301
|
Okamoto S, Komura M, Terao Y, Kurisaki-Arakawa A, Hayashi T, Saito T, Togo S, Shiokawa A, Mitani K, Kobayashi E, Kumasaka T, Takahashi K, Seyama K. Pneumothorax caused by cystic and nodular lung metastases from a malignant uterine perivascular epithelioid cell tumor (PEComa). Respir Med Case Rep 2017; 22:77-82. [PMID: 28706850 PMCID: PMC5496452 DOI: 10.1016/j.rmcr.2017.06.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 06/20/2017] [Indexed: 12/03/2022] Open
Abstract
Perivascular epithelioid cell tumors (PEComas) are mesenchymal neoplasms with immunoreactivity for both melanocytic and smooth muscle markers. PEComas occur at multiple sites, and malignant PEComas can undergo metastasis, recurrence and aggressive clinical courses. Although the lung is a common metastatic site of PEComas, they usually appear as multiple nodules but rarely become cystic or cavitary. Here, we describe a female patient whose lungs manifested multiple cystic, cavity-like and nodular metastases 3 years after the resection of uterine tumors tentatively diagnosed as epithelioid smooth muscle tumors with uncertain malignant potential. This patient's subsequent pneumothorax necessitated video-assisted thoracoscopic surgery, and examination of her resected lung specimens eventually led to correcting the diagnosis, i.e., to a PEComa harboring tuberous sclerosis complex 1 (TSC1) loss-of-heterozygosity that originated in the uterus and then metastasized to the lungs. The administration of a gonadotropin-releasing hormone analogue later stabilized her clinical course. To the best of our knowledge, the present case is the first in the literature that associates PEComas with a TSC1 abnormality. Additionally, the pulmonary manifestations, including imaging appearance and pneumothorax, somewhat resembled those of lymphangioleiomyomatosis, a representative disease belonging to the PEComa family. Although PEComas are rare, clinicians, radiologists and pathologists should become aware of this disease entity, especially in the combined clinical setting of multiple cystic, cavity-like, nodular lesions on computed tomography of the chest and a past history of the tumor in the female reproductive system.
Collapse
Key Words
- CAPUs, clinically aggressive PEComas of the uterine corpus
- CT, computed tomography
- Cystic lung disease
- ESS, endometrial stromal sarcoma
- GnRH, gonadotropin-releasing hormone analogue
- HPF, high-power fields
- LAM, lymphangioleiomyomatosis
- LOH, loss of heterozygosity
- Loss of heterozygosity
- Multiple lung nodules
- PEComa
- PEComa, perivascular epithelioid cell tumor
- PEComa-NOS, PEComa not otherwise specified
- Pneumothorax
- Pulmonary metastasis
- TFE3, transcription factor E3
- TSC, tuberous sclerosis complex
- mTOR, mammalian target of rapamycin
- α-SMA, α-smooth muscle actin
Collapse
Affiliation(s)
- Shouichi Okamoto
- Division of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan.,The Study Group for Pneumothorax and Cystic Lung Diseases, 4-8-1 Seta, Setagaya-ku, Tokyo, 158-0095, Japan
| | - Moegi Komura
- Division of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Yasuhisa Terao
- Department of Gynecology and Obstetrics, Juntendo University Faculty of Medicine and Graduate School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Aiko Kurisaki-Arakawa
- Department of Human Pathology, Juntendo University Faculty of Medicine and Graduate School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Takuo Hayashi
- Department of Human Pathology, Juntendo University Faculty of Medicine and Graduate School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan.,The Study Group for Pneumothorax and Cystic Lung Diseases, 4-8-1 Seta, Setagaya-ku, Tokyo, 158-0095, Japan
| | - Tsuyoshi Saito
- Department of Human Pathology, Juntendo University Faculty of Medicine and Graduate School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Shinsaku Togo
- Division of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Akira Shiokawa
- Department of Clinical Diagnostic Pathology, Showa University Fujigaoka Hospital, 1-30, Fujigaoka Aoba-ku, Yokohama, Kanagawa, 227-8501, Japan
| | - Keiko Mitani
- Department of Human Pathology, Juntendo University Faculty of Medicine and Graduate School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan.,The Study Group for Pneumothorax and Cystic Lung Diseases, 4-8-1 Seta, Setagaya-ku, Tokyo, 158-0095, Japan
| | - Etsuko Kobayashi
- Division of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan.,The Study Group for Pneumothorax and Cystic Lung Diseases, 4-8-1 Seta, Setagaya-ku, Tokyo, 158-0095, Japan
| | - Toshio Kumasaka
- Department of Pathology, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan.,The Study Group for Pneumothorax and Cystic Lung Diseases, 4-8-1 Seta, Setagaya-ku, Tokyo, 158-0095, Japan
| | - Kazuhisa Takahashi
- Division of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Kuniaki Seyama
- Division of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan.,The Study Group for Pneumothorax and Cystic Lung Diseases, 4-8-1 Seta, Setagaya-ku, Tokyo, 158-0095, Japan
| |
Collapse
|
302
|
Stuart LN, Tipton RG, DeWall MR, Parker DC, Stelton CD, Morrison AO, Coleman LW, Fosko SW, Vidal CI, Yadira Hurley M, Deeken AH, Gardner JM. Primary cutaneous perivascular epithelioid cell tumor (PEComa): Five new cases and review of the literature. J Cutan Pathol 2017; 44:713-721. [PMID: 28556973 DOI: 10.1111/cup.12972] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 05/01/2017] [Accepted: 05/19/2017] [Indexed: 12/11/2022]
Abstract
PEComas represent a family of uncommon mesenchymal tumors composed of "perivascular epithelioid cells" with a distinct immunophenotype that typically shows both myogenic and melanocytic differentiation. The PEComa family includes angiomyolipoma (AML), clear cell "sugar" tumor of the lung and extra pulmonary sites, lymphangioleiomyomatosis and clear cell myomelanocytic tumor of the falciform ligament/ligamentum teres. Very rarely, PEComas may arise in the skin. Primary cutaneous PEComas typically display a dermal proliferation of epithelioid cells with pale, clear, or granular pink cytoplasm arranged in nests and trabecula with an intervening arborizing network of delicate capillaries. Primary cutaneous PEComas have a lower frequency of myogenic marker expression than their deep soft tissue and visceral counterparts. They also often express strong diffuse CD10, leading to potential confusion with metastatic renal cell carcinoma. Most cases behave indolently. We report 5 additional cases of this rare entity. All showed classic histologic features and expression of either HMB-45 and/or Melan-A/MART-1. Four cases were tested for myogenic markers (2 were positive & 2 were negative). Three cases were tested for CD10 (all 3 were positive). All of our cases with clinical follow-up behaved indolently. Table 1 provides a summary of findings for all 5 cases in our series.
Collapse
Affiliation(s)
- Lauren N Stuart
- Finan Templeton Dermatopathology Associates, Atlanta, Georgia
| | - Russell G Tipton
- Department of Dermatology, Saint Louis University School of Medicine, Saint Louis, Missouri
| | - Michael R DeWall
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Douglas C Parker
- Department of Pathology, Emory University Hospital, Atlanta, Georgia.,Department of Dermatology, Emory University Hospital, Atlanta, Georgia
| | | | | | - Landon W Coleman
- Department of Pathology, Intermountain Medical Center, Murray, Utah
| | - Scott W Fosko
- Department of Dermatology, Mayo Clinic, Jacksonville, Florida
| | - Claudia I Vidal
- Department of Dermatology, Saint Louis University School of Medicine, Saint Louis, Missouri.,Department of Pathology, Saint Louis University School of Medicine, Saint Louis, Missouri
| | - Maria Yadira Hurley
- Department of Dermatology, Saint Louis University School of Medicine, Saint Louis, Missouri.,Department of Pathology, Saint Louis University School of Medicine, Saint Louis, Missouri
| | - Amy H Deeken
- Department of Pathology and Laboratory Medicine, Summa Health System, Akron, Ohio
| | - Jerad M Gardner
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| |
Collapse
|
303
|
Zhang S, Chen F, Huang X, Jiang Q, Zhao Y, Chen Y, Zhang J, Ma J, Yuan W, Xu Q, Zhao J, Wang C. Perivascular epithelial cell tumor (PEComa) of the pancreas: A case report and review of literature. Medicine (Baltimore) 2017; 96:e7050. [PMID: 28562565 PMCID: PMC5459730 DOI: 10.1097/md.0000000000007050] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
RATIONALE Perivascular epithelial cell tumors (PEComas) of the pancreas are rare mesenchymal tumors and, to our knowledge, only 20 cases have been reported to date. PATIENT CONCERNS We report a 43-year-old female who presented with upper abdominal pain for 1 year. She underwent an exploratory laparotomy at a local hospital, which failed to resect the tumor. Five months later, she came to the Chinese National Cancer Center for surgery. Preoperative imaging revealed an 11.5-cm-sized mass located in the head of the pancreas. At the microscopic level, the tumor was composed of epithelioid and spindle cells possessing clear to focally granular eosinophilic cytoplasm, which grew in a nested and alveolar pattern around blood vessels. The tumor cells showed immunoreactivity for human melanoma black 45 (HMB-45), but did not express epithelial or endocrine markers. DIAGNOSES Pancreatic PEComa. INTERVENTIONS Pancreaticoduodenectomy, partial hepatectomy, and vascular replacement were performed. After the surgery, the patient received 4 cycles of chemotherapy. OUTCOMES The patient is free of recurrence and metastasis 1.5 years after surgical resection. LESSONS PEComa should be recognized as a preoperative differential diagnosis of pancreatic tumors. For treatment, removal of the tumor should be attempted, and in the case of tumors with malignant tendencies, the addition of chemotherapy should be considered.
