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Patel MH, Guerrero Vinsard D, Agrawal U, Kendziora RW, Siontis BL, Swaroop Vege S, Sweetser S. Primary Pancreatic Undifferentiated Pleomorphic Sarcoma. ACG Case Rep J 2023; 10:e01011. [PMID: 36968124 PMCID: PMC10036072 DOI: 10.14309/crj.0000000000001011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 02/13/2023] [Indexed: 03/24/2023] Open
Abstract
Primary pancreatic sarcomas are rare malignancies with an incidence of 0.1%. This case report is of a 48-year-old man who presented with this condition. The patient's treatment plan consisted of distal pancreatectomy and splenectomy with intraoperative immunohistochemistry and adjuvant chemotherapy. To correctly identify and treat undifferentiated pleomorphic sarcoma, a stepwise strategy involving cross-sectional imaging and extensive histopathology analysis is necessary.
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Affiliation(s)
| | | | - Upasana Agrawal
- Department of Internal Medicine, Louisiana State University, Shreveport, LA
| | - Ryan W. Kendziora
- Department of Anatomic and Clinical Pathology, Mayo Clinic, Rochester, MN
| | | | | | - Seth Sweetser
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
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Wang J, Liu B, Hou J, Li T. Undifferentiated Pleomorphic Sarcoma of the Duodenal Papilla: A Rare Case and Worth Discussing History. Front Surg 2022; 9:926003. [PMID: 35874130 PMCID: PMC9299241 DOI: 10.3389/fsurg.2022.926003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/03/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundUndifferentiated pleomorphic sarcoma (UPS) is a malignant tumor that originates in the mesenchymal tissue and is common in the extremities and retroperitoneum. Primary UPS of the duodenal papilla is rare and a distinct clinical entity.Case presentationIn this report, a 48-year-old Chinese man was admitted to our hospital with symptoms of melena. The patient underwent choledochectomy and choledochaljejunostomy for obstructive jaundice 8 years before admission. Endoscopic examination after admission confirmed a mass located at the duodenal papilla. Then, the duodenal papilla and tumor resection were performed, and the histopathology report confirmed the diagnosis of UPS. The patient refused further treatment and died 2 months later due to local recurrence and intrahepatic metastasis.ConclusionsIt is rare that the mass in the duodenal papilla is diagnosed as UPS. The unpredicted behavior of these tumors warrants a careful plan considering their indolent nature and possible recurrence and metastasis. The prognosis was poor despite the early complete resection.
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Affiliation(s)
- Jianlong Wang
- Department of General Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Bin Liu
- Central Laboratory, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jiachao Hou
- Department of General Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Tao Li
- Department of General Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, China
- Correspondence: Tao Li
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Liang Z, Han J, Tuo H, Xue D, Yu H, Peng Y. Undifferentiated pleomorphic sarcoma of the pancreas: a rare case report and literature review. World J Surg Oncol 2022; 20:55. [PMID: 35220968 PMCID: PMC8883712 DOI: 10.1186/s12957-022-02525-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 02/17/2022] [Indexed: 12/27/2022] Open
Abstract
Background Primary undifferentiated pleomorphic sarcoma (UPS) of the pancreas is an exceedingly rare malignant tumor, with only 15 cases have been reported in the medical literature. At present, clinicians have poor recognition of the tumor, the epidemiology, diagnosis, and treatment of this disease have yet not been established. Case presentation In this report, we depict the clinical and imaging characteristics of a 37-year-old man presenting with a primarily cystic UPS. The patient complained of epigastric pain and distention over 20 days. Abdominal CT and pancreatic magnetic resonance imaging revealed cystic and cystic solid masses in the pancreatic body and tail. An abdominal ultrasound echogram revealed the mass in the body of the pancreas to be cystic with separation echo inside, and the wall was thick, not smooth. Besides, a hypoechoic mass was seen in the tail area of the pancreas with an inhomogeneous echoic pattern, containing small patches of no echo zone in the central. Microscopically, spindle fibroblast-like cells are arranged in a characteristic storiform pattern with pleomorphic and multinucleated cells. Immunohistochemically, tumor cells were positive for CD68 and vimentin. Seven months postoperatively, he was diagnosed with pulmonary lymph node metastasis and died 5 months later. Combined with this case report, we also reviewed the literature regarding UPS of the pancreas. Conclusions As we know, this is the first report on ultrasonography findings of pancreatic UPS. Despite there are no distinctive manifestation of UPS, a solid cystic lesion on ultrasonography or a hypodense area in the lesion on T2-weighted imaging, should be considered for differential diagnosis with pancreatic UPS. We believe this article may add some ideas into the diagnosis and therapy of patients with this tumor.
