Spindle Cell Proliferation Research Articles

METASTATIC LEIOMYOSARCOMA OF THE PALATAL GINGIVA MASQUERADING AS A PYOGENIC GRANULOMA

Leiomyosarcoma (LMS) is a smooth muscle neoplasm, accounting for 7% of soft-tissue and 1-4% of head-neck sarco- mas. Oral-LMS is extremely uncommon and may represent primary or metastatic disease. We describe a 46-year- old female with a medical history of "stomach cancer" who presented with a palatal mass. Upon further inquiry, it was discovered that the patient had been diagnosed with high-grade LMS of the retroperitoneum six years prior, which had been treated with radical resection and right nephrectomy followed by post-operative radiation and ad- juvant chemotherapy. She subsequently developed liver metastasis requiring modification of her chemotherapy. However, she had elected to discontinue treatment one year prior to the presentation of the oral lesion. A biopsy of the palatal mass revealed a malignant spindle-cell proliferation expanding the overlying epithelium, with brisk mitotic activity and atypical mitosis, nuclear pleomorphism, and focal areas of tumor necrosis, raising the concern for LMS. Immunohistochemical (IHC) stains for SMA were strongly positive while negative for DOG1 and CD 117. Based on the history and supportive histopathological and IHC findings, a diagnosis of metastatic LMS of the palate was given. Oral metastases of LMS are exceedingly rare and aggressive lesions that arise mostly in females in their sixth-decade. Literature review shows that metastases to the tongue, gingiva, lip, and buccal mucosa are typically associated with primary uterine tumors, while metastasis to the mandibular gingiva is documented frequently with non-uterine primaries. Clinically, lesions can present as a nonspecific painful mass. Microscopic diagnosis is often challenging due to significant overlap with other spindle-cell neoplasms, requiring careful correlation with medical history, physical examination, and ancillary studies. We herein report a rare case of a retroperitoneal LMS that metastasized to the palate. A literature review of metastatic oral-LMS and retrospective institutional analysis of oral metastases will also be presented.

Peritorcular Meningeal Solitary Fibrous Tumor: A Case report

OBJECTIVE: In order to contribute to the Latin American epidemiology of these tumors, we present a Colombian case of a peritorcular meningeal solitary fibrous tumor (mSFT), demonstrating the histological findings, surgical nuances, and relevant anatomy for surgical resection. CASE REPORT: A 47-year-old Hispanic woman presented to the emergency department with a 1-month history of severe headache that was unresponsive to medication. Magnetic resonance imaging demonstrated a 4 x 4 x 4.7 cm hypointense lesion in the left occipital region with peritumoral edema, with homogeneous enhancement after gadolinium administration. Gross total resection was performed through a right occipital parasagittal craniotomy with a straightforward approach. Pathology examination reported the proliferation of spindle cells with diffuse and intense positive nuclear STAT6 staining, confirming the histological diagnosis of a mSTF. CONCLUSIONS: We present to our knowledge the first Colombian mSTF in the English literature, contributing to the epidemiology and presentation of this rare tumor in Latin America.

RECURRENT FIBROUS DYSPLASIA ON RADIUS TREATED WITH VASCULARIZED FIBULAR GRAFT: A CASE REPORT

Introduction: Fibrous Dysplasia is a benign intramedullary fibro-osseous lesion that are reported to represent approximately 5%-7% of benign bone tumor. Treatment of fibrous dysplasia include bisphosphonates therapy and surgical procedures. Case Report: A 9-year-old girl presented with a mass on her left forearm 2 years ago. Primary resection by curettage was performed and patient did not and one year after the surgery, the mass recurred and patient complaint about lump and deformity on her left forearm. A limb salvage surgery by intercalary resection was performed to remove the tumor and the defect was filled with vascularized fibular graft from the right leg. Seven- month follow up show no sign of recurrence and patient underwent surgery to remove the implant. Discussion: Fibrous dysplasia represents a dysplastic disorder of bone characterized by solitary or multifocal polyostotic intramedullary lesion composed of proliferation of fibroblastic spindle cells. Treatment of fibrous dysplasia include conservative treatment and surgical procedures may be required for correction of deformity, prevention of pathologic fracture and/or eradication of symptomatic lesion. The free vascularized fibular graft is particularly suited for reconstruction of large forearm defects because the fibula matches the radius and ulna in size and shape with studies that shown healing rate of 89%. Conclusion: Fibrous Dysplasia is a benign intramedullary fibro-osseous lesion that are reported to represent approximately 5%-7% of benign bone tumor. The most common clinical symptom is swelling or deformity of the affected site. Treatment of fibrous dysplasia using vascularized fibular graft may be an effective option.