Collapse
Affiliation(s)
- Shuisheng Zhang
- Department of Pancreatic and Gastric Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - Fang Chen
- Department of Oncology, Bozhou People's Hospital, Bozhou
| | - Xiaozhun Huang
- Department of Abdominal Surgery, Cancer Hospital of Chinese Academy of Medical Sciences, Shenzhen Center, Shenzhen Cancer Hospital, Shenzhen
| | - Qinglong Jiang
- Department of Pancreatic and Gastric Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - Yajie Zhao
- Department of Pancreatic and Gastric Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - Yingtai Chen
- Department of Pancreatic and Gastric Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - Jianwei Zhang
- Department of Pancreatic and Gastric Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - Jie Ma
- State Key Laboratory of Molecular Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - Wei Yuan
- State Key Laboratory of Molecular Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - Quan Xu
- Department of Pancreatic and Gastric Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - Jiuda Zhao
- Department of Medical Oncology, Affiliated Hospital of Qinghai University, Xining, China
| | - Chengfeng Wang
- Department of Pancreatic and Gastric Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| |
Collapse
|
304
|
Machado I, Cruz J, Lavernia J, Rayon JM, Poveda A, Llombart-Bosch A. Malignant PEComa With Metastatic Disease at Diagnosis and Resistance to Several Chemotherapy Regimens and Targeted Therapy (m-TOR Inhibitor). Int J Surg Pathol 2017; 25:543-549. [PMID: 28459168 DOI: 10.1177/1066896917701245] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Perivascular epithelioid cell tumors (PEComas) are infrequent neoplasms with peculiar myomelanocytic differentiation. The aggressive abdominopelvic variant is rare, with only a small number of published cases. We present an additional case of this unusual variant, which showed an aggressive histologic and clinical behavior with multiple liver metastases and resistance to several therapies. We also discuss the histological and immunohistochemical profiles as well as the differential diagnosis.
Collapse
Affiliation(s)
| | - Julia Cruz
- 1 Instituto Valenciano de Oncología, Valencia, Spain
| | | | - José M Rayon
- 2 Hospital NISA Nueve de Octubre, Valencia, Spain
| | - Andrés Poveda
- 1 Instituto Valenciano de Oncología, Valencia, Spain
| | | |
Collapse
|
305
|
Giant Cell Tumor of the Uterus: A Report of 3 Cases With a Spectrum of Morphologic Features. Int J Gynecol Pathol 2017; 34:340-50. [PMID: 25851705 DOI: 10.1097/pgp.0000000000000164] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Giant cell tumors, a well-recognized neoplasm of bone, can rarely be found in the uterus. Such tumors are characterized by a dual population of mononuclear and osteoclast-like giant cells that lack epithelial and specific mesenchymal differentiation. In this study, the clinicopathologic features of 3 giant cell tumors of the uterus were reviewed. Immunohistochemistry for CD68, CD163, h-caldesmon, desmin, SMA, AE1/AE3, CD10, ER, PR, cyclin D1, CD1a, CD34, CD30, S100, myogenin/myoglobin, and Ki-67 was performed in all tumors, along with ultrastructural analysis in one. The patients were 47, 57, and 59 yr and the tumors measured 2.5, 7.5, and 16.0 cm. One neoplasm was confined to the endometrium, whereas the other 2 were myometrial. All 3 tumors showed a nodular growth comprised of mononuclear and osteoclast-like giant cells. The endometrial-confined tumor consisted of histologically benign mononuclear cells, whereas the others exhibited marked atypia. Mitotic activity was up to 5/10 HPF in the benign tumor and up to 22/10 HPF in the malignant. No cytologic atypia or mitoses were observed in the giant cells. CD68 and CD10 were strongly and diffusely expressed in both components of 3 and 2 neoplasms, respectively. Cyclin D1 was focal in the mononuclear cells and focal to diffuse in the giant cells. CD163 was diffuse in the mononuclear cells, but absent to focal in the giant cells. Ultrastructural analysis lacked diagnostic features of epithelial or specific mesenchymal differentiation. Both malignant tumors demonstrated an aggressive behavior. In summary, although rare, giant cell tumor of the uterus should be included in the differential diagnosis of benign or malignant tumors containing osteoclast-like giant cells.
Collapse
|
306
|
Rao S, Pavithra P, Bhat S, John C, D’Cruz AJ. Cardiac Perivascular Epithelioid Cell Tumor: Report of a Child and Review of the Literature. World J Pediatr Congenit Heart Surg 2017; 11:NP14-NP17. [DOI: 10.1177/2150135116682452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cardiac tumors presenting as mediastinal masses in childhood are rare. This report describes the case of a 6-year-old girl who presented to us after a failed attempt at resection of a mass arising from the left atrial appendage. Computed tomography–guided biopsy suggested a perivascular epithelioid cell tumor (PEComa). Sirolimus was started in order to reduce the mass size. She subsequently underwent resection of the mass by midline sternotomy approach and cardiopulmonary bypass. Recovery was uneventful and the child is doing well at two-year follow-up. Contemporary literature is reviewed. Only seven cases, including two children, with mediastinal PEComa have been reported. Pathology and treatment options are discussed.
Collapse
Affiliation(s)
- Sanjay Rao
- Department of Pediatric Surgery, Mazumdar Shaw Multispecialty Center, Narayana Hrudayalaya Health City, Bengaluru, Karnataka, India
| | - P. Pavithra
- Department of Pediatric Surgery, Mazumdar Shaw Multispecialty Center, Narayana Hrudayalaya Health City, Bengaluru, Karnataka, India
| | - Sunil Bhat
- Department of Pediatric Hemato-Oncology, Mazumdar Shaw Multispecialty Center, Narayana Hrudayalaya Health City, Bengaluru, Karnataka, India
| | - Colin John
- Department of Pediatric Cardiac Surgery, Mazumdar Shaw Multispecialty Center, Narayana Hrudayalaya Health City, Bengaluru, Karnataka, India
| | - Ashley J. D’Cruz
- Department of Pediatric Surgery, Mazumdar Shaw Multispecialty Center, Narayana Hrudayalaya Health City, Bengaluru, Karnataka, India
| |
Collapse
|
307
|
Shin SA, Choi J, Moon KC, Kim WH. Perivascular Epithelioid Cell Tumor in the Stomach. J Pathol Transl Med 2017; 51:428-432. [PMID: 28372349 PMCID: PMC5525029 DOI: 10.4132/jptm.2016.09.16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 09/16/2016] [Indexed: 02/06/2023] Open
Abstract
Perivascular epithelioid cell tumors or PEComas can arise in any location in the body. However, a limited number of cases of gastric PEComa have been reported. We present two cases of gastric PEComas. The first case involved a 62-year-old woman who presented with a 4.2 cm gastric subepithelial mass in the prepyloric antrum, and the second case involved a 67-year-old man with a 5.0 cm mass slightly below the gastroesophageal junction. Microscopic examination revealed that both tumors were composed of perivascular epithelioid cells that were immunoreactive for melanocytic and smooth muscle markers. Prior to surgery, the clinical impression of both tumors was gastrointestinal stromal tumor (GIST), and the second case was erroneously diagnosed as GIST even after microscopic examination. Although gastric PEComa is a very rare neoplasm, it should be considered in the differential diagnosis of gastric submucosal lesions.
Collapse
Affiliation(s)
- Sun Ah Shin
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| | - Jiwoon Choi
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| | - Kyung Chul Moon
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| | - Woo Ho Kim
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| |
Collapse
|
308
|
Abdelkader A, Lam CA, Shahir KS, Christians K, Suster SM. Retroperitoneal lymphangioleiomyoma with lymph node involvement: A pathologic-radiologic correlation of a rare form of myomelanocytic tumor. Ann Diagn Pathol 2017; 27:69-73. [DOI: 10.1016/j.anndiagpath.2017.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 01/29/2017] [Indexed: 12/12/2022]
|
309
|
Son HJ, Kang DW, Kim JH, Han HY, Lee MK. Hepatic perivascular epithelioid cell tumor (PEComa): a case report with a review of literatures. Clin Mol Hepatol 2017; 23:80-86. [PMID: 28288506 PMCID: PMC5381835 DOI: 10.3350/cmh.2016.0034] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 06/30/2016] [Accepted: 07/13/2016] [Indexed: 01/02/2023] Open
Abstract
Hepatic perivascular epithelioid cell tumors (PEComas) are very rare. We report a primary hepatic PEComa with a review of the literature. A 56-year-old women presented with a nodular mass detected during the management of chronic renal failure and chronic hepatitis C. Diagnostic imaging studies suggested a nodular hepatocellular carcinoma in segment 5 of the liver. The patient underwent partial hepatectomy. A brown-colored expansile mass measuring 3.2×3.0 cm was relatively demarcated from the surrounding liver parenchyma. The tumor was mainly composed of epithelioid cells that were arranged in a trabecular growth pattern. Adipose tissue and thick-walled blood vessels were minimally identified. A small amount of extramedullary hematopoiesis was observed in the sinusoidal spaces between tumor cells. Tumor cells were diffusely immunoreactive for human melanoma black 45 (HMB45) and Melan A, focally immunoreactive for smooth muscle actin, but not for hepatocyte specific antigen (HSA).
