Psammomatous Calcifications Research Articles

Nested Stromal Epithelial Tumor of the Liver

Rare cases of nonhepatocytic mixed stromal and epithelial tumors of the liver with associated calcification and ossification have been described previously. We report 6 similar cases in children, including 2 cases associated with ectopic ACTH production. The patients were between 2 and 14 years of age at diagnosis. All tumors presented as a solitary liver mass with no extrahepatic involvement. Two adolescent females with palpable abdominal tumors presented with Cushing syndrome that abated after excision of the tumors. The other children had tumors identified incidentally on imaging studies or at laparotomy. All tumors were well circumscribed, ranging in size from 4.0 to 30.0 cm in greatest diameter. Histologically, they shared an organoid arrangement of cellular nests that were comprised of an admixture of both spindled and epithelioid cells. These cellular nests were surrounded by a band of delicate myofibroblasts and set in a dense fibrous stroma that contained slit-like to dilated blood vessels. A variable proliferation of bile ducts extended from the fibrous stroma and focally surrounded the cellular nests. One case showed a sheet-like overgrowth of the nested cells with associated necrosis. The cellular nest cells were immunoreactive for EMA, CD56, neuron specific enolase, pan-cytokeratin (4 of 6 cases), vimentin (5 of 6 cases), and WT-1 amino terminus (4 of 6 cases). Cytokeratin and EMA stained mostly epithelioid nest cells, with vimentin and WT-1 staining predominantly the spindled nest cells. The 3 cases from adolescent females showed immunoreactivity for ACTH in the nested cell population but not in the surrounding stromal cells. Immunohistochemical stains for synaptophysin and chromogranin were negative in all cases. Psammomatous calcifications were present focally in 2 cases and were extensive in 3 cases. Ossification or osteoid formation was present in 4 cases. The 1 patient whose tumor had sheet-like overgrowth of the nested cell population had a local recurrence with multiple hepatic nodules 1 year following the original resection. A 2-year-old patient has been subsequently diagnosed with nephroblastomatosis and Wilms tumor of the kidney. Follow-up information was available in an additional 3 patients with no tumor recurrence or metastatic disease at 2, 3, and 14 years.

Multiple calcifying fibrous tumors of the pleura

Calcifying fibrous tumor (CFT) is a rare lesion characterized histologically by hypocellular hyalinized collagenous tissue with psammomatous and/or dystrophic calcifications and patchy lymphoplasmacytic infiltrates. CFT usually occurs in the somatic soft tissue of children and young adults but is rarely found in the pleura. We describe here an unusual case of multiple small CFTs in the right mediastinal pleura of a 54-year-old man who had a history of renal cell carcinoma. Suspecting pulmonary and pleural metastases, we performed wedge resection of the right middle lobe and local excision of two nodules in the right pleura. Light microscopy revealed metastatic lesions of renal cell carcinoma in the resected wedge. The pleural nodules were well circumscribed and composed of hypocellular, dense, hyalinized, collagenous tissue with scant lymphoplasmacytic infiltration and characteristic psammoma bodies. Immunohistochemical staining revealed that most spindle cells were positive for vimentin, CD34 and factor XIIIa, and negative for epithelial membrane antigen, keratin, smooth-muscle actin, desmin, S-100 protein and anaplastic lymphoma kinase. We made a histological diagnosis of CFT of the pleura, and the patient remains well 6 months after the wedge resection.

Calcifying Fibrous Pseudotumor of the Pleura

Calcifying fibrous pseudotumor is an uncommon benign lesion that has unique histologic features. We report a case of calcifying fibrous pseudotumor of the pleura occurring in a 31-year-old woman. A computed tomographic scan revealed a pleural mass in the right anterior costophrenic angle. The excised mass was well circumscribed, nonencapsulated, solid, and firm. The tumor showed dense hyalinized collagenous tissue interspersed with spindle cells, psammomatous calcifications, and a predominantly lymphoplasmocytic infiltrate. Most spindle cells were diffusely positive for vimentin, focally positive for CD34, and negative for desmins, smooth muscle actin, S-100 protein, and anaplastic lymphoma kinase-1.