Vascular Tumors in Two Argentine Horned Frogs (Ceratophrys ornata)

Two vascular tumors in two Argentine horned frogs (Ceratophrys ornata) are described. Case 1 involved a 7-year-1-month-old Argentine horned frog that had a splenic mass with a sanguineous coelomic effusion. Histologically, the splenic parenchyma was effaced by a poorly-demarcated, invasive mass, consisting of spindle cells with marked nuclear atypia forming irregular blood vessel channels containing blood. Case 2 involved a pedunculated facial mass located at the upper right lip of an over-8-month-old Argentine horned frog. Histologically, the well-demarcated, poorly cellular mass consisted of sparse proliferation of spindle cells forming irregular slits with prominent edema. Immunohistochemically, the neoplastic cells of both cases were positive for anti-CD31 antibody. The diagnoses were hemangiosarcoma in case 1 and lymphangioma in case 2. To the best of the authors’ knowledge, this is the first description of neoplastic diseases in captive Argentine horned frogs.

Inflammatory Myofibroblastic Tumour of the Common Bile Duct.

Inflammatory myofibroblastic tumour is a rare entity of indeterminate biological potential with a reduced tendency for recurrence and metastasis. Although it can arise from multiple organs, the bile duct is a very rare site of origin. We report the case of a 75-year-old asymptomatic male with elevated gamma-glutamyl transferase [1575 U/L (12 - 64 U/L)] and alkaline phosphatase [271 U/L (40 - 150 U/L)]. Computed tomography showed a 17 mm hypervascular lesion in the confluence of the right and left hepatic ducts, with bile duct ectasia and right liver lobe atrophy. The patient was initially managed as having a Klatskin tumour and underwent right hepatectomy. Histology showed a spindle cell proliferation with an inflammatory infiltrate of lymphocytes, plasma cells and collagen-rich stroma, consistent with an inflammatory myofibroblastic tumour. He was discharged 30 days after admission, and nine months later remains asymptomatic. His liver function tests have normalized and follow-up tests are unremarkable.

Inflammatory pseudotumour of the spleen

Inflammatory pseudotumour (IPT) of the spleen is a very rare benign entity that can clinically and radiologically be misconstrued as malignant. We describe a case in a 62-year-old woman who was incidentally found to have a 5.3 cm mass on abdominal ultrasound. On MRI, the mass had irregular margins and internal necrosis, raising suspicion for a malignancy. The woman then underwent a splenectomy. Histology showed a well circumscribed lesion characterised by a proliferation of bland uniform spindle cells in a background dense mixed inflammatory infiltrate consisting of lymphocytes, plasma cells and eosinophils.

A common tumor in an uncommon site: epithelioid Leiomyoma arising from the seminal vesicle\u2014a case report

