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Szczepanski JM, Lieberman JA, Lamps LW, Gonzalez RS, Xue Y, Zhang X, Yilmaz OH, Hart J, Krausz T, Mantilla JG, McHugh JB, Westerhoff M. Histologic Features of Mycobacterial Spindle Cell Pseudotumors: A Multi-institutional Clinicopathologic Analysis of 14 Cases. Am J Surg Pathol 2024; 48:890-900. [PMID: 38726848 DOI: 10.1097/pas.0000000000002234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
Mycobacterial spindle cell pseudotumors (MSPs) are a rare and diagnostically challenging manifestation of non-tuberculous mycobacterial (NTM) infections. Proper recognition of these pseudotumors is important because they are treatable and benign. In this study, we evaluated the morphologic patterns of MSPs to improve their pathologic identification. Clinical and morphologic features of 14 MSPs were analyzed. Histologic factors evaluated included the architectural growth pattern of spindled or epithelioid macrophages, granulomas and their location within the lesion, neutrophilic microabscesses, multinucleated giant cells, necrosis, and effacement of background tissue. The composition of inflammatory infiltrates, organism density by acid-fast staining, and stromal changes were also assessed. In addition, 8 of 14 cases underwent molecular microbiology identification by a clinical amplicon-sequencing assay for non-tuberculous mycobacteria. MSP sites included 2 bowel, 10 lymph nodes, 1 liver, and 1 extremity. Cases with available clinical history (n=10) all occurred in immunocompromised patients. All demonstrated effacement of normal structures with spindled cells arranged in a storiform or fascicular architectural pattern. In addition, all cases showed lymphocytic inflammation, with prominent concurrent neutrophilic inflammation in 50% (7/14) of cases. Other morphologic findings included foamy histiocytes (64%, 9/14), peripherally situated granulomas (21%, 3/14), and neutrophilic microabscesses (21%, 3/14). All tested cases were positive for NTM by PCR methods. Mycobacterium avium was the most commonly isolated pathogen (6/8). Mycobacterial spindle cell pseudotumors show predominantly spindled morphology that may be mistaken as a neoplasm. Surgical pathologists who evaluate lymph nodes, soft tissue, and gastrointestinal tissues should be aware of this spindled tumefactive phenomenon in the setting of immunocompromised patients. Recognition of key morphologic features of neutrophilic inflammation, peripheral granulomas, or foamy histiocytes within a spindled lesion can help guide the pathologist to a correct diagnosis of an inflammatory process secondary to infection rather than a spindle cell neoplasm. Accurate diagnosis to facilitate appropriate antimicrobial and/or surgical therapy requires a comprehensive evaluation combining clinical, histopathologic, and microbiological findings.
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Affiliation(s)
| | - Joshua A Lieberman
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, WA
| | - Laura W Lamps
- Department of Pathology, University of Michigan, Ann Arbor, MI
| | - Raul S Gonzalez
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA
| | - Yue Xue
- Department of Pathology, Northwestern University
| | - Xuchen Zhang
- Department of Pathology, Yale School of Medicine, New Haven, CT
| | - Osman H Yilmaz
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - John Hart
- Department of Pathology, University of Chicago, Chicago, IL
| | - Thomas Krausz
- Department of Pathology, University of Chicago, Chicago, IL
| | - Jose G Mantilla
- Department of Pathology, NYU Grossman School of Medicine, New York City, NY
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Duong MT, Ungemach A, Malik F, Duong MT, Wasserman N, Cooper K, Pantel AR, O'Neil JC, Szep Z. Mycobacterial spindle cell pseudotumor of the spinal cord: Case report and literature review. J Neuroimmunol 2024; 390:578329. [PMID: 38554665 DOI: 10.1016/j.jneuroim.2024.578329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/28/2024] [Accepted: 03/10/2024] [Indexed: 04/02/2024]
Abstract
We report the first description of spinal cord mycobacterial spindle cell pseudotumor. A patient with newly diagnosed advanced HIV presented with recent-onset bilateral leg weakness and was found to have a hypermetabolic spinal cord mass on structural and molecular imaging. Biopsy and cultures from blood and cerebrospinal fluid confirmed spindle cell pseudotumor due to Mycobacterium avium-intracellulare. Despite control of HIV and initial reduction in pseudotumor volume on antiretrovirals and antimycobacterials (azithromycin, ethambutol, rifampin/rifabutin), he ultimately experienced progressive leg weakness due to pseudotumor re-expansion. Here, we review literature and discuss multidisciplinary diagnosis, monitoring and management challenges, including immune reconstitution inflammatory syndrome.