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Ypsilantis P, Meditskou S, Lambropoulou M, Papamitsou T, Simopoulos C. Spontaneous pancreatic undifferentiated pleomorphic sarcoma in a laboratory rat: A case report. Animal Model Exp Med 2019; 2:222-225. [PMID: 31773099 PMCID: PMC6762044 DOI: 10.1002/ame2.12078] [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: 05/31/2019] [Revised: 07/17/2019] [Accepted: 07/31/2019] [Indexed: 11/26/2022] Open
Abstract
We present a case of spontaneous undifferentiated/unclassified sarcoma, of a pleomorphic subtype formerly known as malignant fibrous histiocytoma (UPS/MFH), arising from the pancreas of a laboratory rat. The mass was excised after laparotomy from a 6-month-old female laboratory Wistar rat. It presented a giant multilobulated mass of irregular shape, which had arisen from the pancreas and occupied almost the entire peritoneal cavity. Histologically the tumor was characterized by a highly variable morphological pattern, with frequent transitions from storiform to pleomorphic areas. An extensive immunohistochemical examination revealed no specific lines of differentiation. Immunohistochemical positivity was observed only to MIB-1 (high Ki-67 proliferation index), vimentin and CD68 antibodies. The diagnosis was compatible with UPS/MFH. To the best of our knowledge, the present case is the first report of a spontaneous primary UPS/MFH arising from the pancreas of a laboratory rat.
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Affiliation(s)
- Petros Ypsilantis
- Laboratory of Experimental Surgery and Surgical ResearchSchool of MedicineDemocritus University of ThraceAlexandroupolisGreece
| | - Soultana Meditskou
- Laboratory of Histology and EmbryologyAristotle University of ThessalonikiThessalonikiGreece
| | - Maria Lambropoulou
- Laboratory of Histology and EmbryologySchool of MedicineDemocritus University of ThraceAlexandroupolisGreece
| | - Theodora Papamitsou
- Laboratory of Histology and EmbryologyAristotle University of ThessalonikiThessalonikiGreece
| | - Constantinos Simopoulos
- Laboratory of Experimental Surgery and Surgical ResearchSchool of MedicineDemocritus University of ThraceAlexandroupolisGreece
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5
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Undifferentiated Pleomorphic Sarcoma of Pancreas: A Case Report and Review of the Literature for the Last Updates. Case Rep Med 2018; 2018:1510759. [PMID: 29955231 PMCID: PMC6000869 DOI: 10.1155/2018/1510759] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 04/21/2018] [Accepted: 05/06/2018] [Indexed: 11/17/2022] Open
Abstract
The most prevalent type of soft tissue sarcoma is undifferentiated pleomorphic sarcoma (UPS) or previously known as malignant fibrous histiocytoma. It accounts over 20% of all soft tissue sarcomas and occurs most frequently in the extremities, trunk, and retroperitoneum. However, it has been rarely observed in the digestive system. Pancreas sarcoma represents less than 1% of all pancreatic tumors, and primary UPS of the pancreas is even rarer. It exhibits high recurrence and poor prognosis. In this case, a 72-year-old woman with a UPS tumor which was located in the pancreas head and neck without adhesion to the retroperitoneum will be discussed.
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Manning MA, Paal EE, Srivastava A, Mortele KJ. Nonepithelial Neoplasms of the Pancreas, Part 2: Malignant Tumors and Tumors of Uncertain Malignant Potential From the Radiologic Pathology Archives. Radiographics 2018; 38:1047-1072. [PMID: 29787363 DOI: 10.1148/rg.2018170201] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Almost all neoplasms of the pancreas are derived from pancreatic epithelial components, including the most common pancreatic mass, primary pancreatic ductal adenocarcinoma (PDAC). Nonepithelial neoplasms comprise only 1%-2% of all pancreatic neoplasms. Although some may arise directly from intrapancreatic elements, many originate from mesenchymal, hematopoietic, or neural elements in the retroperitoneal peripancreatic space and grow into the pancreas. Once these tumors reach a certain size, it can be challenging to identify their origin. Because these manifest at imaging as intrapancreatic masses, awareness of the existence and characteristic features of these nonepithelial neoplasms is crucial for the practicing radiologist in differentiating these tumors from primary epithelial pancreatic tumors, an important distinction given the vastly different management and prognosis. In part 1 of this article, the authors reviewed benign nonepithelial neoplasms of the pancreas. This article focuses on malignant nonepithelial neoplasms and those of uncertain malignant potential that can be seen in the pancreas. The most common malignant or potentially malignant nonepithelial pancreatic tumors are of mesenchymal origin and include soft-tissue sarcomas, solitary fibrous tumor, and inflammatory myofibroblastic tumor. These tumors commonly manifest as large heterogeneous masses, often containing areas of necrosis and hemorrhage. The clinical features associated with these tumors and the imaging characteristics including enhancement patterns and the presence of fat or calcification help distinguish these tumors from PDAC. Hematopoietic tumors, including lymphoma and extramedullary plasmacytoma, can manifest as isolated pancreatic involvement or secondarily involve the pancreas as widespread disease. Hyperenhancing paragangliomas or hypervascular metastatic disease can mimic primary pancreatic neuroendocrine tumors or vascular anomalies.