Extremely well‐differentiated adenocarcinoma of the gastric cardia: A unique case with columnar cells and laminated stones

Extremely well-differentiated adenocarcinoma (EWDA) is an unusual gastric cancer that is histologically too bland to be diagnosed as malignant neoplasm, particularly using biopsy. EWDA may be a gastric counterpart of 'adenoma malignum' or minimal deviation adenocarcinoma (MDA) in the uterine cervix; however, the clinicopathological features of EWDA remain less apparent than those of MDA. A 60-year-old male was complaining of dysphagia. He had been made aware of a small submucosal tumor in the cardia 2 years before the onset of this symptom. Endoscopic ultrasonographic examination revealed a large cardiac tumor consisting of thickened layers, as observed in Borrmann type IV. Three mucosal biopsies suggested only benign changes including adenoma and hyperplastic polyps. At the fourth biopsy, cytologically bland columnar cells were located in the submucosa along with stromal fibrosis and laminated stones. The possibility that non-neoplastic aberrant pancreas with lithiasis formed the tumor was denied at laparotomy by a frozen section that revealed benign-looking glands invading the diaphragm. Immunohistochemically the cancer glands were positive for CA19-9 and human gastric mucin, but not for p53 or MUC2. To our knowledge, this is a previously unknown combination of EWDA and psammomatous calcification in the stomach.

The significance of psammoma bodies in screening cervical cytologic smears

Objective: Although the presence of psammoma bodies in cervical cytologic smears has been associated previously with gynecologic malignancies, the clinical significance of this finding in asymptomatic women who undergo routine cervical cytologic screening has not been well defined. Study Design: For this retrospective clinicopathologic study, a search of the Virginia Mason Medical Center computerized cytology registry from 1993 through March 2002 identified 25 evaluable cervical cytologic smears that contained psammomatous calcifications. Slides were reviewed, and clinical information was obtained from medical records. Results: The median patient age was 36 years (range, 22-72 years). Nine women were postmenopausal. All cytologic smears were obtained for routine screening, and no abnormal cells that were diagnostic of malignancy were identified. Possible explanations for the psammoma bodies was determined for 11 women, including foci of calcifications in benign endometrial or endocervical tissue (4 women), polyps (3 women), marked atrophy (3 women), postpartum (2 women), and follicular cervicitis (1 woman). None of the 25 women had cancer. After excluding 1 woman who was to lost to follow-up, the remaining 24 women were followed up for a median of 3 years (range, 6 months-7 years) without the subsequent detection of cancer. Conclusion: Cancers that were reported in previous studies usually were diagnosed in women with malignant background cytology or abnormal symptoms, such as postmenopausal bleeding. In contrast, our study suggests that the presence of psammoma bodies in normal cytologic smears of asymptomatic women is an incidental finding. (Am J Obstet Gynecol 2003;188:1609-14.)

Familial Peritoneal Multifocal Calcifying Fibrous Tumor

Calcifying fibrous tumor (CFT) is usually solitary, involving the soft tissue, pleura, or peritoneum. The cause and pathogenesis are unclear. Cases with multifocal lesions are rare, and a familial occurrence has not been reported. Herein, a family in which 2 sisters developed multifocal peritoneal CFT is described. The sisters each had abdominal pain, and each was found at laparotomy to have multiple nodular lesions on the mesenteric, omental, and small bowel serosal surfaces. Many lesions were composed of collagenous, paucicellular, fibrous tissue with psammomatous or dystrophic calcification, consistent with CFT. Some lesions were composed of more cellular spindle-celled tissue resembling inflammatory myofibroblastic tumors. Both patients were alive and well 19 and 17 years after diagnosis, respectively. One other sibling and 2 children of one of the sisters were speculated to have the same disorder, based on clinical findings. This report suggests that there may be a genetic susceptibility to CFT, although chance and common environmental etiologic factors cannot be excluded.