BackgroundLeiomyoma of the seminal vesicle is a rare leiomyoma characterized by the formation of benign leiomyomatous tissue within the seminal vesicle. Although histologically benign, excessive size can lead to urinary system disease if left untreated. Herein, we report a case of a seminal vesicle epithelioid leiomyoma.Case presentationA 36-year-old Chinese man sought medical attention at our hospital for urination pain and hemospermia. CT showed a 5.3 cm × 5.0 cm seminal vesicle mass with a mixed density in the right seminal vesicle. The gross specimen showed light yellow, gray, and white tissues, with softness and hemorrhage in some places. Histologically, it showed classic spindle cell proliferation, with spindle cells arranged in fascicles, and mitosis was rare. Immunohistochemistry showed frequent expression of smooth muscle markers, such as calponin, SMA, and desmin. A diagnosis of epithelioid leiomyoma was proposed according to the immunohistochemical findings and morphology. The patient did not receive adjuvant therapy. There was no evidence of tumor recurrence in the 10 months after surgery.ConclusionsWe report the first case of epithelioid leiomyoma in the seminal vesicle. This disease should be included in the differential diagnostic list of seminal vesicle tumors with epithelioid morphology.

Skeletal deformities in a case of digitocutaneous dysplasia

We present a case of a 2 year old female with digital fibrous lesions, dysmorphic facial features, stridor, sensorineural hearing loss, and scoliosis. The patient surgical history included digital amputations at the interphalangeal joint line bilaterally on the middle, ring, and little finger. Physical exam demonstrated knee and elbow flexion contractures and a left ankle varus contracture. Radiographic evaluation revealed several aggressive fibromas in the proximal femori and tibia (Figure 1) and a mild dextroconvex lumbar scoliosis (Figure 2) [1,2]. Biopsy of a digital lesions revealed a dermal spindle cell proliferation without atypia or necrosis, and perinuclear inclusions on H&E and trichrome stains. Comparative genomic hybridization and single nucleotide polymorphism genotyping revealed two adjacent duplications of the DMD gene (OMIM 400477): a duplication of 83 kb from the cytogenic band Xp21.2 to Xp 21.1 and a duplication of 555 kb within the cytogenetic band of Xp21.2.

Intravascular fasciitis involving the external jugular vein and subclavian vein: A case report

BACKGROUNDIntravascular fasciitis (IVF) is a rare nodular fasciitis that often involves the layers and lumens of blood vessels; therefore, it is easily misdiagnosed as a malignant tumor with invasion into blood vessels.CASE SUMMARYA 13-year-old boy was admitted due to a mass on the left side of his neck. Duplex ultrasonography revealed a circular solid hypoechoic mass in the external jugular vein, and magnetic resonance imaging revealed an enhanced longitudinal mass-like lesion in the left supraclavicular fossa. Surgical treatment was arranged and completed, histopathological analysis showed a large amount of spindle cell proliferation, and immunohistochemistry showed that the spindle cells were positive for the expression of vimentin, caldesmon, and smooth muscle actin and negative for the expression of S-100 protein, desmin, CD34, and c-kit; Ki-67 staining revealed a low proliferative index (5%-10%), which confirmed the differentiation characteristics of myofibroblasts. Fluorescence in situ hybridization detected the rearrangement of USP6. IVF was subsequently diagnosed.CONCLUSIONIVF is characterized by intraluminal, intramural and extramural involvement of small to large arteries or veins. Unless the doctor has a deep understanding of the disease or suspects that there is an initial indicator, IVF may be confused with other intravascular malignancies, leading to unnecessary radical surgery. Imaging examination combined with histopathological examination can improve the diagnostic accuracy of this disease.

Multifocal EBV-associated smooth muscle tumors in a patient with cytomegalovirus infection after liver transplantation: a case report from Shiraz, Iran