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Affiliation(s)
- Michael Tran Duong
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Adam Ungemach
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Faizan Malik
- Department of Pathology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Melissa T Duong
- Department of Pathology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Noah Wasserman
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kumarasen Cooper
- Department of Pathology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Austin R Pantel
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jessica C O'Neil
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Zsofia Szep
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Medicine, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA.
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Shen Y, Zhang N, Xu S, Zhao S. Bacillus Calmette-Guérin Vaccine-induced Mycobacterial Spindle Cell Pseudotumor in an Infant. Pediatr Infect Dis J 2024; 43:e74-e75. [PMID: 38197637 DOI: 10.1097/inf.0000000000004166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Affiliation(s)
- Yuelin Shen
- Respiratory Department II, National Clinical Research Center for Respiratory Diseases, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China, Respiratory Department, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, China
| | - Nan Zhang
- Pathology Department, National Clinical Research Center for Respiratory Diseases, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Shasha Xu
- Respiratory Department, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, China
| | - Shunying Zhao
- Respiratory Department II, National Clinical Research Center for Respiratory Diseases, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China, Respiratory Department, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, China
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El Hussein S, Evans AG, Fang H, Wang W, Medeiros LJ. Unicentric Castleman Disease: Illustration of Its Morphologic Spectrum and Review of the Differential Diagnosis. Arch Pathol Lab Med 2024; 148:99-106. [PMID: 36920021 DOI: 10.5858/arpa.2022-0404-ra] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2022] [Indexed: 03/16/2023]
Abstract
CONTEXT.— Unicentric Castleman disease (UCD) is a dynamic entity with a wide spectrum of morphologic findings. UCD can be further subdivided into hyaline-vascular and mixed/plasmacytic variants. Hyaline-vascular UCD has both follicular and interfollicular (stromal) changes, and occasionally these lesions show a skewed representation of either the follicular or stromal compartments. Plasmacytosis is usually minimal in the hyaline-vascular variant. The mixed/plasmacytic variant of UCD is composed of sheets of plasma cells often associated with a variable number of follicles with regressive changes. OBJECTIVE.— To illustrate the differential diagnosis of UCD, as it is quite broad and includes lymphomas, plasma cell neoplasms, stromal neoplasms such as follicular dendritic cell sarcoma and vascular neoplasms, immunoglobulin G4-related disease, infections, and other rare lesions. An additional objective is to enhance awareness of the morphologic features of UCD in excisional and in small core-needle biopsy specimens, the latter of which may inadvertently target follicle- or stroma-rich areas, causing diagnostic challenges. DATA SOURCES.— In this review, we provide readers a concise illustration of the morphologic spectrum of UCD that we have encountered in our practice and a brief discussion of entities in the differential diagnosis. CONCLUSIONS.— UCD exhibits a broad spectrum of morphologic changes, and awareness of these morphologic variations is key to avoid misdiagnosis.
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Affiliation(s)
- Siba El Hussein
- From the Department of Pathology, University of Rochester Medical Center, Rochester, New York (El Hussein, Evans)
| | - Andrew G Evans
- From the Department of Pathology, University of Rochester Medical Center, Rochester, New York (El Hussein, Evans)
| | - Hong Fang
- the Department of Hematopathology, University of Texas MD Anderson Cancer Center, Houston (Fang, Wang, Medeiros)
| | - Wei Wang
- the Department of Hematopathology, University of Texas MD Anderson Cancer Center, Houston (Fang, Wang, Medeiros)
| | - L Jeffrey Medeiros
- the Department of Hematopathology, University of Texas MD Anderson Cancer Center, Houston (Fang, Wang, Medeiros)
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5
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Li C, Zhang Q, Wen Y. Intestinal tuberculosis presented as spindle cell pseudotumor in a HIV-positive case. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2023; 115:723-724. [PMID: 36866839 DOI: 10.17235/reed.2023.9533/2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
MSP is a rare and atypical form of benign granulomatous inflammation characterised by tumour-like local proliferation of spindle-shaped histiocytes containing acid-fast positive mycobacteria, which should be differentiated from neoplastic lesions. A 26-year-old Chinese man complained an intermittent and mild right lower abdominal pain for 5 months in May 2022.Histopathology of biopsy samples showed Mycobacterial spindle cell pseudotumor (MSP). The test of Mycobacterium tuberculosis detected by polymerase chain reaction using intestinal tissue slice was negative. The metagenomic next-generation sequencing (BGI-Shenzhen) using formalin-fixation and paraffin-embedded intestine samples confirmed Mycobacterium tuberculosis complex (MTBC).