Leydig cell tumors of the testis with unusual features: adipose differentiation, calcification with ossification, and spindle-shaped tumor cells.

We report 19 Leydig cell tumors (LCTs) of the testis with adipose differentiation (n = 12) and/or spindle cell growth (n = 8) in patients 28-70 years of age; three tumors with adipose differentiation showed psammomatous calcifications, two of which also had foci of ossification. In eight tumors fat-like cells apparently derived from lipid accumulation within neoplastic Leydig cells and appeared as focal to prominent clusters in a background of vacuolated, neoplastic Leydig cells. The fat-like cells were usually immunoreactive for Leydig cell markers (inhibin-alpha, calretinin, and melan-A) but were typically strongly positive for the adipose tissue marker, S-100 protein, supporting a hybrid cell phenotype. Four tumors had fat of stromal derivation. In two of these there were intermixed mature adipocytes, but in two others only lipoblastic cells were present. These four tumors lacked vacuolated, neoplastic Leydig cells, and the fat cells in the single case studied were negative for inhibin-alpha and melan-A but positive for S-100. Three of the 12 LCTs with adipose differentiation were clinically malignant, and each had several of the established malignant features. Eight tumors with spindle cells occurred in men 34-70 years of age. Two tumors had ill-defined fascicles of spindle cells, and three showed prominent edematous to myxoid areas with spindle-shaped tumor cells. Two additional tumors had a fibroma-like spindled component that blended with islands of more plump, polygonal to spindle-shaped Leydig cells. Finally, one tumor had foci resembling an unclassified sarcoma that merged with conventional LCT; the spindle cell component in this case did not react for Leydig cell markers in contrast to the spindle cells in five of the six other cases in which immunostains were performed. Spindle cell differentiation, by itself, did not appear to have prognostic significance. Of the six patients with available follow-up, two developed metastases, but their tumors had malignant features apart from spindle cells; the remaining four patients were disease free at a mean of 3.6 years. Awareness of these unusual patterns in LCTs may prevent misinterpretation of fat admixed with neoplastic Leydig cells as evidence of extratesticular growth (a criterion for malignant LCT) may help avoid misdiagnosis of a LCT as a testicular "tumor" of the adrenogenital syndrome (which may contain fat) and may prevent misdiagnosis of a LCT with spindle cells as a sarcoma or unclassified sex cord-stromal tumor.

Echogenic ovarian foci without shadowing: are they caused by psammomatous calcifications?

To determine and report the spectrum of ultrasonographic appearances of echogenic ovarian foci (EOF) without shadowing in otherwise normal ovaries and the histopathologic and physical characteristics of these foci. The appearances of foci on transvaginal pelvic sonograms obtained in 189 patients with EOF were prospectively analyzed. The foci were classified according to bilaterality, size, number (<5, 5-10, or >10), and location (peripheral, central, or diffuse). At histopathologic analysis, resected normal ovaries, seven with and 10 without echogenic foci, in a water bath were scanned. The foci were then localized for histopathologic correlation. To assess the physical properties of the foci, tissue-mimicking water- and glycerol-based phantoms, with voids of different diameters, in a water bath were scanned with 8- and 70-MHz transducers. At appearance analysis, EOF (mean diameter, 1.8 mm +/- 0.6 [SD]) were detected unilaterally in 103 (54.5%) of 189 patients. EOF were distributed peripherally in 183 (66.5%), centrally in 15 (5.5%), and diffusely in 77 (28.0%) of 275 ovaries. There were fewer than five foci in 123 (44.7%), five to 10 foci in 91 (33.1%), and more than 10 foci in 61 (22.2%) of 275 ovaries. At histopathologic analysis of the seven ovaries with EOF, the foci had tiny cysts with no evidence of calcifications. A single cyst cluster was identified in two of 10 ovaries that did not have echogenic foci. At physical property analysis, single echogenic foci were associated with specular reflection from the walls of unresolved cysts that were comparable in size to the ultrasound wavelength (about 0.50 mm). EOF without shadowing are caused by a specular reflection from the walls of tiny unresolved benign cysts rather than by psammomatous calcifications.

