Postoperative Spindle Cell Nodule Research Articles

Inflammatory Pseudotumor and Sarcoma of Urinary Bladder: Differential Diagnosis and Outcome in Thirty-Eight Spindle Cell Neoplasms

We assessed diagnostic criteria among 38 spindle cell tumors of the urinary bladder and obtained follow-up in 36 patients. Patients comprised 28 males and 10 females aged 2.5 months to 87 years. Hematuria was the commonest presenting symptom (27 patients). After review and immunohistochemical workup, 17 patients had inflammatory pseudotumor (myofibroblastic tumor), 4 postoperative spindle cell nodule, 1 leiomyoma, 13 sarcoma (7 low-grade; 6 high-grade), and 3 carcinoma. Mean age was 38 years for pseudotumor (range 15 to 74), 65 for postoperative spindle cell nodule, 51 for sarcoma, and 76 for carcinoma. Size of pseudotumor averaged 4.4 ± 0.7 cm (range 1.5 to 13.0), similar to sarcoma, 4.0 ± 0.6 cm (range 0.5 to 7.0). Similar proportions of benign tumors and sarcomas had muscularis propria invasion. The criteria that best differentiated sarcoma from inflammatory pseudotumor were presence of necrosis at the tumor-detrusor muscle interface in muscle-invasive cases, and nuclear atypia. Sarcoma also had less prominent microvasculature, less variable cellularity, consistently ≥1 mitotic figure per 10 high-power fields, and predominant acute inflammation without plasma cells. p53 protein nuclear immunostaining was moderate, unlike the rare to absent staining in pseudotumors. Because all 12 sarcomas were desmin-negative, we did not call them leiomyosarcoma; they overlapped with benign tumor in epithelial, mesenchymal, and actin immunostaining. Among 12 sarcoma patients, 2 died of tumor (at 3 months). Two of four experienced tumor recurrence after partial cystectomy (2 and 26 months). No pseudotumors recurred after transurethral resection or partial cystectomy, although one patient, 5 months after transurethral resection, had histologically identical pseudotumor that the surgeon considered residual. Another patient with pseudotumor, not a candidate for tumor ablation after transurethral resection, had continued tumor growth and he died of urosepsis. In conclusion, inflammatory pseudotumor, although overlapping with sarcoma in presentation, age range, and size, does not metastasize and remains histologically distinct from low-grade sarcoma.

Mesenchymal Tumors and Tumor-Like Lesions of the Female Genital Tract: A Selective Review with Emphasis on Recently Described Entities

The diverse mesenchymal tumors and tumor-like lesions that occur within the female genital tract include a number of lesions that have only been recently characterized and others about which there is new information. In this group are the aggressive angiomyxoma, angiomyofibroblastoma, and cellular angiofibroma. Criteria for the distinction of these lesions are reviewed, as are the pathologic features of prognostic significance in assessing smooth muscle tumors of the vulva. The diagnostic problems that the epithelioid variant of smooth muscle tumors, both benign and malignant, may pose when they occur in various areas of the genital tract are discussed, particularly with regard to problems encountered in the ovary, a site where the diagnosis often is not considered. Recent information expanding the morphologic spectrum of fibroepithelial polyps of the genital tract is presented, and important non-neoplastic entities, including nodular fasciitis and the postoperative spindle cell nodule, are reviewed. Mesenchymal tumors of the various types seen in the soft tissues may be encountered anywhere in the female genital tract and have been the subject of particular recent interest in the ovary; issues relevant to differential diagnosis are reviewed.

Nódulo fusocelular post-quirúrgico en pelvis renal

IntroductionThe postoperative spindle cell nodule of the urinary tract is a bening proliferative lesion similar to sarcoma in the microscopic exam. We present a case of nodulein renal pelvis location CaseA woman presenting a stag horn lithiasis in left kidney was treated by LOC and percutaneous nephroscopy. Because of the large size of the stone a second intervention was required four weeks later. Then we discovered a 2 cm exophytic lesion in renal pelvis and removed it easily with a forceps DiscussionThis kind lesion belong to the group of iatrogenic inflamamtory pseudotumours, wich are secondary to an injury that leads to a tissular repairing response. Differential diagnostic includes sarcomas ConclusionsIt is important that Urology and pathology specialist think of this tumour in patients having a recent surgical intervention. A mistake in the diagnosis would lead us to an unnecessary radical surgery

Spindle cell tumors and tumor-like changes of the prostate and surrounding tissue

Spindle cell lesions of the prostate and surrounding tissues include mesenchymal and epithelial tumors and tumorlike lesions, such as postoperative spindle cell nodules (PSN) and pseudosarcomatous fibromyxoid tumors (PFMT). PSN and PFMT are possibly related fibroblastic and myofibroblastic proliferations respectively. However, they may be misinterpreted as sarcomas. PSN typically are detected incidentally several weeks or months after urological procedures such as cystoscopy. PFMT only rarely reveals a urological history, however, reaching back for several years; here, more often there is a clinical presentation with dysuria and/or hematuria. Important for the differential diagnosis of PSN and PFMT or sarcomas is not only a histological examination, including immunohistochemistry, but also a close clinicopathological correlation. Nevertheless, in some cases it may be impossible to reach a final diagnosis.

