Proliferation Of Spindle-shaped Cells Research Articles

Oral, conjunctival and Auricular Kaposi’s sarcoma in a HIV-negative patient : an unusual presentation

Kaposi’s sarcoma is an unusual multicentric malignant neoplastic disease, that characterized by the proliferation of spindle-shaped cells. This tumor is habitually involving in the skin of the lower extremities. However, it is rarely developing in the mucosa or skin of the head and neck. Herein, we report an uncommon presentation of Kaposi sarcoma affecting auricle,oral and ocula rmucosa in an immunocompetent patient. The diagnosis was made on clinical and histopathological finding.

Mucosal Schwann cell hamartoma: a benign and little-known entity.

Dear editor, 50 years-old female with personal history of mutation of the gene BRCA1 and previous prophylactic double anexectomy consulted for rectal bleeding without pain since two weeks. A blood test was performed, with hemoglobin levels of 13.1g/dl and without iron deficiency. In the anal inspection there were neither external hemorrhoids nor anal fistulas, so a colonoscopy was requested. In the colonoscopy, all the colon mucosa was normal but, in the rectal retroflexion, apart from internal engorged hemorrhoids, surrounding the 50% of the anal opening an erythematous and indurated mucosa was found (figure 1). Biopsies were taken. The pathology report informed of proliferation of spindle-shaped cells exclusively in the lamina propria with eosinophilic cytoplasm and unclear cell borders (figure 2). Not nuclear atypia or mitotic activity were observed. On immunohistochemistry, S-100 protein was strongly positive (figure 3) and CD34, SMA, EMA and c-kit were negative. These results are concordant with the diagnosis of Schwann cells in the context of a mucosal Schwann cell hamartoma (MSCH). Given that these lesions seem to not have malignant potential, the patient was discharged without control colonoscopies. The episodes of rectorrhagia were attributed to the presence of internal hemorrhoids. Discussion: MSCH are benign and intramucosal tumors with a mesenchymal origin. They are most commonly located in the distal colon, but they were also found in the gallbladder, the esophagogastric union and in the antrum. They are observed most frequently in middle aged women (around 60 years-old) and they are generally asymptomatic. They are presented as polyps between 1 and 6mm, but in other cases they appeared as small whitish nodules, protruding lesions with normal superficial mucosa or even they were found in random biopsies of the colon. The MSCH are a rare entity with an unknown prevalence. Less than 100 cases are described in the literature. It is essential the differentiation between this entity and the Schwanomas or the gastrointestinal stromal tumors (GIST). Schwanomas are rare in the colon, they are well circumscribed (in contrast with the MSCH) and they are not limited to the lamina propria. GIST are more frequently located in the stomach and they are positive for c-kit. MSCH are not associated with hereditary syndromes such as neurofibromatosis and, in contrast with Schwanomas or GIST, they do not require surveillance because they are benign.

Immunohistochemical Characteristics of Spindle Cell Ameloblastic Carcinoma in a Horse

A 2-year-old male Thoroughbred horse presented with a mass in the maxilla. The focally ulcerated mass, approximately 8cm in diameter, covered the upper left intermediate and corner incisor teeth (nos. 602 and 603 according to the modified Triadan system) and radiographic examination revealed displacement and lysis of the incisors. Histologically, the tumour was composed of a dense proliferation of spindle-shaped cells and neoplastic odontogenic epithelial cells arranged in island, follicular, plexiform or sheetlike patterns. The spindle-shaped cells were immunopositive for cytokeratins AE1/AE3, 5/6, 14 and 19. The Ki-67 index was 32.6% in the spindle cell component. Based on the histological and immunohistochemical findings, the tumour was diagnosed as spindle cell ameloblastic carcinoma.

