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Demaerel R, Decraene B, Masrori P, Marcelis L, Sciot R, Demaerel P, Van Calenbergh F. Exploring perivascular epithelioid cell tumors (PEComas) in the CNS: insights from two case reports and a comprehensive literature review. Childs Nerv Syst 2025; 41:190. [PMID: 40423698 DOI: 10.1007/s00381-025-06845-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2024] [Accepted: 05/08/2025] [Indexed: 05/28/2025]
Abstract
Perivascular epithelioid cell tumors (PEComas) represent a rare and intriguing subset of neoplasms within the central nervous system (CNS). This report describes two unique cases that highlight distinct origins and clinical behaviors, offering valuable contributions to the limited body of knowledge regarding CNS PEComas. Despite their rarity, PEComas should be considered in the differential diagnosis of mesenchymal tumors that display an atypical combination of clinical, radiological, and histomolecular features, especially when melanocytic and/or myoid markers are present. Treatment with mTOR inhibitors can potentially stabilize the disease in a significant number of more aggressive PEComas, even those located in the CNS.
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Affiliation(s)
- Rik Demaerel
- Department of Neurosurgery, University Hospitals Leuven, Louvain, Belgium
| | - Brecht Decraene
- Department of Neurosurgery, University Hospitals Leuven, Louvain, Belgium.
- Experimental Neurosurgery and Neuroanatomy Research Group, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Louvain, Belgium.
| | - Pegah Masrori
- Department of Neurology, University Hospitals Leuven, Louvain, Belgium
- Experimental Neurology, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Louvain, Belgium
| | - Lukas Marcelis
- Department of Pathology, University Hospitals Leuven, Louvain, Belgium
| | - Raf Sciot
- Department of Pathology, University Hospitals Leuven, Louvain, Belgium
| | - Philippe Demaerel
- Department of Radiology, University Hospitals Leuven, Louvain, Belgium
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Zhou JA, Fan ZC, Zheng RJ, Guo QX, Su S. Diagnostic challenges and radiological insights of rare hepatic perivascular epithelioid cell tumor: A case report and review of the literature. World J Gastrointest Surg 2025; 17:105220. [DOI: 10.4240/wjgs.v17.i5.105220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2025] [Revised: 02/27/2025] [Accepted: 03/21/2025] [Indexed: 05/23/2025] Open
Abstract
BACKGROUND Hepatic perivascular epithelioid cell tumor (PEComa) is an extremely rare neoplasm that is often difficult to diagnose due to its nonspecific clinical and radiological features. This case emphasizes the importance of imaging and histopathological examination in distinguishing PEComa from other liver tumors, and the necessity of early intervention.
CASE SUMMARY A 36-year-old woman presented with a liver mass discovered during a routine physical examination. Initially diagnosed as focal nodular hyperplasia based on contrast-enhanced computed tomography, she declined surgical intervention. Two years later, re-examination revealed an approximately 60% increase in the size of the mass and suggested the possibility of hepatocellular carcinoma. She subsequently underwent surgical resection. Postoperative histopathological and immunohistochemical analysis revealed positivity for HMB-45 and Melan-A, confirming the diagnosis of hepatic PEComa. A 13-month follow-up revealed no recurrence or metastasis.
CONCLUSION Hepatic PEComa requires a combination of radiological and immunohistochemical evaluation for accurate diagnosis. This case highlights the importance of early surgical intervention and regular follow-up to monitor for recurrence or metastasis.
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Affiliation(s)
- Jun-An Zhou
- Department of General Surgery (Hepatobiliary Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Zheng-Chao Fan
- Department of Ultrasound, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Ru-Jun Zheng
- Department of General Surgery (Hepatobiliary Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Qin-Xi Guo
- Department of Pathology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Song Su
- Department of General Surgery (Hepatobiliary Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
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Izubuchi Y, Tanaka T. PEComa-its clinical features, histopathology, and current therapy. Jpn J Clin Oncol 2025:hyaf056. [PMID: 40336169 DOI: 10.1093/jjco/hyaf056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2024] [Accepted: 03/22/2025] [Indexed: 05/09/2025] Open
Abstract
Perivascular epithelioid cell tumors (PEComas) are a rare family of mesenchymal tumors that includes angiomyolipoma, lymphangioleiomyomatosis, pulmonary clear cell "sugar" tumors, and PEComa-not otherwise specified. This study aimed to provide a comprehensive review of the clinical features, molecular biology, and current status of PEComa treatment. It reportedly occurs at several sites, including the uterus, kidney, liver, lung, abdominopelvic soft tissue, gastrointestinal organs, retroperitoneum, soft tissue, bone, and skin. More common in women, it occurs in young to middle-aged people. Although the disease generally follows a benign course, cases of malignant PEComa have been reported. Malignant PEComa is characterized by a large tumor size, a high mitotic rate, and the presence of necrosis and nuclear atypia. Immunohistochemically, PEComas typically express melanocytic markers such as human melanoma black 45 (HMB45) and melanoma antigen (melan-A) and muscle markers such as smooth muscle actin (α-SMA), desmin, and caldesmon. More recently, a subtype of PEComa harboring TFE3 gene rearrangement that is mutually exclusive with tuberous sclerosis complex (TSC) mutations has been identified. The identification of TFE3 gene rearrangement can help confirm the diagnosis. The distinctive features of these TFE3-rearranged PEComas include a young-age tendency, the absence of an association with tuberous sclerosis, predominant alveolar architecture and epithelioid cytology, minimal immunoreactivity for muscle markers, and strong (3+) TFE3 immunoreactivity. Surgery is the curative treatment of choice; however, there are reports of cases and randomized controlled trials showing the efficacy of mTOR inhibitors. To the best of our knowledge, there are no reports of radiation therapy's efficacy.
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Affiliation(s)
- Yuya Izubuchi
- Department of Orthopaedics and Rehabilitaion Medicine, Unit of Surgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui 23-3, Matsuokashimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui 910-1193, Japan
| | - Takaaki Tanaka
- Department of Orthopaedics and Rehabilitaion Medicine, Unit of Surgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui 23-3, Matsuokashimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui 910-1193, Japan
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Huang J, Chen J, Luo Y. Cell-Sheet Shape Transformation by Internally-Driven, Oriented Forces. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2025; 37:e2416624. [PMID: 40165759 DOI: 10.1002/adma.202416624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2024] [Revised: 03/04/2025] [Indexed: 04/02/2025]
Abstract
During morphogenesis, cells collectively execute directional forces that drive the programmed folding and growth of the layers, forming tissues and organs. The ability to recapitulate aspects of these processes in vitro will constitute a significant leap forward in the field of tissue engineering. Free-standing, self-organizing, cell-laden matrices are fabricated using a sequential deposition approach that uses liquid crystal-templated hydrogel fibers to direct cell arrangements. The orientation of hydrogel fibers is controlled using flow or boundary cues, while their microstructures are controlled by depletion interaction and probed by scattering and microscopy. These fibers effectively direct cells embedded in a collagen matrix, creating multilayer structures through contact guidance and by leveraging steric interactions amongst the cells. In uniformly aligned cell matrices, oriented cells exert traction forces that can induce preferential contraction of the matrix. Simultaneously, the matrix densifies and develops anisotropy through cell remodeling. Such an approach can be extended to create cell arrangements with arbitrary in-plane patterns, allowing for coordinated cell forces and pre-programmed, macroscopic shape changes. This work reveals a fundamentally new path for controlled force generation, emphasizing the role of a carefully designed initial orientational field for manipulating shape transformations of reconstituted matrices.
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Affiliation(s)
- Junrou Huang
- Department of Mechanical Engineering and Materials Science, Yale University, 9 Hillhouse Ave, New Haven, CT, 06511, USA
| | - Juan Chen
- Department of Mechanical Engineering and Materials Science, Yale University, 9 Hillhouse Ave, New Haven, CT, 06511, USA
| | - Yimin Luo
- Department of Mechanical Engineering and Materials Science, Yale University, 9 Hillhouse Ave, New Haven, CT, 06511, USA
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Yoo Y, Kim J, Song IH. Risk prediction criteria for the primary hepatic perivascular epithelioid cell tumour family, including angiomyolipoma: analysis of 132 cases with a literature review. Histopathology 2025; 86:979-992. [PMID: 39731184 DOI: 10.1111/his.15405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2024] [Revised: 11/22/2024] [Accepted: 12/15/2024] [Indexed: 12/29/2024]
Abstract
AIMS The hepatic perivascular epithelioid cell tumour (PEComa), including angiomyolipoma, exhibits diverse morphology and clinical behaviour; however, its prognostic features remain undefined. This study aimed to investigate its histological features and prognostic factors. METHODS AND RESULTS In total, 132 patients were included. Clinical data and histopathological slides were assessed along with the p53 and Ki-67 immunohistochemistry. Targeted next-generation sequencing was performed in three cases. Based on the histologic subtypes, 7 (10%), 36 (51%), 13 (18%), and 15 (21%) patients were classified as inflammatory angiomyolipoma, conventional angiomyolipoma, epithelioid angiomyolipoma, and PEComa not otherwise specified (NOS), respectively, among 71 patients who underwent surgical resection. We proposed the risk prediction criteria after defining primary tumour size ≥7 cm, infiltrative border, mitotic rate >1/10 mm2, necrosis, vascular invasion, and PEComa NOS as worrisome features, as follows: high-risk: ≥3 worrisome features; intermediate-risk: 1-2 features; low-risk: none of the features. Applying these criteria, 4 (6%), 31 (44%), and 36 (51%) patients were classified into high-, intermediate-, and low-risk groups, respectively. One patient each in the high-risk (25%) and intermediate-risk (3%) groups developed peritoneal metastases and intrahepatic recurrence, respectively, whereas none in the low-risk group showed disease progression. A literature review of clinically malignant hepatic PEComa family tumours was conducted, and upon application of our criteria, 62% (16/26) of the patients were classified as high-risk and 35% (9/26) as intermediate- or high-risk. CONCLUSION Our risk prediction criteria can effectively predict the clinical outcomes in primary hepatic PEComa.
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Affiliation(s)
- Youngeun Yoo
- Department of Pathology, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Jihun Kim
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - In Hye Song
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Sangoi AR, Lobo A, Jha S, Kaushal S, Tiwari A, Mubeen A, Humble R, Potterveld SK, Williamson SR, Akgul M, Srinivas S, Mohanty SK. Renal Epithelioid Angiomyolipoma: Prognostic Implications of Targeted Immunohistochemical and Molecular Markers in Conjunction with Clinicopathologic Features. Am J Surg Pathol 2025:00000478-990000000-00512. [PMID: 40289813 DOI: 10.1097/pas.0000000000002411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2025]
Abstract
Epithelioid angiomyolipoma (eAML) is an uncommon subtype of angiomyolipoma, a subset of which can demonstrate malignant behavior. While some studies have proposed histopathologic features predictive of aggressive behavior in eAML, there is limited data on the use of immunohistochemistry (IHC) and/or next-generation sequencing (NGS) to identify biomarkers for poor clinical outcome. Moreover, there is limited data on the proposed genetic dichotomy (tuberous sclerosis complex [TSC] alteration versus TFE3 rearrangement) of eAML. Clinicopathologic features (including purported histologic features associated with adverse outcome) of 30 eAML were recorded with IHC performed on 1 whole-slide section per tumor for the following markers (interpretations): p16 (positive or negative), p53 (wild type or mutant), TRIM63 ISH (>10% as positive or ≤10% as negative), ATRX (retained or lost), and RB1 (retained or lost). NGS was performed on 23 tumors. The 30 eAML tumors were from 30 patients (23 female, 7 male) of an age range 22 to 77 years (mean=51.9 y). Clinical follow-up was available from 27 patients (mean=36 mo). The features significantly associated with metastatic disease included ≥70% atypical epithelial cells (P=0.04), ≥2 mitotic figures per 10 high-power fields (P=0.0013), atypical mitotic figures (P=0.0003), and necrosis (P=0.0213). Other features such as local invasion, vascular invasion, tumor size, and immunohistochemical profile (p16, TRIM63, p53, ATRX, and RB1) showed no significant association with the development of metastasis. Interestingly, among the 7 tumors with clinical follow-up showing TFE3 rearrangement, 5 developed metastases (OR=4.50), while 6 of 14 TSC/MTOR mutated tumors with clinical follow-up had metastatic disease (OR=0.222). Notably, TRIM63 ISH showed high sensitivity (100%) for eAML with TFE3 rearrangement but with poor specificity (38%). The genetic dichotomy of eAML comes in the form of TSC/MTOR alterations or TFE3 rearrangement elucidated by NGS, both of which may be associated with poor outcome, and therefore show potential therapeutic implications. As eAML may show overlap with TFE3-rearranged/TFEB-altered renal cell carcinoma, shared TRIM63 ISH positivity for these tumor types represents an important potential diagnostic pitfall.
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Affiliation(s)
| | - Anandi Lobo
- Department of Pathology and Laboratory Medicine and Urology, Kapoor Centre of Urology and Pathology, Raipur
| | - Shilpy Jha
- Department of Pathology and Laboratory Medicine, Manipal Hospitals, Bhubaneswar
| | - Seema Kaushal
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, New Delhi
| | | | | | | | - Susan K Potterveld
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | | | | | - Sandy Srinivas
- Department of Oncology and Medicine, Stanford Medical Center, Stanford, CA
| | - Sambit K Mohanty
- Department of Pathology and Laboratory Medicine, CORE Diagnostics, Gurgaon, India
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Kaur H, Wang M. The role of frozen section in gynecologic pathology. Semin Diagn Pathol 2025; 42:150913. [PMID: 40315682 DOI: 10.1016/j.semdp.2025.150913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2025] [Revised: 04/21/2025] [Accepted: 04/22/2025] [Indexed: 05/04/2025]
Abstract
Intraoperative consultation using frozen sections in gynecologic surgery aids in determining the scope of the surgery. The main indications are to evaluate the presence of malignancy, determine the primary site, histologic type, and grade of the tumor, and assess the extent of local tumor invasion and distant spread. A thorough gross examination of submitted specimens helps identify critical features such as specimen integrity, tumor size, serosa and ovarian surface involvement, myometrial involvement, and lymph node status. Uterine endometrial carcinomas are classified based on histologic type and grade, with attention to features such as myometrial invasion, cervical stromal involvement, and gross tumor size. Correct evaluation of uterine mesenchymal tumors, ovarian epithelial tumors, sex-cord stromal tumors, and germ cell tumors is essential to guide the decision between conservative and extensive surgical staging. It is challenging but essential to distinguish primary ovarian tumors from metastatic neoplasms. Prompt and clear communication with the operating surgeon is crucial for successful consultation. Providing definitive diagnoses on frozen sections can sometimes be difficult; however, understanding the management algorithm and maintaining an open dialogue with the surgeon about differential diagnoses can help in offering the necessary information for subsequent management steps.