Collapse
Affiliation(s)
- Hyun-Jin Son
- Department of Pathology, Eulji University School of Medicine, Daejeon, Korea
| | - Dong Wook Kang
- Department of Pathology, Eulji University School of Medicine, Daejeon, Korea
| | - Joo Heon Kim
- Department of Pathology, Eulji University School of Medicine, Daejeon, Korea
| | - Hyun Young Han
- Department of Radiology, Eulji University School of Medicine, Daejeon, Korea
| | - Min Koo Lee
- Department of Surgery, Cheju Halla General Hospital, Jeju, Korea
| |
Collapse
|
310
|
Acosta AM, Adley BP. Predicting the Behavior of Perivascular Epithelioid Cell Tumors of the Uterine Corpus. Arch Pathol Lab Med 2017; 141:463-469. [PMID: 28234575 DOI: 10.5858/arpa.2016-0092-rs] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Perivascular epithelioid cell tumors (PEComas) are rare neoplasms that share phenotypic features with angiomyolipomas, clear cell sugar tumors, and lymphangioleiomyomatosis. They presumably represent the neoplastic counterpart of a yet-unidentified perivascular epithelioid cell that expresses smooth muscle and melanocytic immunomarkers. The uterus is the second most common site of origin for perivascular epithelioid cell tumors, after the retroperitoneum. Although most uterine perivascular epithelioid cell tumors are clinically benign and can be cured by a complete surgical excision, there is a subset characterized by both local and distant dissemination. Unfortunately, no single histopathologic or immunohistochemical parameter can accurately predict the clinical behavior of these tumors, which is why the 2012 World Health Organization classification of tumors of the female reproductive organs suggests the use of several criteria to predict the risk of aggressive clinical behavior. Here we review those perivascular epithelioid cell tumors of the uterine corpus with aggressive clinical behavior reported in the literature, and we discuss their most relevant clinical and histopathologic features.
Collapse
Affiliation(s)
| | - Brian P Adley
- From the Department of Anatomic/Clinical Pathology, University of Illinois at Chicago Hospital and Health Sciences System (Dr Acosta); and the Department of Pathology, Advocate Lutheran General Hospital, Park Ridge, Illinois (Dr Adley)
| |
Collapse
|
311
|
Kwon BS, Suh DS, Lee NK, Song YJ, Choi KU, Kim KH. Two cases of perivascular epithelioid cell tumor of the uterus: clinical, radiological and pathological diagnostic challenge. Eur J Med Res 2017; 22:7. [PMID: 28270196 PMCID: PMC5341375 DOI: 10.1186/s40001-017-0248-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 03/02/2017] [Indexed: 12/21/2022] Open
Abstract
Background Perivascular epithelioid cell tumor (PEComa) is a rare subtype of mesenchymal origin tumor composed of epithelioid cells which exhibits immunohistochemical co-expressions of melanocytic markers and smooth muscle markers. Case presentation In the first case, malignant uterine PEComa with vaginal and multiple lung metastasis was misdiagnosed preoperatively as uterine leiomyosarcoma despite a preoperative punch biopsy and immunohistochemical analysis of the metastatic vaginal mass. In the second case, synchronous uterine PEComa showing benign histology with lymph node involvement was incidentally detected after a staging operation for ovarian cancer. Definitive diagnosis of uterine PEComa was achieved only after hysterectomy despite preoperative assessment with pelvic magnetic resonance imaging and punch biopsy of metastatic lesion. Conclusion The authors report two rare cases of uterine PEComa diagnosed postoperatively based on the morphologic and immunohistochemical features.
Collapse
Affiliation(s)
- Byung Su Kwon
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, 179, Gudeok-Ro, Seo-Gu, Busan, 49241, South Korea.,Biomedical Research Institute and Pusan Cancer Center, Pusan National University Hospital, 179, Gudeok-Ro, Seo-Gu, Busan, 49241, South Korea
| | - Dong Soo Suh
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, 179, Gudeok-Ro, Seo-Gu, Busan, 49241, South Korea.,Biomedical Research Institute and Pusan Cancer Center, Pusan National University Hospital, 179, Gudeok-Ro, Seo-Gu, Busan, 49241, South Korea
| | - Nam Kyung Lee
- Department of Radiology, Pusan National University School of Medicine, Busan, 49241, South Korea
| | - Yong Jung Song
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, 179, Gudeok-Ro, Seo-Gu, Busan, 49241, South Korea
| | - Kyung Un Choi
- Department of Pathology, Pusan National University School of Medicine, Busan, 49241, South Korea
| | - Ki Hyung Kim
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, 179, Gudeok-Ro, Seo-Gu, Busan, 49241, South Korea. .,Biomedical Research Institute and Pusan Cancer Center, Pusan National University Hospital, 179, Gudeok-Ro, Seo-Gu, Busan, 49241, South Korea.
| |
Collapse
|
312
|
Shrestha S, Meyers C, Shen J, Giacomelli P, Scott MA, Soo C, Dry SM, Ting K, James AW. Ang-1 and Ang-2 expression in angiomyolipoma and PEComa family tumors. J Orthop 2017; 14:154-160. [PMID: 28053374 PMCID: PMC5196089 DOI: 10.1016/j.jor.2016.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 12/05/2016] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Perivascular epithelioid cell tumors (PEComa) are an uncommon family of soft tissue tumors. Previously, we described that the presence of pericyte antigens among PEComa family tumors differs extensively by histologic appearance. METHODS Here, we extend our findings using the pericyte antigens Angiopoietin-1 (Ang-1) and Angiopoietin-2 (Ang-2), using immunohistochemical detection in human tumor samples. RESULTS While Ang-1 showed no expression across any PEComa family tumor, Ang-2 showed expression that like other pericyte markers was largely determined by cytologic appearance. CONCLUSION/IMPLICATIONS Pericytic marker expression in PEComa may represent a true pericytic cell of origin, or alternatively aberrant pericyte marker adoption.
Collapse
Affiliation(s)
- Swati Shrestha
- School of Dentistry, University of California, Los Angeles, USA
| | - Carolyn Meyers
- Department of Pathology, The Johns Hopkins University, Baltimore, MD, USA
| | - Jia Shen
- School of Dentistry, University of California, Los Angeles, USA
| | | | | | - Chia Soo
- Orthopedic Hospital Research Center, University of California, Los Angeles, USA
- Department of Surgery, University of California, Los Angeles, Los Angeles, CA, USA
| | - Sarah M. Dry
- Department of Pathology, The Johns Hopkins University, Baltimore, MD, USA
| | - Kang Ting
- School of Dentistry, University of California, Los Angeles, USA
| | - Aaron W. James
- Department of Pathology, The Johns Hopkins University, Baltimore, MD, USA
- Orthopedic Hospital Research Center, University of California, Los Angeles, USA
| |
Collapse
|
313
|
Hyrcza MD, Winer DA, Shago M, Au K, Zadeh G, Asa SL, Mete O. TFE3-Expressing Perivascular Epithelioid Cell Neoplasm (PEComa) of the Sella Turcica. Endocr Pathol 2017; 28:22-26. [PMID: 27189222 DOI: 10.1007/s12022-016-9434-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We report a primary central nervous system (CNS) perivascular epithelioid cell tumor (PEComa) in a middle-aged female patient. The tumor occurred in suprasellar location with secondary extension into the sella turcica. The patient presented with intracranial hemorrhage and an altered level of consciousness. The tumor had morphologic features matching those of other previously described TFE3-translocated PEComas, including epithelioid morphology, diffuse and strong nuclear immunoreactivity for TFE3, and minimal staining with myoid markers. The TFE3 break-apart FISH testing showed a slight splitting of one of the TFE3 signals in 49.5 % of nuclei. This case illustrates that PEComas should be added to the growing list of mesenchymal tumors that can be encountered in the CNS and specifically in the vicinity of the pituitary gland. The recognition of this entity is of significance given their underlying pathogenesis and possible management implications.
Collapse
Affiliation(s)
- Martin D Hyrcza
- Department of Pathology, University Health Network, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Daniel A Winer
- Department of Pathology, University Health Network, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Endocrine Oncology Site Group, The Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Mary Shago
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Karolyn Au
- Department of Neurosurgery, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Gelareh Zadeh
- Endocrine Oncology Site Group, The Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Department of Neurosurgery, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Sylvia L Asa
- Department of Pathology, University Health Network, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Endocrine Oncology Site Group, The Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Ozgur Mete
- Department of Pathology, University Health Network, Toronto, ON, Canada.
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.
- Endocrine Oncology Site Group, The Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
| |
Collapse
|
314
|
Ortiz S, Tortosa F. Epithelioid angiomyolipoma of the liver: Clinicopathological correlation in a series of 4 cases. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2017; 108:27-30. [PMID: 26765232 DOI: 10.17235/reed.2015.3947/2015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Hepatic angiomyolipoma is a rare neoplasm that can be difficult to diagnose in cases of ecoguide biopsy. We studied 4 cases of female patients with a mean age of 51 years. None of the patients presented specific abdominal symptoms, or other tumour masses detected by chance. One of them had relevant personal history: Renal cell carcinoma. This same patient was diagnosed with a contralateral renal angiomyolipoma. None of the patients showed evidence of tuberous sclerosis. Three tumours have been diagnosed by biopsy and only in one patient was decided to completely remove the tumour surgically. None of the patients had evidence of recurrence of disease or an increase in tumour size over an average period of 45 months. Histologically, the tumours have been sub classified into angiomyolipomas epithelioid. In 50% of the cases, extramedullary haematopoiesis was observed. The first diagnostic impression using imaging methods included: Focal nodular hyperplasia, hepatocellular adenoma, hepatocellular carcinoma and metastasis. By immunohistochemistry, it has been demonstrated that all tumours expressing melanocytic markers (HMB45 and Melan A) and markers of smooth muscle cells (smooth muscle actin). The diagnosis of these tumours is increasing due to programmes for early detection of hepatocellular carcinoma in patients with liver cirrhosis. It must be taken into account their broad spectrum of morphological diversity to avoid incorrect diagnosis of a malignant neoplasm.