Choroidal Ganglioneuroma: An Unexpected Diagnosis

Abstract Introduction/Objective Ganglioneuromas are rare, fully differentiated, benign neuronal tumors arising from neural crest cells anywhere along the sympathetic nervous system. However, they can undergo dedifferentiation and give rise to malignant neuroblastoma and ganglioneuroblastoma. Choroidal ganglioneuroma is exceptionally rare and usually an unexpected histopathological diagnosis. We report a pediatric patient with neurofibromatosis type 1, who underwent evisceration of a painful blind eye with subsequent histopathological examination confirming a diagnosis of choroidal ganglioneuroma. Methods/Case Report A 15-year-old boy with a medical history of neurofibromatosis type 1, plexiform neurofibroma of the right face and right orbit, right optic pathway glioma, and right painful blind eye secondary to congenital glaucoma underwent evisceration of the right eye with placement of orbital implant. On histopathological examination a choroidal lesion was identified adjacent to the pigmented retinal epithelium. This lesion showed proliferation of spindle-shaped cells admixed with clusters of ganglion cells. There were no signs of atypia, necrosis, or pleomorphism. The ganglion cells showed abundant cytoplasm with large vesicular nucleus and prominent nucleoli. The spindle cells were positive for S-100 immunostain and the ganglion cells were positive for synaptophysin. These findings were diagnostic of choroidal ganglioneuroma. Results (if a Case Study enter NA) NA Conclusion Choroidal ganglioneuroma, in addition to being a clinically unsuspected diagnosis, is exceptionally rare in patients with neurofibromatosis type 1. Medical literature on choroidal ganglioneuroma is sparse, however, it is reported that these benign tumors can locally recur with malignant transformation, and therefore close follow-up is advised.

Surgical resection of extremely rare primary giant splenic angiomyolipoma: a case report

BackgroundAngiomyolipoma is a benign mesenchymal tumor that develops commonly in the kidney and rarely in other organs. The involvement of the spleen in angiomyolipoma is extremely rare, and only one such case has been reported in the English literature.Case presentationA 27-year-old man presented with adenoid hyperplasia and bilateral palatal tonsillar hyperplasia. During the treatment for adenoid hyperplasia, a 15-cm tumor was detected in the spleen using abdominal ultrasonography and enhanced computed tomography. Partial resection of the spleen was successfully performed. A giant tumor of approximately 13 cm with a smooth surface was observed in the upper left quadrant of the abdomen. The tumor was confirmed to be continuous with the upper spleen, and there was no invasion of the other organs. The postoperative course was good, and the patient was discharged on the 7th postoperative day. The excised specimen was a smooth, extremely soft tumor measuring 123 × 120 × 82 mm. The cleaved surface of the tumor was reddish brown, and a distressing yellow color was observed. Pathological examination revealed a proliferation of mature adipocytes and an increase in the number of blood vessels of various sizes. Furthermore, spindle-shaped cell proliferation foci were visible between the adipocytes and the surrounding blood vessels. Profuse leakage of erythrocytes from the blood vessels, hemosiderin deposition, and small round cell infiltration were also noted. Immunostaining disclosed that the spindle-shaped cells were weakly positive for smooth muscle antibody and were identified as smooth muscle cells. The adipocytes and spindle cells were negative for HMB 45, Melan A, MDM, and CDK4. However, some parts of the cells were positive for estrogen and progesterone receptors. Besides, vascular endothelial cells were positive for CD31 and CD34 and negative for CD8. Based on these findings, the patient was diagnosed to have primary angiomyolipoma of the spleen.ConclusionsWe have reported the surgical treatment for an extremely rare case of giant splenic angiomyolipoma in a young man. Globally, this is the second report on this condition. We believe that partial splenic resection is a feasible option for the management of giant tumors.

The Viscous Juncture-Juxta Articular Myxoma

Juxta-articular myxoma is an uncommon, benign, hypocellular, bland, myxoid neoplasm of mesenchymal origin occurring within the vicinity of a large joint such as the knee. The neoplasm is exemplified within 16 years to 83 years with a median age at 43 years. A male predominance is observed with a male to a female proportion of nearly 3:1. Localized tissue destruction arising on account of the neoplasm can engender pain or nerve palsy. The minimally cellular tumefaction depicts an abundant, myxoid stroma admixed with a non-malignant proliferation of spindle-shaped cells. Juxta-articular myxoma is immune reactive to vimentin and CD34.

Aggressive Myofibroma of the Maxilla: Report of a Case

Myofibroma is a benign, localized or generalized myofibroblast-derived tumor, occurring most frequently in children, and rarely affecting the maxilla. A 9-year-old girl complained of mainly a painless swelling on the right side of the face since 5 months prior. Intraorally, the swelling extended from teeth #11 to #16, causing displacement of teeth #13, #14, and #15. Computed tomography revealed a large osteolytic lesion causing thinning and erosion of the cortical bones. Incisional biopsy revealed proliferation of spindle-shaped cells, with elongated nuclei and eosinophilic cytoplasm, arranged in interlaced fascicles. The immunohistochemical panel showed cytoplasmic positivity for α-SMA and β-catenin. Ki-67 was positive in 1% of the tumor cells. The diagnosis was myofibroma. After surgical excision of the lesion, the patient is under follow-up. Myofibroma is an aggressive lesion often misdiagnosed as a malignant tumor; the establishment of a correct differential diagnosis is crucial for determining an appropriate treatment approach.