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Affiliation(s)
- Harsimar Kaur
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
| | - Minhua Wang
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA.
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8
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Sugimura N, Hirata D, Iwatate M, Hattori S, Fujita M, Sano W, Fujimori T, Sano Y. A diminutive perivascular epithelioid cell tumor in the colon. DEN OPEN 2025; 5:e390. [PMID: 38774472 PMCID: PMC11106221 DOI: 10.1002/deo2.390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 04/29/2024] [Accepted: 05/05/2024] [Indexed: 05/24/2024]
Abstract
Perivascular epithelioid cell tumor (PEComa) is a rare mesenchymal tumor. Some papers have reported that colonoscopy could be used to treat PEComa with a predominantly pedunculated polyp, whereas surgical intervention is often required for cases with submucosal-type tumors. These findings suggest that the morphology of PEComa changes dramatically with disease progression. Because of the rapid progression of PEComa, endoscopic treatment remains challenging, and early-stage PEComa morphology is not well understood. A 64-year-old man presented to our hospital for a follow-up colonoscopy after undergoing multiple polypectomies. He had a medical history of colorectal adenoma and prostate cancer. A 4-mm pale blue elevated but not pedunculated lesion was observed in the transverse colon, an area where he had not had polyps previously. Since no epithelial change was observed, the presence of a submucosal tumor, such as a gastrointestinal stromal tumor, was suspected. Cold snare polypectomy was performed, and the lesion was completely resected. Histological evaluation using hematoxylin and eosin staining identified that the submucosal tumor included thickened vascular walls and adipose tissue. Although fragmented due to significant degeneration, spindle-shaped cells staining positive for smooth muscle actin were observed within and surrounding the unstructured hyalinized tissue with calcifications. Based on these findings, the lesion was diagnosed as angiomyolipoma, a subtype of PEComa. Complete resection was confirmed by histopathology. To our knowledge, this PEComa is the smallest of any PEComa reported in the literature. Our finding provides valuable insights into the very early stage of colorectal PEComas.
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Affiliation(s)
- Naoki Sugimura
- Gastrointestinal Center & Institute of Minimally‐Invasive Endoscopic Care (i‐MEC)Sano HospitalHyogoJapan
| | - Daizen Hirata
- Gastrointestinal Center & Institute of Minimally‐Invasive Endoscopic Care (i‐MEC)Sano HospitalHyogoJapan
| | - Mineo Iwatate
- Gastrointestinal Center & Institute of Minimally‐Invasive Endoscopic Care (i‐MEC)Sano HospitalHyogoJapan
| | - Santa Hattori
- Gastrointestinal Center & Institute of Minimally‐Invasive Endoscopic Care (i‐MEC)Sano HospitalHyogoJapan
| | - Mikio Fujita
- Gastrointestinal Center & Institute of Minimally‐Invasive Endoscopic Care (i‐MEC)Sano HospitalHyogoJapan
| | - Wataru Sano
- Gastrointestinal Center & Institute of Minimally‐Invasive Endoscopic Care (i‐MEC)Sano HospitalHyogoJapan
| | | | - Yasushi Sano
- Gastrointestinal Center & Institute of Minimally‐Invasive Endoscopic Care (i‐MEC)Sano HospitalHyogoJapan
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9
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Saadoun JE, Traversari E, Meillat H, Guiramand J. Perivascular epithelioid cell tumour (PEComa) of the ligamentum teres hepatis, a rare and mobile tumour presentation. ANZ J Surg 2025; 95:832-833. [PMID: 40018953 PMCID: PMC11982651 DOI: 10.1111/ans.19418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2024] [Revised: 01/15/2025] [Accepted: 01/16/2025] [Indexed: 03/01/2025]
Affiliation(s)
| | - Eddy Traversari
- Department of Surgical Oncology, Institut Paoli Calmettes, Marseille, France
| | - Hélène Meillat
- Department of Surgical Oncology, Institut Paoli Calmettes, Marseille, France
| | - Jérôme Guiramand
- Department of Surgical Oncology, Institut Paoli Calmettes, Marseille, France
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10
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Bigot NJ, Neyaz A, Naous R, Schoedel K, Ergen FB, Hahn E, Karunamurthy A, McGough RL, John I. Rapidly enlarging ACTIN::MITF rearranged clear cell tumour with melanocytic differentiation. Histopathology 2025; 86:829-832. [PMID: 39628354 DOI: 10.1111/his.15386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2025]
Affiliation(s)
- Nathaniel J Bigot
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Azfar Neyaz
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rana Naous
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Karen Schoedel
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Fatma Bilge Ergen
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Elan Hahn
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Pathology and Laboratory Medicine, Sinai Health System, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | | | - Richard L McGough
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ivy John
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA
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Kitagawa A, Nishio A, Hikita H, Kato T, Doi A, Sato K, Tahara S, Kimura Y, Ono Y, Takehara T. A rare case of a malignant hepatic perivascular epithelioid cell tumor (PEComa) with aggressive progression following the relapse of renal pecoma despite everolimus therapy. Clin J Gastroenterol 2025; 18:343-351. [PMID: 39762618 DOI: 10.1007/s12328-024-02085-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2024] [Accepted: 12/08/2024] [Indexed: 02/11/2025]
Abstract
A 55-year-old man with tuberous sclerosis complex (TSC) was diagnosed with left renal angiomyolipoma (AML), a group of perivascular epithelioid cell tumors called PEComas. He had received the mTOR inhibitor everolimus, which resulted in a complete response. However, a left renal mass relapsed in two years, followed by the occurrence of a hepatic mass five months later. Renal biopsy yielded no diagnosis because of massive necrosis in the tumor cells of the left kidney; however, pathological evaluation of the hepatic mass revealed a PEComa with pleomorphic cells. Even with continuous everolimus therapy, hepatic PEComa progressed aggressively and occupied the entire liver within a year from the first detection. An autopsy revealed pleomorphic cells with nuclear atypia spreading in the liver, kidney, and lung, which were not present in the renal AML sample prior to the initiation of everolimus therapy. This finding raises the possibility of a malignant transformation of the PEComa under the mTOR inhibitor therapy. While PEComas often present with benign characteristics, there are rare instances where the tumor exhibits malignant behavior. This highlights the importance of careful monitoring and long-term follow-up to ensure early detection and effective management of potential malignancies.
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Affiliation(s)
- Ayaka Kitagawa
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Akira Nishio
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hayato Hikita
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Taigo Kato
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Akira Doi
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Katsuhiko Sato
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Shinichiro Tahara
- Department of Pathology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yasushi Kimura
- Department of High Precision Image-Guided Percutaneous Intervention, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yusuke Ono
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tetsuo Takehara
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan.
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12
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Omatsu I, Mukai H, Doi T, Ishikawa T, Itoh Y, Konishi E, Shishido-Hara Y. An autopsy case of TFE3-rearranged PEComa-like neoplasm with systematic embolization involving the heart. Cardiovasc Pathol 2025; 75:107715. [PMID: 39793912 DOI: 10.1016/j.carpath.2025.107715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2024] [Revised: 12/18/2024] [Accepted: 01/02/2025] [Indexed: 01/13/2025] Open
Abstract
A rare autopsy case of malignant transcription factor E3 (TFE3)-rearranged perivascular epithelioid cell tumor (PEComa)-like neoplasm is presented. An 84-year-old woman manifested multiple cerebral infarctions and repetitive embolic events in the supra mesenchymal artery (SMA), and the presence of a mobile mass in the heart's left ventricle was also revealed. Tumoral lesions were also found in a pelvic space and a right pleural cavity, and a biopsy was performed from one of the disseminated tumor masses in the right pleura. Pathological diagnosis of TFE3-rearranged PEComa-like neoplasm was defined based on the evidence of partial expression of Melan A, and strong nuclear expression of TFE3 and by detection of the Xp11.2 locus split signal with FISH. A post-mortem analysis via autopsy revealed the widespread intravascular tumors in the heart's left ventricle, supra mesenchymal vein (SMV), and partial vein. The left intraventricular tumoral mass was associated with thrombus and fibrine, and thrombotic emboli were also found in SMA, SMV, and left pulmonary arteries. Interestingly, organ-based tumor invasion accompanying desmoplastic reactions was hardly seen. The small intestine was perforated, likely due to ischemia, which resulted in suppurative peritonitis and sepsis. This was thought of as the direct cause of death. This is the first report of a precise autopsy investigation of TFE3-rearranged PEComa-like neoplasm. Tumoral localization was mostly intravascular or disseminative in the pleural cavity. Given the limited understanding of this tumoral pathophysiology, this case offers valuable insights for prompt diagnosis and effective treatment strategies.
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Affiliation(s)
- Ikoi Omatsu
- Department of Anatomic Pathology, Kyoto Prefectural University of Medicine, Japan
| | - Hiroki Mukai
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Japan
| | - Toshifumi Doi
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Japan
| | - Takeshi Ishikawa
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Japan
| | - Yoshito Itoh
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Japan
| | - Eiichi Konishi
- Department of Anatomic Pathology, Kyoto Prefectural University of Medicine, Japan
| | - Yukiko Shishido-Hara
- Department of Pathology and Applied Neurobiology, Kyoto Prefectural University of Medicine, Japan.
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13
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Boccatonda A, Marcellini MM, Ruggeri E, Felicani C, Brighenti A, Loiacono R, Ercolani G, Serra C. Ceus features of liver pecoma: a case report and literature review. J Ultrasound 2025; 28:261-268. [PMID: 39557792 PMCID: PMC11947360 DOI: 10.1007/s40477-024-00973-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2024] [Accepted: 10/24/2024] [Indexed: 11/20/2024] Open
Abstract
Perivascular epithelioid cell neoplasms (PEComas) and epithelioid angiomyolipomas (EAMLs) are two different denominations for the same "mesenchymal tumor composed of histologically and immunohistochemically distinctive perivascular epithelioid cells". Hepatic PEComa/EAML is a very rare neoplasm, and only 29 case reports of hepatic PEComa and 25 of hepatic EAML have been reported in the current literature. A clear female predominance with a mean age at diagnosis of 42.5 years old can be observed by literature review. Ultrasound (US) examination was the first-line diagnostic technique in most of the cases of hepatic PEComa, but it was documented in very few cases of hepatic EAML. A great variability in the ultrasonographic B-mode, color Doppler and contrast-enhanced ultrasonography (CEUS) features of hepatic PEComa/EAML emerges. Computed tomography and magnetic resonance were the most common used techniques to confirm the nature of the hepatic lesion, even if the anatomo-pathological examination was the only technique to display a certainty diagnosis and to differentiate hepatic PEComa/EAML from benign and malignant hepatic lesions. The great majority of hepatic PEComas/EAMLs are surgically treated without any adjuvant therapy.
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Affiliation(s)
- Andrea Boccatonda
- Diagnostic and Therapeutic Interventional Ultrasound Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico Sant'Orsola-Malpighi, via Massarenti n 9, 40138, Bologna, Italy.
| | | | - Eugenio Ruggeri
- Diagnostic and Therapeutic Interventional Ultrasound Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico Sant'Orsola-Malpighi, via Massarenti n 9, 40138, Bologna, Italy
| | - Cristina Felicani
- Medicina ad Indirizzo Metabolico Nutrizionale. Policlinico di Modena, AOU Modena, Modena, Italy
| | - Alice Brighenti
- Diagnostic and Therapeutic Interventional Ultrasound Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico Sant'Orsola-Malpighi, via Massarenti n 9, 40138, Bologna, Italy
| | - Rossella Loiacono
- Diagnostic and Therapeutic Interventional Ultrasound Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico Sant'Orsola-Malpighi, via Massarenti n 9, 40138, Bologna, Italy
| | - Giorgio Ercolani
- General and Oncologic Surgery, Morgagni-Pierantoni Hospital, AUSL Romagna, Via Forlanini 34, 47121, Forlì, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Via Zamboni 33, 40126, Bologna, Italy
| | - Carla Serra
- Diagnostic and Therapeutic Interventional Ultrasound Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico Sant'Orsola-Malpighi, via Massarenti n 9, 40138, Bologna, Italy
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14
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Papke DJ. Mesenchymal Neoplasms of the Kidney and Perinephric Soft Tissue. Surg Pathol Clin 2025; 18:209-227. [PMID: 39890305 DOI: 10.1016/j.path.2024.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2025]
Abstract
Mesenchymal neoplasms of the kidney present challenges because they are uncommon, and because perinephric soft tissue biopsies are sometimes submitted as "kidney" masses, causing diagnostic confusion. Here, the author thoroughly reviews mesenchymal neoplasms of the kidney, including metanephric stromal tumor, classic and cellular congenital mesoblastic nephroma, anaplastic sarcoma and clear cell sarcoma of the kidney, malignant rhabdoid tumor, PEComa/angiomyolipoma, and anastomosing hemangioma. The author also discusses perinephric myxoid pseudotumor of fat, as well as diagnostic pitfalls presented by well-differentiated/dedifferentiated liposarcoma and sarcomatoid carcinoma.