Collapse
Affiliation(s)
- Santiago Ortiz
- Anatomía Patológica, Centro Hospitalario Lisboa Norte, Portugal
| | | |
Collapse
|
315
|
Chakrabarti A, Bandyopadhyay M, Purkayastha B. Malignant perivascular epitheloid cell tumour (PEComa) of the lung - a rare entity. Innov Surg Sci 2017; 2:39-42. [PMID: 31579733 PMCID: PMC6754007 DOI: 10.1515/iss-2016-0032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 01/09/2017] [Indexed: 01/08/2023] Open
Abstract
Malignant Perivascular Epitheloid Cell Tumour (PEComa) of the lung is very rare, with only six cases reported in literature. This case presented with a large mass originating from right upper lobe of the lung with dilemma in its histopathological diagnosis and management. Postoperative histopathology after a right upper and middle lobectomy describes a tumour with an alveolar/nested pattern of growth and epitheloid morphology with expression of TFE-3 and diagnosed as PEComa. After 6 months the patient had a local recurrence inside the thorax & chest wall.This case qualifies it as a rare type of malignant PEComa with younger age of presentation, aggressive clinical behaviour & malignant histological features along with TFE3 positivity on immunohistochemistry. This case is probably the first of its kind with the largest reported size involving two lobes of the lung.
Collapse
Affiliation(s)
- Amitabha Chakrabarti
- Flat 2B, 2 N N Dutta Road, Kolkata 700040, West Bengal, India.,Department of CTVS-NH Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India.,Department of CTVS-KPC Medical College and Hospitals, Kolkata, India
| | - Manujesh Bandyopadhyay
- Department of CTVS-NH Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India
| | - Biswarup Purkayastha
- Department of CTVS-NH Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India
| |
Collapse
|
316
|
Primary Perivascular Epithelioid Cell Tumor (PEComa) of the Bladder: A Case Report With 2-Years of Follow-Up and Review of Current Literature. Clin Genitourin Cancer 2017; 15:e79-e81. [DOI: 10.1016/j.clgc.2016.08.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 08/04/2016] [Indexed: 11/21/2022]
|
317
|
Cutaneous Perivascular Epithelioid Cell Tumor of Gynecologic Origin Metastatic to Skin, Lung, Stomach, and Brain. Am J Dermatopathol 2017; 39:157-159. [DOI: 10.1097/dad.0000000000000624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
318
|
Melloul S, El Hajjam M, Julié C. A Subhepatic Calcified Cyst. Gastroenterology 2017; 152:488-489. [PMID: 28056349 DOI: 10.1053/j.gastro.2016.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 09/05/2016] [Indexed: 12/02/2022]
Affiliation(s)
- Sarah Melloul
- Department of Pathology, Ambroise Paré, Boulogne-Billancourt, France
| | - Mostafa El Hajjam
- Department of Radiology, Ambroise Paré, Boulogne-Billancourt, France
| | - Catherine Julié
- Department of Pathology, Ambroise Paré, Boulogne-Billancourt, France
| |
Collapse
|
319
|
Jung DH, Hwang S, Hong SM, Kim KH, Ahn CS, Moon DB, Alshahrani AA, Lee SG. Clinico-pathological correlation of hepatic angiomyolipoma: a series of 23 resection cases. ANZ J Surg 2017; 88:E60-E65. [PMID: 28122404 DOI: 10.1111/ans.13880] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Revised: 11/15/2016] [Accepted: 11/16/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Angiomyolipomas are rare neoplasms of mesenchymal origin and are derived from perivascular epithelioid cells. They usually develop in the kidney and rarely in the liver. Due to their rarity, most hepatic angiomyolipomas have been misinterpreted as hepatocellular carcinoma (HCC) or other hypervascular liver tumours on imaging studies. We aimed to assess the clinico-pathological correlation of hepatic angiomyolipoma. METHODS We identified 23 patients with hepatic angiomyolipoma through an institutional database search. RESULTS Of 5680 cases of primary liver tumours, 23 (0.4%) had angiomyolipomas (mean age, 43.6 ± 12.4 years; 16 female patients). Hepatitis B virus infection was noted in four patients, whereas a liver mass was incidentally detected on routine health screening in 13 patients. The preoperative diagnoses, before liver biopsy, included HCC in 14, angiomyolipoma in six, focal nodular hyperplasia in two and hepatic adenoma in one patient. Eventually, the preoperative diagnoses were changed to HCC in 12 and hepatic angiomyolipoma in 11 patients. The tumour size was 5.3 ± 4.6 cm, and 22 patients had a single tumour. All tumours exhibited positive findings for human melanoma black-45 and smooth muscle actin staining. During a follow-up period of 52.2 ± 23.7 months, none of the patients exhibited tumour recurrence or mortality. CONCLUSIONS Hepatic angiomyolipoma is a rare form of primary liver tumour and is often misdiagnosed as other hypervascular tumours. Although angiomyolipoma is benign in nature, it also has malignant potential; hence, resection is indicated if the tumour grows or malignancy cannot be excluded. Surgical resection is a definitive curative treatment of hepatic angiomyolipoma.
Collapse
Affiliation(s)
- Dong Hwan Jung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Shin Hwang
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung Mo Hong
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ki Hun Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chul Soo Ahn
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Deok Bog Moon
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Abdulwahab A Alshahrani
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Gyu Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
320
|
Abstract
PURPOSE Establishing the correct diagnosis of a growing choroidal tumor can be difficult. METHODS Clinical examination and ultrasound of a patient followed for what was thought to be a uveal melanoma. Fine-needle biopsy established the correct diagnosis. RESULTS We demonstrate that fine-needle biopsy can correctly identify a very rare tumor, a myomelanocytic neoplasm. CONCLUSION Myomelanocytic choroidal tumors can be diagnosed on fine-needle biopsy.
Collapse
|
321
|
Tang D, Wang J, Tian Y, Li Q, Yan H, Wang B, Xiong L, Li Q. Hepatic perivascular epithelioid cell tumor: Case report and brief literature review. Medicine (Baltimore) 2016; 95:e5572. [PMID: 28002331 PMCID: PMC5181815 DOI: 10.1097/md.0000000000005572] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
RATIONAL Perivascular epithelioid cell tumor (PEComa) is a rare mesenchymal neoplasm which expresses both myogenic and melanocytic markers. PEComas are found in a variety locations in the body, but up to now only approximately 30 cases about hepatic perivascular epithelioid cell tumor are reported in English language worldwide. PATIENT CONCERNS A 32-year-old woman was admitted in our hospital with intermittent right upper quadrant pain for 1 month and recent (1 day) progressive deterioration. DIAGNOSES Based on the results of the laboratory examinations and the findings of the computed tomography, the diagnosis of hepatic hamartoma or the hepatocecullar carcinoma with hemorrhage was made. INTERVENTIONS The patient underwent a segmentectomy of the liver, and the finally diagnosis of hepatic PEComa was made with immunohistochemical confirmation with HMB-45 and SMA. OUTCOMES There is no clinical or radiographic evidence of recurrence 9 months after surgery. LESSONS This kind of tumor is extremely rare and the natural history of PEComa is uncertain, as the treatment protocol for hepatic PEComa has not reached a consensus. But the main treatment of the disease may be surgical resection. Only after long term follow-up can we know whether the tumor is benign or malignant. It appears that longer clinical follow-up is necessary in all patients with hepatic PEComas.
Collapse
Affiliation(s)
- Da Tang
- Department of General Surgery, Second Xiangya Hospital, Central South University
| | - Jianmin Wang
- Department of General Surgery, Second Xiangya Hospital, Central South University
| | - Yuepeng Tian
- Department of General Surgery, Second Xiangya Hospital, Central South University
| | - Qiuguo Li
- Department of General Surgery, the First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, P.R. China
| | - Haixiong Yan
- Department of General Surgery, Second Xiangya Hospital, Central South University
| | - Biao Wang
- Department of General Surgery, Second Xiangya Hospital, Central South University
| | - Li Xiong
- Department of General Surgery, Second Xiangya Hospital, Central South University
| | - Qinglong Li
- Department of General Surgery, Second Xiangya Hospital, Central South University
| |
Collapse
|
322
|
Gunji-Niitsu Y, Kumasaka T, Kitamura S, Hoshika Y, Hayashi T, Tokuda H, Morita R, Kobayashi E, Mitani K, Kikkawa M, Takahashi K, Seyama K. Benign clear cell "sugar" tumor of the lung in a patient with Birt-Hogg-Dubé syndrome: a case report. BMC MEDICAL GENETICS 2016; 17:85. [PMID: 27871249 PMCID: PMC5117512 DOI: 10.1186/s12881-016-0350-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 11/15/2016] [Indexed: 12/14/2022]
Abstract
Background Birt-Hogg-Dubé (BHD) syndrome is a rare inherited autosomal genodermatosis and caused by germline mutation of the folliculin (FLCN) gene, a tumor suppressor gene of which protein product is involved in mechanistic target of rapamycin (mTOR) signaling pathway regulating cell growth and metabolism. Clinical manifestations in BHD syndrome is characterized by fibrofolliculomas of the skin, pulmonary cysts with or without spontaneous pneumothorax, and renal neoplasms. There has been no pulmonary neoplasm reported in BHD syndrome, although the condition is due to deleterious sequence variants in a tumor suppressor gene. Here we report, for the first time to our knowledge, a patient with BHD syndrome who was complicated with a clear cell “sugar” tumor (CCST) of the lung, a benign tumor belonging to perivascular epithelioid cell tumors (PEComas) with frequent causative relation to tuberous sclerosis complex 1 (TSC1) or 2 (TSC2) gene. Case presentation In a 38-year-old Asian woman, two well-circumscribed nodules in the left lung and multiple thin-walled, irregularly shaped cysts on the basal and medial area of the lungs were disclosed by chest roentgenogram and computer-assisted tomography (CT) during a preoperative survey for a bilateral faucial tonsillectomy. Analysis of the resected tumor showed large polygonal cells with clear cytoplasm proliferating in a solid pattern. Immunohistochemistry revealed that these tumor cells were positive for microphthalmia-transcription factor, S100, and CD1a but negative for HMB45, indicating that the tumor was a CCST. Genetic testing indicated that the patient had a germline mutation on exon 12 of the FLCN gene, i.e., insertion of 7 nucleotides (CCACCCT) (c.1347_1353dupCCACCCT). Direct sequencing of the FLCN exon 12 using genomic DNA obtained from her microdissected CCST cells clearly revealed loss of the wild-type FLCN sequence, which confirmed complete functional loss of the FLCN gene. On the other hand, no loss of heterozygosity around TCS1- or TSC2-associated genetic region was demonstrated. Conclusion To our knowledge, this is the first report of CCST of the lung in a patient with BHDS, indicating that CCST should be added to the spectrum of pulmonary manifestations of BHDS.