Large Adenomatoid Odontogenic Tumor of the Mandible: an Unusual Presentation

Adenomatoid odontogenic tumors represent approximately 2% to 7% of all odontogenic tumors and has a striking tendency to occur in the anterior portion of the maxilla of young females. A 19-year-old man presented with a painless expansion in the anterior region of the mandible, with an 8-month evolution period. Computed tomography analysis showed a well-circumscribed radiolucent lesion with radiopaque foci involving the region from the first right lower premolar to first lower left premolar associated with an impacted canine. Histopathological examination showed proliferation of spindle-shaped cells forming solid sheets and whorled masses and rosette-like structures containing small amounts of eosinophilic material in the central space. Scant duct-like structures surrounded by cuboidal cells, foci of basophilic calcification, and deposition of large amounts of eosinophilic dentinoid matrix were present. Surgical resection with a titanium mesh placement to avoid gingival dehiscence was performed, and after a 1-year follow-up, there was no sign of recurrence.

237 A Case of Dermatofibrosarcoma Protuberans of the Breast

A 62-year-old woman underwent routine mammography as part of her annual health check. The mammography showed a 5.7 cm irregular mass in the left breast, posterior to the nipple and in the middle depth. A needle core biopsy was performed and sent to pathology department for evaluation. Histopathologic examination revealed the core biopsy to be involved completely by a monomorphic cellular proliferation of spindle-shaped cells, arranged in bundles displaying storiform and herring bone growth patterns. The lesion also showed frequent mitosis. The differential diagnosis for this spindle cell breast tumor included myofibroblastoma, metaplastic carcinoma, primary breast sarcoma, malignant phyllodes tumor, and dermatofibrosarcoma protuberans (DFSP). Based on the differential diagnosis an immunohistochemical panel composed of CD34, AE1/AE3, actin, desmin, S100, CK903, CD117, CD10, CD99 and FLI-1 was performed. The cells showed diffuse positivity for CD34 while all other stains were diffusely negative. A Ki67 immunostain was performed, which showed >20% positivity. The results of the immunohistochemical panel combined with clinical and morphologic features led to a diagnosis of dermatofibrosarcoma protuberans of the breast. DFSP is a rare cutaneous low-grade sarcoma that arises from the dermis and usually involves the trunk. The involvement of the breast by DFSP is extremely rare and can be a diagnostic challenge for the pathologists. A combination of immunohistochemistry and morphology can usually aid the diagnosis as in our case.

AGGRESSIVE BORDERLINE FUSOCELLULAR GROWTH OF THE MANDIBLE IN CHILD: CASE REPORT

Borderline tumors are non-invasive neoplasms that have nuclear abnormalities and mitotic activity intermediate between benign and malignant tumors of similar cell types. Its diagnosis poses a problem because of its malignant tendencies and non-specific routine light microscopic features. The present case aims to report a malignant mesenchymal neoplasm with suggestive histopathologic diagnosis of fibrosarcoma of mandible in a 13-year-old female patient. Microscopically, the tumor showed proliferation of spindle-shaped cells, varying little in size and shape, and arranged in parallel bands, partly crossing each other. Immunohistochemical profile was AML positive and S100 - HHF35 negative. Based on clinical, radiologic and histologic findings the diagnosis was suggestive of intraosseous fibrosarcoma and the patient was referred for treatment in a reference center. Patient refused surgical resection of mandible as first choice treatment, opting for chemotherapy and radiotherapy to restaging the tumor. The patient currently is under treatment.

Solitary fibrous tumor of the lung: a case report

Solitary fibrous tumors (SFTs) are relatively rare neoplasms that commonly occur in the pleura. The pathological feature of SFTs is a proliferation of spindle-shaped cells in interlacing or storiform fascicles. SFTs appear to derived from pluripotential submesothelial cells, but not the covering mesothelium. SFTs distinctively show diffuse staining for CD34 but lack staining for smooth muscle markers. We herein report a relatively rare case of a 68-year-old male patient without symptoms, who underwent resection for what was considered to be SFT.

Long-term histopathological developments in knee-joint components in a rat model of osteoarthritis induced by monosodium iodoacetate.