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Affiliation(s)
- David J Papke
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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15
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Choi JH, Thung SN. Mesenchymal Tumors of the Liver: An Update Review. Biomedicines 2025; 13:479. [PMID: 40002892 PMCID: PMC11852400 DOI: 10.3390/biomedicines13020479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2025] [Revised: 02/11/2025] [Accepted: 02/13/2025] [Indexed: 02/27/2025] Open
Abstract
Hepatic mesenchymal tumors (HMTs) are non-epithelial benign and malignant tumors with or without specific mesenchymal cell differentiation. They are relatively uncommon. Except for mesenchymal hamartoma, calcified nested stromal-epithelial tumor, and embryonal sarcoma, most mesenchymal lesions are not specific to the liver. Pathologists face challenges in diagnosing HMTs due to their diverse morphologies and phenotypic variations. Accurate diagnosis is critical for directing appropriate patient care and predicting outcomes. This review focuses on mesenchymal tumors with a relative predilection for the liver, including vascular and non-vascular mesenchymal neoplasms. It provides a thorough and up-to-date overview, concentrating on clinical and pathological features, differential diagnosis, and diagnostic approaches.
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Affiliation(s)
- Joon Hyuk Choi
- Department of Pathology, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Namgu, Daegu 42415, Republic of Korea
| | - Swan N. Thung
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, New York, NY 10029, USA;
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16
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Shi H, Yin Y, Liang S, Liu C, Huang Y, Lu B, Zhang L. Mass resection as a candidate treatment for uterine PEComas of uncertain malignant potential: a case report and literature review. Front Oncol 2025; 14:1521253. [PMID: 39931214 PMCID: PMC11807954 DOI: 10.3389/fonc.2024.1521253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2024] [Accepted: 12/30/2024] [Indexed: 02/13/2025] Open
Abstract
Background Perivascular epithelioid cell tumours (PEComas) occurring in the uterus are rare, with surgery being the most recommended primary treatment for malignant cases. This study aims to provide clinical guidance on the clinicopathological features and appropriate treatment options for patients with uterine PEComas of uncertain malignant potential. Cases This case series summarises the clinical courses of 13 patients diagnosed with uterine PEComas of uncertain malignant potential, including clinical and pathological data as well as their outcomes. We identified one case at our hospital, and data for the other 12 cases were extracted from the PubMed database. The 13 patients were aged 9-75 years, with tumour sizes ranging from 1 to 21 cm, and follow-up times ranging from 2 to 71 months. The most common signs and symptoms included abnormal uterine bleeding (AUB) and abdominal pain. Most of the patients (11/13) were managed surgically without any chemotherapy or radiation therapy. Except for the patients who were lost to follow-up, 11 patients were free of any recurrence or metastasis at their last follow-up. Patients with group A tumours (abundant HMB45 expression) had a longer disease-free survival than those with group B tumours. Conclusions Surgery alone may be appropriate for uterine PEComas of uncertain malignant potential. Surgical treatment plans should consider the patient's age, fertility requirements, and personal preferences. Mass resection is a viable treatment option for fertility preservation in reproductive-age patients.
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Affiliation(s)
- Haijuan Shi
- Department of Gynaecology, The Second Affiliated Hospital of Guangxi Medical
University, Nanning, China
| | - Yan Yin
- Department of Gynaecology, The Second Affiliated Hospital of Guangxi Medical
University, Nanning, China
| | - Shoujun Liang
- Department of Gynaecology, The Second Affiliated Hospital of Guangxi Medical
University, Nanning, China
| | - Chuanzhong Liu
- Department of Gynaecology, The Second Affiliated Hospital of Guangxi Medical
University, Nanning, China
| | - Yibao Huang
- Department of Gynaecology, The Second Affiliated Hospital of Guangxi Medical
University, Nanning, China
| | - Bingfeng Lu
- Department of Radiology, The Second Affiliated Hospital of Guangxi Medical
University, Nanning, China
| | - Liying Zhang
- Department of Gynaecology, The Second Affiliated Hospital of Guangxi Medical
University, Nanning, China
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17
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Teng D, Xu Y, Meng Q, Yang Q. Unveiling the mystery of hepatic epithelioid angiomyolipoma: A unique case report with literature review. SAGE Open Med Case Rep 2025; 13:2050313X251314072. [PMID: 39835254 PMCID: PMC11744629 DOI: 10.1177/2050313x251314072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2024] [Accepted: 01/02/2025] [Indexed: 01/22/2025] Open
Abstract
Hepatic epithelioid angiomyolipoma is a rare mesenchymal liver tumor within the perivascular epithelioid cell tumor family, known for its uncertain malignancy and potential for aggressive behavior. Clinical presentation, laboratory findings, and imaging results lack specificity, making pathological examination critical for definitive diagnosis. This case report presents a 61-year-old male patient with a single tumor in the right liver lobe, measuring approximately 101 mm × 99 mm. Initial imaging misdiagnosed the mass as hepatocellular carcinoma. Following multidisciplinary treatment discussions and subsequent tumor resection, histopathology and immunohistochemistry confirmed hepatic epithelioid angiomyolipoma. Accurate diagnosis of hepatic epithelioid angiomyolipoma is challenging, relying on histopathological examination and immunohistochemistry as diagnostic standards. Continuous monitoring of patients with hepatic epithelioid angiomyolipoma over an extended period is deemed essential. This report highlights the positive impact of multidisciplinary treatment in diagnosing and managing hepatic epithelioid angiomyolipoma.
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Affiliation(s)
- Da Teng
- Department of Hepatobiliary Pancreatic and Splenic Surgery Ward Ⅰ, The Affiliated ChuZhou Hospital of Anhui Medical University (The First People’s Hospital of Chuzhou), ChuZhou, China
| | - Yue Xu
- Department of Ultrasound Medicine, The Affiliated ChuZhou Hospital of Anhui Medical University (The First People’s Hospital of Chuzhou), ChuZhou, China
| | - Qingtao Meng
- Department of Radiology, The Affiliated ChuZhou Hospital of Anhui Medical University (The First People’s Hospital of Chuzhou), ChuZhou, China
| | - Qingsong Yang
- Department of Hepatobiliary Pancreatic and Splenic Surgery Ward Ⅰ, The Affiliated ChuZhou Hospital of Anhui Medical University (The First People’s Hospital of Chuzhou), ChuZhou, China
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18
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Takahashi Y, Yoshida A, Yoshimoto S, Suzuki S, Kishikawa S, Mitsui A, Ryo E, Kojima Y, Yonemori K, Yatabe Y, Mori T. TFE3-rearranged perivascular epithelioid cell tumors of the head and neck with rare fusion partners: clues to the differential diagnosis between benign and malignant tumors. Diagn Pathol 2025; 20:7. [PMID: 39815310 PMCID: PMC11734225 DOI: 10.1186/s13000-025-01602-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2024] [Accepted: 01/07/2025] [Indexed: 01/30/2025] Open
Abstract
BACKGROUND Perivascular epithelioid cell tumors (PEComas) rarely appear in the head and neck region. This case report describes two transcription factor E3 (TFE3)-rearranged PEComa cases, consisting of one in the orbit and one in the nasal cavity. CASE PRESENTATION Both cases demonstrated sheet-like or focal nested architecture and comprised epithelioid cells with abundant clear to eosinophilic cytoplasm and vascular stroma. The first case exhibited partial pleomorphism, a small necrosis area, and slightly increased mitosis and was classified as malignant. The second case demonstrated mild atypia and no mitosis or necrosis and was categorized as benign. The nasal tumor was initially considered a TFE3-rearranged renal cell carcinoma metastasis. However, a subsequent renal tumor biopsy revealed angiomyolipoma. The RNA sequence revealed ZC3H4::TFE3 and PRCC::TFE3 fusions in the first and second cases, respectively. CONCLUSION The fusion partner gene ZC3H4 is uncommon, and this is the third reported PEComa case. The fusion partner gene PRCC is often reported in TFE3-rearranged renal cell carcinoma, and this PEComa case is the second reported in the head and neck region. The initially reported cases with the fusion partner genes ZC3H4 and PRCC were categorized as malignant. These cases were discussed with a literature review.
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Affiliation(s)
- Yuka Takahashi
- Department of Diagnostic Pathology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Akihiko Yoshida
- Department of Diagnostic Pathology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Seiichi Yoshimoto
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Shigenobu Suzuki
- Department of Ophthalmic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Satsuki Kishikawa
- Department of Diagnostic Pathology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Ayaka Mitsui
- Department of Diagnostic Pathology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Eijitsu Ryo
- Division of Molecular Pathology, National Cancer Center Research Institute, Tokyo, Japan
| | - Yuki Kojima
- Department of Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Kan Yonemori
- Department of Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yasushi Yatabe
- Department of Diagnostic Pathology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
- Division of Molecular Pathology, National Cancer Center Research Institute, Tokyo, Japan
| | - Taisuke Mori
- Department of Diagnostic Pathology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
- Division of Molecular Pathology, National Cancer Center Research Institute, Tokyo, Japan.
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19
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Sharma A, Sharma R, Bala J, Sharma M. Malignant Perivascular Epithelioid Cell Tumor of Ovary: A Rare Case Report. J Midlife Health 2025; 16:107-109. [PMID: 40330237 PMCID: PMC12052290 DOI: 10.4103/jmh.jmh_157_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2024] [Revised: 09/24/2024] [Accepted: 10/26/2024] [Indexed: 05/08/2025] Open
Abstract
Perivascular epithelioid cell tumors (PEComas) have unique morphology comprised perivascular epitheloid cells and express both melanocytic and smooth muscle cell markers. Gynecological PEComas account for approximately 25% of all PEComas, and in most cases, the primary site of the tumor is the uterine body. Ovarian PEComa is exceptional. Here, we report a case of primary malignant PEComa of ovary in a 38 years female.
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Affiliation(s)
- Anuradha Sharma
- Department of Pathology, Dr. RKGMC, Hamirpur, Himachal Pradesh, India
| | - Reetika Sharma
- Department of Pathology, Dr. RKGMC, Hamirpur, Himachal Pradesh, India
| | - Jyoti Bala
- Department of Pathology, Dr. RKGMC, Hamirpur, Himachal Pradesh, India
| | - Monika Sharma
- Department of OBG, Dr. RKGMC, Hamirpur, Himachal Pradesh, India
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20
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Dundr P, Matěj R, Hojný J, Hájková N, Němejcová K, Kendall Bártů M. The Spectrum of Fusions Occurring in Non-Smooth Muscle Mesenchymal Uterine Tumors: A Review of the Current Knowledge. Arch Pathol Lab Med 2025; 149:90-102. [PMID: 38484759 DOI: 10.5858/arpa.2023-0324-ra] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2023] [Indexed: 12/28/2024]
Abstract
CONTEXT.— Non-smooth muscle uterine sarcomas are mostly represented by low-grade endometrial stromal sarcoma. However, several other rare, distinct types of uterine sarcoma are recognized, including high-grade endometrial stromal sarcoma, tumors with kinase fusions, uterine tumors resembling ovarian sex cord tumors, soft tissue-type sarcoma, and emerging entities such as KAT6A/B-rearranged tumors. The landscape of uterine sarcomas has changed, mostly because of the increasing knowledge concerning their molecular aberrations. OBJECTIVE.— To offer a comprehensive review of the literature focusing on fusions occurring in tumors other than smooth muscle mesenchymal uterine tumors with respect to their type, frequency, and overlap between diagnostic categories and entities. DATA SOURCES.— The data were mined from the PubMed/MEDLINE database covering the time period from January 1988 to June 2023. In total, 156 studies focusing on the problematics of fusions occurring in non-smooth muscle mesenchymal uterine tumors were selected, and thus became the basis for this review. CONCLUSIONS.— One hundred ten fusions were identified in 703 tumors. The diagnostic significance of the molecular aberrations occurring in these tumors can be unclear in some cases. This can be related to the rare aberrations with a limited number of reported cases. Additionally, even well-known aberrations considered as specific for a certain distinct entity can occur in other lesions, the biological behavior and clinical significance of which can differ substantially.
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Affiliation(s)
- Pavel Dundr
- From the Department of Pathology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic (Dundr, Matěj, Hojný, Hájková, Němejcová, Kendall Bártů)
| | - Radoslav Matěj
- From the Department of Pathology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic (Dundr, Matěj, Hojný, Hájková, Němejcová, Kendall Bártů)
- the Department of Pathology, Charles University, Third Faculty of Medicine, University Hospital Kralovske Vinohrady, Prague, Czech Republic (Matěj)
- the Department of Pathology and Molecular Medicine, Third Faculty of Medicine, Charles University, Thomayer University Hospital, Prague, Czech Republic (Matěj)
| | - Jan Hojný
- From the Department of Pathology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic (Dundr, Matěj, Hojný, Hájková, Němejcová, Kendall Bártů)
| | - Nikola Hájková
- From the Department of Pathology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic (Dundr, Matěj, Hojný, Hájková, Němejcová, Kendall Bártů)
| | - Kristýna Němejcová
- From the Department of Pathology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic (Dundr, Matěj, Hojný, Hájková, Němejcová, Kendall Bártů)
| | - Michaela Kendall Bártů
- From the Department of Pathology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic (Dundr, Matěj, Hojný, Hájková, Němejcová, Kendall Bártů)
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21
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Fontanges Q, Truffaux N, Azmani R, Bourdon A, Croce S. [Translocation-associated uterine mesenchymal tumors: The new without forgetting the old. An integrated diagnostic approach]. Ann Pathol 2025; 45:53-77. [PMID: 39424447 DOI: 10.1016/j.annpat.2024.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 09/15/2024] [Accepted: 09/16/2024] [Indexed: 10/21/2024]
Abstract
This review focuses on uterine mesenchymal tumors that are defined on a molecular level by a single and unique genetic alteration, that is somehow necessary and sufficient to allow tumor growth and progression. Although diverse from a clinical, morphological and immunohistochemical point of view, the different entities we are going to talk about share both a simple genomic profile with a low number of chromosomal alterations observed by CGH Array (few deletions, gains or amplifications...) and a low mutational burden observed by sequencing technics. Some of these entities are already well known and described in the literature when found outside of the uterus and gynecological tract. It remains intriguing that uterine mesenchymal pathology has been lagging behind when compared to its extrauterine counterpart. How can we explain that when it comes to inflammatory myofibroblastic tumors, abundant numbers of articles have been published since the 70's, but it was only in the early 2000s that the first relevant descriptions of this tumor in the uterus emerged? Certainly, the increased accuracy, availability, and use of molecular biology technics and in particular RNA sequencing in the area of uterine pathology can partly explain the reduction of the gap between soft tissue and uterine pathology we currently observe. Other reasons explaining this gap may be the high prevalence of smooth muscle tumors in the uterus and the abounding diversity of their morphological aspects, which may have partly eclipsed the array of differential diagnoses. Last but not least, one can hypothesize that the relative "simplicity" of hysterectomy procedures, referring to their safety and accessibility, has cured most of the lesions and partly clouded our knowledge regarding the biological potential and natural history of these newly described entities. As a consequence of this situation, our reader will often encounter the wording "uncertain malignant potential", as for some of these rare entities, evidence to establish reliable prognostic variables is still insufficient. We hope this review to be a useful tool to guide pathologists through the diversity and complexity of uterine mesenchymal tumors. As a scientific and medical community, sharing this knowledge will help us to collectively raise our vigilance and awareness by expanding the array of our differential diagnoses. We hope this will lead to more cases being accurately diagnosed, and ultimately, to a deeper knowledge regarding the biological potential and clinical evolution of these tumors. From a therapeutical point of view, the consequences of an accurate diagnosis for the patient are already appreciable through the use of targeted therapy. Examples include: ALK inhibitors in inflammatory myofibroblastic tumor, tyrosine-kinase inhibitors in COL1A::PDGFB rearranged sarcomas or mTOR inhibitors in PEComa.