Collapse
Affiliation(s)
- Yoko Gunji-Niitsu
- Divisions of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, 3-1-3, Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan.,The Study Group of Pneumothorax and Cystic Lung Diseases, 4-8-1 Seta, Setagaya-Ku, Tokyo, 158-0095, Japan
| | - Toshio Kumasaka
- Department of Pathology, Japanese Red Cross Medical Center, 4-1-22, Hiroo, Shibuya-Ku, Tokyo, 150-8935, Japan.,The Study Group of Pneumothorax and Cystic Lung Diseases, 4-8-1 Seta, Setagaya-Ku, Tokyo, 158-0095, Japan
| | - Shigehiro Kitamura
- Departments of Pathology, JCHO Tokyo Yamate Medical Center, 3-22-1 Hyakunin-cho, Shinjuku-Ku, Tokyo, 169-0073, Japan
| | - Yoshito Hoshika
- Divisions of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, 3-1-3, Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan.,The Study Group of Pneumothorax and Cystic Lung Diseases, 4-8-1 Seta, Setagaya-Ku, Tokyo, 158-0095, Japan
| | - Takuo Hayashi
- Human Pathology, Juntendo University Faculty of Medicine and Graduate School of Medicine, 3-1-3, Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan.,The Study Group of Pneumothorax and Cystic Lung Diseases, 4-8-1 Seta, Setagaya-Ku, Tokyo, 158-0095, Japan
| | - Hitoshi Tokuda
- Respiratory Medicine, JCHO Tokyo Yamate Medical Center, 3-22-1 Hyakunin-cho, Shinjuku-Ku, Tokyo, 169-0073, Japan
| | - Riichiro Morita
- Thoracic Surgery, JCHO Tokyo Yamate Medical Center, 3-22-1 Hyakunin-cho, Shinjuku-Ku, Tokyo, 169-0073, Japan
| | - Etsuko Kobayashi
- Divisions of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, 3-1-3, Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan.,The Study Group of Pneumothorax and Cystic Lung Diseases, 4-8-1 Seta, Setagaya-Ku, Tokyo, 158-0095, Japan
| | - Keiko Mitani
- Human Pathology, Juntendo University Faculty of Medicine and Graduate School of Medicine, 3-1-3, Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan.,The Study Group of Pneumothorax and Cystic Lung Diseases, 4-8-1 Seta, Setagaya-Ku, Tokyo, 158-0095, Japan
| | - Mika Kikkawa
- Laboratory of Proteomics and Biomolecular Science, Biomedical Research Center, Juntendo University Faculty of Medicine and Graduate School of Medicine, 3-1-3, Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan
| | - Kazuhisa Takahashi
- Divisions of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, 3-1-3, Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan
| | - Kuniaki Seyama
- Divisions of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, 3-1-3, Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan. .,The Study Group of Pneumothorax and Cystic Lung Diseases, 4-8-1 Seta, Setagaya-Ku, Tokyo, 158-0095, Japan.
| |
Collapse
|
323
|
Wang Q, Huang HF, Li ZT, Zhao XR, Duan J, Lin J, Xia ZC, Zeng Z. Diagnosis and treatment of hepatic perivascular epithelioid cell tumor: A case report and literature review. Shijie Huaren Xiaohua Zazhi 2016; 24:4315-4318. [DOI: 10.11569/wcjd.v24.i31.4315] [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] [Indexed: 02/06/2023] Open
Abstract
Liver perivascular epithelioid cell tumor is a rare liver mesenchymal tumor with an insidious onset. This entity is often misdiagnosed due to the lack of typical clinical symptoms and signs and the low diagnosis rate achieved by imaging examinations. Here we report a case of liver perivascular epithelioid cell tumor. We also performed a literature review to summarize and analyze the clinical characteristics and treatment of this disease.
Collapse
|
324
|
Hartley CP, Kwiatkowski DJ, Hamieh L, Lefferts JA, Smith KD, Lisovsky M. Pancreatic PEComa is a novel member of the family of tuberous sclerosis complex-associated tumors: case report and review of the literature. Virchows Arch 2016; 469:707-710. [DOI: 10.1007/s00428-016-2032-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 08/25/2016] [Accepted: 10/09/2016] [Indexed: 11/28/2022]
|
325
|
Theofanakis C, Thomakos N, Sotiropoulou M, Rodolakis A. Perivascular epithelioid cell tumor of the uterus: Report of two cases and mini-review of the literature. Int J Surg Case Rep 2016; 28:85-87. [PMID: 27689526 PMCID: PMC5043388 DOI: 10.1016/j.ijscr.2016.09.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 09/01/2016] [Accepted: 09/06/2016] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Perivascular Epithelioid Cell tumor (PEComa) is a rare neoplasm of mesenchymal origin, with the uterus being the most common site of appearance, regarding the female genital tract. CASE REPORT We present two cases of PEComas of the uterus in patients aged 57 and 42-years-old, presented to our department with palpable abdominal masses and abnormal vaginal bleeding. During follow up period, both patients are free of recurrent disease one and two years after surgery, respectively, without receiving any adjuvant treatment. CONCLUSIONS PEComa of the female gynecological tract is a rare entity presenting with variable symptoms and different prognosis for each individual case. The diagnosis is based on histopathology and immunohistochemistry reports and the optimal treatment is the surgical resection of the tumor.
Collapse
Affiliation(s)
- Charalampos Theofanakis
- Division of Gynecologic Oncology, 1st Department of Obstetrics & Gynecology, University of Athens, Alexandra Hospital, Vasilissis Sofias 80 & Lourou 1, 11528, Athens, Greece.
| | - Nikolaos Thomakos
- Division of Gynecologic Oncology, 1st Department of Obstetrics & Gynecology, University of Athens, Alexandra Hospital, Vasilissis Sofias 80 & Lourou 1, 11528, Athens, Greece
| | - Maria Sotiropoulou
- Histopathology Lab, Alexandra Hospital, Vasilissis Sofias 80 & Lourou 1, 11528, Athens, Greece
| | - Alexandros Rodolakis
- Division of Gynecologic Oncology, 1st Department of Obstetrics & Gynecology, University of Athens, Alexandra Hospital, Vasilissis Sofias 80 & Lourou 1, 11528, Athens, Greece
| |
Collapse
|
326
|
Abstract
The authors present a first case of pigmented perivascular epithelioid cell tumor (PEComa) of the skin, which was misdiagnosed histopathologically as metastatic melanoma. PEComa are exceedingly rare neoplasms, and only a few cases have been reported in kidney, liver, and pelvis. Herein, we describe this very rare entity in the subcutaneous tissue of the flank with very similar if not identical morphology of renal clear cell carcinoma. Because of the presence of focal melanin pigmentation and strong positivity for HMB-45, the lesion was mistaken for metastatic melanoma. To the best of authors' knowledge, this is the first case of cutaneous PEComa with melanin pigmentation. Awareness about occurrence of the lesion in the subcutaneous tissue and its unique immunoprofile would be helpful to reach correct diagnosis and to distinguish this lesion from melanoma or metastatic renal clear cell carcinoma.
Collapse
|
327
|
Kiriyama Y, Tsukamoto T, Mizoguchi Y, Ishihara S, Horiguchi A, Tokoro T, Kato Y, Sugioka A, Kuroda M. Intrahepatic peribiliary perivascular epithelioid cell tumor (PEComa) associated with heterotopic pancreas: A case report. Diagn Pathol 2016; 11:81. [PMID: 27542598 PMCID: PMC4992331 DOI: 10.1186/s13000-016-0528-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 08/06/2016] [Indexed: 03/05/2023] Open
Abstract
Background Perivascular epithelioid-cell tumor (PEComa) is a group of rare mesenchymal neoplasms that express myomelanocytic-cell markers and exhibit a wide variety of histopathological features. Although heterotopic pancreas has been reported to occur in the gastrointestinal tract, intrahepatic heterotopic pancreas has been reported only rarely. Case presentation We present a case of intrahepatic PEComa that showed a strong regional correlation with the presence of heterotopic pancreas. An intrahepatic tumor and biliary dilatation was incidentally discovered during a diagnostic evaluation to investigate low-back pain in a 47-year-old Japanese male. Cholangiocarcinoma was suspected and a left hemihepatectomy performed. Histological examination revealed a 3 × 3.8-mm tumor in the neighboring B2 bile duct. Histological and immunohistochemical investigations revealed the presence of a PEComa and pancreatic acini within the tumor mass. PEComa in the hepatobiliary and pancreatic regions are extremely rare. The presence of heterotopic pancreas is also relatively uncommon. Conclusion The strong regional association of these 2 lesions raises the possibility of a PEComa originating from heterotopic pancreas or from an irritable response caused by heterotopic pancreas.