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Affiliation(s)
- Maria A Manning
- From the American Institute for Radiologic Pathology, 1100 Wayne Ave, Suite 1010, Silver Spring, MD 20910 (M.A.M.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (M.A.M.); Pathology and Laboratory Medicine Service, VA Medical Center, Washington, DC (E.E.P.); Department of Pathology, George Washington University School of Medicine and Health Sciences, Washington, DC (E.E.P.); Department of Radiology, MetroWest Medical Center, Framingham, Mass (A.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (K.J.M.)
| | - Edina E Paal
- From the American Institute for Radiologic Pathology, 1100 Wayne Ave, Suite 1010, Silver Spring, MD 20910 (M.A.M.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (M.A.M.); Pathology and Laboratory Medicine Service, VA Medical Center, Washington, DC (E.E.P.); Department of Pathology, George Washington University School of Medicine and Health Sciences, Washington, DC (E.E.P.); Department of Radiology, MetroWest Medical Center, Framingham, Mass (A.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (K.J.M.)
| | - Amogh Srivastava
- From the American Institute for Radiologic Pathology, 1100 Wayne Ave, Suite 1010, Silver Spring, MD 20910 (M.A.M.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (M.A.M.); Pathology and Laboratory Medicine Service, VA Medical Center, Washington, DC (E.E.P.); Department of Pathology, George Washington University School of Medicine and Health Sciences, Washington, DC (E.E.P.); Department of Radiology, MetroWest Medical Center, Framingham, Mass (A.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (K.J.M.)
| | - Koenraad J Mortele
- From the American Institute for Radiologic Pathology, 1100 Wayne Ave, Suite 1010, Silver Spring, MD 20910 (M.A.M.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (M.A.M.); Pathology and Laboratory Medicine Service, VA Medical Center, Washington, DC (E.E.P.); Department of Pathology, George Washington University School of Medicine and Health Sciences, Washington, DC (E.E.P.); Department of Radiology, MetroWest Medical Center, Framingham, Mass (A.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (K.J.M.)
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Abstract
In this review, we will focus on rare pancreatic tumors. Most of these tumors do not have distinct characteristic appearances so the key to diagnosis requires a combination of imaging appearance, laboratory data, patient demographics, and associated medical syndromes in order to narrow the differential diagnosis. Nonetheless, imaging plays a vital role in narrowing the differential and guiding management. While there are many variant pathologic entities that cannot be encompassed by a single review, we aim to illustrate the imaging appearance of less common pancreatic tumors highlighting key distinctive diagnostic characteristics and discuss the implications for management. While there is overlap in the imaging appearances of many of these entities, for educational purposes, lesions will be categorized into solid (hypoenhancing and hyperenhancing), cystic lesions, mesenchymal neoplasms, and neoplasms seen in younger patients (< 40 years).
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Affiliation(s)
- Jonathan Steinman
- Columbia University Medical Center, 622 W. 168th Street, PB 1-301, New York, NY, 10032, USA
| | - Atif Zaheer
- Johns Hopkins University School of Medicine, 601 N. Caroline Street, Baltimore, MD, USA
| | - Michael D Kluger
- Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY, 10032, USA
| | - Helen Remotti
- Columbia University Medical Center, 630 West 168th Street, VC 14-215, New York, NY, 10032, USA
| | - Elizabeth M Hecht
- Columbia University Medical Center, 622 W. 168th Street, PB 1-301, New York, NY, 10032, USA.