[Purpose] This study was performed to evaluate the long-term histopathological changes in knee-joint components including synovial membrane and joint capsule in a rat model of osteoarthritis (OA) induced by monosodium iodoacetate (MIA). [Subjects and Methods] Fifty male rats were used. OA was induced through intra-articular injection of MIA, and ten rats were randomly allocated to each of five groups induced with OA for 1, 2, 4, 6, or 8 weeks. At the end of each period, the knee components were examined histopathologically. [Results] After 1 and 2 weeks, chondrocytes were weakly stained. After 4 weeks, fibrillation, fissuring, and eburnation were observed, whereas after 6 weeks, chondrocyte clustering and osteophyte formation were detected. In the synovial membrane, the proliferation of spindle-shaped cells and a multilayered structure of the surface cells were observed at 1 and 2 weeks, but the degree of these changes decreased over time. In the joint capsule, a narrowing of the space between collagen fiber bundles was observed at 4–8 weeks. [Conclusion] The long-term histopathological changes of the joint components observed in a rat model of OA induced by MIA were similar to those detected in OA, but differed at specific times and tissues.

A Case of Solitary Neurofibroma in Outer Surface of Nose

Solitary neurofibroma is a benign tumor originating from Schwann cells in peripheral nerves. In an investigation of 430000 pathologic samples, only 6 cases of neurofibroma had been reported in nose and paranasal sinuses. Present patient was a 15-year-old girl with left-sided nasal and malar mass, whose CT scan and MRI showed a non-circumscribed solid mass with total thickness affecting outer part of nose in left side as well as surface and deep soft tissue. The mentioned mass underwent excision by sub-labial incision and open rhinoplasty keeping infra-orbit nerve intact. Pathologic investigation of samples showed adipose fibroblast and skeletal muscle fibers with proliferation of spindle-shaped cells and staining was negative for GFAP and positive for S-100 which represents diagnosis of neurofibroma. Main differential diagnoses of benign tumors of paranasal sinuses and nasal cavity include neurofibroma, fibroma, leiomyomas, papilloma, and schwannoma. After resection tumor should be precisely monitored, since there is malignant transformation possibility in solitary neurofibromas.

Emergency surgery for hemorrhagic shock caused by a gastrointestinal stromal tumor of the ileum: A case report.

In this report, a case of hemorrhagic shock caused by a gastrointestinal stromal tumor (GIST) of the ileum, which was successfully treated by emergency surgery, is presented. A 67-year-old male patient presented to the Ibaraki Medical Center, Tokyo Medical University (Ami, Japan) in July 18, 2014, with dizziness and blood in the stool. Upper endoscopy and colonoscopy failed to reveal the source of the hemorrhage, although abdominal contrast-enhanced computed tomography revealed extravasation of the contrast medium into the small intestine. The patient developed hemorrhagic shock; thus, double-balloon enteroscopy (DBE) was performed, which revealed a Meckel's diverticulum and a submucosal tumor with excessive bleeding at 60 and 100 cm proximal to the ileocecal valve, respectively. Subsequent emergency partial resection of the ileum, including the tumor and the Meckel's diverticulum, was performed in July 20, 2014. Histological examination of the excised tumor revealed proliferation of spindle-shaped cells, and immunohistochemical staining of the tumor was positive for CD34, KIT and α-smooth muscle actin, but negative for S-100 protein. These immunohistological results supported the diagnosis of GIST of the ileum. The patient had an uneventful recovery and has been monitored at our outpatient clinic for 14 months after surgery. This case demonstrated the efficacy of DBE for the diagnosis of small intestinal bleeding, and immediate emergency surgery should be considered for cases of small intestinal GISTs with excessive bleeding.

Hemoperitoneum secondary to perforated inflammatory myofibroblastic tumor: A case report of an unusual complication

Inflammatory myofibroblastic tumors (IMT) are rare neoplasms characterized by a proliferation of spindle-shaped cells with a stroma infiltrated by macrophages, lymphocytes and plasma cells. We report a case of 59 years old male who presented an acute abdomen due to a mass of the mesentery of the terminal ileum, which was perforated with active bleeding. Histopathology reported a low-grade TMI with clear margins. Inflammatory myofibroblastic tumors of the mesentery are rare entities whose etio-pathogenia remains unclear. It requires a histopathological diagnosis and inmunohistochemical evaluation and its treatment is based on complete resection of the tumor. These type of neoplasms require close monitoring due to local recurrence.

