Mammary Myofibroblastoma: A Tumor With a Wide Morphologic Spectrum

2008 ◽  
Vol 132 (11) ◽  
pp. 1813-1820 ◽  
Author(s):  
Gaetano Magro
Keyword(s):  
Stromal Cells ◽  
Benign Tumor ◽  
Spindle Cell ◽  
Correct Diagnosis ◽  
Original Description ◽  
Needle Aspiration ◽  
Mammographic Screening ◽  
Diagnostic Pitfall ◽  
Pathologic Features ◽  
The Family

Abstract Context.—Myofibroblastoma (MFB) of the breast is an unusual benign tumor that belongs to the family of the “benign spindle cell tumors of the mammary stroma.” The name MFB reflects its cellular composition, comprising mainly stromal cells with fibromyofibroblastic and, less frequently, myoid differentiation. Since the original description, the morphologic spectrum of MFB has been expanded by the recognition of several unusual morphologic variants, such as the cellular, infiltrative, epithelioid, deciduoid-like, lipomatous, collagenized/fibrous, and myxoid variants. Objective.—To review the literature on mammary MFB, discussing the main clinical, radiologic, and pathologic features helpful for diagnosis. Since MFB may show alarming morphologic features, which can lead to a misdiagnosis of malignancy, histologic figures of this tumor, including its more unusual variants, are provided to offer pathologists a practical approach to a correct diagnosis. Histogenesis and pathogenesis of this tumor are also proposed. Data Sources.—Clinicopathologic data on MFB were extracted from all identified articles through PUB Medline– based research. Histologic figures have been taken from the personal archive of the author. Conclusions.—The incidence of MFB diagnosis has increased in recent years, likely due to the mammographic screening. Accordingly, this unusual benign tumor may represent a potential diagnostic pitfall, especially when interpreting fine-needle aspiration and/or needle core biopsy. Pathologists should be aware of the wide morphologic spectrum exhibited by MFB to avoid a misdiagnosis of malignancy.

Keratin Expression Patterns in Stromal Cells of Benign Sclerosing Lesions of the Breast: A Potential Diagnostic Pitfall

2015 ◽  
Vol 139 (9) ◽  
pp. 1143-1148 ◽  
Author(s):  
Eun-Yeong Oh ◽  
Laura C. Collins
Keyword(s):  
Stromal Cells ◽  
Spindle Cell ◽  
Expression Patterns ◽  
Metaplastic Carcinoma ◽  
Low Grade ◽  
Cell Reactivity ◽  
Diagnostic Pitfall ◽  
Spindle Cells ◽  
Complex Sclerosing Lesion ◽  
Spindle Cell Proliferation

Context Metaplastic carcinomas arising in association with benign sclerosing lesions (BSLs) are rare malignancies in which a neoplastic spindle cell proliferation can be recognized extending beyond the boundaries of the complex sclerosing lesion or papilloma. However, in cases in which the metaplastic carcinoma is of the low-grade fibromatosis-like type or is a low-grade adenosquamous carcinoma, distinction from the background BSL can be a significant challenge. Cytokeratin (CK) and/or p63 immunostains are helpful in confirming the diagnosis of metaplastic carcinoma, but the expression patterns of these markers in the stromal cells of BSLs have not been well characterized. Objective To characterize the expression patterns of CKs and p63 in BSLs. Design We evaluated the spindle cell component of 55 BSLs using CK 5/6, CK 903, CK MNF116, and p63. Results A total of 45 cases (81%) showed no staining for CKs or p63 in benign stromal cells. CK 5/6, CK 903, and p63 were positive in one case each. CK MNF116 stained spindle cells within 10 BSLs. No cases showed spindle cell reactivity for all 4 markers. Positive cases demonstrated very focal, weak staining of spindle cells; only 1 case showed focal, moderate CK staining. Spindle cell positivity was not associated with lesion type, growth pattern, spindle cell atypia, or mitoses. Conclusions These findings suggest that although the presence or absence of expression of CK 5/6, CK 903, and p63 may be useful to distinguish BSL from metaplastic carcinomas arising in this setting, CK MNF116 positivity may be a diagnostic pitfall.

