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Abstract
This article provides an overview of rare orbital diseases. Congenital
malformations, inflammatory diseases, benign and malignant neoplasias are
described. Although it represents a relatively small area of the body the
orbit contains multiple different tissues. Therefore, a great variety of
diseases can be found within the orbital space. That is the reason, why both
the completeness and the level of detail in the description of particular
diseases must be somewhat limited. Nevertheless, clinical manifestations,
important aspects of diagnosis, treatment strategies, and, when specific
data are available, the prognosis are described. The authors tried to
highlight the most characteristic aspects of the different diseases to
describe their relevant aspects in spite of the brevity of the
subsections.
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Affiliation(s)
- Ulrich Kisser
- Universitätsklinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Halle/S. (Klinikdirektor: Prof. Dr. med. S. Plontke)
| | - Jens Heichel
- Universitätsklinik und Poliklinik für Augenheilkunde, Halle/S. (Klinikdirektor: Prof. Dr. med. A. Viestenz)
| | - Alexander Glien
- Universitätsklinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Halle/S. (Klinikdirektor: Prof. Dr. med. S. Plontke)
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2
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Chang AY, Tran AQ, Plum W, Tooley AA, Purushothaman S, Kazim M. Atypical presentation of invasive myoepithelioma in a pediatric patient. Orbit 2021; 41:657-660. [PMID: 33906572 DOI: 10.1080/01676830.2021.1918724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
A 15-year-old girl presented with a mobile lesion with yellowish hue on the posterior lamella of the right lower eyelid adjacent to the punctum. Four years prior, a lesion thought to be a chalazion was excised from the same location. There was subsequent progressive painless enlargement. The patient ultimately underwent an internal excision of the mass. Histopathology demonstrated infiltrative nests and cords of epithelioid and plasmacytoid cells with abundant eosinophilic myxoid-collagenous stroma along with focal infiltration of skeletal muscle with immunohistochemical staining consistent with an invasive myoepithelioma of mixed-cell type. Given concern for invasive disease, the patient underwent subsequent Mohs resection resulting in a 25% full thickness eyelid defect, which was repaired with direct closure of the wedge defect. There has been no recurrence of the disease for 7 months since the Mohs resection. This case illustrates the atypical presentation of an invasive myoepithelioma of the eyelid in a pediatric patient.
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Affiliation(s)
- Angela Y Chang
- Columbia University Irving Medical Center - NewYork-Presbyterian Hospital, New York, New York, USA
| | - Ann Q Tran
- Columbia University Irving Medical Center - NewYork-Presbyterian Hospital, New York, New York, USA
| | - William Plum
- Columbia University Irving Medical Center - NewYork-Presbyterian Hospital, New York, New York, USA
| | - Andrea A Tooley
- Columbia University Irving Medical Center - NewYork-Presbyterian Hospital, New York, New York, USA
| | - Sonya Purushothaman
- Department of Pathology, Columbia University Irving Medical Center - NewYork-Presbyterian Hospital, New York, New York, USA
| | - Michael Kazim
- Columbia University Irving Medical Center - NewYork-Presbyterian Hospital, New York, New York, USA
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3
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Larbcharoensub N, Pangpunyakulchai D, Aroonroch R, Tuntiyatorn L, Mahaisavariya P. Lacrimal myoepithelial carcinoma ex recurrent pleomorphic adenoma: A clinicopathological report and review of the literature. Mol Clin Oncol 2017; 8:209-213. [PMID: 29387416 DOI: 10.3892/mco.2017.1488] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 10/31/2017] [Indexed: 11/05/2022] Open
Abstract
Myoepithelial carcinoma is an uncommon malignant tumor of the lacrimal gland, composed of neoplastic myoepithelial cells with an infiltrative growth. The present study describes a unique case of progressive proptosis and blindness of the right eye in a 68-year-old woman following total tumor removal for lacrimal pleomorphic adenoma. Clinical study, surgical exploration, and pathology revealed lacrimal myoepithelial carcinoma ex recurrent pleomorphic adenoma, T2N0M0. In addition, 18 cases of lacrimal myoepithelial tumor that have been previously described in the literature are reviewed. The application of clinical, radiological, histopathologic, and immunohistochemical investigations may help to reach the definite diagnosis. Criteria for malignancy of lacrimal myoepithelial tumor should be the same as salivary myoepithelial tumor diagnosis, until long-term outcome data for a larger number of patients with lacrimal myoepithelial carcinoma become available.
