表浅性血管黏液瘤一例

患者男,60岁.因右足第一趾外伤后经久不愈10年,时有痒感,于2008年4月8日就诊于浙江省嘉兴市中医医院.检查见右足第一趾背侧有一5 cm×5 cm×3 cm肿块,表面有溃疡形成,肿块境界尚清,质稍硬,易出血.全身检查未见异常.患者既往健康,无心脏黏液瘤,家族中无类似疾病患者.当日行肿物切除术,术中见右足第一趾肿块,深达骨膜,质稍硬,有包膜,境界较清晰,甲床破坏.     

颈部浅表性血管黏液瘤一例

患者男,26岁。2年前发现左侧颈部有一包块并逐渐增大,于2005年11月25日入院。体检:患者健康状况良好。左侧颈部皮下软组织内触及一卵圆形肿物,约2．5 cm×1．5 cm,表面光滑,无压痛及波动感,与周围软组织无粘连,活动度好,皮肤无红肿及破溃。全身检查及实验室检查均正常。行肿物切除术,术中见:肿物位于皮下,呈椭圆形,表面光滑,质软,完整摘除肿物送病理检查。     

浅表性血管黏液瘤3例临床病理分析

目的探讨浅表性血管黏液瘤(superficial angiomyxoma,SA)的临床病理特征、免疫组化及鉴别诊断要点。方法对3例SA进行临床病理学及免疫组化染色观察,结合文献对该肿瘤的临床表现、病理形态学特征以及鉴别诊断要点进行讨论。结果 SA主要位于皮肤真皮及皮下,镜下肿瘤略呈分叶状,黏液性基质中可见散在无异型的梭形和星形瘤细胞及较多的中、小薄壁血管,散在有多少不等的中性粒细胞浸润。免疫组化染色显示肿瘤细胞表达vimentin。结论 SA是罕见的黏液性肿瘤,位于皮肤表浅部位,可局部复发但不转移,诊断时应注意和其它黏液性软组织肿瘤鉴别。     

Superficial angiomyxoma: a c linicopathologic analysis of three cases

目的 探讨浅表性血管黏液瘤(superficial angiomyxoma,SA)的临床病理特征、免疫组化及鉴别诊断要点.方法 对3例SA进行临床病理学及免疫组化染色观察,结合文献对该肿瘤的临床表现、病理形态学特征以及鉴别诊断要点进行讨论.结果 SA主要位于皮肤真皮及皮下,镜下肿瘤略呈分叶状,黏液性基质中可见散在无异型的梭形和星形瘤细胞及较多的中、小薄壁血管,散在有多少不等的中性粒细胞浸润.免疫组化染色显示肿瘤细胞表达vimentin.结论 SA是罕见的黏液性肿瘤,位于皮肤表浅部位,可局部复发但不转移,诊断时应注意和其它黏液性软组织肿瘤鉴别.     

Aggressive angiomyxoma: an ultrastructural study of four cases

The histogenesis of the aggressive angiomyxoma of the vulvo-vaginal region was studied. Four cases of aggressive angiomyxoma were examined by using light microscopy, electron microscopy, and immunohistochemistry. Myofibroblastic from smooth muscle cell differentiation was distinguished by paying close attention to the structures of the neoplastic cell membrane. Aggressive angiomyxomas exhibit subtle features of smooth muscle differentiation, suggesting that the neoplastic cells differentiate from a multipotent perivascular cell.     

Peritoneal serous borderline tumors: report of two cases

Two cases of serous borderline tumors of the peritoneum are reported. These rare tumors may show variable histological features. The lack of peritoneal invasion, which may be difficult to assess, with minimal or no ovarian involvement are major features for the diagnosis. These tumors should be distinguished from other peritoneal neoplasms such as serous carcinomas because of their good prognosis after surgical therapy alone.     

Intrarenal schwannoma: a report of four cases including three cellular variants.

Renal schwannomas are extraordinarily rare neoplasms; only six have been reported, the majority of which occurred in the renal pelvis. We report the clinical and pathologic features of four additional cases. The resected kidney in all patients contained a well-demarcated, yellow-tan, smooth, and bulging intraparenchymal tumor (mean size, 9.7 cm; range, 4 to 16 cm). Microscopically, three cases were classified as cellular schwannomas, and one was a usual-type schwannoma, with degenerative nuclear atypia. By immunohistochemistry, all tumors were strongly S-100 protein positive and negative for pan-cytokeratin, CD57, smooth muscle actin, desmin, and CD34. Epithelial elements were not noted in the tumors, and there was no history of any clinical syndromes in these patients. Analysis of the four cases showed the mean age at presentation to be 47 years (range, 18 to 84 years), with no sex predisposition (two men, two women). Most patients were asymptomatic, and all received a diagnosis of renal cell carcinoma and treated as having such. Recognition and awareness of these rare, benign tumors will assist in the differential diagnosis of spindle cell tumors of the kidney and prevent their misdiagnosis as sarcomatoid carcinomas of the kidney or renal sarcomas. Our study, the largest series to date of renal schwannomas, demonstrates a predilection for the cellular variant in the kidney, documents that these tumors may present in the nonhilar region of the kidney, and provides clinical evidence of their benign biologic behavior.     