Benign Cervical Teratoma in the Adult: Report of a Rare Case with Dense Fibrosis Involving Adjacent Vital Structures

1996 ◽  
Vol 115 (1) ◽  
pp. 152-155 ◽  
Author(s):  
William I. Kuhel ◽  
Michelle Yagoda ◽  
Powers Peterson
Keyword(s):  
Benign Tumor ◽  
Correct Diagnosis ◽  
Needle Aspiration ◽  
Tissue Reaction ◽  
Laryngeal Nerve ◽  
Cervical Teratoma ◽  
Great Vessels ◽  
Prevertebral Fascia ◽  
Left Recurrent Laryngeal Nerve ◽  
Neonates And Infants

Cervical teratomas are rare tumors occurring mainly in neonates and infants. Fewer than 20 cases involving adults have been reported. Unlike congenital pediatric cervical teratomas, which are almost always benign, most adult cervical teratomas are malignant. We describe an adult with a benign cervical teratoma that had several interesting features. First, the preoperative workup, consisting of computed tomography (CT), magnetic resonance (MR) imaging, and fine–needle aspiration (FNA) suggested the correct diagnosis. Second, this histologically and clinically benign tumor was densely adherent to the prevertebral fascia, the great vessels, and the trachea. The magnitude of this tissue reaction was such that the left recurrent laryngeal nerve could not be separated from the tumor. Although not previously described for benign cervical teratomas in the adult, this dense adherence to vital structures parallels the behavior of benign mediastinal teratomas and should be anticipated.

scholarly journals Complete Resolution of Pseudomalignant Erosion in a Reflux Gastroesophageal Polyp with Proton Pump Inhibitor

2015 ◽  
Vol 2015 ◽  
pp. 1-3
Author(s):  
Takahiko Nakajima ◽  
Haruo Yagi ◽  
Hayato Baba ◽  
Takashi Minamisaka ◽  
Shigeharu Miwa ◽  
...  
Keyword(s):  
Proton Pump Inhibitor ◽  
Proton Pump ◽  
Stromal Cells ◽  
Complete Resolution ◽  
Biopsy Specimen ◽  
Esophagogastric Junction ◽  
Correct Diagnosis ◽  
Malignant Neoplasm ◽  
Malignant Neoplasms ◽  
Diagnostic Pitfall

Pseudomalignant erosion is a diagnostic pitfall for pathologists in the differential diagnosis of malignant neoplasms. Here, we present a challenging case of a biopsy specimen from the eroded head of a polyp at the esophagogastric junction. A malignant neoplasm could not be ruled out due to the presence of bizarre stromal cells. A second biopsy performed after the administration of a proton pump inhibitor (PPI) for 4 weeks revealed endoscopic resolution of the polyp along with the complete histological resolution of the bizarre stromal cells and led to the diagnosis of pseudomalignant erosion in a reflux gastroesophageal polyp. In conclusion, histological and endoscopic response to PPI therapy is an important clue for the correct diagnosis of reflux gastroesophageal polyps with pseudomalignant erosion.

The incidentaloma of the thyroid

2005 ◽  
Vol 44 (05) ◽  
pp. 213-224
Author(s):  
C. Kobe ◽  
M. Schmidt ◽  
H. Schicha ◽  
M. Dietlein
Keyword(s):  
Risk Stratification ◽  
Fine Needle Aspiration ◽  
Thyroid Nodules ◽  
Outcome Measurement ◽  
Needle Aspiration ◽  
Epidemiological Studies ◽  
Fine Needle ◽  
Small Cancer ◽  
The Family ◽  
Wait And See