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Affiliation(s)
- Quitterie Fontanges
- Département de pathologie, cliniques universitaires de Saint-Luc, Bruxelles, Belgique.
| | | | - Rihab Azmani
- Unité bio-informatique, direction données et santé numérique, institut Bergonié, Bordeaux, France
| | - Aurélien Bourdon
- Unité bio-informatique, direction données et santé numérique, institut Bergonié, Bordeaux, France
| | - Sabrina Croce
- Département de biopathologie, institut Bergonié, Bordeaux, France; Unité Inserm 1312, Bordeaux, France
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22
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Ladwig N, Boyraz B. Risk Stratification of Miscellaneous Uterine Mesenchymal Neoplasms: The Role of Morphology, Immunohistochemistry, and Molecular Testing. Adv Anat Pathol 2025; 32:57-69. [PMID: 39711163 DOI: 10.1097/pap.0000000000000479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2024]
Abstract
Uterine mesenchymal tumors are a diverse group of tumors that can display a broad range of morphologic, immunohistochemical, and molecular profiles and are associated with varied clinical behaviors. In recent years, they have increasingly been classified by their underlying molecular alterations, leading to a more precise separation of diagnostic entities. As their diagnostic criteria have been refined, so too have the features that can be used to predict clinical outcomes. This review includes a discussion of uterine inflammatory myofibroblastic tumors, perivascular epithelioid cell tumors (PEComa), and uterine tumors resembling ovarian sex cord tumors, with a focus on updates on their clinical behavior and tools for risk stratification to identify malignant tumors. In addition, we discuss the importance of using an integrated approach when classifying uterine mesenchymal tumors to improve diagnostic accuracy and guide clinical management.
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Affiliation(s)
- Nicholas Ladwig
- Department of Pathology, University of California San Francisco, San Francisco, CA
| | - Baris Boyraz
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY
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23
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López-Terrada D, Stahlschmidt J, Pérez-Atayde AR. "Update on pediatric primary liver tumors". Virchows Arch 2025; 486:23-47. [PMID: 39836187 DOI: 10.1007/s00428-024-03985-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2024] [Revised: 11/14/2024] [Accepted: 11/15/2024] [Indexed: 01/22/2025]
Abstract
Liver masses are common in children, however primary malignant neoplasms are rare, representing only 1% of all pediatric cancers. Hepatocellular neoplasms are the most common primary liver malignancies and hepatoblastoma (HB) is the most frequently diagnosed. The incidence of HB, which is increasing, is approximately of 2 cases per million in the United States, followed by hepatocellular carcinoma (HCC). Pediatric primary liver tumors of mesenchymal origin are less common, except for benign vascular tumors (hemangiomas). Malignant mesenchymal neoplasms represent approximately 10-15% of all, the most common being embryonal sarcoma and malignant rhabdoid tumor. Malignant vascular tumors are rare, but epithelioid hemangioendothelioma (EHE) and angiosarcoma can be seen in children. The development and adoption of consensus diagnostic, therapeutic and risk-stratifying approaches for pediatric patients with malignant liver tumors has been historically challenged by their rarity and by their diverse clinical and histological appearance. On-going collaborative efforts of international consortia including the Children's Oncology Group (COG) in North America, the German Society of Paediatric Oncology and Haematology (GPOH), the Societe Internationale d' Oncologie Pediatrique Liver Tumor Study Group (SIOPEL) in Europe and the Japanese Liver Tumor group (JPLT), have made significant contributions to understanding the clinical and histopathological features, as well as the underlying biology of pediatric liver tumors, in particular HB. A new classification of pediatric liver tumors drafted at the international consensus meeting held in Los Angeles, has been incorporated in the recent WHO classification and is currently used by the PHITT (Paediatric Hepatic Malignancy International Tumour Trial) and other therapeutic protocols. This manuscript provides an overview of salient diagnostic features and updates in classification and molecular characterization for the most common pediatric primary liver neoplasms. It also includes a brief overview of other less common but relevant tumors, which should be considered in the differential diagnosis.
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Affiliation(s)
- Dolores López-Terrada
- Department of Pathology, Texas Children's Hospital, and Baylor College of Medicine, Houston, TX, USA.
| | - Jens Stahlschmidt
- Department of Histopathology and Molecular Pathology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Antonio R Pérez-Atayde
- Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
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24
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Paula D, Amaral MJ, Madeira J, Simões J, Lázaro A, Silva N, Tralhão JG. Rare Encounter: A Case Report of Hepatic Perivascular Epithelioid Cell Tumor - An Uncommon Mesenchymal Tumor in the Liver. Case Rep Gastroenterol 2025; 19:43-51. [PMID: 39981171 PMCID: PMC11759453 DOI: 10.1159/000543018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 11/29/2024] [Indexed: 02/22/2025] Open
Abstract
Introduction Perivascular epithelioid cell tumor (PEComa) is a rare neoplastic mesenchymal tumor, more frequently found in the uterus, although it can occur in different organs. Hepatic PEComa is extremely rare, with only a few cases described in the literature. Case Presentation We present a case report of a 33-year-old female patient with a history of macroprolactinoma. She was initially referred to our Department due to a 9-mm hepatic nodule incidentally diagnosed in an abdominal ultrasound in 2018. She was asymptomatic. Follow-up ultrasound showed a growth from 9 mm to 16 mm in 2019 and 30 mm in a liver magnetic resonance imaging (MRI) scan in 2022. The case was discussed in a multidisciplinary team meeting, and since malignant transformation or hepatocellular carcinoma could not be ruled out, the decision was to undergo hepatic resection. An open hepatic subsegmentectomy of segment 5 was performed, with uneventful postoperative period. The definitive diagnosis was hepatic PEComa. Conclusion Hepatic PEComas are rare liver tumors, and their preoperative diagnosis is challenging due to the lack of specific radiological features. In most cases, the diagnosis is only confirmed through histopathological and immunohistochemical studies. Resection of the lesion appears to be the curative treatment; however, due to the rarity of the condition, there are no studies comparing surgical treatment with other options. In our case, the hypervascular lesion was initially misdiagnosed as an adenoma. PEComas should be considered as a differential diagnosis in liver nodules with well-defined margins and increased uptake in the arterial phase in computed tomography or MRI scan. Surgical resection was curative, and no recurrence was detected during the patient's follow-up.
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Affiliation(s)
- Diogo Paula
- General Surgery Unit, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
- Clinical Academic Center of Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, FMUC, Coimbra, Portugal
| | - Maria João Amaral
- General Surgery Unit, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
- Clinical Academic Center of Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, FMUC, Coimbra, Portugal
| | - Joana Madeira
- Clinical Academic Center of Coimbra, Coimbra, Portugal
- Pathology Unit, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
| | - João Simões
- General Surgery Unit, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
- Clinical Academic Center of Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, FMUC, Coimbra, Portugal
| | - André Lázaro
- General Surgery Unit, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
- Clinical Academic Center of Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, FMUC, Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR) Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Nuno Silva
- Clinical Academic Center of Coimbra, Coimbra, Portugal
- Hepatic Transplantation Unit, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
| | - José Guilherme Tralhão
- General Surgery Unit, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
- Clinical Academic Center of Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, FMUC, Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR) Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Institute of Biophysics, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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Afzal A, Tahir MJ, Asghar A, Din IU, Naveed MA. Malignant epithelioid angiomyolipoma of the submandibular gland: A case report. Radiol Case Rep 2024; 19:6333-6338. [PMID: 39387025 PMCID: PMC11461934 DOI: 10.1016/j.radcr.2024.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2024] [Revised: 09/02/2024] [Accepted: 09/04/2024] [Indexed: 10/12/2024] Open
Abstract
An epithelioid angiomyolipoma (a perivascular epithelioid cell tumor) is a rare mesenchymal neoplasm with distinctive cellular morphology and nonspecific imaging appearances. Mostly reported perivascular epithelioid cell tumors (PEComas) are benign; however, rarely, PEComas can be malignant with pulmonary, hepatic, nodal, and osseous metastases. We present a case of a 40-year-old man with malignant right submandibular salivary gland PEComa, metastasized to the bones, lungs, and liver. We are going to discuss the diagnosis and management options of the rare disease of metastatic PEComa of the submandibular salivary gland.
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Affiliation(s)
- Ayesha Afzal
- Department of Radiology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Punjab province, Pakistan
| | - Muhammad Junaid Tahir
- Department of Radiology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Punjab province, Pakistan
| | - Asma Asghar
- Department of Radiology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Punjab province, Pakistan
| | - Islah Ud Din
- Department of Radiology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Punjab province, Pakistan
| | - Muhammad Atif Naveed
- Department of Radiology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Punjab province, Pakistan
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26
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Bennett JA, Pinto A. The "Other" Uterine Mesenchymal Neoplasms: Recent Developments and Emerging Entities. Adv Anat Pathol 2024; 31:380-396. [PMID: 38623604 DOI: 10.1097/pap.0000000000000440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
Uterine mesenchymal neoplasms are a challenging group of tumors that often show overlapping morphologic features and immunohistochemical profiles. The increasing use of molecular testing in these tumors has enabled a better appreciation of their pathobiology, resulting in a wave of emerging neoplasms and improved characterization of ones previously considered exceptionally rare. Identification of specific molecular alterations has permitted targeted therapy options in tumors that were typically unresponsive to conventional therapies, as well as recognition that a subset can have a hereditary basis. This review will discuss the more "common" of the uncommon uterine mesenchymal neoplasms, including inflammatory myofibroblastic tumor, perivascular epithelioid cell tumor, uterine tumor resembling ovarian sex cord tumor, and embryonal rhabdomyosarcoma. This will be followed by an overview of emerging entities, including NTRK -rearranged uterine sarcoma, SMARCA4 -deficient uterine sarcoma, KAT6B/A::KANSL1 fusion uterine sarcoma, and MEIS1::NCOA2/1 fusion sarcoma.
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Affiliation(s)
| | - Andre Pinto
- Department of Pathology and Laboratory Medicine, University of Miami, Miami, FL
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Hanna J, Russell-Goldman E, Baranov E, Pissaloux D, Li YY, Tirode F, de la Fouchardiere A, Fletcher CDM. PEComa With MITF Overexpression: Clinicopathologic and Molecular Analysis of a Series of 36 Cases. Am J Surg Pathol 2024; 48:1381-1388. [PMID: 38934541 DOI: 10.1097/pas.0000000000002276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
Perivascular epithelioid cell neoplasms (PEComas) are tumors of uncertain cell lineage that occur across a wide age range, at a variety of anatomic sites, and with a female predominance. Most PEComas are associated with dysregulation of the mTOR pathway, most commonly through inactivating mutations of TSC2 or TSC1 . However, a small subset of PEComas are instead associated with TFE3 gene fusions. MITF is closely related to TFE3 and is frequently overexpressed in PEComas, often in a mutually exclusive manner with TFE3. Here we report the clinical, histopathologic, and molecular features of MITF-overexpressing PEComas in a series of 36 cases. The clinical and morphologic features were comparable to conventional PEComa, although the immunohistochemical profile was notable for the relatively limited expression of melanocytic markers, a surprising finding given that MITF is the master regulator of melanocytic differentiation. At the molecular level, 20 cases (56%) showed supernumerary copies of the MITF gene, suggesting a potential explanation for MITF overexpression. A putative genetic driver event within the mTOR pathway was identified in 11 of 15 cases (73%) analyzed by DNA or RNA sequencing. Interestingly, the malignant PEComas showed 2 distinguishing molecular features: they were associated with a complex chromosomal copy number profile, and they tended to show additional genetic changes, most commonly inactivating events involving TP53 , RB1 , and ATRX . These results elucidate key features of PEComas showing MITF overexpression, begin to explain the molecular basis for MITF overexpression in some PEComas and identify potential molecular correlates for malignancy that may be applicable to the broader PEComa family.