IntroductionImmunodeficient patients, including the recipients of solid organs, exhibit an increase in the incidence of neoplasms. Post-transplant smooth muscle tumor (PTSMT) is a distinct and infrequent entity of these groups of neoplasms. Epstein–Barr virus (EBV) is considered to be involved in the etiology of this neoplasm.Case reportA 28-year-old man who underwent liver transplantation presented with abdominal pain and diarrhea for several months. He had a history of resistant systemic cytomegalovirus (CMV) infection after transplantation. Radiologic evaluation and colonoscopy revealed multiple liver, spleen, lung, and colon lesions. Microscopic assessment of colon and liver lesions using IHC study were in favor of spindle cell proliferation with mild atypia and a mild increase in mitotic rate without any necrosis, with features of smooth muscle tumor. Considering the transplantation history, EBER chromogenic in situ hybridization (CISH) study on paraffin blocks was requested, which demonstrated EBV RNA in tumor cell nuclei, suggesting EBV-associated smooth muscle tumor. In addition, PCR for CMV on paraffin blocks was positive. PCR for EBV and CMV viremia were negative. The dosage of immunosuppressive agents was reduced, and currently, he is being followed, with slow expansion in the size of the lesions.ConclusionAlthough the incidence of post-transplant smooth muscle tumors (PTSMTs) is low, it should be remained in the differential diagnosis in post-transplantation patients, especially dealing with multifocal tumors. As strong stimulant for smooth muscle tumors, close follow-up and screening for EBV and CMV infection and early treatment at the time of diagnosis are recommended to avoid these virus-induced tumors.

Short-Time Development of Esophageal Inflammatory Myofibroblastic Tumor Which Resected by Endoscopic Submucosal Dissection.

A 53-year-old man was pointed out an elevated lesion in the esophagus by screening upper gastrointestinal series. A esophagogastroduodenoscopy showed a submucosal tumor 10 mm in diameter in the lower thoracic esophagus (Figure A). A biopsy specimen taken from the tumor showed no malignancy. One year later, the tumor had more than doubled in size (Figure B). So, we decided to perform endoscopic ultrasonography–guided fine-needle aspiration for this tumor. Endoscopic ultrasonography showed a hypoechoic mass 21 mm in size which come from the second layer. The biopsy specimen showed spindle cell proliferation and actin and anaplastic lymphoma kinase positivity (Figure C), which lead to the diagnosis of inflammatory myofibroblastic tumor (IMT). Because of the strong accumulation on positron emission tomography/computed tomography and the growing trend of submucosal tumor, we decided to perform endoscopic submucosal dissection (ESD). The pathological results were consistent with IMT which complete resected by ESD (Figure D). No recurrence has been observed for a year. Although IMT is a tumor of mesenchymal origin which occurs systemically, there are few reports of its occurrence in the esophagus. This is the first case in which short-time growth can be observed and resected by ESD.

Undifferentiated Embryonal Sarcoma of the Liver: A Case Report

Undifferentiated embryonal sarcoma of the liver((UESL) is a very rare primary hepatic tumor, of mesenchymal origin. Primary malignant mesenchymal tumors of the liver are relatively rare compared with carcinomas originating from hepatocytes or cholangiocytes. UESL is usually observed in children, and cases of adults are very uncommon. It was first reported in 1978. Because of rarity of the disease, there were few reported cases. Herein we report an our experience of UES of the liver patient. A 33-year-old woman visit our outpatient department presented with epigastric pain for 2 weeks. Huge complex cystic mass of the left liver(about 12cm) was identified on computed tomography(CT) of the abdomen. Compared with CT of 8 months ago, the size of the lesion was increased by 5 cm. Her laboratory study including tumor marker at initial presentation revealed no abnormal findings. We considered the lesion to be a complicated hepatic cyst. Since an increase in the size of the lesion was observed and she also had epigastric pain, we decided to proceed with surgery. We performed laparoscopic left hepatectomy. Microscopically, the tumor was composed of spindle cell proliferation, nuclear pleomorphism, myxoid stroma and frequent mitosis. The pathologic report revealed undifferntiated embryonal sarcoma. This case presented as a cystic lesion in the liver and had typical histological features of UESL. It is a rare case of a malignant pediatric tumor occurring in an adult patient.

Gastrointestinal: Rapid-growing multiple maculopapular and polypoid lesions in the gastrointestinal tract.