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Tong Y, Yu H, Shen B, Feng X, Wang G, Cai X. Primary hepatic malignant fibrous histiocytoma combined with invasion of inferior vena cava: A case report and literature review. Medicine (Baltimore) 2017; 96:e7110. [PMID: 28591058 PMCID: PMC5466236 DOI: 10.1097/md.0000000000007110] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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
RATIONALE Malignant fibrous histiocytoma (MFH), primary presented in liver, was very rare and displayed a poor prognosis because of high aggression. As a few of cases had been reported merely, we shared the case of primary hepatic MFH combined with invasion of inferior vena cava (IVC). PATIENTS CONCERNS A 69-year-old women presented with abdominal pain. DIAGNOSES Abdominal computed tomography and magnetic resonance imaging indicated a soft mass about 5.4 × 4.2 cm in the caudate lobe, accompanied with IVC invaded. INTERVENTIONS After the multidisciplinary consultation, laparotomy was performed, followed by chemotherapy and radiotherapy. Primary hepatic MFH was demonstrated pathologically. Till now, the patient was alive for >22 months after surgery and no evidence of recurrence or distant metastasis was suspected. OUTCOMES We discussed the integrated procedure of diagnosis and treatment, combined with data from literature review. LESSONS To our knowledge, the primary hepatic MFH combined with invasion of IVC was hardly reported. Despite the poor prognosis, the comprehensive treatment integrating the surgery, chemotherapy, and radiotherapy showed the satisfactory disease-free and overall survival. However, further investigations are definitely warranted.
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Affiliation(s)
| | - Hong Yu
- Department of General Surgery
| | - Bo Shen
- Department of General Surgery
| | - Xu Feng
- Department of General Surgery
| | - Guanglan Wang
- Department of Pathology, Sir Run Run Shaw Hospital Affiliated to Zhejiang University, Hangzhou, China
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Abstract
OBJECTIVE Primary mesenchymal tumors of the pancreas are extremely rare and no comprehensive study of this class of tumors has been previously performed. METHODS Twenty cases of the primary mesenchymal tumors of the pancreas were selected and compared clinicopathologic variables with consecutively resected 500 pancreatic ductal adenocarcinomas. RESULTS Finally, 20 (0.3%) cases were confirmed as primary mesenchymal tumors. The 14 (70%) cases of benign/borderline tumors included 4 cases of fibromatoses, 2 cases of cavernous hemangiomas, 2 cases of schwannomas, 2 cases of solid and cystic hamartomas, 2 cases of solitary fibrous tumors, 1 case of inflammatory myofibroblastic tumor, and 1 case of angiomyolipoma. The 6 (30%) cases of sarcomas comprised 3 cases of undifferentiated/unclassified sarcomas, 1 case of leiomyosarcoma, 1 case of Ewing sarcoma/primitive neuroectodermal tumor, and 1 case of atypical lipomatous tumor/well-differentiated liposarcoma. When compared with the 500 ductal adenocarcinomas, the 3 surgically resected sarcomas were larger (mean, 5.8 cm vs 3.6 cm; P = 0.02); however, no difference in median survival time was observed between patients with sarcoma (23 months) and patients with ductal adenocarcinoma (16 months). CONCLUSIONS First, primary mesenchymal tumors of the pancreas are extremely rare. Second, several primary mesenchymal tumor types can be observed in the pancreas. Understanding these rare disease entities will help ensure their correct diagnosis.
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Qiu LL, Yu RS, Chen Y, Zhang Q. Sarcomas of abdominal organs: computed tomography and magnetic resonance imaging findings. Semin Ultrasound CT MR 2012; 32:405-21. [PMID: 21963162 DOI: 10.1053/j.sult.2011.04.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Sarcomas originating from abdominal organs are extremely rare, and literature in which investigators focus on their imaging features is scarce. This article aims to review the computed tomography and magnetic resonance imaging features of these rare tumors and to help in clinical diagnosis. Various sarcomas (eg, angiosarcoma, undifferentiated embryonal sarcoma, leiomyosarcoma, carcinosarcoma, rhabdomyosarcoma) originating, respectively, from different abdominal visceral organs (liver, pancreas, spleen, kidney, adrenal gland, uterus, and prostate gland) are reviewed along with cases we encountered.
