express smooth muscle markers such as SMA (90%) and desmin (50%). However, immunoreactivity for caldesmon is rarely reported. ALK immunoreactivity is seen in about 35–60% of cases, and when gene rearrangement involving ALK is detected the diagnosis can be confirmed. Conclusion Historically, several terms have been used to describe IMTs, including inflammatory pseudotumor and inflammatory pseudosarcomatous fibromyxoid tumor. While the nomenclature consistently implies an inflammatory infiltrate, this tumor could have various morphological patterns with some areas showing very little to absent inflammation, as demonstrated in our case. Hence, making an accurate diagnosis could be challenging on a limited biopsy. Therefore, ALK testing should be included as part of the diagnostic workup of spindle cell neoplasms with smooth muscle differentiation.

Plasmacytoid urothelial carcinoma of renal pelvis with positive zinc finger E\u2013box\u2013binding homeobox 1: a case report

BackgroundThe tumor transformation mechanism of a plasmacytoid urothelial carcinoma remains unexplained. We describe the case of a plasmacytoid urothelial carcinoma of the renal pelvis in which the expression of zinc finger E–box–binding homeobox 1 (ZEB1), a key nuclear transcription factor in an epithelial–mesenchymal transition, is involved in tumor transformation.Case presentationThe patient had a left nephrectomy with the clinical diagnosis of left pelvic renal cancer. The resected specimen showed that the tumor surface comprised a noninvasive papillary urothelial carcinoma with the carcinoma in situ, and the invasive area comprised a plasmacytoid urothelial carcinoma characterized by the presence of single dyscohesive malignant cells that resembled plasma cells in a loose myxoid stroma. The noninvasive urothelial carcinoma was positive for cytokeratin and E–cadherin, and negative for vimentin and ZEB1. In contrast, the invasive plasmacytoid urothelial carcinoma was positive for cytokeratin and also vimentin and ZEB1, and negative for E–cadherin. Additionally, this component was immunoreactive for CD138 and CD38 that are immunohistochemical markers for plasma cells.ConclusionWe suggest that ZEB1 is involved in the plasmacytoid transformation by repressing the E–cadherin in a plasmacytoid urothelial carcinoma.

ODONTOGENIC MYXOMA

A 19-year-old female patient was referred to the oral medicine clinic to evaluate an asymptomatic and unilateral swelling in the left mandibular area. The periapical radiography showed an apparently unilocular radiolucency located in the radicular area of the left second premolar. Previous radiographic examinations and a cone beam CT study were requested for lesion study. An incisional biopsy was performed for histopathologic analysis. Macroscopic examination showed a sample with a white and gelatinous appearance. Microscopically, the lesion was composed of haphazardly arranged stellate, spindle-shaped, and round cells in an abundant, loose myxoid stroma. Histopathologicfindings were compatible with odontogenic myxoma. Immunohistochemical study was performed to rule out other pathologic entities. The complete elimination of the lesion was performed by block resection followed by reconstruction and subsequent clinical controls. The case is reported under the informed consent of the patient. A 19-year-old female patient was referred to the oral medicine clinic to evaluate an asymptomatic and unilateral swelling in the left mandibular area. The periapical radiography showed an apparently unilocular radiolucency located in the radicular area of the left second premolar. Previous radiographic examinations and a cone beam CT study were requested for lesion study. An incisional biopsy was performed for histopathologic analysis. Macroscopic examination showed a sample with a white and gelatinous appearance. Microscopically, the lesion was composed of haphazardly arranged stellate, spindle-shaped, and round cells in an abundant, loose myxoid stroma. Histopathologicfindings were compatible with odontogenic myxoma. Immunohistochemical study was performed to rule out other pathologic entities. The complete elimination of the lesion was performed by block resection followed by reconstruction and subsequent clinical controls. The case is reported under the informed consent of the patient.