A 34-year-old human immunodeficiency virus (HIV)-infected man, who had received highly active antiretroviral therapy (HAART) for about 3 weeks with initial low CD4 count (84 cells/μL), presented to the hospital with dyspnea. Physical examination did not reveal any significant skin lesion. The patient developed melena during hospitalization, and the hemoglobin dropped to 5.8 g/dL from 11.4 g/dL within 1 week. The esophagogastroduodenoscopy and colonoscopy showed multiple 0.5- to 1.0-cm reddish maculopapular and polypoid lesions at the esophagus (Fig. 1a), stomach (Fig. 1b), colon (Fig. 1d), and with central ulceration at the duodenum (Fig. 1c), which were not present in his previous esophagogastroduodenoscopy 1 month ago. Biopsies revealed lamina propria-based lesion composed of a focal proliferation of spindle cells in fascicles with interstitial erythrocytes (Fig. 2a,b). Human herpesvirus 8 staining (Fig. 2c) was positive. An inclusion body was detected, and the cytomegalovirus (CMV) staining (Fig. 2d) was positive. In addition to the pathological characteristics of Kaposi's sarcoma, CMV stain showed positive-staining cells in the specimens of the stomach, duodenum, and colon, compatible with Kaposi's sarcoma with CMV coinfection. Kaposi's sarcoma is a low-grade tumor of the vascular endothelium, often associated with HIV. The manifestation of gastrointestinal Kaposi's sarcoma is variable, and can be asymptomatic or can cause gastrointestinal symptoms such as nausea, vomiting, malabsorption, and gastrointestinal bleeding. There are different endoscopic characteristics of Kaposi's sarcoma, such dark pink or scarlet maculopapular, polypoid lesion, or volcano-like lesions. The pathological findings include spindle cells with cytologic atypia, extravasated red blood cells, and lymphocytic and plasma cell infiltrate. Improvement in immunologic function after the initiation of HAART may unmask previous unrecognized preexisting infection, as also known as immune reconstitution inflammatory syndrome. In our case, the rapid progression of gastrointestinal Kaposi's sarcoma with CMV coinfection could be one of the manifestations of immune reconstitution inflammatory syndrome, a significant but uncommon clinical problem in the post-HAART era. Furthermore, endoscopic biopsies may still carry a risk of false-negative results, especially for the lesion in esophagus, with small size (< 1 cm) or localized in submucosa. Caution should be taken in performing endoscopy in HIV-infected patients, even for those who had received HAART.

Schwannoma of the Appendix Orifice

Schwannomas are rare mesenchymal tumors. They are usually diagnosed incidentally during endoscopic or diagnostic imaging for another reason. Malignant transformation is rare. In this case report, we present an incidental schwannoma protruding through the appendiceal orifice diagnosed during endoscopy. A healthy 56-year-old female underwent a surveillance colonoscopy for family history of colorectal cancer. A prominent and edematous appendiceal orifice was noted, and the area was aggressively biopsied. Histopathological assessment revealed a benign schwannoma. Computerized topography was unremarkable. Subsequently, the patient underwent a right hemicolectomy. Patient is scheduled to undergo routine surveillance in three years. Grossly, schwannomas are white, encapsulated, and well-circumscribed lesions that stain strongly positive for S100, GFAP, and CD57. Histologically, schwannomas demonstrate spindle cell proliferation. Several imaging modalities have been utilized in the diagnosis and management of mesenchymal neoplasms. Despite the benign nature of the diagnosis, complete surgical resection with clear margins remains the gold standard management strategy. Our case highlights the presence of a relatively uncommon tumor in an unusual anatomical location.

Sclerosing rhabdomyosarcoma of the gingiva mimicking malignant peripheral nerve sheath tumor: a case report