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Affiliation(s)
- Ling-Ling Qiu
- Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Gupta P, Behari A, Jain M. A Case of Primary Myxoid Malignant Fibrous Histiocytoma of the Pancreas: Clinical, Histopathology, and Immunohistochemistry Findings. J Gastrointest Cancer 2011; 43 Suppl 1:S16-9. [DOI: 10.1007/s12029-011-9293-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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12
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Xie FL, Song YN, Qu LJ, Yu YH, Zheng ZY. Clinicopathologic features of perivascular epithelioid cell tumor of the pancreas. Shijie Huaren Xiaohua Zazhi 2011; 19:964-968. [DOI: 10.11569/wcjd.v19.i9.964] [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
AIM: To investigate the clinicopathologic features, diagnosis, treatment and prognosis of perivascular epithelioid cell tumor (PEComa) of the pancreas.
METHODS: One case of PEComa of the pancreas was investigated by light microscopy and immunohistochemistry. A literature review was performed to summarize the characteristics of the disease.
RESULTS: The tumor was located in the head of the pancreas. Microscopically, the lesion was composed of thick or thin blood vessels and nest- or slice-shaped cells around the blood vessels. The tumor cells were huge, showed different polygons and had abundant clear to eosinophilic, granular cytoplasm. The nuclei were polymorphic and no mitoses were observed. Immunohistochemistrically, the tumor cells were strongly positive for HMB45, Melan-A, SMA, HHF35 and vimentin, weakly positive for D2-40 and S-100, and negative for Syn, CK (Pan), CD117, CD34, insuin, somatostatin, gastrin, calcitonin, α-hCG, ACTH, serotonin, PP, VIP and glucagon.
CONCLUSION: Pancreatic PEComa is a mesenchymal tumor with undetermined biological behavior and has unique histological, immunohistochemical and ultrastructural features. There are no definitely diagnostic criteria currently available to differentiate malignant and benign pancreatic PEComa. Current management has relied on surgery, and postoperative long-term close follow-up is needed.
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Choi H, Kwon Y, Chang J, Jeong S, Lee H, Kim J, Jung J, Lee Y. Undifferentiated pleomorphic sarcoma (malignant fibrous histiocytoma) of the head in a dog. J Vet Med Sci 2010; 73:235-9. [PMID: 20877156 DOI: 10.1292/jvms.10-0183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A six year-old intact female miniature poodle was presented with a soft mass of the forehead region. Computed tomography identified generalized frontal bone loss and a large extracranial mass, which had a low attenuation area of hemorrhagic necrosis with septation and enhancement of solid components. In magnetic resonance imaging, the mass was isointense in T1-weighted images except its fluid parts and hyperintense in T2-weighted images with lobulated by low-signal septa. Surgery was performed to remove the mass, and histopathologic examination revealed that the mass was consistent with undifferentiated pleomorphic sarcoma (malignant fibrous histiocytoma). The dog died from the rapidly recurrent mass and severe pulmonary metastasis.
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Affiliation(s)
- Hojung Choi
- College of Veterinary Medicine and Research Institute of Veterinary Medicine, Chungnam National University, Korea
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Leiomyosarcoma arising in the pancreatic duct: a case report and review of the current literature. Case Rep Med 2010; 2010:252364. [PMID: 20589089 PMCID: PMC2892659 DOI: 10.1155/2010/252364] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2010] [Accepted: 04/12/2010] [Indexed: 12/13/2022] Open
Abstract
Context. Leiomyosarcomas are rare malignant smooth muscle tumors that may arise in any organ or tissue that contains smooth muscle, commonly within the gastrointestinal tract. They are most often found in the stomach, large and small intestines, and retroperitoneum. Primary pancreatic leiomyosarcoma is extremely rare, and to the best of our knowledge only 30 cases have been reported in the world literature since 1951. Our case represents the first to have a clear origin from the main pancreatic duct. Case Report. This case was diagnosed in a large, tertiary care center in Tampa, Florida. Pertinent information was obtained from chart review and interdepartmental collaboration. A mass in the tail of the pancreas was identified with large pleomorphic and spindle-shaped cells. Immunohistochemistry for vimentin, smooth muscle actin, and desmin was positive. All remaining immunohistochemical markers performed were negative. The tumor clearly originated from the pancreatic duct wall, filled and expanded the duct lumen, and was covered with a layer of benign biliary epithelium. Conclusion. Leiomyosarcoma of the pancreas is an extremely rare malignancy with few reported cases in the literature. The prognosis is poor, and treatment consists of alleviating symptoms and pain management. To our knowledge, this represents the first reported case demonstrating clear origin of a leiomyosarcoma from the pancreatic duct.
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