Primary Renal Neoplasms with the ASPL-TFE3 Gene Fusion of Alveolar Soft Part Sarcoma : A Distinctive Tumor Entity Previously Included among Renal Cell Carcinomas of Children and Adolescents

The unbalanced translocation, der(17)t(X;17)(p11.2;q25), is characteristic of alveolar soft part sarcoma (ASPS). We have recently shown that this translocation fuses the TFE3 transcription factor gene at Xp11.2 to ASPL, a novel gene at 17q25. We describe herein eight morphologically distinctive renal tumors occurring in young people that bear the identical ASPL-TFE3 fusion transcript as ASPS, with the distinction that the t(X;17) translocation is cytogenetically balanced in these renal tumors. A relationship between these renal tumors and ASPS was initially suggested by the cytogenetic finding of a balanced t(X;17)(p11.2;q25) in two of the cases, and the ASPL-TFE3 fusion transcripts were then confirmed by reverse transcriptase-polymerase chain reaction. The morphology of these eight ASPL-TFE3 fusion-positive renal tumors, although overlapping in some aspects that of classic ASPS, more closely resembles renal cell carcinoma (RCC), which was the a priori diagnosis in all cases. These tumors demonstrate nested and pseudopapillary patterns of growth, psammomatous calcifications, and epithelioid cells with abundant clear cytoplasm and well-defined cell borders. By immunohistochemistry, four tumors were negative for all epithelial markers tested, whereas four were focally positive for cytokeratin and two were reactive for epithelial membrane antigen (EMA) (one diffusely, one focally). Electron microscopy of six tumors demonstrated a combination of ASPS-like features (dense granules in four cases, rhomboid crystals in two cases) and epithelial features (cell junctions in six cases, microvilli and true glandular lumens in three cases). Overall, although seven of eight tumors demonstrated at least focal epithelial features by electron microscopy or immunohistochemistry, the degree and extent of epithelial differentiation was notably less than expected for typical RCC. We confirmed the balanced nature of the t(X;17) translocation by fluorescence in situ hybridization in all seven renal tumors thus analyzed, which contrasts sharply with the unbalanced nature of the translocation in ASPS. In summary, a subset of tumors previously considered to be RCC in young people are in fact genetically related to ASPS, although their distinctive morphological and genetic features justify their classification as a distinctive neoplastic entity. Finally, the finding of distinctive tumors being associated with balanced and unbalanced forms of the same translocation is to our knowledge, unprecedented.

Immunohistochemical analysis of anaplastic lymphoma kinase expression in deep soft tissue calcifying fibrous pseudotumor: evidence of a late sclerosing stage of inflammatory myofibroblastic tumor?

Calcifying fibrous pseudotumor (CFT) is a rare benign soft tissue lesion composed of dense hyalinized fibrous tissue containing bland spindle-shaped cells admixed with a lymphoplasmacytic infiltrate and foci of dystrophic and often psammomatous calcifications. It has been suggested that CFT represents a late sclerosing stage of inflammatory myofibroblastic tumor (IMT). Recently, clonal cytogenetic abnormalities involving the anaplastic lymphoma kinase (ALK) gene on chromosome 2p have been identified in IMT, particularly those arising in deep soft tissue sites. We evaluated seven cases of deep soft tissue CFT diagnosed at the Cleveland Clinic Foundation and the University of Florida with available paraffin-embedded blocks using a monoclonal antibody to ALK (Dako, Carpenteria, CA) and a modified avidin-biotin complex method. The cohort included six women and one man with a median age at diagnosis of 43 years (range, 26 to 67 years). Sites of CFT included mesentery (3), peritoneum (1), omentum (1), serosa of small bowel (1), and anterior mediastinum (1). Immunohistochemically, only one case showed focal staining for ALK. The remaining six cases were negative, with appropriate positive and negative control staining. In conclusion, unlike IMT, CFT in deep soft tissue locations rarely expresses ALK by immunohistochemistry, suggesting that CFT is a different clinicopathologic entity than IMT, as opposed to representing a "burned out" IMT. Ann Diagn Pathol 5:10-14, 2001.