Background: Spindle cell/Sclerosing rhabdomyosarcoma is the rarest variant of rhabdomyosarcoma, accounting for 5-10% of all rhabdomyosarcoma cases. Pathologically, these tumors can provide a variety of features and can resemble other tumors, thus often difficult to diagnose. We report a case of sclerosing rhabdomyosarcoma of the gingiva with histomorphology mimicking a malignant peripheral nerve sheath tumor. Case Presentation: The patient was a 39-years old Balinese male who noticed a lump on the left gum since 9 months ago. Head CT scan revealed a solid mass with soft tissue density at the left lower gingiva that extend superiorly and laterally, involving the left parapharyngeal and masticator spaces, infiltrated into the left mylohyoid muscle and left medial and lateral pterygoid muscles, and caused destruction of the left mandibular ramus and alveolar process of the left maxilla. The initial biopsy showed the proliferation of atypical spindle cells with a pattern resembling peripheral nerve sheath tumor and concluded as a low-grade malignant peripheral nerve sheath tumor. Wide excision specimen consists of proliferation of low-grade atypical spindle cells arranged in a fascicular pattern with foci of strap cells embedded in glassy eosinophilic sclerosis matrix. Some parts of the tumor showed palisading nuclei. The tumor cells were diffusely positive for desmin and negative for S100. This case was finally diagnosed as sclerosing rhabdomyosarcoma.Conclusion: Sclerosing rhabdomyosarcoma should be considered when atypical spindle lesions occur between the hyalinized stromal matrix of the head and neck in adults. Because of wide differential diagnosis, an adequate sampling, careful microscopic examination, and immunohistochemistry staining can avoid misdiagnosis.

Infantile Systemic Hyalinosis Presenting as Pseudo-Paralysis in Infancy: Study of Six Cases.

Infantile systemic hyalinosis is a very rare fatal autosomal recessive genetic disorder with a mutation in capillary morphogenesis gene-2- CMG2 /Human anthrax toxin-2 ANTXR2 resulting in spindle cell proliferation, altered collagen metabolism along with extensive deposition of hyaline material in the skin and several tissues. To date only a few cases have been reported in the literature, hence we reported this series. This study is a retrospective chart review of infants diagnosed with infantile systemic hyalinosis from January 2015 through December 2020 at a tertiary care children's hospital in South India. The mean age of presentation was 9.4 months, with a male to female ratio of 1:5. All children were born of consanguineous marriage except one child. All children had symptoms at birth, painful limb movements, multiple joint stiffness, gingival thickening, skin lesions around perianal, perioral areas, and frog-like position. Three (50%) children had stiff skin. Routine tests including complete blood count, liver function test, renal function test, creatine phosphokinase, nerve conduction studies, and metabolic tests were normal in all children. Skin biopsy showed hyalinized collagenous tissue in the dermis. Genetic study results of two cases revealed pathogenic variants in ANTXR2 gene. Infantile systemic hyalinosis should be considered in infants presenting with painful limb movements. The diagnosis helped in avoiding unnecessary investigations and prognostications. The genetic information from proband mutation helped in prenatal diagnosis in two families.

Gastric Fibromatosis

Gastrointestinal fibromatosis is a rare mesenchymal tumor. It has local invasive behaviour with low-metastatic potential. We present a 36-year-old female patient presented to Oncology Center, Mansoura University, Egypt, with accidentally discovered gastric mass by abdominal computed tomography (CT). The mass was adherent to the posterior wall of the gastric fundus, the tail of pancreas and encasing the splenic artery. The patient underwent partial gastrectomy, distal pancreatectomy and splenectomy. Pathological examination of the specimen showed bland spindle cell proliferation, with oval nuclei, scanty eosinophilic cytoplasm. There was no detected mitosis or necrosis or haemorrhage. Immunohistochemistry of tumor cells was positive with β-catenin and SMA, while Desmin, CD117, DOG-1 and S-100 were negative. The patient did not receive any adjuvant therapy. The patient underwent strict periodic follow-up every 3 months with abdominal CT for 6 months after surgery.