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Affiliation(s)
- Noppadol Larbcharoensub
- Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Ratchathewi, Bangkok 10400, Thailand
| | - Duangjai Pangpunyakulchai
- Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Ratchathewi, Bangkok 10400, Thailand
| | - Rangsima Aroonroch
- Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Ratchathewi, Bangkok 10400, Thailand
| | - Lojana Tuntiyatorn
- Department of Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Ratchathewi, Bangkok 10400, Thailand
| | - Pornchai Mahaisavariya
- Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Ratchathewi, Bangkok 10400, Thailand
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4
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Jakobiec FA, Callahan AB, Stagner AM, Lee NG, Rashid A, Mendoza P, Grove A, Freitag SK. Malignant rhabdoid transformation of a longstanding, aggressive, and recurrent orbital angiomyxoma. Surv Ophthalmol 2015; 60:166-76. [DOI: 10.1016/j.survophthal.2014.12.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 12/04/2014] [Accepted: 12/09/2014] [Indexed: 10/24/2022]
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Pleomorphic Adenoma With Prominent Clear Cell Myoepithelioma Component of the Lacrimal Gland. Ophthalmic Plast Reconstr Surg 2015; 32:e18-21. [PMID: 25603534 DOI: 10.1097/iop.0000000000000374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A case of a pleomorphic adenoma of the lacrimal gland with a prominent clear cell myoepitheliomatous component was reported. An 81-year-old Caucasian woman experienced a 2-month history of right supraorbital swelling and proptosis. Excisional biopsy revealed a multicomponent lesion including a stromal component featuring glandular structures made of small epithelioid and spindle cells and a trabecular component with small islands of vacuolated cells, displaced nuclei, and clear cytoplasm. Immunohistochemical analysis revealed strong cytokeratin AE1/3 reactivity and focal smooth muscle actin positivity. The pathologic findings including immunohistochemistry results were consistent with a pleomorphic adenoma with prominent clear cell myoepithelioma component.
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Hayward DM, Yoo D, Lee JM, Wild E, Prabhu VC. Myoepithelioma of the Orbital Apex and Middle Cranial Fossa: Case Report and Review of the Literature. Neuroophthalmology 2014; 38:14-20. [PMID: 27928268 PMCID: PMC5122934 DOI: 10.3109/01658107.2013.856030] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 08/24/2013] [Accepted: 08/25/2013] [Indexed: 11/13/2022] Open
Abstract
Myoepitheliomas are rare tumours that originate from glandular tissues such as the parotid or salivary glands, and less commonly from soft tissues of the head, neck, and other parts of the body. Intraorbital myoepitheliomas generally arise from the lacrimal gland. Intracranial myoepitheliomas are rare. We report a myoepithelioma of the orbital apex that did not originate from the lacrimal gland. It extended to the middle cranial fossa from the orbital apex and involved the dura and adjacent bone. A diagnostic biopsy via a lateral orbitotomy preceded resection. We review the natural course and histopathology of myoepithelial neoplasms, the surgical nuances of approaching an orbital apex tumour with maximal functional preservation, and the optimal management practices of these rare lesions.
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Affiliation(s)
- Dustin M. Hayward
- Department of Neurological Surgery, Loyola University Medical CenterMaywood, IllinoisUSA
| | - David Yoo
- Department of Ophthalmology, Loyola University Medical CenterMaywood, IllinoisUSA
| | - John M. Lee
- Department of Pathology (Neuropathology section), Northshore University Medical CenterChicago, IllinoisUSA
| | - Elizabeth Wild
- Department of Neurological Surgery, Louisiana State University Health Sciences CenterShreveport, LouisianaUSA
| | - Vikram C. Prabhu
- Department of Neurological Surgery, Loyola University Medical CenterMaywood, IllinoisUSA
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A case of myoepithelioma emerging in the buccal region: verification of the primary site based on magnetic resonance imaging, computed tomography, histopathological, and anatomical findings. Oral Radiol 2013. [DOI: 10.1007/s11282-013-0141-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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8
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von Holstein SL, Coupland SE, Briscoe D, Le Tourneau C, Heegaard S. Epithelial tumours of the lacrimal gland: a clinical, histopathological, surgical and oncological survey. Acta Ophthalmol 2013; 91:195-206. [PMID: 22471335 DOI: 10.1111/j.1755-3768.2012.02402.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Epithelial tumours of the lacrimal gland represent a large spectrum of lesions with similarities in clinical signs and symptoms but with different biological behaviour and prognosis. They are rare, but with aggressive malignant potential. Tumours of the lacrimal gland may present with swelling of the lacrimal gland, displacement of the eyeball, reduced eye motility and diplopia. Pain and symptoms of short duration before the first ophthalmic consultation are characteristic of malignant tumours. The histological diagnosis determines the subsequent treatment regimen and provides important clues regarding the prognosis. The purpose of this paper is to describe the various primary epithelial tumours of the lacrimal gland. In the first part of the review, the frequency, demographics, clinical presentation and diagnostic features are described. In the second part, primarily tumour-specific histological characteristics are given. Finally, treatment modalities including surgical procedures and medical oncology as well as prognosis are discussed.
