Intranodal palisaded myofibroblastoma.
|Article Type:||Letter to the editor|
Histology, Pathological (Research)
Connective tissue tumors (Diagnosis)
Connective tissue tumors (Care and treatment)
Perez Campos, Ana I.
|Publication:||Name: Archives of Pathology & Laboratory Medicine Publisher: College of American Pathologists Audience: Academic; Professional Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2008 College of American Pathologists ISSN: 1543-2165|
|Issue:||Date: August, 2008 Source Volume: 132 Source Issue: 8|
|Topic:||Event Code: 310 Science & research Canadian Subject Form: Connective tissue tumours; Connective tissue tumours|
|Geographic:||Geographic Scope: United States Geographic Code: 1USA United States|
To the Editor.--We read with interest the article "Intranodal
Palisaded Myofibroblastoma" by Nguyen and Eltorky, (1) published in
the Archives. We wish to complement their extensive review by reporting
another case, diagnosed by incisional biopsy and confirmed by lymph node
A 52-year-old man presented to the Department of Internal Medicine with a slow-growing tender mass in the left groin. The patient had no significant medical history. Incisional biopsy was performed, obtaining tiny pieces of tissue (Figure 1). Histologically, most of the biopsy was composed of a sclerotic pseudocapsule with lymphoid tissue aggregates. In just one fragment, a proliferation of bland-looking spindle cells with areas of nuclear palisading was identified. Isolated amianthoid fibers and extravasation of red blood cells between spindle cells were also seen (Figure 2). Because of the suggestion of palisaded myofibroblastoma, immunohistochemistry was performed, showing the typical profile of this tumor (positivity to muscle-specific actin and desmin; negativity to S100 protein, CD34, and glial fibrillary acidic protein). Staining with Ki-67 antigen demonstrated a low-proliferative index. As previously published, (1,2) cyclin D1 staining was strongly positive in more than 50% of cells (Figure 3). The diagnosis was "suggestive of intranodal palisaded myofibroblastoma/hemorrhagic spindle-cell tumor with amianthoid fibers," (1) and excisional biopsy was recommended.
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Six months later, surgery was performed. Macroscopically, the greatest node diameter was 2.7 cm, showing a solid gray-white to tan cut surface. Microscopically, low-power examination identified a compressed rim of normal lymphoid tissue in the outermost part; the inner zone showed hemorrhagic areas. The tumor was composed of bland-looking spindle cells with nuclear palisading. Intraparenchymal hemorrhage with extravasation of red blood cells and amianthoid fibers was seen. Extracellular and intracellular fuschinophilic bodies were detected with smooth muscle actin immunohistochemical stain. These findings confirmed the previous diagnosis. The patient was discharged without complication and has been free of disease since (9 months).
In conclusion, intranodal palisaded myofibroblastoma is an uncommon tumor with well-defined histologic and immunohistochemical features. To our knowledge, this report brings the total number of cases to 43.
(1.) Nguyen T, Eltorky MA. Intranodal palisaded myofibroblastoma. Arch Pathol Lab Med. 2007;131:306-310.
(2.) Kleist B, Poetsch M, Schmoll J. Intranodal palisaded myofibroblastoma with over expression of cyclin D1. Arch Pathol Lab Med. 2003; 127:1040-1043.
The authors have no relevant financial interest in the products or companies described in this article.
BELEN PEREZ-MIES, MD
ANA I. PEREZ CAMPOS, MD
Department of Pathology
University Hospital of Guadalajara
19002 Guadalajara, Spain
|Gale Copyright:||Copyright 2008 Gale, Cengage Learning. All rights reserved.|