Collapse
Affiliation(s)
- Yuka Kiriyama
- Department of Diagnostic Pathology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Tetsuya Tsukamoto
- Department of Diagnostic Pathology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.
| | - Yoshikazu Mizoguchi
- Department of Diagnostic Pathology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Shin Ishihara
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Akihiko Horiguchi
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Takamasa Tokoro
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Yutaro Kato
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Atsushi Sugioka
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Makoto Kuroda
- Department of Diagnostic Pathology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| |
Collapse
|
328
|
Yoo-Bee H, Ri SY, Jun KK, Jiyoung K. Computerized Tomography and Magnetic Resonance Imaging Findings in Malignant Perivascular Epithelioid Cell Tumors of the Ovaries with Pulmonary Metastasis. IRANIAN JOURNAL OF RADIOLOGY 2016; 13:e34712. [PMID: 27895874 PMCID: PMC5117114 DOI: 10.5812/iranjradiol.34712] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 02/06/2016] [Accepted: 05/02/2016] [Indexed: 12/16/2022]
Abstract
Perivascular epithelioid cell tumor (PEComa) is a rare mesenchymal tumor composed of immunohistochemically and histologically distinctive perivascular epithelioid cells. Here, we report on the computed tomography (CT) and magnetic resonance imaging (MRI) findings of ovarian PEComa with pulmonary metastasis. The tumor was visible as a multilocular hemorrhagic mass that encased the ovarian vessels. These findings were different to those of other common ovarian tumors.
Collapse
Affiliation(s)
- Han Yoo-Bee
- Department of Radiology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
| | - Shin Yu Ri
- Department of Radiology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
- Corresponding author: Shin Yu Ri, Department of Radiology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea. Tel: +82-322805233, Fax: +82-322805230, E-mail:
| | - Kim Ki Jun
- Department of Radiology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
| | - Kim Jiyoung
- Department of Hospital Pathology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
| |
Collapse
|
329
|
Refinements in Sarcoma Classification in the Current 2013 World Health Organization Classification of Tumours of Soft Tissue and Bone. Surg Oncol Clin N Am 2016; 25:621-43. [PMID: 27591490 DOI: 10.1016/j.soc.2016.05.001] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The fourth edition of the World Health Organization (WHO) Classification of Tumours of Soft Tissue and Bone was published in February 2013. The 2013 WHO volume provides an updated classification scheme and reproducible diagnostic criteria, which are based on recent clinicopathologic studies and genetic and molecular data that facilitated refined definition of established tumor types, recognition of novel entities, and the development of novel diagnostic markers. This article reviews updates and changes in the classification of bone and soft tissue tumors from the 2002 volume.
Collapse
|
330
|
Padhi P, Rali P, Hattab Y, Adjapong O, Malik KJ, Mao S. WITHDRAWN: A Unique Case of Perivascular Epithelioid Cell Tumor Associated With Birt-Hogg-Dube Syndrome. Clin Genitourin Cancer 2016:S1558-7673(16)30203-8. [PMID: 29079164 DOI: 10.1016/j.clgc.2016.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 07/13/2016] [Indexed: 11/15/2022]
Abstract
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.
Collapse
Affiliation(s)
- Parikshit Padhi
- Department of Hematology and Oncology, Allegheny Health Network, Pittsburgh, PA
| | - Parth Rali
- Department of Pulmonary and Critical Care Medicine, Allegheny Health Network, Pittsburgh, PA
| | - Yousef Hattab
- Department of Pulmonary and Critical Care Medicine, Allegheny Health Network, Pittsburgh, PA
| | - Opoku Adjapong
- Department of Pathology, Allegheny Health Network, Pittsburgh, PA
| | - Khalid J Malik
- Department of Pulmonary and Critical Care Medicine, Allegheny Health Network, Pittsburgh, PA
| | - Shifeng Mao
- Department of Hematology and Oncology, Allegheny Health Network, Pittsburgh, PA
| |
Collapse
|
331
|
Choi YJ, Hong JH, Kim A, Kim H, Chang H. A Case of Malignant PEComa of the Uterus Associated with Intramural Leiomyoma and Endometrial Carcinoma. J Pathol Transl Med 2016; 50:469-473. [PMID: 27452081 PMCID: PMC5122724 DOI: 10.4132/jptm.2016.04.20] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 03/24/2016] [Accepted: 04/20/2016] [Indexed: 02/05/2023] Open
Abstract
Perivascular epithelioid cell tumors (PEComas) refers to a family of mesenchymal neoplasms composed of angiomyolipomas, clear cell “sugar” tumors of the lung, and lymphangioleiomyomatoses. These tumors have a distinctive and common component of perivascular epithelioid cells that show an association with blood vessel walls and immunohistochemically display myomelanocytic differentiation. The unique neoplasms have been shown to have an expanded range through a variety of case reports, including visceral, intra-abdominal, soft tissue, and bone tumors. The retroperitoneum, abdominopelvic region, and uterus have been reported to be the most common sites. Most PEComas follow a benign course. However, reports of malignant PEComas are increasing. Many papers have described uterine PEComas, but to our knowledge, there have not yet been any reports of a malignant PEComa arising concomitant with another epithelial tumor and mesenchymal tumor. We report herein the case of a 67-year-old woman who experienced a malignant uterine PEComa infiltrating a preexisting intramural leiomyoma with synchronous well differentiated endometrial carcinoma and multiple liver and lung metastases.
Collapse
Affiliation(s)
- Yoo Jin Choi
- Department of Pathology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jin Hwa Hong
- Department of Obsterics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Aeree Kim
- Department of Pathology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hankyeom Kim
- Department of Pathology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hyeyoon Chang
- Department of Pathology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| |
Collapse
|
332
|
Feasel PC, Cheah AL, Fritchie K, Winn B, Piliang M, Billings SD. Primary clear cell sarcoma of the head and neck: a case series with review of the literature. J Cutan Pathol 2016; 43:838-46. [PMID: 27264732 DOI: 10.1111/cup.12755] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 02/01/2016] [Accepted: 05/04/2016] [Indexed: 01/12/2023]
Abstract
BACKGROUND Clear cell sarcoma typically arises in deep soft tissues of the foot/ankle. Primary head and neck clear cell sarcoma is rare. We report three molecularly confirmed primary head and neck clear cell sarcoma and review the literature. METHODS Head and neck clear cell sarcoma with no primary elsewhere were retrieved from archival/consultation files. English language literature review of all reported head and neck clear cell sarcoma was performed. RESULTS Three cases were identified. The tumors, all in men, presented on the scalp of a 33-year-old, face of a 20-year-old and tongue of a 44-year-old. Tumors ranged from 0.6 to 1.4 cm. All had typical features of clear cell sarcoma, including nests of tumor cells divided by fibrous septae. One had multinucleated wreath-like giant cells. One had a focal junctional component. Immunohistochemistry was positive for S100 (three out of three), HMB45 (three out of three) and Melan-A (two out of three). All had EWSR1 rearrangements by fluorescence in situ hybridization. Follow up available for one patient revealed no evidence of disease after wide excision and radiation. Seven additional reported cases were identified and tabulated. CONCLUSION Head and neck clear cell sarcoma is rare but should be considered in the differential diagnosis of nested tumors with fibrous septae. Molecular analysis should be considered for definitive diagnosis regardless of location.
Collapse
Affiliation(s)
| | - Alison L Cheah
- Department of Histopathology, Douglass Hanly Moir Pathology, Macquarie Park, NSW, Australia
| | - Karen Fritchie
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Brody Winn
- Department of Pathology, University Medical Center of Southern Nevada, Las Vegas, NV, USA
| | - Melissa Piliang
- Department of Dermatology, Cleveland Clinic, Cleveland, OH, USA
| | | |
Collapse
|
333
|
Chen Z, Han S, Wu J, Xiong M, Huang Y, Chen J, Yuan Y, Peng J, Song W. A systematic review: perivascular epithelioid cell tumor of gastrointestinal tract. Medicine (Baltimore) 2016; 95:e3890. [PMID: 27428182 PMCID: PMC4956776 DOI: 10.1097/md.0000000000003890] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Perivascular epithelioid cell tumor (PEComa) is a rare entity with distinctive morphology and of expressing myomelanocytic markers. Gastrointestinal tract (GI) is one of the most common anatomic sites of origin and counts for 20% to 25% of all reported cases of perivascular epithelioid cell tumors not otherwise specified (PEComas-NOS). However, the biologic behavior of perivascular epithelioid cell tumors of gastrointestinal tract (GI PEComas-NOS) is still unclear. The aim of conducting this systematic review is to sum up what is known so far of the epidemiology, natural history, management and prognosis of GI PEComas-NOS.A systematic research was performed on PubMed and EMBASE using the following terms: ("perivascular epithelioid cell tumor" or "PEComa") and ("gastrointestinal tract" or "GI" or "oral " or "mouth" or "esophagus" or "gullet" or "gastric" or "stomach" or "duodenum" or "jejunum" or "ileum" or "cecum" or "colon" or "colorectal" or "sigmoid" or "rectum" or "anus" or "mesentery") up to December 1, 2015. Retrieved GI PEComas-NOS publications, which included these terms, contains case reports, case series to case characteristic researches.A total of 168 articles were reviewed, 41 GI PEComa-NOS English studies among which were retrieved for analysis. We reviewed epidemiology, natural history, management and prognosis of GI PEComa-NOS. Generally GI PEComa-NOS is believed to have women predomination. The most frequently involved location is colon with non-specific clinical signs. Pathologically, GI PEComas-NOS shows epithelioid predominance (70%), meanwhile coexpresses melanocytic and muscle markers characteristically, while immunohistochemistry is a useful tool for identify, which indicates that HMB-45 is regarded as the most sensitive reagent. Complete resection served as mainstay of treatment, while chemotherapy should be unanimously considered to apply in malignant cases. Eventually, it is necessary for closed and long-term follow-up with endoscope and imaging for ruling out local recurrence or distant metastasis of this tumor.GI PEComas-NOS lives with unclear behavior. There are still many unverified clinicopathological issues of GI PEComas-NOS that needs to be clarified. Further studies and analyses concerning this rare entity should be brought out. Thus, the randomized clinical researches (RCTs) are required to be conducted.