Cytomorphological diagnosis of malignant eccrine tumors: report of two cases

Though FNAC has been successfully used in diagnosing various neoplastic and nonneoplastic cutaneous lesions, there is a paucity of case reports describing the cytomorphological features of adnexal tumors. We hereby describe the cytological features of two histologically confirmed cases of malignant eccrine tumors. Case number 1 presented with an ulcerated infraclavicular swelling whereas case number 2 presented with a cystic swelling over left foot. FNA and histological examination of the resected specimens was performed using standard techniques. A cytological diagnosis of low grade papillary adenocarcinoma arising from skin adnexal structures was given in case number 1. Aspirate from case number 2 was reported as positive for malignant cells, and histological examination was advised. Histological examination revealed the presence of malignant eccrine acrospiroma in case number 1 and papillary digital adenocarcinoma in case number 2. Careful cytological examination displayed the characteristic of two cell population seen in eccrine tumors in both the cases. Diagnosis of malignant eccrine tumors cannot be made with certainity on cytology alone, hence the need to document the cytological features of these entities is emphasized.     

Chondroid tumors of the larynx: a clinicopathologic study of 19 cases, including two dedifferentiated chondrosarcomas

We studied 19 cases of chondroid tumors of the larynx: two chondrometaplastic nodules, two chondromas and 15 chondrosarcomas (including two dedifferentiated chondrosarcomas). One of chondromas recurred 18 months after resection because of inadequate surgical treatment. Chondrosarcomas were separated as low-grade (nine cases), intermediate (three cases), high-grade (one case), and dedifferentiated (two cases) according to histologic appearance. Chondrosarcomas are nearly always histologically low grade, make up the largest numbers of the neoplasms, and arise from the cricoid cartilage. Conservative surgical management, when possible, is advocated to preserve the larynx. Chondrometaplastic nodules are to be distinguished from chondrosarcoma and the rarely occurring chondroma. The nodules are not neoplastic and have a low to nil recurrent potential.     

Primitive neuroectodermal tumors of the uterus: a report of four cases.

Four cases of primitive neuroectodermal tumor (PNET) of the uterine corpus are reported, bringing the total number of reported PNETs in this site to seven. The four women were in their seventh decade of life and presented with abnormal vaginal bleeding and, in two cases, an enlarged uterus. The patients underwent total or subtotal abdominal hysterectomy and bilateral salpingo-oophorectomy and, in one patient, pelvic lymphadenectomy. Three patients received postoperative radiation therapy, chemotherapy, or both. Gross examination revealed fleshy polypoid masses filling the endometrial cavity and, in two cases, deeply invading the myometrium. Histologic, immunohistochemical, and, in two cases, ultrastructural examination revealed typical PNETs that exhibited variable degrees of neural, glial, ependymal, and medulloepithelial differentiation. Two PNETs were admixed with other neoplasms: in one case a grade I endometrial adenocarcinoma and in the other a low-grade endometrial stromal sarcoma. The prognosis of the tumors was related to their stage: two patients with stage I tumor were alive with no evidence of disease at 5 and 6 years, whereas two patients with stage III or IV tumor died of tumor at 6 and 12 months. Although it has been suggested that uterine PNETs may be derived from displaced germ cells or implanted fetal tissues, evidence provided by this study, including the advanced ages of the patients and an admixture with neoplasms of unquestioned müllerian origin, suggests a müllerian origin for these tumors in at least some cases.     

Atypical lipomatous tumors with smooth muscle differentiation: report of two cases

Two cases of soft-tissue atypical lipomatous tumors with areas of smooth muscle cell differentiation are presented. The patients were a 72-year-old man (Case 1) and a 62-year-old woman (Case 2); their neoplasms were located in the left inguinal region and on the chest, respectively. The adipocytic component in Case 1 contained cells with nuclear atypism and lipoblasts. Case 2 showed only slight nuclear atypism and lacked any lipoblasts. Smooth muscle fascicles were composed of well-differentiated cells with a few mitoses having none or only a slight atypism. They expressed muscle-specific actin and desmin in both cases. No recurrence was recorded during the follow-up time.     