A Challenging and Rare Case of Metastatic Follicular Dendritic Cell Sarcoma Originating from a Tonsil

Abstract Introduction/Objective Follicular dendritic cell sarcoma (FDCS) is a rare malignant tumor of follicular dendritic cells. Most cases of FDCS are described in lymph nodes, but it can involve extra-nodal locations such as the tonsil. Methods/Case Report We report a case of a 55-year-old male with a 6-month history of a slow growing left neck mass. The patient had a poorly differentiated carcinoma of the left tonsil diagnosed based on morphologic features eight years ago, followed by chemoradiation, and subsequent left tonsillectomy without tumor identified. Imaging reported a 4.0 cm mass in the left neck level III lymph node location. Biopsy of the mass revealed a spindle cell neoplasm. It was difficult to reach a definitive diagnosis despite an extensive work-up. Review of the previous left tonsil biopsy showed a pleomorphic epithelioid cell proliferation. On the radical resection specimen of the left neck mass, a 4.5 cm, tan-gray, fleshy, necrotic mass was present. Microscopically, it demonstrated a neoplasm with spindle cell and epithelioid cell proliferation, with extensive necrosis. A wide panel of immunostains was performed; the tumor cells showed positivity for CD21, CD23, CD35, and focally weak positivity for cytokeratin OSCAR and Synaptophysin. Squamous cell markers were negative. These findings are consistent with FDCS. Further work-up on the original tonsil tumor displayed immunostaining profile of FDCS. This case was consulted with the National Institute of Health (NIH) for confirmation of the diagnosis. Results (if a Case Study enter NA) NA Conclusion Morphologically, FDCS can present with various histologic patterns, which can lead to diagnostic pitfalls, and common confusion with poorly differentiated carcinoma or soft tissue tumors, especially in needle biopsies. Generally, patients present with a prolonged clinical course, with a 50% and 25% chance of recurrence and metastasis respectively, hence the awareness and accurate diagnosis of this entity is important in biopsies of lymph nodes or of extranodal locations such as a tonsil.

Clinical and Laboratory Profile of People Living with HIV/AIDS with Oral Kaposi Sarcoma.

The aim of this article was to evaluate the clinical and laboratory profile of people with oral Kaposi's sarcoma (KS) associated with AIDS (KS-AIDS), followed-up at a public university hospital in Salvador, Bahia, Brazil, in the past 10 years. We identified patients diagnosed with KS-AIDS, presenting oral manifestation from January 2007 to December 2017. We searched, in the hospital information systems, the patient demographics, diagnostic data, treatment, image studies, and oral photographic records. Of the 39 cases of KS-AIDS identified at the institution, 14 (22.8%) presented oral lesions. There was a predominance of black men, with a mean age of 32.5 years. Most cases (85.1%) manifested signs of KS simultaneously with the diagnosis of HIV infection, with extremely low initial CD4 T cell counts (average of 52.6 cells/mm2) and visceral involvement (64.3%). The palate (32.1%) and gingiva (21.4%) were the most affected oral sites. Histologically, the tumors exhibited proliferation of spindle cells between vascular clefts and extravasated erythrocytes. Oral KS-AIDS was frequent in young black adult men, with severe immunosuppression and high viral load counting, mostly with lesions manifested in the same period of diagnosis of infection by the HIV.

Cytologic and Histologic Findings of Nephroblastoma in a Captive Desert Tortoise (Gopherus agassizii)

A 97-year-old, male, captive desert tortoise ( Gopherus agassizii ) had a 2 month history of lethargy. Imaging with ultrasound, X-ray, and computed tomography revealed a 10-cm-diameter mass in the caudal coelom. Fine needle aspiration revealed spindle and epithelial cell proliferations with formation of rosettes. Exploratory surgery was performed and the mass was removed and submitted for pathology. There was no evidence of metastasis on imaging or at surgery. Histology revealed a mass arising from and compressing the kidney. The mass was composed of primitive glomeruli, tubules, blastemal cells, and mesenchymal cells, features that are diagnostic for nephroblastoma. Tubules were reactive to cytokeratin and mesenchymal cells were reactive to desmin via immunohistochemistry; other immunohistochemical markers were either negative (i.e. S-100) or non-contributory (i.e. epithelial membrane antigen, myogenin, vimentin, and Wilms’ Tumor 1). This is the first report of nephroblastoma in a chelonian.