Collapse
Affiliation(s)
- Zehong Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital,Sun Yat-Sen University
| | - Siqi Han
- Faculty of Medical Statistics and Epidemiology, School of Public Health,Sun Yat-Sen University
| | - Jialin Wu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital,Sun Yat-Sen University
| | - Minmin Xiong
- Center for Stem Cell Biology and Tissue Engineering, Key Laboratory for Stem Cells and Tissue Engineering, Ministry of Education, Sun Yat-Sen University
| | - Yanqiao Huang
- Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Jianhui Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital,Sun Yat-Sen University
| | - Yujie Yuan
- Department of Gastrointestinal Surgery, The First Affiliated Hospital,Sun Yat-Sen University
| | - Jianjun Peng
- Department of Gastrointestinal Surgery, The First Affiliated Hospital,Sun Yat-Sen University
| | - Wu Song
- Department of Gastrointestinal Surgery, The First Affiliated Hospital,Sun Yat-Sen University
- Correspondence: Wu Song, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China (e-mail: )
| |
Collapse
|
334
|
Neoadjuvant or adjuvant sirolimus for malignant metastatic or locally advanced perivascular epithelioid cell tumors: two case reports. Anticancer Drugs 2016; 27:254-8. [PMID: 26645891 DOI: 10.1097/cad.0000000000000324] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Perivascular epithelioid cell tumors (PEComas) are very rare mesenchymal tumors, characterized by the presence of perivascular epithelioid cells. Despite their often benign nature, malignant variants with a locally aggressive growth pattern and even distant metastases are known. We describe two cases of malignant PEComas. The first patient had an extensive peritoneal spread and a history of multiple resections, and received the mechanistic target of rapamycin inhibitor sirolimus in a postoperative setting as maintenance therapy. The second patient presented with locally advanced disease in the iliac fossa and was treated with sirolimus in a neoadjuvant setting and achieved complete remission. Both patients have been under treatment for 18 and 52 months, respectively, and are currently in complete remission. These two cases indicate that mechanistic target of rapamycin inhibition for malignant PEComas could be a safe and successful treatment strategy in a neoadjuvant setting with an acceptable toxicity profile.
Collapse
|
335
|
Perivascular epithelial cell tumor (PEComa) of the pancreas: a case report and review of previous literatures. Surg Case Rep 2016; 2:59. [PMID: 27307283 PMCID: PMC4909687 DOI: 10.1186/s40792-016-0186-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 06/09/2016] [Indexed: 12/28/2022] Open
Abstract
Perivascular epithelial cell tumors (PEComas), firstly described by Bonetti in 1992, are a family of mesenchymal tumor composed of perivascular epithelioid cells having epithelioid or spindle morphology and exhibiting melanocytic and myogenic immunoreactivities. We herein described a 61-year-old woman who presented with epigastric pain. Preoperative imaging studies showed that 7-cm-sized mass was located in pancreatic head and body, and pancreaticoduodenectomy was performed. Histological findings showed that the tumor was composed of clear epithelioid cells with abundant glycogen granules, which grew in a nested and alveolar pattern around blood vessels. The tumor cells showed immunoreactivities for HMB-45 but did not express epithelial or endocrine markers. These histological features indicated those of PEComa. This report underlines that we should recognize PEComa as a preoperative differential diagnosis of pancreatic tumors.
Collapse
|
336
|
Abstract
This review covers gynecologic manifestations that may occur in rare hereditary syndromes. Recent advances in disorders, such as hereditary leiomyomatosis, renal cell carcinoma syndrome and tuberous sclerosis complex, are discussed as well as lesions that occur in von Hippel-Lindau syndrome, nevoid basal cell carcinoma syndrome, Cowden syndrome, Ollier disease/Maffucci syndrome, and Carney complex. Characteristic clinicopathologic features of each of these syndromes are discussed with an emphasis on the key features that enable pathologists to identify patients at highest risk for these diseases.
Collapse
|
337
|
Schaefer IM, Fletcher CDM. Diagnostically Challenging Spindle Cell Neoplasms of the Retroperitoneum. Surg Pathol Clin 2016; 8:353-74. [PMID: 26297061 DOI: 10.1016/j.path.2015.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The diagnostic spectrum of spindle cell neoplasms arising in the retroperitoneum is wide and, in the presence of commonly shared morphologic features, it may be challenging to establish a correct diagnosis in certain cases. Beyond seemingly undifferentiated spindle cell morphology, most neoplasms may reveal distinctive adipocytic, smooth muscle or myofibroblastic or nerve sheath differentiation and show additional diagnostic clues or characteristic molecular abnormalities. Obtaining sufficient and representative biopsy material, a thorough work-up, and extensive sampling of gross specimens followed by a combined histopathologic, immunohistochemical, and, if necessary, molecular work-up of these cases is advisable so as not to miss important diagnostic and/or prognostic indicators.
Collapse
Affiliation(s)
- Inga-Marie Schaefer
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Christopher D M Fletcher
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
| |
Collapse
|
338
|
Fitzpatrick M, Pulver T, Klein M, Murugan P, Khalifa M, Amin K. Perivascular Epithelioid Cell Tumor of the Uterus with Ovarian Involvement: A Case Report and Review of the Literature. AMERICAN JOURNAL OF CASE REPORTS 2016; 17:309-14. [PMID: 27150246 PMCID: PMC4913755 DOI: 10.12659/ajcr.896401] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patient: Female, 61 Final Diagnosis: Uterine PEComa with ovarian involvement Symptoms: Palpable abdominal mass Medication: — Clinical Procedure: Hysterectomy and bilateral salpingo-oophorectomy Specialty: Obstetrics and Gynecology
Collapse
Affiliation(s)
- Megan Fitzpatrick
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Tanya Pulver
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, Minneapolis, MN, USA
| | - Molly Klein
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Paari Murugan
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Mahmoud Khalifa
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Khalid Amin
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
339
|
Cheng M. Perivascular epithelioid cell neoplasm: A case report and an overview of the current literature. SURGICAL PRACTICE 2016. [DOI: 10.1111/1744-1633.12171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Mina Cheng
- Department of Surgery; Princess Margaret Hospital; Hong Kong
| |
Collapse
|
340
|
Primary pulmonary clear cell sarcoma-the first two reported cases. Virchows Arch 2016; 469:111-7. [PMID: 27112339 DOI: 10.1007/s00428-016-1943-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 03/27/2016] [Accepted: 04/14/2016] [Indexed: 10/21/2022]
Abstract
We report two cases (male patients 50 and 55 years old) of clear cell sarcoma ("melanoma of soft parts") arising in the lung, of which one case showed regional lymph node metastases. Histologically, both tumors displayed varying clear epithelioid and spindle neoplastic cells arranged in storiform and nested growth patterns, separated by thin fibrovascular septa. Immunohistochemical studies demonstrated positive expression of S-100 protein, HMB-45 and Melan-A in one case and S-100 protein only in the other. Fluorescence in situ hybridization showed positive EWSR1 gene rearrangement, and a presence of EWS-ATF1 fusion transcript was confirmed by RT-PCR and sequencing in one case.
Collapse
|
341
|
Oh HW, Kim TH, Cha RR, Kim NY, Kim HJ, Jung WT, Lee OJ, Lee JH. [A case of malignant perivascular epithelioid cell tumor of the retroperitoneum with multiple metastases]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2016; 64:302-6. [PMID: 25420742 DOI: 10.4166/kjg.2014.64.5.302] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Perivascular epithelioid cell tumors (PEComas) are unusual mesenchymal neoplasms composed of histologically and immunohistochemically distinct perivascular epithelioid cells (PECs). Although PEComas have the potential to behave in a malignant fashion, malignant PEComas arising from the retroperitoneum are extremely rare. A 68-year-old woman presented with a painful palpable mass in her left upper abdomen. Computed tomography of the abdomen showed a 9 cm sized heterogeneous mass in left para-aortic space and multiple hypervascular nodules in the liver. (18)F-fludeoxyglucose-PET/CT showed multifocal hyper-metabolic lesions in retroperitoneum, liver, and skeletal bones. Percutaneous needle biopsies were done on the retroperitoneal and hepatic mass. Both specimens were positive for human melanoma black-45 (HMB-45) on histological and immunohistochemical staining which was compatible with PEComas. Herein, we report a rare case of retroperitoneal PEComa with multiple metastases involving liver and bone at initial diagnosis that exhibited aggressive behavior and resulted in a devastating prognosis.