Tenosynovial giant cell tumor with extensive myxoid change: A rare variant of a common tumor

Tenosynovial giant cell tumor is a common tumor of synovial origin that usually occurs between the ages of 30 and 50 years. It is classified into localized and diffuse types based on the presence of a capsule around the lesion. Histologically, it is characterized by scattered large epithelioid cells with eosinophilic cytoplasm and eccentric nuclei, histiocytoid cells, multinucleated osteoclast-like giant cells, and varying amounts of hemosiderin deposition. Prominent myxoid stroma is a very rare finding in this tumor. We report the case of a 35-year-old woman with tenosynovial giant cell tumor, whereby otherwise typical cells are set in a predominant loose myxoid stroma. This morphology is important to recognize, as it can closely mimic other soft tissue tumors with a predominant myxoid matrix.

Odontogenic Myxoma of Mandible: Report of A Rare Case.

Odontogenic Myxoma of Mandible: Report of A Rare Case.

Odontogenic myxoma in children: case report

Odontogenic myxoma is a rare tumor, often diagnosed during routine radiographs or when it is so severe that it causes pain, a noticeable increase in volume or tooth displacement and mobility. Young adults (25-30 years of life) are more often affected by the lesion but all ages are vulnerable. The mandible is more commonly involved than the maxilla and the tumors usually grow slowly and silently. However, growth can be rapid and destructive. The radiographic aspect of a myxoma is that of a uni or multilocular, radiolucent lesion reminiscent of honeycomb or soap bubbles, depending on its size. It is an expansive tumor that may cause displacement or resorption of the teeth involved. Microscopically, the tumor is composed of round and spindle cells, with a star arrangement, arranged in a loose abundant myxoid stroma, containing only a few collagen fibrils. The treatment of choice is radical surgical excision because myxomas are not encapsulated and tend to infiltrate the surrounding bone. However, small tumors can be treated by curettage. Periodic reassessment is required for at least five years due to the high rate of recurrence. Larger tumors may need to be treated using a more extensive resection with a safety margin. This study reports a clinical case of odontogenic myxoma in a child aged 7 years. The tumor was located in the posterior region of the mandible and was surgically treated with an en bloc resection with preservation of the base of the mandible. The follow-up of the case is ongoing and no recurrence has been observed to date.

Infant Odontogenic Myxoma: A specific entity

IntroductionIn children, and specifically in infants, odontogenic myxomas are extremely rare. In infants, myxoma seems to display mostly the same clinical, radiological and pathological characteristics. This paper presents a series of odontogenic myxomas in infant patients. Materials and methodsFour infant patients were included in this retrospective study. The clinical, radiological and pathological presentation was characterized and the treatment analysed. ResultsAll patients presented with a rapidly evolving paranasal swelling. CT-scan showed a maxillary homogeneous unilocular and intraosseous tumour. In all cases, pathological examination revealed a loose myxoid stroma within stellate and spindle shaped cells. All patients underwent conservative surgery through a vestibular approach. ConclusionThis patient series and a review of the literature demonstrates that odontogenic myxoma is specific in infant. We propose the name of Infant Odontogenic Myxoma for this entity.

Low-Grade Myofibroblastic Proliferations of the Urinary Bladder

Myofibroblastic proliferations of the urinary bladder, which share some similarities with nodular fasciitis, were first reported in 1980. Since then, they have had several designations, the most frequently used being inflammatory myofibroblastic tumor. Based on both histopathologic and prognostic grounds, some authors prefer the term pseudosarcomatous myofibroblastic proliferation, at least for some of the proliferations. These same scientists also assimilate the so-called postoperative spindle cell nodules with the pseudosarcomatous myofibroblastic proliferations. Little is known about these low-grade myofibroblastic proliferations. To review the literature about low-grade myofibroblastic proliferations occurring in the urinary bladder. Textbooks and literature review. We obtained most of the clinicopathologic peculiarities from a patient population composed of the most-relevant, previously reported cases. The low-grade myofibroblastic proliferations of the urinary bladder are rare lesions affecting males more often than they do females. The most-common signs and symptoms are hematuria and dysuria. Histopathologically, they are spindle cell proliferations in a loose myxoid stroma, even though compact proliferations or hypocellular fibrous patterns can be found. Immunohistochemistry is quite nonspecific, except for ALK-1 positivity (20%-89%). Fluorescence in situ hybridization has demonstrated clonal genetic aberrations involving the ALK gene in 50% to 60% of cases. After surgery, only 6% of patients experience local recurrence, without metastases or deaths from the disease. Malignant transformation has been reported exceptionally. These myofibroblastic proliferations are probably part of a continuum with, at one end, benign pseudosarcomatous proliferations and, at the opposite end, more-aggressive lesions. Because of the frequently indolent clinical course, aggressive treatment would be unjustified.