Large solitary fibrous tumor of the oral cavity—Report of a case

The solitary fibrous tumor (SFT) is a rare soft tissue tumor with a substantially benign clinical behavior. The SFT of the oral cavity is a very uncommon entity. It is also of complicated diagnosis because of its extensive morphologic diversity and because of its similarity to many mesenchymal tumors. A 44-year-old man was referred for management of an asymptomatic lesion in the left buccal mucosa, which had been identified 10 years earlier. Intra-oral examination revealed a well-demarcated, fibroelastic, rounded exophytic mass located in the left buccal mucosa. The mass was covered with a non-ulcerated mucosa of normal color and measured approximately 4.0cm in diameter. Histopathological examination showed proliferation of spindle-shaped cells arranged in fascicles and in a patternless pattern, highly vascularized, with focal staghorn vessels. Immunohistochemical analysis revealed diffuse positivity for CD34 and focal positivity for Bcl-2. Awareness of the morphological diversity of SFT coupled to a judicious use of appropriate immunohistochemical probes should prove valuable to accurately segregate SFT from other spindle cell neoplasms.

FDG PET/CT Findings of Superficial Angiomyxoma

Superficial angiomyxoma, also known as cutaneous myxoma, is a rare but distinctive soft tissue tumor characterized by a sparse proliferation of spindle-shaped cells in a prominent myxoid matrix with numerous thin-walled blood vessels. We present a case of a pathologically proven superficial angiomyxoma arising in the first web space of the left hand of a 39-year-old man. Integrated PET/CT images showed mild focal FDG uptake in a subcutaneous soft tissue mass, with a maximum standardized uptake value of 2.94.

Malignant Triton Tumor in the Abdominal Wall: A Case Report

Malignant triton tumor (MTT) is a rare variant of malignant peripheral nerve sheath tumor (MPNST) with rhabdomyosarcomatous differentiation. We report the case of a 54-year-old male without a history of neurofibromatosis type 1 (NF1) who had a growing abdominal wall tumor diagnosed as MTT. Computed tomography (CT), magnetic resonance imaging (MRI) and 2-[F-18]-fluoro-2-deoxy-D-glucose positron emission tomography/CT (FDG-PET/CT) were performed. The MRI and FDG-PET/CT indicated that the lateral component of the tumor was composed of many proliferative cells, corresponding to the histopathological finding of a cellular proliferation of spindle-shaped cells. In light of this case and previous reports, it is apparent that FDG-PET/CT is a helpful tool for distinguishing MTT from benign peripheral nerve sheath tumor.

Resection of a giant, invasive malignant solitary fibrous tumor of pleura

Solitary fibrous tumor of pleura (SFTP) is a rare mesenchymal neoplasm that most commonly involves the pleura, is probably derived from fibroblasts, and has no relationship to malignant mesothelioma. Here, we report a case of complete resection of a giant malignant SFTP. A 61-year-old woman developed fever and left flank pain. Computed tomography revealed the tumor to be 13 cm in size and located in the left thoracic cavity, directly invading the left lower lobe of the lung. The patient underwent radical resection and left lower lobectomy. Immunohistochemical examination revealed a dense proliferation of spindle-shaped cells with ovoid nuclei and collagen fibers hyperplasia. The cells were positive for CD34 and vimentin, and were negative for cytokeratin AE1/AE3, calretinin, S-100 and smooth muscle α-actin. SFTPs have malignant potential, as 20-30 % of resected SFTPs reportedly contain malignant components. Careful long-term clinical follow-up is therefore required for all cases of SFTP.

Fatal esophageal fibrosarcoma associated to parasitism by spirurid nematode Spirocerca lupi in a dog: a case report

A 7-years-old intact female mixed breed dog was referred to the private veterinary clinic because of history of intense food regurgitation. The plain X-ray examination and the contrast-enhanced X-ray using barium sulfate revealed the presence of a radio-opaque mass in the final third of the esophagus. Stool samples were collected and the coproparasitological test was done, which showed thick-shelled eggs from Spirocerca lupi. As the canine died, the necropsy was performed, showing nodular lesions in the esophagus, compatible with the typical lesions of spirocercosis. The histopathological analysis showed the proliferation of spindle-shaped cells, process compatible with fibrosarcoma. This is the first official report of the presence of canine spirocercosis in Guapimirim city, Rio de Janeiro, Brazil, and can serve as a warning to veterinary practitioners, about this probably endemic region for S. lupi.