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Affiliation(s)
- Chengbo Li
- Infectious Diseases, The First Affiliated Hospital of China Medical University
| | - Qingfu Zhang
- Pathology, The First Affiliated Hospital of China Medical University,
| | - Ying Wen
- Infectious Diseases, The First Affiliated Hospital of China Medical University, China
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Argyris PP, Wakely PE. Mycobacterial Spindle Cell Pseudotumor of the Nasal Cavity. Head Neck Pathol 2023; 17:782-787. [PMID: 37027086 PMCID: PMC10513965 DOI: 10.1007/s12105-023-01550-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 03/24/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND Mycobacterial spindle cell pseudotumor (MSCP) represents an uncommon tumor-like proliferation associated with nontuberculous mycobacterial infection, i.e., M. avium intracellulare, affecting primarily the lymph nodes of immunocompromised men in their 5th decade. Involvement of the nasal cavity by MSCP is exceedingly rare with only 3 well-documented examples in the literature. METHODS A 74-year-old, HIV-negative, man presented with a 0.5-cm nodule of the left nasal cavity clinically presenting as a "nasal polyp." His medical history was significant for colonic adenocarcinoma, cutaneous basal cell carcinoma, and chronic lymphocytic leukemia (CLL) transforming to B-cell prolymphocytic leukemia, responsive to chemotherapy. The patient was diagnosed with prostatic adenocarcinoma treated with radiotherapy two months before the nasal lesion was detected. No lymph node enlargement, pulmonary involvement or hepatosplenomegaly were noticed. The nasal nodule was surgically excised and histopathologically examined to rule out metastatic disease or CLL relapse. RESULTS Microscopically, the lesion comprised a well-circumscribed, monotonous, spindle cell population in a vaguely storiform arrangement mixed with a heavy infiltrate of neutrophils and sparse lymphocytes. The spindle cells featured finely granular rich eosinophilic cytoplasm with rounded, oval to epithelioid, or elongated nuclei with vesicular chromatin and one or two distinct nucleoli. The lesional cells lacked overt cytologic atypia and showed occasional regular mitoses. The surface epithelium was intact or focally ulcerated. By immunohistochemistry, the spindle cell population stained strongly and diffusely for CD68 and was negative for AE1/AE3, SMA, CD34, and PSA. CD3 highlighted scattered lymphocytes. Ziehl-Neelsen stain disclosed numerous intracytoplasmic acid-fast bacilli. A diagnosis of MSCP was rendered. No recurrences were observed during a 24-month follow-up period. CONCLUSION Although exceptionally rare, MSCP should be considered in the differential diagnosis of nodular lesions of the nasal cavity that are characterized microscopically by marked spindle cell proliferation in a vague storiform pattern, admixed with a lymphocytic or mixed inflammatory infiltrate. A negative medical history for HIV infection and medication-induced immunosuppression should not preclude a diagnosis of MSCP, particularly in extranodal sites. Once the diagnosis is established, prognosis appears to be excellent for nasal MSCP following conservative surgical excision.
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Affiliation(s)
- Prokopios P Argyris
- Division of Oral and Maxillofacial Pathology, The Ohio State University College of Dentistry, 2191 Postle Hall, 305 W. 12th Ave, Columbus, OH, 43210, USA.
| | - Paul E Wakely
- Department of Pathology, The Ohio State University Wexner Medical Center, James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
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Haefliger S, Tzankov A. Mycobacterial spindle cell pseudotumor mimicking Richter transformation in a patient with hairy cell leukemia. Int J Hematol 2023; 118:153-154. [PMID: 37351689 DOI: 10.1007/s12185-023-03628-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 06/24/2023]
Affiliation(s)
- Simon Haefliger
- Department of Pathology, Institute of Medical Genetics and Pathology, University Hospital of Basel, University of Basel, Schönbeinstrasse 40, 4031, Basel, Switzerland.