THE THYROID AND PARATHYROID GLANDS: CT and MR Imaging and Correlation with Pathology and Clinical Findings

Thyroid imaging approach is based on the preliminary clinical evaluation. Lesions that are smaller than 2 cm should be assessed with US, which is capable of discriminating masses as small as 2 mm and distinguishing solid from cystic nodules. US-guided FNAB provides tissue for cytologic examination of thyroid nodules. CT and MR imaging are indicated for larger tumors (greater than 3 cm diameter) that extend outside the gland to adjoining structures, including the mediastinum, and retropharyngeal region. Metastatic lymph nodes in the neck and invasion of the aerodigestive tract are also in the realm of CT and MR imaging. Thyroid nodules are categorized on scintigraphy as hot or cold nodules. Hot nodules are rarely malignant, whereas cold nodules have an incidence of 10% to 20% of malignancy. Calcifications (amorphous, globular, nodular, and linear) occur in adenomas and carcinomas and have no differential diagnostic features except for psammomatous calcifications, which are a pathognomonic finding in papillary carcinomas and a small percentage of medullary carcinomas. Papillary carcinoma is the most common malignant tumor (80%) followed by follicular (20% to 25%); medullary (5%); undifferentiated; anaplastic carcinomas (< 5%); lymphoma (5%); and metastases. Lymph node metastases are common in papillary carcinoma, 50% at presentation, and less common in follicular carcinomas. The metastatic nodes in papillary carcinoma may enhance markedly (hypervascular); show increased signal intensity on T1-weighted images (increased thyroglobulin content or hemorrhage); and reveal punctate calcifications. Localized invasion of the larynx, trachea, and esophagus occurs predominantly in papillary and follicular carcinomas; the incidence is less than 5%. Ectopic thyroid tissue may be encountered in the tongue (foramen cecum); along the midline between posterior tongue and isthmus of thyroid gland; lateral neck; mediastinum; and oral cavity. Goiter and malignant tumors, notably papillary carcinoma, may develop in ectopic thyroid tissue. Carcinomas may also arise in thyroglossal duct cysts, which develop from duct remnants between the foramen cecum and thyroid isthmus. Infectious disease of the thyroid gland is not common and the CT and MR imaging findings are similar as described under neck infection. Other types of inflammatory disorders including Hashimoto's thyroiditis, granulomatous thyroiditis, and Riedel's struma display no specific imaging features. Imaging studies may, however, be indicated to confirm a suspected clinical diagnosis and assess compromise of the airway (Riedel's struma). HPT is a clinical diagnosis in which hypercalcemia is the most important finding. Parathyroid hyperplasia, adenoma, and carcinoma represent underlying lesions. To relieve the patient's symptoms surgical extirpation is indicated. The surgical success rate without imaging is 95%. The indications for imaging studies vary but it is generally agreed that reoperation after a previous failed surgical attempt and suspicion of an ectopic parathyroid adenoma should be investigated by imaging. These consist of US, nuclear medicine studies, CT and MR imaging. US and technetium sestamibi scanning have the highest accuracy rate for localizing an adenomatous gland at and near the thyroid gland. Ectopic adenomas, particularly if they are located in the mediastinum, are preferrably investigated with CT and MR imaging with gadolinium and fat suppression. Carcinomas and parathyroid cysts are optimally evaluated by CT and MR imaging. On MR imaging adenomas are low in signal intensity on T1-weighted images, high in signal intensity on T2-weighted images, and enhance post introduction of gadolinium.