Lymphangioma of esophagus presenting with dysphagia: A case report

Lymphangioma of the esophagus is a benign vascular tumor that rarely occurs in the upper gastrointestinal tract. We report a rare case of lymphangioma of the esophagus and our experience with endoscopic resection of this lesion. Lymphangiomas are benign lesions that arise from the cystic dilatation of hamartomas in deep lymphatic tissue and are rarely found in the GI tract (1%). The esophagus is the most unusual location for this lesion. The diagnosis of lymphagioma is usually made on histopathology. The masses are composed of enlarged channels lined by lymphatic endothelial cells surrounded by a loose myxoid stroma. Standard biopsies are often normal as the lesions are submucosal. The treatment of esophageal lymphangioma is conservative in asymptomatic patients. For symptomatic pateints, response to surgical or endoscopic removal of these tumors is excellent. However, a large tumor with symptoms or a lesion suspicious for malignancy requires surgical resection. Conclusion: Lymphangioma of the esophagus is a rare submucosal tumor, generally small and benign in nature. Endoscopic ultrasound is an excellent tool for diagnosis of these lesions. Our experience reaffirms that endoscopic excision of such lesions is safe and appears to be without major complications.

Lymphangioma of Esophagus Presenting with Dysphagia: A Case Report

Purpose: Lymphangioma of the esophagus is a benign vascular tumor that rarely occurs in the upper GI tract. We report a rare case of lymphangioma of the esophagus and our experience with endoscopic resection of this lesion. A 61 year old Hispanic man with history of dysphagia was referred for evaluation of a polypoid lesion in the mid-esophagus. An EGD done by his gastroenterologist a year earlier demonstrated a submucosal polypoid lesion in the mid esophagus. The patient was placed on a PPI and was referred for an EUS. EGD showed a 1 cm submucosal lesion at 25 cm from incisors. It was round, with normal appearing overlying mucosa and was easily compressed with cold forceps. EUS demonstrated a 13 × 5 mm anechoic lesion arising from the second echo layer corresponding to submucosal space. Next, using cold standard forceps, multiple biopsies were taken in a “bite and bite” tunneling method with obliteration of the lesion. Histology showed cavernous lymphangioma of the esophagus. His dysphagia improved after removal of the lesion. Discussion: Lymphangiomas are benign lesions that arise from the cystic dilatation of hamartomas in deep lymphatic tissue and are rarely found in the GI tract (1%). The esophagus is the most unusual location for this lesion. The diagnosis of lymphagioma is usually made on histopathology. The masses are composed of enlarged channels lined by lymphatic endothelial cells surrounded by a loose myxoid stroma. On gross examination, they are usually pale and smooth, with a multicystic cut surface and a clear yellowish fluid exudate. The common tools to establish the diagnosis are esophagram and EGD. Lymphangiomas appear as a translucent, yellowish, easily compressible mass lesions that are < 5 mm. Standard biopsies are often normal as the lesions are submucosal. EUS may the most useful tool for distinguishing a lymphangioma from other submucosal tumors because it aids in differentiating submucosal lesions from lesions that arise from the muscular layers of the esophagus. The treatment of esophageal lymphangioma is conservative in asymptomatic patients. For symptomatic pateints, response to surgical or endoscopic removal of these tumors is excellent. However, a large tumor with symptoms or a lesion suspicious for malignancy requires surgical resection. Determining the extent of the tumor through the esophageal wall may be difficult during resection as the lymphangioma is soft and compressible. Conclusion: Lymphangioma of the esophagus is a rare submucosal tumor, generally small and benign in nature. Endoscopic ultrasound is an excellent tool for diagnosis of these lesions. Our experience reaffirms that endoscopic excision of such lesions is safe and appears to be without major complications.