| | - Alexandar Tzankov
- Department of Pathology, Institute of Medical Genetics and Pathology, University Hospital of Basel, University of Basel, Schönbeinstrasse 40, 4031, Basel, Switzerland
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8
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Arthur A, Fortier JC, Vincek V, Valdes Rodriguez RH. Mycobacterial Spindle Cell Pseudotumor (MSP): A Case Report. Cureus 2023; 15:e40432. [PMID: 37456437 PMCID: PMC10348883 DOI: 10.7759/cureus.40432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2023] [Indexed: 07/18/2023] Open
Abstract
Mycobacterial spindle cell pseudotumor (MSP) is a rare proliferation of spindle-shaped histiocytes that occurs most frequently in lymph nodes but has also been documented in the skin, soft tissue, abdomen, and other sites. These lesions contain acid-fast mycobacteria, most commonly Mycobacterium avium complex. Fewer than 10 cases of cutaneous MSPs have been published, and most have occurred in immunocompromised patients, either due to human immunodeficiency virus (HIV) infection or immunosuppressive medications. The differential diagnosis includes Kaposi's sarcoma and other spindle cell neoplasms, which can be distinguished based on histology and special stains. We present the case of a 76-year-old man with HIV infection who presented with a diffuse rash on his arms and legs. A pretibial biopsy was performed and revealed tubercular MSP.
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Affiliation(s)
- Anita Arthur
- Dermatology, University of Florida, Gainesville, USA
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9
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Mann D, Lueking R, Emanuel A, Teixeira C. Mycobacterial Spindle Cell Pseudotumor. IDCases 2023; 32:e01757. [PMID: 37114207 PMCID: PMC10127109 DOI: 10.1016/j.idcr.2023.e01757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 03/28/2023] [Indexed: 04/09/2023] Open
Affiliation(s)
- Davis Mann
- Division of Infectious Diseases, Medical University of South Carolina, United States
| | - Richard Lueking
- Division of Infectious Diseases, Medical University of South Carolina, United States
- Corresponding author.
| | - Anthony Emanuel
- Division of Pathology and Laboratory Medicine, Medical University of South Carolina, United States
| | - Charles Teixeira
- Division of Infectious Diseases, Medical University of South Carolina, United States
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10
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Nomura Y, Mizukami A, Ueno K, Watanabe R, Kinoshita S, Fujiwara N, Kakuta K, Morita T, Asano K, Saito A. Epidural intracranial abscesses and multiple bone metastases caused by disseminated Mycobacterium avium complex infection: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2022; 4:CASE22407. [PMID: 36471577 PMCID: PMC9724007 DOI: 10.3171/case22407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 10/24/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND Mycobacterium avium complex (MAC) generally causes localized pulmonary infections in immunocompromised hosts, but rarely in other organs and tissues, which is called disseminated MAC infection. OBSERVATIONS The authors herein present a 48-year-old male patient with disseminated MAC infectious lesions in the lungs and on the cranial, vertebral, femoral, and pelvic bones, a normal CD4 count, and immunopositivity for the interferon-ɤ (IFN-ɤ) neutralization antibody. Cranial lesions were multiple osteolytic lesions associated with abscesses in the cranial bones. The patient initially received conservative treatment with multiple antibiotics; however, cranial lesions worsened. Therefore, multiple cranial lesions were removed via osteoplastic craniectomy and the postoperative course was uneventful. Pathological findings revealed MAC infection. The patient was discharged without recurrence or complications. LESSONS Multiple cranial MAC dissemination with immunopositivity for the IFN-ɤ antibody is rare. The authors herein present the clinical course of a rare surgical case of MAC dissemination with a literature review.