Primary Papillary Serous Carcinoma of the Peritoneum: A Case Report

Primary papillary serous carcinoma of the peritoneum is a rare primary tumor involving the peritoneum. Histologically, it is indistinguishable from serous ovarian papillary carcinoma, although it either spares the o-varies or only microscopically involves their surface. The characteristic features of this tumor are extensive peritoneal and omental masses or implants with psammomatous calcification, and ascites. In addition, it can occur focally in the pelvic peritoneum. We report the CT findings, with histopathologic correlation of primary papillary serous carcinoma of the peritoneum occurring in the upper mesorectum.

Calcifying Fibrous Pseudotumor Involving the Neck of a Five-week-old Infant. Presence of Factor XIIIa in the Lesional Cells

Calcifying fibrous pseudotumor is an uncommon lesion characterized by hyalinized collagen, psammomatous or dystrophic calcifications, and a predominantly lymphoplasmacytic infiltrate. Although the pathogenesis is unclear, a possible relationship with other inflammatory "pseudotumors" has been proposed. We describe the pathology of two right neck calcifying fibrous pseudotumors present in a five-week-old female infant. The masses had many of the pathologic features of calcifying fibrous pseudotumor. The presence of a florid, mixed infiltrate, and the occurrence of more than one lesion in the same patient, favor the proposal that calcifying fibrous pseudotumor may be a sclerosing end stage of inflammatory myofibroblastic tumor. However, the presence of a previously undescribed participation of Factor XIIIa-positive cells suggests that the tumor may be of dermal dendrocyte origin.

CT and ultrasound features of metanephric adenoma in adults with pathologic correlation.

The purpose of this work was to correlate the CT, ultrasound, and pathologic features of metanephric adenoma, a rare benign renal tumor in adults. Retrospective review of medical records (1990-1997) revealed three adult female patients who had both preoperative imaging and nephrectomy with pathologic diagnosis of metanephric adenoma performed at our institution. CT (n = 3) and ultrasound (n = 2) features were reviewed in consensus by two radiologists and correlated with pathologic findings. In all three cases, the metanephric adenoma was of increased attenuation relative to adjacent renal parenchyma on unenhanced CT scans. No septa or calcifications were seen. Ultrasound images showed both tumors to be hyperechoic with enhanced through-transmission. The CT and ultrasound findings correlate with the pathologic features of a high nuclear-to-cytoplasmic ratio and psammomatous calcifications. In the adult population, it is unlikely that metanephric adenoma can be prospectively differentiated from renal cell carcinoma based on imaging features.

Case Report: Calcifying Fibrous Pseudotumor: An Ultrastructural Study

To clarify the pathogenesis of calcification in calcifying fibrous pseudotumor (CFT), the lesion arising in the chest wall of a 16-month-old boy was ultrastructurally investigated. Fibroblasts were surrounded by large amounts of collagen fibrils. The dystrophic and psammomatous calcifications were observed as electron-dense amorphous masses and laminated bodies, respectively, within the cytoplasm of fibroblasts and in the collagenous stroma. The degeneration of cytoplasm seemed to be an initial event of intracytoplasmic calcification. Extracellular calcified substances often abutted to fibroblasts. Fibroblasts may play an important role in both intracellular and extracellular calcifications of CFT.

Transvaginal sonographic evaluation of multiple peripherally distributed echogenic foci of the ovary: prevalence and histologic correlation.

Our aim was to determine the prevalence, histopathologic correlation, and clinical significance of multiple peripherally distributed echogenic foci seen within ovaries on transvaginal sonography. Transvaginal sonograms of 264 ovaries in 135 patients were prospectively analyzed for the presence of peripheral echogenic foci that were then characterized as linear, punctate, or globular. Previous examinations, when available, were reviewed for this sonographic feature, and the time interval between studies was recorded as a measure of stability. Sonograms were correlated with available surgical specimens in six patients, five of whom underwent hysterectomy and bilateral oophorectomy and the remaining patient who underwent laparoscopic ovarian wedge biopsy. Multiple peripheral echogenic foci were common and were found in 66 patients (49%) and 97 ovaries (37%). The punctate pattern was seen in 63 (95%) of 66 patients. The linear and globular patterns were present in only three and four patients, respectively. These echogenic foci were found on previous examinations in 18 patients. No suspicious sonographic features were seen in the ovaries of any of these patients. Histologic evaluation revealed multiple superficial epithelial inclusion cysts and associated psammomatous calcifications in all five patients who underwent bilateral oophorectomy. An additional finding in one of these patients was extensive endosalpingiosis. Multiple peripheral echogenic foci involving the ovaries is a common incidental finding on routine transvaginal sonography of the pelvis. Our data suggest that this sonographic finding represents psammomatous calcifications associated with superficial epithelial inclusion cysts.