Post‐operative spindle cell nodule of the vulva

A case of post-operative spindle cell nodule arising in the vulva of a 33-year old woman is reported and the relevant literature reviewed. This is an uncommon, benign lesion which develops soon after a surgical procedure and which is composed of mitotically active spindle cells, causing possible confusion with sarcoma. Knowledge of the clinical history and an awareness of the existence of such lesions is necessary in order to avoid misinterpretation.

Perce the permissive pathologist: a cautionary tale of one who misdiagnosed a pseudosarcoma, killed the patient and was found out.

Perce, a promising young trainee pathologist, correctly recognizes a biopsy of a benign pseudosarcoma but his diagnosis is overruled by the less well read Head of Pathology. Acting under instructions from his Chief, Perce knowingly and without protest 'signs out' this benign condition as a sarcoma. The surgeon accepts the diagnosis without question and performs radical surgery, which is complicated by postoperative haemorrhage from which the patient dies. The Coroner orders a review of the slides and the misdiagnosis is discovered. Perce's defense that he did as he was told is rejected; he is forced to quit pathology and becomes an administrator. This unfortunate tale, which is related in verse, is intended to stress the importance of such benign but uncommon pseudosarcomas as nodular fasciitis, proliferative myositis, myositis ossificans, postoperative spindle cell nodule, pseudosarcoma of the bladder and juxta-articular myxoma. The poem also implies that surgeons should not carry out radical surgery based on an uncommon pathological diagnosis without checking on the adequacy of consultation and informed review of the sections.

Posttraumatic spindle cell nodule of the buccal mucosa: Report of a case

A benign posttraumatic spindle cell proliferation arising at a site of laceration in the buccal mucosa of a 19-year old man is described. This lesion, which histologically mimicked a leiomyosarcoma, appears to represent a reactive process similar to that described as postoperative spindle cell nodules of the genitourinary tract. Reexcision of the area 1 month after biopsy revealed only scar formation and mild chronic inflammation. Recognition of this type of benign spindle cell proliferation at traumatized sites in the oral cavity is important if misdiagnosis and subsequent aggressive therapy is to be avoided.

Spindle-Cell Proliferations of the Urinary Tract: An Immunohistochemical Study

In order to define the immunohistochemical features of spindle cell proliferations of the urinary tract, we studied 18 lesions of this type with a panel of antibodies to epithelial and mesenchymal determinants. Histologically, 13 cases showed features that were not conclusively those of either spindle cell carcinoma or sarcoma, three contained overtly epithelial areas, and two were classified as postoperative spindle cell nodules (PSCN). Nine tumors in the indeterminate group and three with focally overt carcinomatous growth stained for cytokeratin and epithelial membrane antigen (EMA) and were classified as carcinomas. Eleven of these coexpressed vimentin, but desmin and muscle-specific actin were undetectable. The four remaining indeterminate neoplasms expressed desmin and muscle-specific actin as well as vimentin, but they lacked epithelial markers; these were categorized as leiomyosarcomas. Both PSCN were reactive for cytokeratin with each of three separate monoclonal antibody preparations. Desmin, actin, and vimentin were also observed in such lesions, but EMA was not. Because spindle cell proliferations may be difficult to interpret in routinely stained tissue sections, the additional information provided by immunohistochemical studies is helpful in establishing a diagnosis and separating biologically disparate lesions.

Spindle-cell proliferations of the urinary tract. An immunohistochemical study.

In order to define the immunohistochemical features of spindle cell proliferations of the urinary tract, we studied 18 lesions of this type with a panel of antibodies to epithelial and mesenchymal determinants. Histologically, 13 cases showed features that were not conclusively those of either spindle cell carcinoma or sarcoma, three contained overtly epithelial areas, and two were classified as "postoperative spindle cell nodules" (PSCN). Nine tumors in the indeterminate group and three with focally overt carcinomatous growth stained for cytokeratin and epithelial membrane antigen (EMA) and were classified as carcinomas. Eleven of these coexpressed vimentin, but desmin and muscle-specific actin were undetectable. The four remaining indeterminate neoplasms expressed desmin and muscle-specific actin as well as vimentin, but they lacked epithelial markers; these were categorized as leiomyosarcomas. Both PSCN were reactive for cytokeratin with each of three separate monoclonal antibody preparations. Desmin, actin, and vimentin were also observed in such lesions, but EMA was not. Because spindle cell proliferations may be difficult to interpret in routinely stained tissue sections, the additional information provided by immunohistochemical studies is helpful in establishing a diagnosis and separating biologically disparate lesions.