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Shah AA, Wang S, Shires C, Johnston GA, Billings SD. Sinonasal Melanotic PEComa With NONO::TFE3 Fusion : A Case Report and Letter to the Editor. Am J Surg Pathol 2024; 48:634-636. [PMID: 38446114 DOI: 10.1097/pas.0000000000002203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Affiliation(s)
- Akeesha A Shah
- Department of Pathology, Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
| | - Sophie Wang
- Department of Pathology, Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
| | - Courtney Shires
- Department of Head and Neck Surgery West Cancer Center, Germantown
| | - Gina A Johnston
- Department of Pathology, Pathology Specialists of Memphis, Methodist University Hospital Memphis, TN
| | - Steven D Billings
- Department of Pathology, Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
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2
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Simms K, Tiwari N, Ramasubramanian A. Ciliary Body Perivascular Epithelioid Cell Tumor. Ophthalmology 2024; 131:621. [PMID: 37702634 DOI: 10.1016/j.ophtha.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/01/2023] [Accepted: 08/14/2023] [Indexed: 09/14/2023] Open
Affiliation(s)
- Katie Simms
- Department of Ophthalmology, Phoenix Children's Hospital, Phoenix, Arizona
| | - Nishant Tiwari
- Department of Pathology, Phoenix Children's Hospital, Phoenix, Arizona
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3
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Tsukita H, Koyama K, Ishinari T, Takahashi A, Miyabe K, Umakoshi M, Yoshida M, Kudo-Asabe Y, Nishida A, Otsuka N, Yasui O, Kato I, Fukushima N, Goto A. A case of pancreatic PEComa with prominent inflammatory cell infiltration: the inflammatory subtype is a distinct histologic group of PEComa. Diagn Pathol 2024; 19:59. [PMID: 38622713 PMCID: PMC11017648 DOI: 10.1186/s13000-024-01485-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 04/06/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND PEComa is a mesenchymal tumor that can occur in various organs including the uterus and soft tissues. PEComas are composed of perivascular epithelioid cells, and angiomyolipoma (AML), clear cell sugar tumor (CCST), and lymphangiomyomatosis (LAM) are considered lesions of the same lineage as tumors of the PEComa family. Histologically, a common PEComa shows solid or sheet-like proliferation of epithelioid cells. This is accompanied by an increase in the number of dilated blood vessels. Here, we report a case of pancreatic PEComa with marked inflammatory cell infiltration. CASE PRESENTATION A 74-year-old male patient underwent an appendectomy for acute appendicitis. Postoperative computed tomography and magnetic resonance imaging revealed a 30 × 25 mm non-contrast-enhanced circular lesion in the tail of the pancreas. The imaging findings were consistent with a malignant tumor, and distal pancreatectomy was performed. Histologically, most area of the lesion was infiltrated with inflammatory cells. A few epithelioid cells with large, round nuclei, distinct nucleoli, and eosinophilic granular cytoplasm were observed. Spindle-shaped tumor cells were observed. Delicate and dilated blood vessels were observed around the tumor cells. Immunohistochemically, the atypical cells were positive for αSMA, Melan A, HMB-45, and TFE3. The cytological characteristics of the tumor cells and the results of immunohistochemical staining led to a diagnosis of pancreatic PEComa. CONCLUSIONS A histological variant known as the inflammatory subtype has been defined for hepatic AML. A small number of tumor cells present with marked inflammatory cell infiltration, accounting for more than half of the lesions, and an inflammatory myofibroblastic tumor-like appearance. To our knowledge, this is the first report of pancreatic PEComa with severe inflammation. PEComa is also a generic term for tumors derived from perivascular epithelioid cells, such as AML, CCST, and LAM. Thus, this case is considered an inflammatory subtype of PEComa. It has a distinctive morphology that is not typical of PEComa. This histological phenotype should be widely recognized.