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Affiliation(s)
- John Hanna
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Eleanor Russell-Goldman
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Esther Baranov
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Daniel Pissaloux
- INSERM 1052, CNRS 5286, Cancer Research Center of Lyon
- Department of Biopathology, Centre Leon Bernard, Lyon, France
| | - Yvonne Y Li
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Franck Tirode
- Department of Biopathology, Centre Leon Bernard, Lyon, France
| | - Arnaud de la Fouchardiere
- INSERM 1052, CNRS 5286, Cancer Research Center of Lyon
- Department of Biopathology, Centre Leon Bernard, Lyon, France
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28
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Wang R, Luo H, Cao W. Clinical and ultrasound features of uterine perivascular epithelioid cell tumors: case series and literature review. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2024; 64:687-695. [PMID: 39395194 DOI: 10.1002/uog.29116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 08/25/2024] [Accepted: 09/03/2024] [Indexed: 10/14/2024]
Abstract
OBJECTIVE To describe the clinical and ultrasonographic features of uterine perivascular epithelioid cell tumor (PEComa) using standardized terminology. METHODS This was a retrospective analysis of patients with uterine PEComa diagnosed and confirmed by pathology and immunohistochemistry at West China Second University Hospital, Sichuan University, Sichuan, China, between January 2010 and September 2023. The Morphological Uterus Sonographic Assessment (MUSA) consensus and the International Endometrial Tumor Analysis (IETA) consensus were utilized for the standardized description of the sonographic characteristics of uterine PEComa. We summarized the clinical and ultrasound features of uterine PEComa in cases from our center and those found in a review of the literature conducted using PubMed from 1 January 2013 to 30 September 2023 (inclusive). RESULTS Five patients, aged 33-57 (median, 52) years, with a total of six uterine PEComa lesions were included in our cohort. All cases had complete ultrasonographic and pathological images. None of the patients had a history of tuberous sclerosis complex. Two patients had malignant PEComa (one patient had two lesions) and three had benign PEComa, originating from the cervix, myometrium or uterine cavity. Patients presented with symptoms including increased vaginal discharge, vaginal bleeding and pelvic or abdominal pain. The three patients with benign PEComa underwent total hysterectomy and bilateral adnexectomy, tumor excision and conservative management, respectively, while both malignant cases underwent total hysterectomy and bilateral adnexectomy followed by chemotherapy. Regular follow-up (from 6 to 24 months) revealed recurrence in one case. Two lesions were misdiagnosed as uterine fibroids, two as cervical cancer, one as metastatic cervical cancer (with myometrial invasion) and one was indeterminate. Ultrasound examination showed that most lesions displayed regular round or ovoid shape (66.7%), uniform echoes (66.7%) and hypoechogenicity (66.7%), with one (16.7%) malignant PEComa showing cystic areas and one (16.7%) benign PEComa showing punctate calcifications. All lesions lacked shadowing and the majority showed moderate to abundant vascularity (color score of 3-4, 83.3%). The color score was 2-4 in the periphery in 100% of cases and internally in 83.3% of cases. The three benign PEComas showed similar characteristics in vascular distribution, with scattered internal vessels and peripheral vessels exhibiting a circular pattern. The literature search identified 11 articles describing the ultrasonographic appearance of 18 cases of uterine PEComa, with similar characteristics to those in our cohort. CONCLUSIONS The sonographic features of uterine PEComa include a uniform or non-uniform hypoechogenic mass, typically round or ovoid with regular margins, occasionally containing cystic areas or calcifications, lacking shadowing and often showing moderate to abundant vascularity. Although the preoperative ultrasound diagnosis of uterine PEComa remains challenging, particularly given the non-specific nature of the sonographic characteristics described here, dispersed intratumoral vessels and a peripheral circular vascular distribution may serve as diagnostic clues for uterine PEComa, but more cases are needed for confirmation. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- R Wang
- Department of Ultrasonic Medicine, West China Second Hospital of Sichuan University, Chengdu, Sichuan, China
| | - H Luo
- Department of Ultrasonic Medicine, West China Second Hospital of Sichuan University, Chengdu, Sichuan, China
| | - W Cao
- Department of Ultrasonic Medicine, West China Second Hospital of Sichuan University, Chengdu, Sichuan, China
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29
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Hammer PM, Toland A, Shaheen M, Shenoy A, Esnakula A, Hicks MJ, Warran M, Al-Ibraheemi A, Davis JL, Tan SY. Perivascular Epithelioid Cell-Family Tumors in Children, Adolescents, and Young Adults: Clinicopathologic Features in 70 Cases. Arch Pathol Lab Med 2024; 148:e374-e385. [PMID: 38547914 DOI: 10.5858/arpa.2023-0552-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2024] [Indexed: 10/29/2024]
Abstract
CONTEXT.— Perivascular epithelioid cell tumors (PEComas) are rare mesenchymal tumors of uncertain histogenesis expressing smooth muscle and melanocytic markers. The clinicopathologic spectrum in young patients is not well documented. OBJECTIVE.— To describe a multi-institutional series of PEComas in children, adolescents, and young adults. DESIGN.— PEComas, not otherwise specified (NOS); angiomyolipomas (AMLs); lymphangioleiomyomatosis; and clear cell sugar tumors were retrospectively identified from 6 institutions and the authors' files. RESULTS.— Seventy PEComas in 64 patients (median age, 15 years) were identified. They were more common in females (45 of 64 patients), occurring predominantly in the kidney (53 of 70), followed by the liver (6 of 70). Thirty-four patients had confirmed tuberous sclerosis complex (TSC), 3 suspected TSC mosaicism, 2 Li-Fraumeni syndrome (LFS) and 1 neurofibromatosis type 1. Most common variants were classic (49 of 70) and epithelioid (8 of 70) AML. Among patients with AMLs, most (34 of 47) had TSC, and more TSC patients had multiple AMLs (15 of 36) than non-TSC patients (2 of 13). Two TSC patients developed malignant transformation of classic AMLs: 1 angiosarcomatous and 1 malignant epithelioid. Lymphangioleiomyomatosis (5 of 70) occurred in females only, usually in the TSC context (4 of 5). PEComas-NOS (6 of 70) occurred exclusively in non-TSC patients, 2 of whom had LFS (2 of 6). Three were malignant, 1 had uncertain malignant potential, and 2 were benign. All 4 PEComas-NOS in non-LFS patients had TFE3 rearrangements. CONCLUSIONS.— Compared to the general population, TSC was more prevalent in our cohort; PEComas-NOS showed more frequent TFE3 rearrangements and possible association with LFS. This series expands the spectrum of PEComas in young patients and demonstrates molecular features and germline contexts that set them apart from older patients.
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Affiliation(s)
- Phoebe M Hammer
- From the Department of Pathology, Stanford University School of Medicine, Stanford, California (Hammer, Tan)
| | - Angus Toland
- the Department of Pathology, Texas Children's Hospital, Baylor College of Medicine, Houston (Toland, Hicks)
| | - Muhammad Shaheen
- the Department of Pathology, Indiana University School of Medicine, Indianapolis (Shaheen, Davis)
| | - Archana Shenoy
- the Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio (Shenoy)
- the Department of Pathology, The Ohio State University College of Medicine, Columbus (Shenoy, Esnakula)
| | - Ashwini Esnakula
- the Department of Pathology, The Ohio State University College of Medicine, Columbus (Shenoy, Esnakula)
| | - M John Hicks
- the Department of Pathology, Texas Children's Hospital, Baylor College of Medicine, Houston (Toland, Hicks)
| | - Mikako Warran
- the Department of Pathology, Children's Hospital Los Angeles, University of Southern California, Los Angeles (Warran)
| | - Alyaa Al-Ibraheemi
- the Department of Pathology, Boston Children's Hospital, Boston, Massachusetts (Al-Ibraheemi)
| | - Jessica L Davis
- the Department of Pathology, Indiana University School of Medicine, Indianapolis (Shaheen, Davis)
| | - Serena Y Tan
- From the Department of Pathology, Stanford University School of Medicine, Stanford, California (Hammer, Tan)
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30
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Yu X, Duan R, Yang B, Huang L, Hou M, Qie M. Perivascular epithelioid cell tumor of the uterus and pelvic cavity. Front Oncol 2024; 14:1449936. [PMID: 39540153 PMCID: PMC11557460 DOI: 10.3389/fonc.2024.1449936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2024] [Accepted: 10/10/2024] [Indexed: 11/16/2024] Open
Abstract
Background Primary perivascular epithelioid cell tumors (PEComas) of the female reproductive tract have been primarily reported as case reports owing to their clinical rarity. Limited incidence rates and clinical case data hinder a comprehensive understanding of the risks and invasiveness of this disease. We discuss herein the diagnosis, treatment, and prognosis of this disease to enhance comprehension and therapeutic strategies. Methods We conducted a clinical analysis of patients with PEComa treated at the Gynecology Department of The West China Second University Hospital of Sichuan University between May 2018 and January 2024. Diagnosis and treatment were evaluated based on pertinent literature. Results Overall, eight patients (seven patients with tumors in the uterus and one patient with tumors in the pelvic cavity) were evaluated. One patient with PEComa of unknown malignant potential and two patients with malignant PEComa underwent hysterectomy and bilateral adnexectomy with or without adjuvant therapy and did not develop recurrence. Meanwhile, three patients who underwent lesion resection only exhibited radiological evidence of new lesions. Furthermore, postoperative imaging identified new pulmonary nodules in three patients. Conclusion Although the current criteria are generally effective in assessing the tumor invasiveness of PEComa, emphasizing the significance of complete lesion resection remains crucial. Inadequate treatment significantly increases the risks of recurrence and metastasis. Additionally, the prevalence of pulmonary metastases may have been underestimated. Refining risk stratification to prevent overtreatment of low-grade malignancies or overlooking highly aggressive tumors is an important area for further study.
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Affiliation(s)
- Xiuzhang Yu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Ruiqi Duan
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Bowen Yang
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Liyan Huang
- Department of Pathology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Minmin Hou
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Mingrong Qie
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
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31
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Zhang R, Feng RL, Yin ZY, Ke CX. Giant malignant perivascular epithelioid cell tumor of the right kidney. Asian J Surg 2024:S1015-9584(24)02188-2. [PMID: 39384439 DOI: 10.1016/j.asjsur.2024.09.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2024] [Accepted: 09/19/2024] [Indexed: 10/11/2024] Open
Affiliation(s)
- Ran Zhang
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Yunnan Province, Kunming, 650101, PR China
| | - Run-Lin Feng
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Yunnan Province, Kunming, 650101, PR China
| | - Zhi-Yuan Yin
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Yunnan Province, Kunming, 650101, PR China
| | - Chang-Xing Ke
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Yunnan Province, Kunming, 650101, PR China.
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Ray-Coquard I, Casali PG, Croce S, Fennessy FM, Fischerova D, Jones R, Sanfilippo R, Zapardiel I, Amant F, Blay JY, Martἰn-Broto J, Casado A, Chiang S, Dei Tos AP, Haas R, Hensley ML, Hohenberger P, Kim JW, Kim SI, Meydanli MM, Pautier P, Abdul Razak AR, Sehouli J, van Houdt W, Planchamp F, Friedlander M. ESGO/EURACAN/GCIG guidelines for the management of patients with uterine sarcomas. Int J Gynecol Cancer 2024; 34:1499-1521. [PMID: 39322612 DOI: 10.1136/ijgc-2024-005823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2024] Open
Affiliation(s)
- Isabelle Ray-Coquard
- Department of Medical Oncology, Centre Leon Berard, Lyon, France
- Hesper Laboratory, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Paolo Giovanni Casali
- Medical Oncology Unit 2, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Sabrina Croce
- Department of Biopathology, Institut Bergonié, Bordeaux, France
| | - Fiona M Fennessy
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Daniela Fischerova
- Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague 2, Czech Republic
| | - Robin Jones
- Royal Marsden Hospital NHS Trust, London, UK
| | - Roberta Sanfilippo
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Ignacio Zapardiel
- Gynecologic Oncology Unit, La Paz University Hospital, Madrid, Spain
| | - Frédéric Amant
- Department of Oncology, KU Leuven, Leuven, Flanders, Belgium
- Department of Gynecology, Antoni van Leeuwenhoek Nederlands Kanker Instituut afdeling Gynaecologie, Amsterdam, Netherlands
| | - Jean-Yves Blay
- Department of Medical Oncology, Centre Leon Berard, Lyon, France
| | - Javier Martἰn-Broto
- Department of Medical Oncology, Fundación Jimenez Diaz University Hospital, Madrid, Spain
- University Hospital General de Villalba, Madrid, Spain
| | - Antonio Casado
- Department of Medical Oncology, University Hospital San Carlos, Madrid, Spain
| | - Sarah Chiang
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Angelo Paolo Dei Tos
- Department of Integrated Diagnostics, Azienda Ospedale-Università Padova, Padua, Italy
- Department of Medicine, University of Padua, Padua, Italy
| | - Rick Haas
- Department of Radiotherapy, Netherlands Cancer Institute, Amsterdam, Netherlands
- Department of Radiotherapy, Leiden University Medical Center, Leiden, Netherlands
| | - Martee L Hensley
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Peter Hohenberger
- Division of Surgical Oncology and Thoracic Surgery, Mannheim University Medical Centre, University of Heidelberg, Mannheim, Germany
| | - Jae-Weon Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - Se Ik Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | | | - Patricia Pautier
- Department of Medical Oncology, Institut Gustave-Roussy, Villejuif, Île-de-France, France
| | - Albiruni R Abdul Razak
- Division of Medical Oncology and Hematology, Princess Margaret Hospital Cancer Centre Gynecologic Site Group, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jalid Sehouli
- Department of Gynecology with Center for Oncological Surgery, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Winan van Houdt
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | - Michael Friedlander
- Department of Medical Oncology, School of Clinical Medicine, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Department of Medical Oncology, Prince of Wales and Royal Hospital for Women, Randwick, New South Wales, Australia
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Zemni I, Houissa I, Boujelbene N, Sakhri S, Sassi I, Dhiab TB. Conservative treatment in uterine perivascular epithelioid cell tumor of uncertain malignant potential: a case report. J Med Case Rep 2024; 18:454. [PMID: 39354628 PMCID: PMC11446033 DOI: 10.1186/s13256-024-04781-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Accepted: 08/25/2024] [Indexed: 10/03/2024] Open
Abstract
INTRODUCTION Perivascular epithelioid cell tumors are uncommon mesenchymal tumors. The genital tract is the most common extrarenal location. Preoperative diagnosis is rarely achieved owing to non-specific symptoms and imaging features. Consensus on treatment strategies remains elusive. Case presentation We report the case a 38 year-old north African woman with a primary sterility, who was diagnosed with a uterine Perivascular epithelioid cell tumor of uncertain malignant potential on a resection specimen of an intracavity polypoid mass. Immunohistochemistry confirmed the diagnosis and we opted for conservative surgery to preserve the patient's fertility desires. CONCLUSION Uterine perivascular epithelioid cell tumor is a rare entity that warrants consideration in the differential diagnosis of uterine tumors. Treatment modalities, follow-up protocols, and prognosis remain ambiguous. Given their unpredictable behavior, accurate diagnosis and long-term monitoring are imperative.
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Affiliation(s)
- Ines Zemni
- Department of Surgical Oncology, Salah Azaiez Institute, Faculty of Medicine of Tunis, University of Tunis El Manar, Boulevard 9 Avril 1938, Tunis, Tunisia.