Novel use of a Weerda laryngoscope for transoral excision of a cervical ganglioneuroma: a case report

IntroductionA ganglioneuroma is a benign neoplasm arising from neural crest cells of the sympathetic nerve fibers and is most commonly seen in the posterior mediastinum or retroperitoneum. Although very uncommon, ganglioneuromas must be included in the differential diagnosis of neck masses. In young adult women, neck incisions made for excision of these benign tumors should be avoided whenever possible.Case presentationWe herein describe the case of a 19-year-old Japanese woman with a ganglioneuroma. The tumor was found in the parapharyngeal space, an unusual location. A fine-needle aspiration biopsy was performed but was considered inadequate to make a definitive diagnosis, so the asymptomatic lesion was surgically excised using a Weerda laryngoscope. The lesion measured 4 × 3 cm in size and was encapsulated. A pathological analysis showed the presence of two distinct cell types, ganglion cells and Schwann cells, embedded in a loose myxoid stroma. The final diagnosis was a ganglioneuroma.ConclusionA complete excision was made possible by using a transoral approach with a novel use of the Weerda laryngoscope. Although its applicability to specific cases depends on the location, size and nature of the tumor, we believe that the Weerda laryngoscope will continue to be useful for performing transoral surgery for cervical tumors.

Embryonal (Undifferentiated) Sarcoma of the Liver With Peripheral Angiosarcoma Differentiation Arising in a Mesenchymal Hamartoma in an Adult Patient

Embryonal (undifferentiated) sarcoma of the liver (ESL) is a rare malignant neoplasm composed of undifferentiated sarcomatous tissue. We are presenting a case of a 74-year-old woman diagnosed with an ESL arising from a mesenchymal hamartoma of the liver (MHL). Both lesions occur typically in childhood, with only rare reported cases in adults. Histologically, the mass consisted primarily of loose myxoid stroma admixed with bland spindle cells and extensive, cystic (lymphangioma-like) degeneration. However, also present peripherally were markedly atypical cells (including multi-nucleated forms) and hyaline globules. Additionally, atypical cells with a sinusoid tectorial growth pattern were identified, which were positive for CD31, CD34 and Factor VIII. The tumor cells of ESL are classically described as being negative for tissue-specific immunohistochemical markers. However our case demonstrated focal positivity for vascular markers CD31, CD34 and Factor VIII and this along with the sinusoidal tectorial growth pattern, mimicked an angiosarcoma.

Radiologic and Pathologic Findings in Breast Tumors with High Signal Intensity on T2-weighted MR Images

Various histopathologic components in benign and malignant breast lesions may generate hyperintense signal at T2-weighted magnetic resonance (MR) imaging. A comparison of the specific histologic features found in breast lesions with a high-signal-intensity appearance on unenhanced T2-weighted turbo spin-echo MR images obtained without spectral fat suppression shows that this MR imaging characteristic is often suggestive of the differential diagnosis. Histopathologic features that may produce high signal intensity in breast lesions include extensive necrosis, a cystic or microcystic component, an adipose or sebaceous component, mucinous stroma, loose myxoid stroma, stromal edema, and hemorrhagic changes. A more nuanced understanding of the correlation between the MR imaging appearance and specific pathologic findings may help radiologists achieve earlier and more accurate differentiation among this group of breast lesions.