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11
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Kirchner A, Sergeyenko A, Keane J, Belinski K, Liu W. Diagnosis of cutaneous mycobacterial spindle cell pseudotumor in the absence of typical inflammatory cells: A case report. J Cutan Pathol 2021; 48:1178-1181. [PMID: 33948982 DOI: 10.1111/cup.14042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/25/2021] [Accepted: 04/28/2021] [Indexed: 11/30/2022]
Abstract
Mycobacterial spindle cell pseudotumor (MSP) is a non-neoplastic condition that is characterized by spindle-shaped histiocytes colonized by mycobacteria. MSP is most commonly diagnosed in the immunocompromised and, while MSP can occur throughout the body, the most common sites of MSP involvement are the lymph nodes and the skin. To diagnose MSP, histopathological analysis typically demonstrates the presence of inflammatory cells, in addition to spindle cells and the unequivocal mycobacteria, which guides the diagnosis away from potential neoplasms. If properly diagnosed and treated with appropriate antibiotic therapy, patients tend to experience almost complete resolution of their symptoms. MSP is a rare condition; to our knowledge, there have only been 11 documented cases of cutaneous MSP, including the one introduced in this report. Here, we present a unique case of a 50-year-old female on chronic immunosuppressive therapy diagnosed with cutaneous MSP in the absence of inflammatory cells on pathology.
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Affiliation(s)
- Allison Kirchner
- University of Illinois College of Medicine, Chicago, Illinois, USA
| | | | | | | | - Wenhua Liu
- Consolidated Pathology Consultants, Libertyville, Illinois, USA
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12
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Singh B, Kaur P, Majachani N, Guragai N, Gupta S, Maroules M. Mycobacterial Spindle Cell Pseudotumor of the Lymph Nodes. J Investig Med High Impact Case Rep 2021; 9:23247096211013190. [PMID: 33966499 PMCID: PMC8114242 DOI: 10.1177/23247096211013190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Mycobacterial spindle cell pseudotumor (MSP) is characterized by benign proliferation of spindle-shaped histiocytes containing acid-fast Mycobacterium. It is usually seen in immunocompromised patients. Limited literature is available regarding MSP. In this article, we report a case of 36-year-old African American male with past medical history of HIV (diagnosed in 2005), noncompliance who presented with generalized weakness, fever, and dizziness on ambulation and was found to have generalized lymphadenopathy and underwent biopsy of the lymph nodes, which was consistent with MSP.
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Affiliation(s)
- Balraj Singh
- Saint Joseph's University Medical Center, Paterson, NJ, USA
| | - Parminder Kaur
- Saint Joseph's University Medical Center, Paterson, NJ, USA
| | | | - Nirmal Guragai
- Saint Joseph's University Medical Center, Paterson, NJ, USA
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13
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Brunet A, Plouhinec H, Henn A, Scoazec JY, Ngo C. [Spindle cell tumor: Infection or neoplasm?]. Ann Pathol 2021; 41:418-421. [PMID: 33879356 DOI: 10.1016/j.annpat.2021.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/21/2021] [Accepted: 03/22/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Anaïs Brunet
- Service de pathologie morphologique, département de biologie et pathologie médicales, Gustave-Roussy Cancer Campus, Villejuif, France.
| | - Hélène Plouhinec
- Service d'anatomie et de cytologie pathologiques, centre hospitalier Sud Francilien, Corbeil-Essonnes, France
| | - Aurélia Henn
- Service de maladies infectieuses et tropicales, centre hospitalier Sud Francilien, Corbeil-Essonnes, France
| | - Jean-Yves Scoazec
- Service de pathologie morphologique, département de biologie et pathologie médicales, Gustave-Roussy Cancer Campus, Villejuif, France; Université Paris Saclay, faculté de medecine de Bicêtre, Le Kremlin-Bicêtre, France
| | - Carine Ngo
- Service de pathologie morphologique, département de biologie et pathologie médicales, Gustave-Roussy Cancer Campus, Villejuif, France.
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14
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Poyuran R, Ponnambath DK, Vilanilam GC, Chandrasekharan K, Narasimhaiah D. Mycobacterial spindle cell pseudotumour of the brain in an immunocompetent adult. Pathology 2021; 53:782-785. [PMID: 33838921 DOI: 10.1016/j.pathol.2020.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 11/04/2020] [Accepted: 11/20/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Rajalakshmi Poyuran
- Department of Pathology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, India
| | - Dinoop K Ponnambath
- Department of Microbiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, India
| | - George C Vilanilam
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, India
| | - Kesavadas Chandrasekharan
- Department of Imaging Sciences and Intervention Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, India
| | - Deepti Narasimhaiah
- Department of Pathology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, India.