- University Tunis El Manar, Tunis, Tunisia.
| | - Ines Houissa
- Department of Surgical Oncology, Salah Azaiez Institute, Faculty of Medicine of Tunis, University of Tunis El Manar, Boulevard 9 Avril 1938, Tunis, Tunisia
| | - Nadia Boujelbene
- University Tunis El Manar, Tunis, Tunisia
- Department of Pathology, Salah Azaiez Institute, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Saida Sakhri
- Department of Surgical Oncology, Salah Azaiez Institute, Faculty of Medicine of Tunis, University of Tunis El Manar, Boulevard 9 Avril 1938, Tunis, Tunisia
- University Tunis El Manar, Tunis, Tunisia
| | - Imene Sassi
- Department of Surgical Oncology, Salah Azaiez Institute, Faculty of Medicine of Tunis, University of Tunis El Manar, Boulevard 9 Avril 1938, Tunis, Tunisia
- University Tunis El Manar, Tunis, Tunisia
| | - Tarek Ben Dhiab
- Department of Surgical Oncology, Salah Azaiez Institute, Faculty of Medicine of Tunis, University of Tunis El Manar, Boulevard 9 Avril 1938, Tunis, Tunisia
- University Tunis El Manar, Tunis, Tunisia
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Garzon S, Caliò A, Ferrari FA, Iannicello CQ, Zorzato PC, Bosco M, Piazzola E, Martignoni G, Laganà AS, Mariani A, Uccella S. Uterine perivascular epithelioid cell tumors (PEComa) and the accuracy of proposed classification systems in predicting the malignant versus non-malignant behavior. Gynecol Oncol 2024; 188:35-43. [PMID: 38905754 DOI: 10.1016/j.ygyno.2024.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 06/08/2024] [Accepted: 06/11/2024] [Indexed: 06/23/2024]
Abstract
OBJECTIVE To compare the accuracy of available classification systems (Folpe, modified Folpe, Bennet, and Schoolmester) in predicting the behavior of uterine Perivascular Epithelioid Cell tumors (PEComas). METHODS We reviewed the pathology registry to identify all uterine PEComas treated at our center. We conducted a systematic literature review searching electronic databases from inception to November 2023. We included all references reporting at least one case of uterine PEComa; cases associated with tuberous sclerosis complex were excluded. Patient-level data were extracted by identified records. Survival analysis was used to assess the accuracy of all proposed classification systems to classify uterine PEComas as malignant versus non-malignant. RESULTS Six uterine PEComas were treated at our center. The literature search identified 101 uterine PEComas from 32 studies. Eighty-five out of 107 PEComas (28 studies and our series) reported enough follow-up data and details to apply all four classifications. The modified Folpe classification demonstrated the highest hazard ratio (HR) for relapse (HR:8.63; 95% confidence interval [CI] 2.06-36.1) and death due to PEComa (HR:6.8, 95%CI:0.89-51.6) for malignant versus non-malignant PEComas. Changing the cut-off of PEComa size to ≥8 cm and mitotic figures per 50 high power fields to ≥5, the HR for recurrence lowered (HR:6.26; 95% CI 2.20-17.80), but HR for death increased (HR:10.3; 95% CI 1.35-77.80). CONCLUSIONS The modified Folpe classification was the most accurate in predicting the PEComa behavior. Changing the cut-off of PEComa size and number of mitotic figures may improve the accuracy in predicting death due to disease.
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Affiliation(s)
- Simone Garzon
- Unit of Obstetrics and Gynecology, Department of Surgery, Dentistry, Pediatrics, and Gynecology, AOUI Verona, University of Verona, Verona, Italy.
| | - Anna Caliò
- Section of Pathology, Department of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - Filippo Alberto Ferrari
- Unit of Obstetrics and Gynecology, Department of Surgery, Dentistry, Pediatrics, and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Cesare Quintino Iannicello
- Unit of Obstetrics and Gynecology, Department of Surgery, Dentistry, Pediatrics, and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Pier Carlo Zorzato
- Unit of Obstetrics and Gynecology, Department of Surgery, Dentistry, Pediatrics, and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Mariachiara Bosco
- Unit of Obstetrics and Gynecology, Department of Surgery, Dentistry, Pediatrics, and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Elena Piazzola
- Section of Pathology, Department of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - Guido Martignoni
- Section of Pathology, Department of Diagnostic and Public Health, University of Verona, Verona, Italy; Department of Pathology, Pederzoli Hospital, Peschiera del Garda, Verona, Italy
| | - Antonio Simone Laganà
- Unit of Obstetrics and Gynecology, "Paolo Giaccone" Hospital, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Andrea Mariani
- Department of Gynecology and Obstetrics, Mayo Clinic, Rochester, MN, USA
| | - Stefano Uccella
- Unit of Obstetrics and Gynecology, Department of Surgery, Dentistry, Pediatrics, and Gynecology, AOUI Verona, University of Verona, Verona, Italy
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Chen JM, Hernandez E, Frosina D, Ruh PA, Ariyan C, Busam KJ, Jungbluth AA. In Situ Protein Expression Analysis of Melanocyte Differentiation Antigen TRP1 (Tyrosinase-Related Protein-1). Am J Dermatopathol 2024; 46:563-571. [PMID: 39008470 DOI: 10.1097/dad.0000000000002772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/17/2024]
Abstract
ABSTRACT Melanocyte differentiation antigens refer to molecules expressed in cells of melanocytic lineage such as gp100/PMEL, tyrosinase, and Melan-A. Corresponding antibodies such as HMB45, T311, and A103 have become key immunohistochemical tools in surgical pathology for the diagnosis of pigmented and related lesions. Little is known about tyrosinase-related protein 1 (TRP1), another melanocyte differentiation antigen, which is an enzymatic component of melanogenesis and known as the brown locus in mice. In this study, we tested several commercial reagents to TRP1 and identified one clone, EPR13063, which we further characterized by testing its specificity and usefulness for surgical pathology. Subsequently, we analyzed the expression of TRP1 in panels of normal tissues and tumors. TRP1 is regularly expressed in normal skin and in cutaneous nevi predominantly present in junctional and to a lesser extent in dermal nevocytes. In melanoma, TRP1 is present in 100% and 44% of primary and metastatic melanomas, respectively. TRP1 was absent in 5 desmoplastic melanomas but heterogeneously present in 9 of 11 PEComas/angiomyolipomas. No TRP1 was found in neoplasms of nonmelanocytic lineage. We demonstrate that EPR13063 is a valuable reagent for the analysis of TRP1 expression in archival surgical pathology material. The TRP1 expression pattern in melanocytic and related lesions appears to parallel other melanocyte differentiation antigens with a higher incidence in primary and a lower incidence in metastatic melanomas.
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Ji M, Zhang Y, Liu S, Zhang M, Qiao B. Hepatic perivascular epithelioid cell tumor: a retrospective analysis of 36 cases. Front Oncol 2024; 14:1416254. [PMID: 39220650 PMCID: PMC11361986 DOI: 10.3389/fonc.2024.1416254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 07/31/2024] [Indexed: 09/04/2024] Open
Abstract
Background and aims Hepatic perivascular epithelioid cell tumor (PEComa) is a rare type of mesenchymal neoplasm and lacks systematic reports. The aim was to analyze the features of hepatic PEComa in order to provide our own experience for diagnosis and management from a single center. Methods We retrospectively analyzed clinical data, imaging findings, pathology, treatments and prognosis of 36 patients with hepatic PEComa in the First Affiliated Hospital of Zhengzhou University from January 2016 to September 2023. Results 29 females and 7 males (median age, 47.8 years) were included in this study. The majority (26/36, 72.2%) of patients were diagnosed incidentally with non-specific symptoms. Abnormal enhancement of enlarged blood vessels (27/36,75%) can be observed on CT/MRI and only 7 patients (19.4%) were correctly diagnosed by imaging examinations. The positive immunohistochemical expressions were HMB-45(35/36,97.2%), Melan-A (34/35,97.1%), SMA (23/26,88.5%) and CD34(86.7%,26/30). Treatments include resection (24/36,67.7%), radiofrequency ablation (6/36,16.7%), transcatheter arterial chemoembolization(1/36,2.7%), conservative clinical follow-up(2/36,5.6%), and sirolimus-chemotherapy (3/36,8.3%). During the follow-up period (range, 2-81 months), except for one patient with a single intrahepatic recurrence and 3 malignant patients died in 6 months, the remaining patients had no signs of recurrence and metastasis. Conclusions Hepatic PEComa has no specific clinical features and mainly depends on clinicopathological characteristics for accurate diagnosis. Resection is the best treatment for benign PEComa, but TACE and radiofrequency ablation can also be considered in case of contraindications for surgery.
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Affiliation(s)
- Min Ji
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Wang Y, Zheng A. A rare case of uterine perivascular epithelioid cell tumor (PEComa). Asian J Surg 2024:S1015-9584(24)01394-0. [PMID: 38987145 DOI: 10.1016/j.asjsur.2024.07.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 07/04/2024] [Indexed: 07/12/2024] Open
Affiliation(s)
- Yuhe Wang
- Department of Obstetrics and Gynecology, West China Second Hospital, Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, Sichuan, 610041, China
| | - Ai Zheng
- Department of Obstetrics and Gynecology, West China Second Hospital, Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, Sichuan, 610041, China.
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Dymkowski M, Kalman P, Niecikowski P, Koperski Ł, Kosieradzki M. Case report: Liver PEComa after kidney transplantation in recipient with tuberous sclerosis complex. Front Oncol 2024; 14:1386569. [PMID: 39026968 PMCID: PMC11254673 DOI: 10.3389/fonc.2024.1386569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 06/19/2024] [Indexed: 07/20/2024] Open
Abstract
Introduction Perivascular epithelioid cell tumors (PEComa) are rare tumors of mesenchymal origin that exhibit perivascular epithelioid cell phenotype. One of its most common localizations is uterus, whereas only a few studies reported PEComa localization as liver. There is a correlation between the presence of PEComa and tuberous sclerosis complex (TSC). TSC is a rare disease which leads to the development of mostly non-cancerous tumors in various organs. We would like to present a case of a kidney transplant recipient with a PEComa detected post-transplant in the liver. Case report A 27-year-old patient, 3 years after kidney transplantation (KTx) due to chronic renal failure in the course of autosomal dominant polycystic kidney disease and concomitant TSC, was admitted to the Clinic and Department of General and Transplant Surgery for abnormal findings in computed tomography (CT). A CT scan was conducted for oncological follow-up after a kidney transplant (KTx) because before the transplantation, a small cystic lesion measuring 7 mm in diameter was removed from the donor kidney and diagnosed as papillary renal cell carcinoma (PRCC). Two tumors in the liver were detected - one 27mm in diameter in segment VII/VIII and the other 8mm in diameter in segment II/III. Because of typical radiological signs hepatocellular carcinoma was suspected, but the serum level of alpha fetoprotein was within normal limits and liver function was preserved. The intraoperative biopsy and the radiofrequency ablation (RFA) of the larger tumor were performed three months later. In the histopathological examination benign PEComa (HMB45 +, Melan A +) was detected. Conclusion The oncological surveillance made it possible to detect liver lesion in early stage and in 3,5-year follow-up no sign of recurrence of PEComa was found. This case is the second to show RFA as treatment method of liver PEComa and first in kidney transplant recipient.
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Affiliation(s)
- Marcin Dymkowski
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Paulina Kalman
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Niecikowski
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Łukasz Koperski
- Department of Pathology, Medical University of Warsaw, Warsaw, Poland
| | - Maciej Kosieradzki
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland
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Gantzer J, Toulmonde M, Severac F, Chamseddine AN, Charon-Barra C, Vinson C, Hervieu A, Bourgmayer A, Bertucci F, Ryckewaert T, Valentin T, Firmin N, Chaigneau L, Bompas E, Follana P, Rioux-Leclercq N, Soibinet-Oudot P, Bozec L, Le Loarer F, Weingertner N, Chevreau C, Duffaud F, Blay JY, Kurtz JE, Schöffski P, Brahmi M, Malouf GG. PEC-PRO: A new prognostic score from a series of 87 patients with localized perivascular epithelioid cell neoplasms (PEComas) treated with curative intent. Cancer 2024; 130:2304-2314. [PMID: 38470379 DOI: 10.1002/cncr.35277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/18/2023] [Accepted: 01/23/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Perivascular epithelioid cell neoplasms (PEComas) encompass a heterogeneous family of mesenchymal tumors. Previously described clinicopathologic features aimed at distinguishing benign from malignant variants but lacked prognostic value. METHODS This retrospective analysis examined clinicopathologic data from patients who had localized PEComa across French Sarcoma Network centers. The authors analyzed 12 clinicopathologic features in a Cox proportional hazard framework to derive a multivariate prognostic risk model for event-free survival (EFS). They built the PEComa prognostic score (PEC-PRO), in which scores ranged from 0 to 5, based on the coefficients of the multivariate model. Three groups were identified: low risk (score = 0), intermediate risk (score = 1), and high risk (score ≥ 2). RESULTS Analyzing 87 patients who had a median 46-month follow-up (interquartile range, 20-74 months), the median EFS was 96.5 months (95% confidence interval [CI], 47.1 months to not applicable), with 2-year and 5-year EFS rates of 64.7% and 58%, respectively. The median overall survival was unreached, with 2-year and 5-year overall survival rates of 82.3% and 69.3%, respectively. The simplified Folpe classification did not correlate with EFS. Multivariate analysis identified three factors affecting EFS: positive surgical margins (hazard ratio [HR], 5.17; 95% CI, 1.65-16.24; p = .008), necrosis (HR, 3.94; 95% CI, 1.16-13.43; p = .030), and male sex (HR, 3.13; 95% CI, 1.19-8.27; p = 0.023). Four variables were retained in the prognostic model. Patients with low-risk PEC-PRO scores had a 2-year EFS rate of 93.7% (95% CI, 83.8%-100.0%), those with intermediate-risk PEC-PRO scores had a 2-year EFS rate of 67.4% (95% CI, 53.9%-80.9%), and those with high-risk PEC-PRO scores had a 2-year EFS rate of 2.3% (95% CI, 0.0%-18.3%). CONCLUSIONS The PEC-PRO score reliably predicts the risk of postoperative recurrence in patients with localized PEComa. It has the potential to improve follow-up strategies but requires validation in a prospective trial.