Upper eyelid tumour

Abstract Purpose To describe the clinical and histologic features of a rare eyelid tumour. Methods A 56‐year‐old male patient presented with a nodular subcutaneous tumour in his right upper eyelid close to the eye brow. The lesion had been present for 2 years; there was no pain or inflammation but a slow increase in size. No other significant ocular abnormality was noted, and the patient's general health was good without any medication. On MRI, the tumour presented as a circumscribed non‐infiltrating pseudocystic mass, 20mm in diameter in size and located in the subcutis. Results Histopathology showed a loose myxoid stroma with low cellularity and occasional small blood vessels. A distinct capsule or pseudocapsule was not identified. Near the periphery some fat lobules were seen. The mucoid ground substance stained lightly with Alcian blue. The tumour cells were sparsely distributed throughout the tumour without any particular pattern; most appeared spindle‐shaped with an inconspicuous nucleus and no mitotic figures. Several mast cells were identified. Together with immunohistochemical findings (CD34+, SMA‐, Desmin‐), the diagnosis of myxoid spindle cell lipoma was made. Conclusion To our knowledge, no tumour has been documented in the literature that was histologically really similar to the one present in our patient. There was only very little normal adipose tissue, and a floret‐like nuclear pattern typical for pleomorphic lipoma (but also seen occasionally in normal orbital fat) was not observed. Even though the distinction from other lesions might in some cases be somewhat academic the differential diagnosis includes herniated orbital fat, other lipoma variants such as myolipoma and the hitherto mentioned pleomorphic lipoma, other myxoid tumours, and obiously malignant lesions such as (especially myxoid) liposarcoma.

Large cell calcifying Sertoli cell tumor of the testis: Comparative immunohistochemical study with Leydig cell tumor

Large cell calcifying Sertoli cell tumor is a rare type of testicular tumor. Reported herein is a Japanese patient with this tumor not associated with Carney's complex. An 11-year-old boy was admitted to hospital because of left testicular enlargement, and radical orchiectomy was performed. Macroscopically, the tumor was well circumscribed and had a maximum diameter of approximately 2 cm. The cut surface showed a yellow-white solid mass. Histologically, the tumor was composed of large neoplastic cells with abundant eosinophilic cytoplasm with a tubular, trabecular, and solid arrangement and loose myxoid stroma with irregularly shaped calcification. Immunohistochemically, the tumor cells were positive for vimentin, S-100 protein, calretinin, inhibin-alpha, melan-A, and CD10, and type IV collagen and laminin were observed in the extracellular matrix around the tumor cells. The distributions of melan-A, CD10, and mitochondria were characteristically patchy; in contrast, they were diffusely distributed in the cytoplasm in a control case of Leydig cell tumor. The differences in immunostaining patterns for melan-A, CD10, and mitochondria as well as positivity for S-100 protein-beta might be useful diagnostic hallmarks of large cell calcifying Sertoli cell tumor for discrimination from Leydig cell tumor.

A persistently recurring peri-urethral soft tissue lesion of the vulva

Various mesenchymal lesions, some of which have only recently been characterized, may affect the vulva. Because of their apparently shared origin from vulvovaginal mesenchyme, these lesions can resemble one another superficially and can be challenging diagnostically. Clinically, benign lesions and tumor-like conditions may mimic a malignant process because of hypercellularity, mitotic activity, and rapid growth. We report on a 84-year-old diabetic and hypertensive woman who had previously undergone skinning vulvectomy for lichen planus and an embolectomy of the left femoral artery. The patient presented with a rapidly growing vulvar mass. The biopsy showed spindle cell proliferation in a loose myxoid stroma with granulation tissue and a mixed inflammatory infiltrate. Based on histology and immunohistochemistry, the initial diagnosis was that of a benign lesion. In view of the persistent recurrence of the lesion and the absence of metastatic spread, we conclude that the lesion has a low-grade malignant potential and suggest the diagnosis of florid cellular reactive pseudosarcomatous myofibroblastic proliferation.