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MESH Headings
- Adenocarcinoma/epidemiology
- Adenocarcinoma/pathology
- Adenocarcinoma/surgery
- Adenoma, Pleomorphic/epidemiology
- Adenoma, Pleomorphic/pathology
- Adenoma, Pleomorphic/surgery
- Adult
- Carcinoma/epidemiology
- Carcinoma/pathology
- Carcinoma/surgery
- Carcinoma, Adenoid Cystic/epidemiology
- Carcinoma, Adenoid Cystic/pathology
- Carcinoma, Adenoid Cystic/surgery
- Carcinoma, Mucoepidermoid/epidemiology
- Carcinoma, Mucoepidermoid/pathology
- Carcinoma, Mucoepidermoid/surgery
- Eye Neoplasms/epidemiology
- Eye Neoplasms/pathology
- Eye Neoplasms/surgery
- Humans
- Lacrimal Apparatus Diseases/epidemiology
- Lacrimal Apparatus Diseases/pathology
- Lacrimal Apparatus Diseases/surgery
- Male
- Middle Aged
- Neoplasms, Glandular and Epithelial/epidemiology
- Neoplasms, Glandular and Epithelial/pathology
- Neoplasms, Glandular and Epithelial/surgery
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Affiliation(s)
- Sarah Linéa von Holstein
- Eye Pathology Institute, Department of Neuroscience and Pharmacology, University of Copenhagen, Copenhagen, Denmark
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Primary myoepithelioma of the orbit in an infant. J AAPOS 2009; 13:303-5. [PMID: 19541273 DOI: 10.1016/j.jaapos.2009.02.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Revised: 02/21/2009] [Accepted: 02/23/2009] [Indexed: 11/23/2022]
Abstract
Myoepitheliomas are rare tumors with various growth patterns and cellular variants. Primary myoepithelioma is rare in the orbit, with most previously reported cases involving the lacrimal gland region of adult patients. The authors report the case of a primary orbital soft tissue myoepithelioma in a 3-month-old boy. Diagnostic criteria and management considerations of this unusual tumor presenting in a young child are discussed.
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Zevallos-Giampietri EA, Barrionuevo C. Proximal-Type Epithelioid Sarcoma: Report of Two Cases in the Perineum. Appl Immunohistochem Mol Morphol 2005; 13:221-30. [PMID: 16082246 DOI: 10.1097/01.pai.0000145131.80060.6c] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The authors report two cases of perineal proximal-type epithelioid sarcoma in middle-aged men, age 51 and 43 years old. Both tumors were located in the right side. In the first patient a 7.5-cm, well-encapsulated tumor was completely excised. The second patient was a referral case with incomplete excision, but the computed tomography scan and magnetic resonance imaging showed a 14-cm nonencapsulated tumor involving the soft tissues of the inner thigh and perineum, as well as metastasis in right inguinal and retroperitoneal lymph nodes. Both neoplasms had a predominant solid pattern alternating with occasional discohesive areas. Both were composed of large oval to polygonal cells with vesicular nuclei, conspicuous nucleoli, and amphophilic to eosinophilic cytoplasm. Rhabdoid phenotype was identified in the second case only. The first neoplasm displayed 15% necrosis, 7 mitoses per 10 high-power field, focal vascular invasion, and no extracapsular invasion. The other exhibited 60% necrosis, 12 mitoses per 10 high-power fields, extensive vascular invasion, no distinct capsule, and invasion of the surrounding fatty tissue. Both were positive for vimentin, cytokeratin, epithelial membrane antigen, and CD34. Muscle-specific actin was negative in the first case and focally positive in the second. CD56 was positive in the second case and negative in the first case. Desmin, CD45, CD30, factor VIII, CD31, S100, HMB45, calretinin, and synaptophysin were negative in both. Since proximal-type epithelioid sarcoma can be confused with a number of other soft tissue tumors with epithelioid and/or rhabdoid features, the authors emphasize the immunohistochemical differential diagnosis.
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Pasquale S, Strianese D, Mansueto G, Tranfa F. Epithelioid myoepithelioma of lacrimal gland. Virchows Arch 2004; 446:97. [PMID: 15568156 DOI: 10.1007/s00428-004-1149-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2004] [Accepted: 07/14/2004] [Indexed: 10/26/2022]
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Bolzoni A, Pianta L, Farina D, Nicolai P. Benign myoepithelioma of the lacrimal gland: report of a case. Eur Arch Otorhinolaryngol 2004; 262:186-8. [PMID: 15138773 DOI: 10.1007/s00405-004-0787-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2004] [Accepted: 03/02/2004] [Indexed: 10/26/2022]
Abstract
Myoepithelioma of the lacrimal gland is an extremely rare monomorphic adenoma, with only six previously reported cases in the literature. We herein report the radiological, clinical and histopathological evaluation of a 46-year-old patient with a history of right eye proptosis and progressive diplopia. A mass in the right lacrimal fossa was detected at MRI and turned out to be benign myoepithelioma of the lacrimal gland at the histopathological examination. The patient underwent excision of the mass by means of a coronal bitemporal approach and lateral orbitotomy. The lesion was entirely removed "en-bloc" with the lacrimal gland. MRI did not show any evidence of recurrent disease 12 months after surgery. The patient was clinically free of disease after 22 months. Surgery is the treatment of choice for this kind of lesion. The coronal bi-temporal approach herein reported offered good exposure of the entire lesion and a satisfactory aesthetic result. Periodic postoperative radiological evaluations with MRI are mandatory.