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15
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Lim DD, Bushra A, Zhang H. Abdominal wall mycobacterial spindle cell pseudotumor lesion. Proc (Bayl Univ Med Cent) 2021; 34:505-506. [PMID: 34219940 DOI: 10.1080/08998280.2021.1897340] [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] Open
Abstract
Mycobacterial spindle cell pseudotumor is a rare entity that is histologically characterized by spindle-shaped histiocytes with acid-fast bacilli. It is primarily reported in immunocompromised patient in various body sites. We present a case of mycobacterial spindle cell pseudotumor in an abdominal wall mass from an immunosuppressed patient and discuss the characteristic findings.
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Affiliation(s)
- Douglas D Lim
- Department of Pathology, Baylor University Medical Center, Dallas, Texas
| | - Abida Bushra
- Department of Pathology, Baylor University Medical Center, Dallas, Texas
| | - Haiying Zhang
- Department of Pathology, Baylor University Medical Center, Dallas, Texas
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16
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Algorithmic Approach to Fibroinflammatory Sinonasal Tract Lesions. Head Neck Pathol 2021; 15:120-129. [PMID: 33723762 PMCID: PMC8010064 DOI: 10.1007/s12105-020-01272-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/08/2020] [Accepted: 12/10/2020] [Indexed: 12/21/2022]
Abstract
Fibroinflammatory lesions of the sinonasal tract are one of the most common head and neck lesions submitted to surgical pathology. When the fibroinflammatory pattern represents the lesion (i.e., not surface reactive ulceration), an algorithmic approach can be useful. Separated into reactive, infectious, and neoplastic, and then further divided based on common to rare, this logical progression through a series of differential considerations allows for many of these lesions to be correctly diagnosed. The reactive lesions include chronic rhinosinusitis and polyps, granulomatosis with polyangiitis, and eosinophilic angiocentric fibrosis. Infectious etiologies include acute invasive fungal rhinosinusitis, rhinoscleroma, and mycobacterial infections. The neoplastic category includes lobular capillary hemangioma, inflammatory myofibroblastic tumor, and NK/T-cell lymphoma, nasal type. Utilizing patterns of growth, dominant cell types, and additional histologic features, selected ancillary studies help to confirm the diagnosis, guiding further clinical management.
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17
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Mohanlal R, Reddy DL. Spectrum of HIV-associated infectious diseases: A case series through the eyes of the histopathologist. South Afr J HIV Med 2020; 21:1087. [PMID: 32670628 PMCID: PMC7343954 DOI: 10.4102/sajhivmed.v21i1.1087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 04/23/2020] [Indexed: 11/11/2022] Open
Abstract
Background Human immunodeficiency virus (HIV) infection increases the risk of infection by a host of other opportunistic pathogens. The clinical presentations of these co-infections in immunocompromised patients are often atypical; therefore diagnosis is delayed in the absence of investigations such as tissue biopsy. Infection may involve sites that are difficult to access for biopsy and, as a consequence, there is limited diagnostic tissue available for analysis. The histopathologist, aided by ancillary tests, is relied upon to make a timeous and accurate diagnosis. Objectives To illustrate key histological features of HIV-associated infectious diseases encountered in a histopathology laboratory and to highlight, with the aid of literature, the relevance of histopathology in diagnosis. Method A retrospective descriptive case series of biopsies histologically diagnosed with HIV-associated infectious diseases over four years (2015–2019) was performed at the Chris Hani Baragwanath Academic Hospital National Health Laboratory Services Histopathology department. These cases have been photographed to illustrate microscopic aspects and will be accompanied by a literature review of opportunistic infections in the context of HIV infection. Results This article highlights aspects of fungal, parasitic, viral and selected bacterial infections of people living with HIV for whom the histopathological examination of tissue was an essential component of the clinical diagnosis. Histological features are noted on routine slides and accompanied by diagnostic features revealed with histochemical and immunohistochemical stains. Conclusion Medical practitioners working in areas of high HIV endemicity should be familiar with the variety of infectious diseases that are encountered and with the diagnostic importance of the histopathologist in clinical management.