Superficial cervico-vaginal myofibroblastoma: a report of five cases

AIMS: To describe the pathological and immunohistochemical features of five cases of superficial cervico-vaginal myofibroblastoma (SCVM), a recently described mesenchymal tumour affecting middle-aged and elderly females. METHODS: The histological features of five cases of SCVM arising in four patients were reviewed including one case which recurred locally 9 years after initial excision biopsy. All cases were immunostained using the streptavidin-biotin technique using antisera to vimentin, smooth muscle actin, desmin, S100 protein, cytokeratin, h-caldesmon, calponin, CD99, CD117 (c-kit), bcl-2, oestrogen receptor and progesterone receptor. RESULTS: The patients were aged from 40 to 71 years (mean 55.2 years). The tumours were situated within the vagina (four cases) and cervix (one case) and ranged from 16 to 45 mm in greatest dimension. One patient had two separate vaginal SCVM. The tumours were characterised by uniform spindle and stellate-shaped cells separated by a collagenous or myxoid stroma. No mitotic activity was identified. Characteristically the tumours were well circumscribed and separated from the surface epithelium by a rim of normal stroma. The initial and recurrent tumours in one patient were similar except for increased stromal collagen in the recurrence. All tumours were immunoreactive for vimentin, desmin, CD34, CD99, bcl-2, calponin and hormone receptors while two tumours showed focal smooth muscle actin expression. There was no expression of S100 protein, h-caldesmon, CD117 or cytokeratin. CONCLUSIONS: SCVM appears to be a relatively distinct lesion although there is some histological and immunophenotypical overlap with other mesenchymal tumours, particularly fibroepithelial polyp, leiomyoma and solitary fibrous tumour. As local recurrence developed 9 years after intial treatment in one patient, long-term clinical follow-up would seem appropriate.     

Ossifying fibromyxoid tumour of soft parts: report of four cases including one mediastinal and one infantile

Four cases of ossifying fibromyxoid tumour of soft parts are described. One of them was in the mediastinum, a hitherto unreported location of this rare neoplasm. Another was removed from the subcutaneous tissue of the head of a two-year-old girl, the youngest patient so far described. A peculiar feature of this tumour was haphazard spindle cell groups showing smooth muscle differentiation. One tumour was remarkably proliferative with 20 mitotic figures per 10 high power fields and 50% of cells positive for Ki-67 antigen. Immunohistochemical analysis revealed that all the tumours were diffusely positive for vimentin, and focally for S-100-protein. In addition to this the infantile tumour expressed focal alpha-smooth muscle actin, desmin and glial fibrillary acidic protein, while the mediastinal tumour expressed only alpha-smooth muscle actin and the highly proliferative one expressed none of these antigens. Background cells, including histiocytes, lymphocytes and mast cells were numerous. DNA cytometry analysis using both static and flow methods showed that the mediastinal tumour contained two cell clones, while the others were diploid. The proliferative fraction of cells (S plus G2 phases) was prominent in the proliferative and infantile tumours.     

Cytodifferentiated renal tumors occurring with Wilms' tumors of the opposite kidneys: report of two cases.

The most common differentiated renal tumor of early childhood is the congenital mesoblastic neophroma. Well-differentiated forms of Wilms' tumor may present a difficult differential diagnosis from these benign neoplasms. The cases of two patients found to have well-differentiated renal neoplasms after being treated for Wilms' tumor of the opposite kidneys are reported. The second neoplasms were composed of a benign-appearing stroma with mature skeletal muscle and completely lacked any embryonal, nephroblastic tissue. These benign-appearing neoplasms may be cytodifferentiated variants of Wilms' tumor. Though tumors of this type may have a malignant potential, there is evidence to indicate that they may be approached more conservatively than the usual nephroblastoma. In cases of bilateral Wilms' tumor, well-differentiated tumors might be treated by partial nephrectomy alone, with careful preservation of functional renal tissue.     

Mammary hamartoma: report of two cases including one in a male breast, and review of the literature

Mammary hamartoma is best viewed as a "breast within a breast" and is most often mistaken for fibroadenoma, phyllodes tumour or lipoma. It shows an abnormal blending of normal breast tissue components and is cured by removal. We present two cases of mammary hamartoma one occurring in a male breast. Although it is true, that all diseases occurring in female breast can also be seen in a male breast, there has been no report of this condition in a male. To the best of our knowledge, this is the first case of mammary hamartoma occurring in a male.     

Placental candidiasis: report of four cases, one with villitis

Four cases of placental candidiasis, an uncommon complication of rupture of the membranes, are presented. In addition to chorioamnionitis, in one of these cases villitis was also observed. Villitis is a rare occurrence in Candida infection and this represents only the second case in the literature. The involvement of villi may be suggestive of blood-borne infection. However, since neither the mother nor the foetus presented any signs of systemic dissemination, the authors suggest a hypothesis of contamination of the villi from foci of chorioamnionitis.     

Multifocal aggressive angiomyxoma: a case report

A case of aggressive angiomyxoma in a 25 year old woman is presented. The patient was admitted to hospital with a history of hesitancy of micturation and pain in the right iliac fossa. She was found to have a left labial mass, which was clinically diagnosed to be a Bartholin gland cyst. A pelvic ultrasound revealed an additional mass in the right paravesical region. At surgery, two distinct masses were removed, one from the right perivesical space and the other from the left labium. Both masses were rubbery, white, and gelatinous and showed similar histopathology findings of thick and thin walled vascular channels set in a loose myxoid stroma. A diagnosis of multifocal aggressive angiomyxoma was made. This is the first reported case of aggressive angiomyxoma occurring as two distinct masses in one patient.