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Affiliation(s)
- Andrea Bolzoni
- Department of Otorhinolaryngology, University of Brescia Spedali Civili, Piazza Spedali Civili 1, 25123 Brescia, Italy
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Shields JA, Shields CL, Epstein JA, Scartozzi R, Eagle RC. Review: primary epithelial malignancies of the lacrimal gland: the 2003 Ramon L. Font lecture. Ophthalmic Plast Reconstr Surg 2004; 20:10-21. [PMID: 14752304 DOI: 10.1097/01.iop.0000103003.87842.bb] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Jerry A Shields
- Oncology Service and the dagger Pathology Department, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
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Mizokami H, Inokuchi A, Sawatsubashi M, Takagi S, Tsuda K, Tokunaga O. Adenoid cystic carcinoma of the lacrimal gland with wide and severe myoepithelial differentiation. Auris Nasus Larynx 2002; 29:77-82. [PMID: 11772496 DOI: 10.1016/s0385-8146(01)00117-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Adenoid cystic carcinoma (ACC) of the lacrimal gland is the second most common epithelial tumor for which different biologic courses can be predicted by histologic criteria. Three main types of growth patterns, cribriform; tubular; and solid have been identified. Tumors with solid components frequently follow a more aggressive clinical course and show worse prognosis than those with other patterns. We herein report a case of ACC with wide and severe myoepithelial differentiation arising from the lacrimal gland and presenting with aggressive clinical behavior. Postoperative radiotherapy may be the treatment of choice to control residual lesions and provide long-term survival even in the case of incomplete resection. Despite extensive surgery and radiation therapy, the prognosis of these tumors, especially with solid components, remains extremely poor. Accurate diagnosis is important because tumor histopathology is generally believed to be the most significant factor in patient survival.
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Affiliation(s)
- Hiroyuki Mizokami
- Department of Otolaryngology-Head and Neck Surgery, Saga Medical School, Saga 849-8501, Japan
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Chandrasekhar J, Farr DR, Whear NM. Pleomorphic adenoma of the lacrimal gland: case report. Br J Oral Maxillofac Surg 2001; 39:390-3. [PMID: 11601822 DOI: 10.1054/bjom.2001.0624] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Lacrimal gland tumours are rare. We present a case of a lacrimal gland pleomorphic adenoma in a 19-year-old man. The tumour was removed and he has made an uncomplicated recovery, with no sign of recurrence after nine months of follow-up. We will keep him under long-term review.
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Okudela K, Ito T, Iida MI, Kameda Y, Furuno K, Kitamura H. Myoepithelioma of the lacrimal gland: report of a case with potentially malignant transformation. Pathol Int 2000; 50:238-43. [PMID: 10792788 DOI: 10.1046/j.1440-1827.2000.01022.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Myoepithelioma of the lacrimal gland is extremely rare and only four cases, one of which was malignant, have been reported in detail. The present report describes a case of lacrimal gland myoepithelioma in a Japanese male with histological features suggestive of potentially malignant transformation. The excised tumor consisted of two components, a central nodular component and a peripheral component surrounding the former. These components were separated by a fibrous tissue. Microscopically, both components were comprised almost entirely of spindle-shaped cells, but with some epithelioid cells containing glycogen granules. Extracellular spaces in the peripheral component were filled with eosinophilic materials with the occasional crystalloid structures, which were immunoreactive for collagen type I. Neoplastic cells were immunoreactive focally for vimentin and S-100, but negative for cytokeratins, epithelial membrane antigen, muscle actin, smooth muscle actin, desmin, myosin, and glial fibrillary acidic protein. The neoplastic cells in the central component showed nuclear pleomorphism and atypia with a higher frequency of mitotic figures, and higher labelings of proliferation markers than those in the peripheral component. Neither invasion, necrosis, nor hemorrhage was observed in the tumor. From these findings we proposed a diagnosis of potentially malignant myoepithelioma.
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Affiliation(s)
- K Okudela
- Department of Pathology, Yokohama City University School of Medicine, Yokohama, Japan.
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