Collapse
|
342
|
Perivascular epithelioid cell tumors of the uterine cervix. Pathol Res Pract 2016; 212:667-71. [PMID: 27083240 DOI: 10.1016/j.prp.2016.03.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 03/09/2016] [Accepted: 03/29/2016] [Indexed: 12/17/2022]
Abstract
The World Health Organization (WHO) defines PEComas as mesenchymal tumors composed of histologically and immunohistochemically distinctive perivascular cells. Uterus is the most common site of a subgroup of PEComas not otherwise specified(NOS). PEComas of the uterine cervix are extremely rare, and only thirteen cases have been described in the English literature to date. In this review, we summarize the available data concerning diagnostics, immunohistochemical analysis, genetics and treatment of cervical PEComas. Radical hysterectomy with bilateral salpingooophorectomy is the best surgical approach available. Adjuvant therapy in its present form is not efficient. Therefore, further studies are needed to evaluate the newest treatment strategies.
Collapse
|
343
|
Gao F, Huang C, Zhang Y, Sun R, Zhang Y, Wang H, Zhang S. Combination targeted therapy of VEGFR inhibitor, sorafenib, with an mTOR inhibitor, sirolimus induced a remakable response of rapid progressive Uterine PEComa. Cancer Biol Ther 2016; 17:595-8. [PMID: 27030639 DOI: 10.1080/15384047.2016.1167290] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Perivascular epithelioid cell tumor is a rare tumor. To date, there is no consensus of therapy to be recommended for unresectable disease. For a low incidence and a rarely curable disease, the finding of new therapy is essential. Here we report the first case of a patient with perivascular epithelioid cell tumor whose disease had a rapid progression after surgery and had a rapid remarkable response of combination therapy of a VEGFR inhibitor, sorafenib, with an mTOR inhibitor, sirolimus. This result may have potential to deliver a new treatment option and inhibiting the mTOR pathway combined with inhibiting the VEGF pathways may be a useful strategy for malignant PEComas.
Collapse
Affiliation(s)
- Fang Gao
- a Department of Medical Oncology , Shandong Cancer Hospital, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences , Jinan ; Shandong Province , China
| | - Chengsuo Huang
- a Department of Medical Oncology , Shandong Cancer Hospital, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences , Jinan ; Shandong Province , China
| | - Yiping Zhang
- b Department of Medicine , Weihai Guoan Hospital , Weihai , Shandong Province , China
| | - Ruirui Sun
- c Department of Medicine , Weihai Children's Hospital ; Weihai , Shandong Province , China
| | - Yujie Zhang
- d Department of Oncology , Xinjiang Medical University Hospital , Wulumuqi , Xinjiang Province , China
| | - Huijun Wang
- a Department of Medical Oncology , Shandong Cancer Hospital, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences , Jinan ; Shandong Province , China
| | - Shu Zhang
- a Department of Medical Oncology , Shandong Cancer Hospital, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences , Jinan ; Shandong Province , China
| |
Collapse
|
344
|
Llamas-Velasco M, Requena L, Mentzel T. Cutaneous perivascular epithelioid cell tumors: A review on an infrequent neoplasm. World J Methodol 2016; 6:87-92. [PMID: 27019799 PMCID: PMC4804255 DOI: 10.5662/wjm.v6.i1.87] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Revised: 12/15/2015] [Accepted: 02/17/2016] [Indexed: 02/06/2023] Open
Abstract
“Perivascular epithelioid cutaneous” cell tumors (PEComa) are a family of mesenchymal tumors with shared microscopic and immunohistochemical properties: They exhibit both smooth muscle cell and melanocytic differentiation. Non-neoplastic counterpart of PEComa’s cells are unknown, as well as the relationship between extracutaneous PEComa and primary cutaneous ones. We will review the clinical setting, histopathologic features, chromosomal abnormalities, differential diagnosis and treatment options for cutaneous PEComa.
Collapse
|
345
|
D'Andrea D, Hanspeter E, D'Elia C, Martini T, Pycha A. Malignant Perivascular Epithelioid Cell Neoplasm (PEComa) of the Pelvis: A Case Report. Urol Case Rep 2016; 6:36-8. [PMID: 27169023 PMCID: PMC4855909 DOI: 10.1016/j.eucr.2016.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 02/08/2016] [Accepted: 02/10/2016] [Indexed: 11/13/2022] Open
Abstract
Perivascular epithelioid cell neoplasms (PEComa) are rare mesenchymal tumors that can occur in any part of the body and have unpredictable pathological behavior. They are usually benign, but may be malignant. We present a case of malignant PEComa of the pelvic retroperitoneum treated with radical surgery.
Collapse
Affiliation(s)
- David D'Andrea
- Urology Department, Central Hospital of Bolzano, Via Lorenz Böhler, 5, 39100 Bolzano, Italy
| | - Esther Hanspeter
- Pathology Department, Central Hospital of Bolzano, Via Lorenz Böhler, 5, 39100 Bolzano, Italy
| | - Carolina D'Elia
- Urology Department, Central Hospital of Bolzano, Via Lorenz Böhler, 5, 39100 Bolzano, Italy
| | - Thomas Martini
- Department of Urology, Ulm University Medical Center, Prittwitzstrasse 43, 89075 Ulm, Germany
| | - Armin Pycha
- Urology Department, Central Hospital of Bolzano, Via Lorenz Böhler, 5, 39100 Bolzano, Italy
| |
Collapse
|
346
|
Rampisela D, Grossmann P, Donner LR. Rhabdoid Myomelanocytic Tumor (PEComa) of the Ovary. Int J Surg Pathol 2016; 24:431-5. [DOI: 10.1177/1066896916635815] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A 3.0 × 2.5 cm rhabdoid myomelanocytic tumor was incidentally found in the left ovary of a 43-year-old black woman. The tumor cells were cytologically bland with minimal proliferation rate, multifocally weakly or moderately expressed TFE3, strongly expressed smooth muscle markers and SMARCB1/INI1, and focally expressed HMB45. They contained numerous paranuclear whorls of intermediate filaments that were verified by ultrastructure. No other lines of differentiation were detected within the tumor. Neither translocation nor increased number of copies of the TFE3 gene at Xp11.22 was detected by fluorescence in situ hybridization. The patient remains well, free of tumor, 7 years after surgery. A rhabdoid variant of myomelanocytic tumor is a rarity, with only a single case described previously.
Collapse
Affiliation(s)
- Debby Rampisela
- Baylor Scott & White Health/Texas A&M Health Science Center College of Medicine, Temple, TX, USA
| | | | - Ludvik R. Donner
- Baylor Scott & White Health/Texas A&M Health Science Center College of Medicine, Temple, TX, USA
| |
Collapse
|
347
|
Liu TH, Liang CW, Lu LC. Perivascular epithelioid cell tumor of the gastrointestinal tract. JOURNAL OF CANCER RESEARCH AND PRACTICE 2016. [DOI: 10.1016/j.jcrpr.2015.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
|
348
|
Angiomyolipoma and Malignant PEComa: Discussion of Two Rare Adrenal Tumors. Case Rep Oncol Med 2016; 2016:5204092. [PMID: 26998374 PMCID: PMC4779821 DOI: 10.1155/2016/5204092] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 01/26/2016] [Accepted: 01/31/2016] [Indexed: 12/26/2022] Open
Abstract
Angiomyolipoma and PEComa are rare tumors descending from perivascular epithelial cells (PECs), with distinctive IHC, morphological, and ultrastructural features. The kidney is the most frequent site of origin, but not the only one; however, adrenal gland angiomyolipomas are extremely rare. We describe two cases being found in the adrenal glands. Given the paucity of literature on the subject, more information on this disease is necessary for diagnosis and treatment. Here, we describe two complete case reports, from presentation to treatment and follow-up, along with imaging and microscopic pathology samples, and provide a comprehensive review as to the history and current literature available regarding these extremely rare tumors.
Collapse
|
349
|
Phillips CH, Keraliya AR, Shinagare AB, Ramaiya NH, Tirumani SH. Update on the imaging of malignant perivascular epithelioid cell tumors (PEComas). Abdom Radiol (NY) 2016; 41:368-76. [PMID: 26867923 DOI: 10.1007/s00261-015-0568-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Malignant perivascular epithelioid cell tumors (PEComas) are a histologic group of mesenchymal neoplasms that share a distinctive histological phenotype, the perivascular epithelioid cell. These tumors are known for their perivascular distribution. Malignant PEComas have a female predominance and are associated with aggressive disease and poor prognosis, making timely diagnosis critical to management. Imaging features of malignant PEComas are nonspecific and mimic other benign and malignant neoplasms. Surgery is the mainstay in the management of malignant PEComas. Promising novel molecular targeted therapies like m-TOR inhibitors have been shown to be effective in the metastatic setting. The aim of this review is to familiarize radiologists with the imaging appearances of and potential therapies for primary and metastatic malignant PEComa.
Collapse
Affiliation(s)
- Catherine H Phillips
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Abhishek R Keraliya
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
- Department of Imaging, Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Atul B Shinagare
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
- Department of Imaging, Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Nikhil H Ramaiya
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
- Department of Imaging, Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Sree Harsha Tirumani
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
- Department of Imaging, Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA.
| |
Collapse
|
350
|
Could the Study by Tallon and Beer Solve the Paradox of Primary Cutaneous PEComas? Am J Dermatopathol 2016; 38:81-2. [PMID: 26730697 DOI: 10.1097/dad.0000000000000322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|