Summary:The incidentally detected thyroid nodule using sonography is described as incidentaloma; the most nodules have a diameter up to 1.5 cm. Sonography will detect thyroid nodules in more than 20% of the population in Germany. Epidemiological studies investigating the prevalence of malignancy in such incidentalomas are missing. The incidence of differentiated thyroid cancer is about 3 per 100,000 people and year. However, several monocentric studies have shown a prevalence of malignancy of up to 10% of the thyroid nodules in selected patients’ group. The histology did not found microcarcinomas only, but also small cancer with infiltration of the thyroid capsule, lymph node metastasis or multifocal spread. The studies were not designed for outcome measurement after early and incidental detection of small thyroid cancers. Hypoechogenity, ill defined borders, central hypervascularization or microcalcifications were used as combined criteria for risk stratification. The second method for risk stratification is scintigraphy and further tests are warranted for hypofunctioning nodule ≥1 cm. Additionally, the family history, patient’s age <20 years, former radiation of the neck, and measurement of calcitonin should be regarded. Without such a risk stratification selection for fine needle aspiration is impossible. Fine needle aspiration of non-palpable incidentalomas led to non-representative or unequivocal cytological findings in up to 40%. Because better outcome of incidentally detected small thyroid carcinomas is not proved and because sonography, scintigraphy and fine needle aspiration remain imprecise regarding dignity of incidentalomas, fine needle aspiration is not the standard for small, non-palpable thyroid nodules. Conclusion: For management of incidentaloma, sonographically unsuspicious, scintigraphically indifferent (nodules ≥1 cm) and without any risk factors in patients’ history, wait and see is justified when patient is informed about the problem.

A case of splenomegaly with RK-39 positivity: A diagnostic pitfall

2021 ◽  
pp. 004947552110206
Author(s):  
Prasad Dange ◽  
Ankesh Gupta ◽  
Richa Juneja ◽  
Renu Saxena
Keyword(s):  
Hereditary Spherocytosis ◽  
Correct Diagnosis ◽  
Young Male ◽  
Differential Diagnoses ◽  
Patient Evaluation ◽  
Serological Testing ◽  
Endemic Region ◽  
Careful Patient ◽  
Diagnostic Pitfall ◽  
Marked Splenomegaly

Long-standing moderate to marked splenomegaly suggests several differential diagnoses, both haematological and infectious, particularly leishmaniasis and malaria in endemic areas. Non-infectious causes may be missed in these regions, especially if pitfalls of serological testing are not considered. Careful patient evaluation is necessary to arrive at the correct diagnosis. We report a case of a young male whose hereditary spherocytosis was initially missed because of RK-39 positivity, splenomegaly and the fact that he hailed from an endemic region.

Salzburg Criteria, A Useful Tool in Non-Convulsive Status Epilepticus Diagnosis: A Retrospective Study

2021 ◽  
pp. 155005942199171
Author(s):  
Adriana Gómez Domínguez ◽  
Raidili C. Mateo Montero ◽  
Alba Díaz Cid ◽  
Antonio J. P. Mazarro ◽  
Ignacio R. Bailly-Bailliere ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Status Epilepticus ◽  
Prospective Studies ◽  
Correct Diagnosis ◽  
Original Description ◽  
Neurological Deficits ◽  
Convulsive Status Epilepticus ◽  
Poor Outcome

Introduction. Non-convulsive status epilepticus (NCSE) has been traditionally a challenging electroencephalographic (EEG) diagnosis. For this reason, Salzburg consensus criteria (SCC) have been proposed to facilitate correct diagnosis. Methods. We retrospectively reanalyzed 41 cases referred to our department (from 2016 to 2018) under the suspicion of NCSE. In this study, we compared the original description (standard criteria) versus the updated description (SCC) of the same EEG. Results. Originally, 15 patients were diagnosed as NCSE (37%) and 26 patients as no NCSE (63%), using the standard criteria. Then, we analyzed EEGs according to the SCC, which led to the following results: 9 patients fulfilled the criteria for definite NCSE (22%), 20 patients were diagnosed as possible NCSE (49%) and 12 patients were diagnosed as no NCSE (29%). Subsequently, when we analyze the outcome of possible NCSE cases, we note that 50% of these patients presented mild-poor outcome (neurological deficits, deceased). Indeed, we observed worse outcomes in patients previously diagnosed as no NCSE and untreated, specifically post-anoxic cases. Conclusions. Salzburg criteria seem to be a useful tool to support NCSE diagnosis, introducing the category of possible NCSE. In our study, we observed that it contributes to improving the prognosis and management of the patients. However, more prospective studies are needed to demonstrate the accuracy of SCC.

scholarly journals Deep sedation versus minimal sedation during endobronchial ultrasound transbronchial needle aspiration