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Affiliation(s)
- Justine Gantzer
- Department of Medical Oncology, Institut de Cancérologie de Strasbourg-Europe, Strasbourg, France
| | - Maud Toulmonde
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - François Severac
- Department of Public Health, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Ali N Chamseddine
- Department of Medical Oncology, Institut Gustave Roussy, Villejuif, France
| | | | - Charles Vinson
- Department of Pathology, Centre Georges François Leclerc, Dijon, France
| | - Alice Hervieu
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Agathe Bourgmayer
- Department of Medical Oncology, Institut de Cancérologie de Strasbourg-Europe, Strasbourg, France
| | - François Bertucci
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseilles, France
| | | | - Thibaud Valentin
- Department of Medical Oncology, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Nelly Firmin
- Department of Medical Oncology, Institut du Cancer de Montpellier, Montpellier, France
| | - Loïc Chaigneau
- Department of Medical Oncology, Institut Regional du Cancer en Franche-Comté, Besançon, France
| | - Emmanuelle Bompas
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest, Nantes, France
| | - Philippe Follana
- Department of Medical Oncology, Centre Antoine-Lacassagne, Nice, France
| | | | | | - Laurence Bozec
- Department of Medical Oncology, Institut Curie, Saint-Cloud, France
| | | | - Noëlle Weingertner
- Department of Pathology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Christine Chevreau
- Department of Medical Oncology, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Florence Duffaud
- Department of Medical Oncology, Centre Hospitalier Universitaire de Marseilles, Marseilles, France
| | - Jean-Yves Blay
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Jean-Emmanuel Kurtz
- Department of Medical Oncology, Institut de Cancérologie de Strasbourg-Europe, Strasbourg, France
| | - Patrick Schöffski
- Department of Medical Oncology, University Hospitals, Leuven, Belgium
| | - Mehdi Brahmi
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Gabriel G Malouf
- Department of Medical Oncology, Institut de Cancérologie de Strasbourg-Europe, Strasbourg, France
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Dong BN, Zhan H, Luan T, Wang JS. Comprehensive Insights Into Renal Perivascular Epithelioid Cell Neoplasms: From Molecular Mechanisms to Clinical Practice. World J Oncol 2024; 15:372-381. [PMID: 38751707 PMCID: PMC11092404 DOI: 10.14740/wjon1794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/16/2024] [Indexed: 05/18/2024] Open
Abstract
Perivascular epithelioid cell neoplasms (PEComas) are a rare category of mesenchymal tissue tumors, manifesting across various tissues and organs such as the kidneys, liver, lungs, pancreas, uterus, ovaries, and gastrointestinal tract. They predominantly affect females more than males. PEComas characteristically express both melanocytic and smooth muscle markers, making immunohistochemistry vital for their diagnosis. Renal angiomyolipoma (AML) represents a common variant of PEComas, typically marked by favorable prognoses. Nonetheless, only a small fraction of subtypes, especially epithelioid AML, possess the capacity to be malignant. Renal PEComas usually appear as asymptomatic masses accompanied by vague imaging characteristics. The main methods for diagnosis are histopathological analysis and the application of immunohistochemical stains. Presently, a uniform treatment plan for renal PEComas is absent. Strategies for management include active surveillance, selective arterial embolization, surgical procedures, and drug-based treatments. The focus of this review is on renal PEComas, shedding light on their pathogenesis, pathological characteristics, clinical presentations, diagnosis, and treatment modalities, and incorporating a clinical case study.
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Affiliation(s)
- Bao Nan Dong
- Urology Surgery Department, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Hui Zhan
- Urology Surgery Department, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Ting Luan
- Urology Surgery Department, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Jian Song Wang
- Urology Surgery Department, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
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Levin G, Capella MP, Meyer R, Brezinov Y, Gotlieb WH. Gynecologic perivascular epithelioid cell tumors (PEComas): a review of recent evidence. Arch Gynecol Obstet 2024; 309:2381-2386. [PMID: 38664269 PMCID: PMC11147862 DOI: 10.1007/s00404-024-07510-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/07/2024] [Indexed: 06/04/2024]
Abstract
Gynecologic perivascular epithelioid cell (PEC) tumors, or 'PEComas,' represent a rare and intriguing subset of tumors within the female reproductive tract. This systematic literature review aims to provide an updated understanding of gynecologic PEComas based on available literature and data. Although PEComa is rare, there are varied tumor-site presentations across gynecologic organs, with uterine PEComas being the most prevalent. There is scarce high-quality literature regarding gynecologic PEComa, and studies on malignant PEComa underscore the challenges in diagnosis. Among the diverse mutations, mTOR alterations are the most prominent. Survival analysis reveals a high rate of local recurrence and metastatic disease, which commonly affects the lungs. Treatment strategies are limited, however mTOR inhibitors have pivotal role when indicated and chemotherapy may also be used. with some cases demonstrating promising responses. The paucity of data underscores the need for multicentric studies, an international registry for PEComas, and standardized reporting in case series to enhance clinical and pathological data.
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Affiliation(s)
- Gabriel Levin
- Department of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, QC, Canada.
| | - Mariana Pilon Capella
- Department of Oncology, Brazilian Institute for Cancer Control, São Paulo, SP, Brazil
| | - Raanan Meyer
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Cedar Sinai Medical Center, Los Angeles, CA, USA
| | - Yoav Brezinov
- Experimental Surgery, McGill University, Montreal, Canada
| | - Walter H Gotlieb
- Department of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, QC, Canada
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Xu W, Ma R, Li Y, Hu Z, Zhang G, Hu J, Hei Y, Yang X. Perivascular epithelioid cell tumor of the lacrimal gland. Orbit 2024; 43:362-365. [PMID: 36734431 DOI: 10.1080/01676830.2022.2141804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 10/25/2022] [Indexed: 02/04/2023]
Abstract
A 33-year-old lady was referred to our clinic with a history of left upper eyelid swelling and difficulty to open her left eye for more than 4 years. Her globe was in infero-nasal displacement, and ocular movement was not full, with restriction to every direction. No clinical sign including eye redness, pain or visual loss was found on examination. Exophthalmometry confirmed 2 mm of left-sided proptosis. Computed tomography (CT) imaging of the orbit obtained in axial and coronal planes depicted an irregular and heterogeneous soft-tissue density mass in the left lacrimal gland, measuring 25 × 17 mm. Magnetic resonance imaging (MRI) revealed the mass of slightly longer T1 and slightly longer/shorter T2 signal, and Gd-enhanced MRI showed a significant enhancement. The tumor was first presumably diagnosed of pleomorphic adenomas. A surgery was applied to remove the tumor completely. Histopathological evaluation led to the diagnosis of PEComa.
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Affiliation(s)
- Wenqin Xu
- Department of Orbital Disease, Department of Ophthalmology, The Third Medical Center of PLA General Hospital, Beijing, China
| | - Rui Ma
- Department of Orbital Disease, Department of Ophthalmology, The Third Medical Center of PLA General Hospital, Beijing, China
| | - Yueyue Li
- Department of Orbital Disease, Department of Ophthalmology, The Third Medical Center of PLA General Hospital, Beijing, China
| | - Zhicha Hu
- Department of Orbital Disease, Department of Ophthalmology, The Third Medical Center of PLA General Hospital, Beijing, China
| | | | - Jian Hu
- Department of Orbital Disease, Department of Ophthalmology, The Third Medical Center of PLA General Hospital, Beijing, China
| | - Yan Hei
- Department of Orbital Disease, Department of Ophthalmology, The Third Medical Center of PLA General Hospital, Beijing, China
| | - Xinji Yang
- Department of Orbital Disease, Department of Ophthalmology, The Third Medical Center of PLA General Hospital, Beijing, China
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Amante MF. Hepatic perivascular epithelioid cell tumors: Benign, malignant, and uncertain malignant potential. World J Gastroenterol 2024; 30:2374-2378. [PMID: 38764772 PMCID: PMC11099397 DOI: 10.3748/wjg.v30.i18.2374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 02/20/2024] [Accepted: 04/25/2024] [Indexed: 05/11/2024] Open
Abstract
In 2013, the World Health Organization defined perivascular epithelioid cell tumor (PEComa) as "a mesenchymal tumor which shows a local association with vessel walls and usually expresses melanocyte and smooth muscle markers." This generic definition seems to better fit the PEComa family, which includes angiomyolipoma, clear cell sugar tumor of the lung, lymphangioleiomyomatosis, and a group of histologically and immunophenotypically similar tumors that include primary extrapulmonary sugar tumor and clear cell myomelanocytic tumor. Clear cell tumors with this immunophenotypic pattern have also had their malignant variants described. When localizing to the liver, preoperative radiological diagnosis has proven to be very difficult, and most patients have been diagnosed with hepatocellular carcinoma, focal nodular hyperplasia, hemangioma, or hepatic adenoma based on imaging findings. Examples of a malignant variant of the liver have been described. Finally, reports of malignant variants of these lesions have increased in recent years. Therefore, we support the use of the Folpe criteria, which in 2005 established the criteria for categorizing a PEComa as benign, malignant, or of uncertain malignant potential. Although they are not considered ideal, they currently seem to be the best approach and could be used for the categorization of liver tumors.
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Affiliation(s)
- Marcelo Fabián Amante
- División Patología, Hospital General de Agudos Cosme Argerich, Buenos Aires C1155AHA, Argentina
- División Patología, Hospital Alemán de Buenos Aires, Buenos Aires C1155AHA, Argentina
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Möller K, Holz T, Jenssen C, Braden B, Hocke M, On W, Everett SM, Dong Y, Ge N, Sun S, Gerber M, Faiss S, Schlag C, Srivastava D, Dietrich CF. Comments and illustrations of the European Federation of Societies for Ultrasound in Medicine contrast-enhanced ultrasonography guidelines: multiparametric imaging and EUS-guided sampling in rare pancreatic tumors. Mesenchymal pancreatic tumors of intermediate biological behaviour. Endosc Ultrasound 2024; 13:145-153. [PMID: 39318650 PMCID: PMC11419476 DOI: 10.1097/eus.0000000000000071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 03/14/2024] [Indexed: 09/26/2024] Open
Abstract
The focus of the review is on mesenchymal pancreatic tumors with intermediate biological behavior and their imaging appearance. Similar to benign and malignant mesenchymal pancreatic tumors, these tumors are extremely rare. The diagnosis is often confirmed only by postoperative histology. The very limited data on abdominal ultrasound and EUS findings including contrast-enhanced techniques of these pancreatic lesions are summarized here.
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Affiliation(s)
- Kathleen Möller
- Medical Department I/Gastroenterology, Sana Hospital Lichtenberg, Berlin, Germany
| | - Tamara Holz
- Department Allgemeine Innere Medizin der Kliniken (DAIM) Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
| | - Christian Jenssen
- Department of Internal Medicine, Krankenhaus Märkisch-Oderland, Strausberg, Germany; Brandenburg Institute for Clinical Ultrasound (BICUS) at Medical University Brandenburg, Neuruppin, Germany
| | - Barbara Braden
- Translational Gastroenterology Unit, Oxford University Hospitals, Oxford, UK; Medical Department B, University Muenster, Muenster, Germany
| | - Michael Hocke
- Medical Department, Helios Klinikum Meiningen, Meiningen, Germany
| | - Wei On
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | | | - Yi Dong
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Nan Ge
- Department of Endoscopy Center, Shengjing Hospital of China Medical University, Liaoning Province, China
| | - Siyu Sun
- Department of Endoscopy Center, Shengjing Hospital of China Medical University, Liaoning Province, China
| | - Michael Gerber
- Medical Department I/Gastroenterology, Sana Hospital Lichtenberg, Berlin, Germany
| | - Siegbert Faiss
- Medical Department I/Gastroenterology, Sana Hospital Lichtenberg, Berlin, Germany
| | - Christoph Schlag
- Klinik für Gastroenterologie und Hepatologie, Universitätsspital Zürich, Zürich, Switzerland
| | | | - Christoph F. Dietrich
- Department Allgemeine Innere Medizin der Kliniken (DAIM) Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
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Yan J, Zhou D, Wang Y, Yang B, Wang Y, Zhang K, Zhang S, Zhang B, Meng Q, Lv Q. A retrospective clinical analysis of 11 cases of PEComa from different sites. World J Surg Oncol 2024; 22:116. [PMID: 38689335 PMCID: PMC11059644 DOI: 10.1186/s12957-024-03349-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 02/24/2024] [Indexed: 05/02/2024] Open
Abstract
PURPOSE The objective of this paper is to offer a thorough examination of the clinical presentations, etiology, and treatment strategies associated with perivascular epithelioid cell tumors (PEComas). METHODS This retrospective study examined the comprehensive archival data of PEComa cases diagnosed at Beijing Hospital from 2015 to 2023. The pathology slides of all patients were thoroughly reassessed by two experienced pathologists. A thorough retrospective analysis was undertaken, incorporating clinicopathological data including gender, age at diagnosis, initial clinical manifestations, signs, disease onset site, tumor markers, imaging findings, therapeutic modalities, pathological features, immunohistochemical profiles, treatment responses, and prognostic indicators. Patients were evaluated for disease severity according to established pathological classification criteria and were followed up until the designated analysis cut-off date. In instances where patients were unable to be monitored on-site, they were contacted via telephone for postoperative follow-up inquiries. RESULTS This study included 11 patients with ages ranging from 17 to 66 years old, presenting with the disease in multiple anatomical sites, including the retroperitoneum (2/11), liver (4/11), kidney (4/11), lung (1/11), and broad ligament of the uterus (1/11). Most patients presented with non-specific clinical symptoms and were subsequently diagnosed with space-occupying lesions upon physical examination. The tumor demonstrated progressive growth and enlargement, which could result in compression of neighboring organs. Preoperative imaging alone is insufficient for a definitive diagnosis of PEComa, but MRI can provide an initial evaluation of the tumor's potential malignancy. Molecular marker testing specific to PEComa, such as HMB-45 (90.0%), SMA (81.8%), Melan-A (90.9%), vimentin (90.9%), and Desmin (36.3%), was conducted on all patients. No adjuvant therapies were administered postoperatively. Upon analysis, no instances of relapse at the primary site or the development of new tumors at other sites were observed. Regular imaging reviews of three patients with malignant PEComa post-surgery showed no evidence of recurrence. CONCLUSIONS The clinical presentation, tumor biomarkers, and imaging characteristics of PEComa lack specificity, necessitating dependence on pathology and immunohistochemistry for precise diagnosis. The mainstay of treatment consists of surgical resection, with patients typically experiencing a favorable prognosis.