Psammoma bodies in fine-needle aspirates of the thyroid: predictive value for papillary carcinoma.

Although characteristic of thyroid papillary carcinoma, psammoma bodies occasionally arise in benign or nonpapillary lesions. Their predictive value in fine-needle aspirates (FNA), without other features suggestive of papillary carcinoma, is uncertain. This retrospective study determined the frequency of psammoma bodies and other calcifications in 313 FNAs and 69 resected thyroids; positive predictive value, sensitivity, and specificity were calculated and compared with a triad of characteristic cytologic features (papillary fronds, nuclear ridges/grooves, and intranuclear inclusions). Psammoma bodies from benign and malignant conditions were assessed for differentiating architectural or staining characteristics. Psammoma bodies were found in only 8 of 313 FNAs. Their positive predictive value for papillary carcinoma was 50%, the rest arising from multinodular goiters. By contrast, the positive predictive value of combined cytologic features was 100%. These features were also much more sensitive, present in 80% of papillary carcinomas compared with 14% with psammoma bodies. The psammoma bodies of papillary carcinoma could not be differentiated from those of other lesions either by staining characteristics or by architecture. Other types of calcifications also were present in diverse conditions, and did not discriminate among them. Isolated psammoma bodies are an unreliable predictor of papillary carcinoma in the absence of cytologic features. In view of the relatively low aggressiveness of papillary carcinoma in most age groups, repeat fine-needle aspiration and clinical correlation are recommended prior to consideration of surgery.

Axilläre Lymphknotenmetastase eines Ovarialkarzinoms 15 Jahre nach Primäroperation

Wir berichten über den seltenen Fall einer isolierten axillären Metastase eines 15 Jahre zuvor operierten Ovarialkarzinoms. Dies ist nach unserer Kenntnis einer der wenigen Fälle, in dem nicht gleichzeitig ein metastatischer Befall der Brustdrüse nachgewiesen werden konnte. Es wird daher angenommen, daß auch eine direkte Metastasierung aus dem Peritonealraum in axilläre Lymphknoten erfolgen kann. Das für Ovarialkarzinome spezifische psammomatöse Verkalkungsmuster des befallenen Lymphknotens war röntgenologisch kennzeichnend und führte bereits präoperativ zur richtigen Verdachtsdiagnose.

Calcifying Fibrous Pseudotumor of the Mediastinum

Calcifying fibrous pseudotumor has recently been described in the soft tissues. It is a rare benign lesion characterized by the presence of abundant hyalinized collagen with psammomatous or dystrophic calcifications and lymphoplasmacytic infiltrate. We report a case of a young woman with a mediastinal mass treated by a complete resection. The mass had all the pathologic features of calcifying fibrous pseudotumor.(Ann Thorac Surg 1997;63:543–4)

Intraabdominal Calcifying Fibrous Pseudotumor

Calcifying fibrous pseudotumor was recently described as a rare, distinctive, benign, fibrous lesion characterized by the presence of abundant hyalinized collagen with psammomatous or dystrophic calcification and a lymphoplasmacytic infiltrate. The lesions reported to date in the literature involved subcutaneous and deep soft tissues of the extremities, trunk, scrotum, groin, neck, and axilla of children and young adults. Four cases in which the lesion arose intraabdominally in elderly patients are reported. This report expands the age spectrum and anatomic topography of this lesion.