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Affiliation(s)
- Reena Mohanlal
- Department of Anatomical Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,National Health Laboratory Services, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Denasha L Reddy
- Division of Infectious Diseases, Department of Internal Medicine, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
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Krause JR, Findeis SK. Mycobacterial spindle cell pseudotumor in a woman with HIV. Proc (Bayl Univ Med Cent) 2020; 33:438-439. [PMID: 32675978 DOI: 10.1080/08998280.2020.1753454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/30/2020] [Accepted: 04/06/2020] [Indexed: 10/24/2022] Open
Abstract
Mycobacterial spindle cell pseudotumor (MSP) is a rare benign entity characterized by tumor-like proliferations of spindle-shaped histiocytes containing acid-fast positive mycobacteria. MSPs tend to occur predominantly in immunocompromised individuals and are concerning for a malignant neoplasm. We report a case of MSP occurring in a woman with human immunodeficiency virus and a tumor-like mass in the abdomen. A subsequent biopsy revealed MSP, which was successfully treated with antimycobacterial therapy.
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Affiliation(s)
- John R Krause
- Section of Hematology, Department of Pathology, Baylor University Medical Center at DallasDallasTexas
| | - Sarah K Findeis
- Section of Hematology, Department of Pathology, Baylor University Medical Center at DallasDallasTexas
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Furlan K, Rohra P, Mir F, Sethi S, Almajnooni A, Gattuso P, Moore N. Mycobacterium Spindle Cell Pseudotumor Caused by Mycobacterium xenopi: A First Described Association of a Rare Entity Presenting in the Lung. Int J Surg Pathol 2019; 28:316-320. [PMID: 31601138 DOI: 10.1177/1066896919879745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Mycobacterial spindle cell pseudotumor (MSP) is a rare benign lesion characterized by a proliferation of bland spindle-shaped histiocytes with vague granulomatous formation, positive for acid-fast bacilli staining. This lesion is usually reported in the lymph nodes and skin of immunocompromised patients; only 6 cases primary in the lung have been reported in the English literature to this date. In this article, we present the case of a 42-year-old female status post failed kidney-pancreas transplant with subsequent multiple kidney transplants, on chronic immunosuppression, who developed a mass in the left lower lobe consistent with MSP. Mycobacterium xenopi was identified in lung tissue culture, an association never previously described in literature. This case report alerts for the possible association of this rare form of non-tuberculous mycobacteria in the pathogenesis of MSP and highlights the importance of this differential diagnosis in lung masses of immunocompromised patients.
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Affiliation(s)
| | - Prih Rohra
- Rush University Medical Center, Chicago, IL, USA
| | - Fatima Mir
- Rush University Medical Center, Chicago, IL, USA
| | - Shenon Sethi
- Rush University Medical Center, Chicago, IL, USA
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Suarez-Zamora DA, Palau-Lazaro MA, Rodriguez-Urrego PA. Esophageal tuberculosis in an HIV-positive patient mimicking a spindle cell tumor. REVISTA ESPAÑOLA DE PATOLOGÍA : PUBLICACIÓN OFICIAL DE LA SOCIEDAD ESPAÑOLA DE ANATOMÍA PATOLÓGICA Y DE LA SOCIEDAD ESPAÑOLA DE CITOLOGÍA 2019; 52:199-201. [PMID: 31213262 DOI: 10.1016/j.patol.2019.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/21/2019] [Accepted: 02/04/2019] [Indexed: 12/30/2022]
Abstract
Tuberculosis (TB) of the esophagus is an extremely rare condition, even in immunocompromised patients. We report the case of a 24-year-old man with a past history of HIV and pulmonary tuberculosis who presented with dysphagia and a 2cm submucosal mass in the proximal esophagus. The biopsy was diagnosed as a spindle cell neoplasm in another center. Sections displayed a submucosal lesion formed by spindle and epithelioid cells, surrounded by chronic inflammation. The spindle cells were positive for S100 and CD68, but negative for cytokeratin, desmin, smooth muscle actin, ALK, CD34 and CD117. Ziehl-Neelsen stain was performed and showed many intracellular acid-fast bacilli, confirming the diagnosis of esophageal TB. This case is a reminder that esophageal TB may become manifest as a submucosal lesion and the histiocytic-granulomatous reaction may mimic a spindle cell tumor.
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Affiliation(s)
- David A Suarez-Zamora
- Department of Pathology and Laboratories, Fundación Santa Fe de Bogotá, Bogotá D.C., Colombia
| | - Mauricio A Palau-Lazaro
- Department of Pathology and Laboratories, Fundación Santa Fe de Bogotá, Bogotá D.C., Colombia; School of Medicine, Universidad de los Andes, Bogotá D.C., Colombia
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