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Affiliation(s)
- Jinbowen Yan
- Department of Obstetrics and Gynecology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, P. R. China
| | - Dan Zhou
- Department of Obstetrics and Gynecology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, P. R. China.
| | - Yifei Wang
- Department of Pathology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing, 100730, P. R. China
| | - Bowen Yang
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, P. R. China
| | - Yuefeng Wang
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Institute of Geriatric Medicine, Beijing Hospital, Chinese Academy of Medical Sciences, National Center of Gerontology of National Health Commission, Beijing, P. R. China
| | - Kaili Zhang
- Department of Obstetrics and Gynecology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, P. R. China
| | - Shuo Zhang
- Department of Obstetrics and Gynecology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, P. R. China
| | - Bo Zhang
- Department of Obstetrics and Gynecology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, P. R. China
| | - Qingwei Meng
- Department of Obstetrics and Gynecology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, P. R. China
| | - Qiubo Lv
- Department of Obstetrics and Gynecology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, P. R. China
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Tsukita H, Koyama K, Ishinari T, Takahashi A, Miyabe K, Umakoshi M, Yoshida M, Kudo-Asabe Y, Nishida A, Otsuka N, Yasui O, Kato I, Fukushima N, Goto A. A case of pancreatic PEComa with prominent inflammatory cell infiltration: the inflammatory subtype is a distinct histologic group of PEComa. Diagn Pathol 2024; 19:59. [PMID: 38622713 PMCID: PMC11017648 DOI: 10.1186/s13000-024-01485-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 04/06/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND PEComa is a mesenchymal tumor that can occur in various organs including the uterus and soft tissues. PEComas are composed of perivascular epithelioid cells, and angiomyolipoma (AML), clear cell sugar tumor (CCST), and lymphangiomyomatosis (LAM) are considered lesions of the same lineage as tumors of the PEComa family. Histologically, a common PEComa shows solid or sheet-like proliferation of epithelioid cells. This is accompanied by an increase in the number of dilated blood vessels. Here, we report a case of pancreatic PEComa with marked inflammatory cell infiltration. CASE PRESENTATION A 74-year-old male patient underwent an appendectomy for acute appendicitis. Postoperative computed tomography and magnetic resonance imaging revealed a 30 × 25 mm non-contrast-enhanced circular lesion in the tail of the pancreas. The imaging findings were consistent with a malignant tumor, and distal pancreatectomy was performed. Histologically, most area of the lesion was infiltrated with inflammatory cells. A few epithelioid cells with large, round nuclei, distinct nucleoli, and eosinophilic granular cytoplasm were observed. Spindle-shaped tumor cells were observed. Delicate and dilated blood vessels were observed around the tumor cells. Immunohistochemically, the atypical cells were positive for αSMA, Melan A, HMB-45, and TFE3. The cytological characteristics of the tumor cells and the results of immunohistochemical staining led to a diagnosis of pancreatic PEComa. CONCLUSIONS A histological variant known as the inflammatory subtype has been defined for hepatic AML. A small number of tumor cells present with marked inflammatory cell infiltration, accounting for more than half of the lesions, and an inflammatory myofibroblastic tumor-like appearance. To our knowledge, this is the first report of pancreatic PEComa with severe inflammation. PEComa is also a generic term for tumors derived from perivascular epithelioid cells, such as AML, CCST, and LAM. Thus, this case is considered an inflammatory subtype of PEComa. It has a distinctive morphology that is not typical of PEComa. This histological phenotype should be widely recognized.
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Affiliation(s)
- Hikaru Tsukita
- Department of Cellular and Organ Pathology, Akita University Graduate School of Medicine, 1- 1-1 Hondo, Akita-shi, Akita, 010-8543, Japan
- Department of Pathology, Nihonkai General Hospital, Sakata, Japan
| | - Kei Koyama
- Department of Cellular and Organ Pathology, Akita University Graduate School of Medicine, 1- 1-1 Hondo, Akita-shi, Akita, 010-8543, Japan.
| | - Takahiro Ishinari
- Department of Cellular and Organ Pathology, Akita University Graduate School of Medicine, 1- 1-1 Hondo, Akita-shi, Akita, 010-8543, Japan
| | - Ayana Takahashi
- Department of Cellular and Organ Pathology, Akita University Graduate School of Medicine, 1- 1-1 Hondo, Akita-shi, Akita, 010-8543, Japan
- Department of Pathology, Nihonkai General Hospital, Sakata, Japan
| | - Ken Miyabe
- Department of Cellular and Organ Pathology, Akita University Graduate School of Medicine, 1- 1-1 Hondo, Akita-shi, Akita, 010-8543, Japan
| | - Michinobu Umakoshi
- Department of Cellular and Organ Pathology, Akita University Graduate School of Medicine, 1- 1-1 Hondo, Akita-shi, Akita, 010-8543, Japan
- Department of Pathology, Akita City Hospital, Akita, Japan
| | - Makoto Yoshida
- Department of Cellular and Organ Pathology, Akita University Graduate School of Medicine, 1- 1-1 Hondo, Akita-shi, Akita, 010-8543, Japan
| | - Yukitsugu Kudo-Asabe
- Department of Cellular and Organ Pathology, Akita University Graduate School of Medicine, 1- 1-1 Hondo, Akita-shi, Akita, 010-8543, Japan
| | - Akiko Nishida
- Department of Pathology, Nihonkai General Hospital, Sakata, Japan
| | - Naohiko Otsuka
- Department of Surgery, Noshiro Yamamoto Medical Association Hospital, Noshiro, Japan
| | - Ouki Yasui
- Department of Surgery, Noshiro Yamamoto Medical Association Hospital, Noshiro, Japan
| | - Ikuma Kato
- Department of Molecular Pathology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | | | - Akiteru Goto
- Department of Cellular and Organ Pathology, Akita University Graduate School of Medicine, 1- 1-1 Hondo, Akita-shi, Akita, 010-8543, Japan
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Hu D, Miao M, Zhou H, Gu X, Wang X, Teichmann AT, Wang Q, Yang Y. A Case Report of Malignant Perivascular Epithelioid Cell Tumors of the Uterus and Literature Review. Int J Womens Health 2024; 16:619-628. [PMID: 38645980 PMCID: PMC11027917 DOI: 10.2147/ijwh.s453226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 03/09/2024] [Indexed: 04/23/2024] Open
Abstract
Perivascular epithelioid cell tumors (PEComas) are rare mesenchymal tumors originating from perivascular epithelioid cells. In gynecological system, the uterus is one of the most common sites affected by PEComas. Most PEComas are benign, and patients usually have a good prognosis. However, malignant uterus PEComa is rare, and better comprehensive epidemiological investigations are needed. To date, there are a few reported cases of uterus PEComa. We herein report a rare case of malignant PEComa occurred in the uterine corpus and cervix, possibly accompanied by pulmonary lymphangioleiomyomatosis (PLAM). In addition, 55 cases of malignant uterus PEComa were picked out and collected in the data base of PubMed and Medline. On the one hand, the age of onset, population distribution, clinical manifestations, metastatic sites and routes of metastasis were analysed. On the other hand, a summary of the epidemiology, pathogenesis, diagnosis, and treatments of uterus PEComa was given.
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Affiliation(s)
- Daifeng Hu
- Sichuan Provincial Center for Gynaecology and Breast Diseases, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People’s Republic of China
| | - Mengyue Miao
- Sichuan Provincial Center for Gynaecology and Breast Diseases, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People’s Republic of China
| | - Hui Zhou
- Sichuan Provincial Center for Gynaecology and Breast Diseases, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People’s Republic of China
| | - Xia Gu
- Sichuan Provincial Center for Gynaecology and Breast Diseases, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People’s Republic of China
- Academician (Expert) Workstation of Sichuan Province, Luzhou, 646000, People’s Republic of China
| | - Xuedan Wang
- Department of Pathology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People’s Republic of China
| | - Alexander Tobias Teichmann
- Sichuan Provincial Center for Gynaecology and Breast Diseases, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People’s Republic of China
| | - Qin Wang
- Sichuan Provincial Center for Gynaecology and Breast Diseases, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People’s Republic of China
| | - Youzhe Yang
- Sichuan Provincial Center for Gynaecology and Breast Diseases, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People’s Republic of China
- Academician (Expert) Workstation of Sichuan Province, Luzhou, 646000, People’s Republic of China
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48
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Yan S, Lu JJ, Chen L, Cai WH, Wu JZ. Hepatic perivascular epithelioid cell tumors: The importance of preoperative diagnosis. World J Gastroenterol 2024; 30:1926-1933. [PMID: 38659487 PMCID: PMC11036502 DOI: 10.3748/wjg.v30.i13.1926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/17/2024] [Accepted: 03/19/2024] [Indexed: 04/03/2024] Open
Abstract
Accurate preoperative diagnosis is highly important for the treatment of perivascular epithelioid cell tumors (PEComas) because PEComas are mainly benign tumors and may not require surgical intervention. By analyzing the causes, properties and clinical manifestations of PEComas, we summarize the challenges and solutions in the diagnosis of PEComas.
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Affiliation(s)
- Shuai Yan
- Department of Medical School, Nantong University, Nantong 226300, Jiangsu Province, China
- Department of Hepatobiliary Surgery, Affiliated Nantong Hospital 3 of Nantong University, Nantong 226006, Jiangsu Province, China
| | - Jia-Jie Lu
- Department of Medical School, Nantong University, Nantong 226300, Jiangsu Province, China
- Department of Hepatobiliary Surgery, Affiliated Nantong Hospital 3 of Nantong University, Nantong 226006, Jiangsu Province, China
| | - Lin Chen
- Nantong Institute of Liver Disease, Affiliated Nantong Hospital 3 of Nantong University, Nantong 226006, Jiangsu Province, China
| | - Wei-Hua Cai
- Department of Medical School, Nantong University, Nantong 226300, Jiangsu Province, China
- Department of Hepatobiliary Surgery, Affiliated Nantong Hospital 3 of Nantong University, Nantong 226006, Jiangsu Province, China
| | - Jin-Zhu Wu
- Department of Medical School, Nantong University, Nantong 226300, Jiangsu Province, China
- Department of Hepatobiliary Surgery, Affiliated Nantong Hospital 3 of Nantong University, Nantong 226006, Jiangsu Province, China
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Kumar P, Maloney NS, Razzouk A, Pai RG, Varadarajan P. A case report of recurrent primary posterior mediastinal perivascular epithelioid cell tumour compressing the right inferior pulmonary vein, atria, and inferior vena cava. Eur Heart J Case Rep 2024; 8:ytae142. [PMID: 38576467 PMCID: PMC10993020 DOI: 10.1093/ehjcr/ytae142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 03/11/2024] [Accepted: 03/18/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Perivascular epithelioid cell tumours (PEComas) are rare soft tissue neoplasms that commonly occur in the uterus, skin, and liver and less commonly in the retroperitoneum, colon, and mediastinum. CASE SUMMARY A 36-year-old male patient with a history of mediastinal PEComa status post resection, essential hypertension, and atrial fibrillation status post appendage ligation currently not on anticoagulation presented with a 1-week history of fevers, chills, productive cough, chest pain, dyspnoea on exertion, loss of appetite, and general weakness. Vital signs, physical exam, laboratory data, electrocardiogram, and chest radiograph were grossly unremarkable. A multimodality imaging approach utilizing transthoracic echocardiogram, transoesophageal echocardiogram (TEE), cardiac magnetic resonance imaging (cMRI), and computed tomography angiography of the chest, abdomen, and pelvis revealed a local 40 mm × 53 mm globular bilobed vascularized scar-free posterior mediastinal mass arising from the roof of the left and right atria and extending superiorly to the main pulmonary artery and inferiorly to the inferior vena cava. Based on the mass' size and proximity to vital structures and tumour recurrence, the case was presented during tumour board rounds, and the outcome was to surgically resect the mass and then have the patient follow up with medical oncology and radiation oncology for possible chemotherapy and radiation, respectively. DISCUSSION Perivascular epithelioid cell tumours are rare, and mediastinal PEComas are even rarer, warranting a multimodality imaging approach involving TEE and cMRI and a multidisciplinary approach involving anaesthesiologists, cardiologists, cardiothoracic surgeons, medical oncologists, pathologists, radiologists, and radiation oncologists.
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Affiliation(s)
- Preetham Kumar
- Division of Cardiology, Department of Medicine, University of California, Riverside, 900 University Ave, Riverside, CA 92521, USA
| | - Nolan S Maloney
- Department of Pathology, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Anees Razzouk
- Department of Cardiothoracic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Ramdas G Pai
- Division of Cardiology, Department of Medicine, University of California, Riverside, 900 University Ave, Riverside, CA 92521, USA
| | - Padmini Varadarajan
- Division of Cardiology, Department of Medicine, University of California, Riverside, 900 University Ave, Riverside, CA 92521, USA
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50
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Capella MP, Levin G, de Lima Benedito V, de Souza LB, Filho ACBN, Lealdini V. Pelvic PEComa-an unusual presentation as a giant benign mass. Arch Gynecol Obstet 2024; 309:1675-1676. [PMID: 38175214 DOI: 10.1007/s00404-023-07320-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 11/27/2023] [Indexed: 01/05/2024]
Affiliation(s)
- Mariana Pilon Capella
- Department of Oncology, Brazilian Institute for Cancer Control, San paulo, SP, Brazil
| | - Gabriel Levin
- Department of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, QC, Canada.
| | | | - Lucas Borges de Souza
- Department of Oncology, Brazilian Institute for Cancer Control, San paulo, SP, Brazil
| | | | - Viviane Lealdini
- Department of Oncology, Brazilian Institute for Cancer Control, San paulo, SP, Brazil
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