2018 ◽  
Vol 88 (3) ◽  
Author(s):  
Sergio C. Conte ◽  
Giulia Spagnol ◽  
Marco Confalonieri ◽  
Beatrice Brizi
Keyword(s):  
Diagnostic Accuracy ◽  
Deep Sedation ◽  
Correct Diagnosis ◽  
Needle Aspiration ◽  
Endobronchial Ultrasound ◽  
Multicenter Studies ◽  
Transbronchial Needle Aspiration ◽  
Patient Tolerance ◽  
Procedural Time ◽  
Comparable Accuracy

The sedation plays an important role in the endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) procedure. The sedation can be Minimal (anxiolysis), Moderate (conscious sedation) or Deep. The ACCP guidelines suggest that moderate or deep sedation (DS) is an acceptable approach. In fact, several studies compare moderate versus deep sedation, but no study has been carried out to compare deep sedation versus minimal. We carried out a retrospective study to compare the Deep versus Minimal sedation (MiS) in patients undergoing EBUS-TBNA.  The primary end point was the diagnostic accuracy. The secondary end points were adequacy and sensitivity. We evaluated the LN size sampling, procedural time, complications and patient tolerance. Thirty-six patients underwent EBUS-TBNA, 16 under DS and 20 under MiS. The overall diagnostic accuracy for correct diagnosis was 92.9% in DS group and 94.1% in MiS group (p=0.554). Sample adequacy, defined as the percentage of patients with a specific diagnosis by EBUS-TBNA, was 87.5% (14 of 16) and 85% (17 of 20) for the DS group and MiS group, respectively, (p=0.788); the sensitivity was 92.9% in the DS group (95% CI, 73-100%) and 92.9% in the MiS group (95% CI, 77-100%) (p=0.463). There were no major complications in either group. Minor complications were 4 in MiS and 1 in DS (p=0.355).  The patients in the MiS group recalled the procedure more often compared to the other group (p=0.041). The majority of the patients would agree to undergo the same procedure again in the future in both groups (p=0.766).  In our experience EBUS-TBNA performed under MiS has comparable accuracy, adequacy, sensitivity, complications and patient satisfaction to DS, even if the sample was small.  Future prospective multicenter studies are needed to confirm our results.

Juvenile Granulosa Cell Tumors of the Ovary

2020 ◽  
Vol 154 (5) ◽  
pp. 635-644
Author(s):  
Yuhong Ye ◽  
Chengyu Lv ◽  
Songhua Xu ◽  
Yupeng Chen ◽  
Ru Qian ◽  
...  
Keyword(s):  
Granulosa Cell ◽  
Correct Diagnosis ◽  
Pelvic Mass ◽  
Stage Iv ◽  
Abdominal Distension ◽  
Granulosa Cell Tumors ◽  
Pathologic Features ◽  
Stage Iv Disease ◽  
Sclerosing Stromal Tumor

Abstract Objective To explore the clinical and pathologic features of ovarian juvenile granulosa cell tumors (JGCTs). Methods Clinical data, histopathologic observations, immunohistochemical results, FOXL2 mutation status, and follow-up information of 7 JGCT cases were studied. Results The patients most commonly presented with abdominal distension and pain (5 cases), followed by precocious puberty (1 case) and a pelvic mass (1 case). Six patients had stage I disease, and 1 had stage IV disease. The microscopic examinations typically showed lobular growth punctuated by variably sized and shaped follicles. Rare features included a reticular-cystic appearance mimicking a yolk sac tumor (2 cases), a lobular appearance similar to a sclerosing stromal tumor (1 case), strands and cords (1 case), pseudopapillary appearance (2 cases), spindle cell appearance (1 case), microcystic appearance (1 case), hobnail cells (1 case), and rhabdomyoid cells (1 case). No FOXL2 mutation was encountered. After a median follow-up of 53 months, only 1 patient with a strongly diffuse TP53-positive tumor died of the disease, and 2 successfully had babies. Conclusions JGCT is a rare neoplasm with a wide morphologic spectrum and is easily confused with other tumors. Familiarity with the characteristics, rare atypical appearances, and immunohistochemical results may aid in obtaining a correct diagnosis.

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