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Affiliation(s)
- Hikaru Tsukita
- Department of Cellular and Organ Pathology, Akita University Graduate School of Medicine, 1- 1-1 Hondo, Akita-shi, Akita, 010-8543, Japan
- Department of Pathology, Nihonkai General Hospital, Sakata, Japan
| | - Kei Koyama
- Department of Cellular and Organ Pathology, Akita University Graduate School of Medicine, 1- 1-1 Hondo, Akita-shi, Akita, 010-8543, Japan.
| | - Takahiro Ishinari
- Department of Cellular and Organ Pathology, Akita University Graduate School of Medicine, 1- 1-1 Hondo, Akita-shi, Akita, 010-8543, Japan
| | - Ayana Takahashi
- Department of Cellular and Organ Pathology, Akita University Graduate School of Medicine, 1- 1-1 Hondo, Akita-shi, Akita, 010-8543, Japan
- Department of Pathology, Nihonkai General Hospital, Sakata, Japan
| | - Ken Miyabe
- Department of Cellular and Organ Pathology, Akita University Graduate School of Medicine, 1- 1-1 Hondo, Akita-shi, Akita, 010-8543, Japan
| | - Michinobu Umakoshi
- Department of Cellular and Organ Pathology, Akita University Graduate School of Medicine, 1- 1-1 Hondo, Akita-shi, Akita, 010-8543, Japan
- Department of Pathology, Akita City Hospital, Akita, Japan
| | - Makoto Yoshida
- Department of Cellular and Organ Pathology, Akita University Graduate School of Medicine, 1- 1-1 Hondo, Akita-shi, Akita, 010-8543, Japan
| | - Yukitsugu Kudo-Asabe
- Department of Cellular and Organ Pathology, Akita University Graduate School of Medicine, 1- 1-1 Hondo, Akita-shi, Akita, 010-8543, Japan
| | - Akiko Nishida
- Department of Pathology, Nihonkai General Hospital, Sakata, Japan
| | - Naohiko Otsuka
- Department of Surgery, Noshiro Yamamoto Medical Association Hospital, Noshiro, Japan
| | - Ouki Yasui
- Department of Surgery, Noshiro Yamamoto Medical Association Hospital, Noshiro, Japan
| | - Ikuma Kato
- Department of Molecular Pathology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | | | - Akiteru Goto
- Department of Cellular and Organ Pathology, Akita University Graduate School of Medicine, 1- 1-1 Hondo, Akita-shi, Akita, 010-8543, Japan
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4
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Yan S, Lu JJ, Chen L, Cai WH, Wu JZ. Hepatic perivascular epithelioid cell tumors: The importance of preoperative diagnosis. World J Gastroenterol 2024; 30:1926-1933. [PMID: 38659487 PMCID: PMC11036502 DOI: 10.3748/wjg.v30.i13.1926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/17/2024] [Accepted: 03/19/2024] [Indexed: 04/03/2024] Open
Abstract
Accurate preoperative diagnosis is highly important for the treatment of perivascular epithelioid cell tumors (PEComas) because PEComas are mainly benign tumors and may not require surgical intervention. By analyzing the causes, properties and clinical manifestations of PEComas, we summarize the challenges and solutions in the diagnosis of PEComas.
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Affiliation(s)
- Shuai Yan
- Department of Medical School, Nantong University, Nantong 226300, Jiangsu Province, China
- Department of Hepatobiliary Surgery, Affiliated Nantong Hospital 3 of Nantong University, Nantong 226006, Jiangsu Province, China
| | - Jia-Jie Lu
- Department of Medical School, Nantong University, Nantong 226300, Jiangsu Province, China
- Department of Hepatobiliary Surgery, Affiliated Nantong Hospital 3 of Nantong University, Nantong 226006, Jiangsu Province, China
| | - Lin Chen
- Nantong Institute of Liver Disease, Affiliated Nantong Hospital 3 of Nantong University, Nantong 226006, Jiangsu Province, China
| | - Wei-Hua Cai
- Department of Medical School, Nantong University, Nantong 226300, Jiangsu Province, China
- Department of Hepatobiliary Surgery, Affiliated Nantong Hospital 3 of Nantong University, Nantong 226006, Jiangsu Province, China
| | - Jin-Zhu Wu
- Department of Medical School, Nantong University, Nantong 226300, Jiangsu Province, China
- Department of Hepatobiliary Surgery, Affiliated Nantong Hospital 3 of Nantong University, Nantong 226006, Jiangsu Province, China
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5
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Lei S, Fang X, Zhang W, Duan H. Primary malignant PEComa with TFE3 rearrangement in foot bones: A case report. Asian J Surg 2024; 47:1837-1838. [PMID: 38143179 DOI: 10.1016/j.asjsur.2023.12.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 12/15/2023] [Indexed: 12/26/2023] Open
Affiliation(s)
- Senlin Lei
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China
| | - Xiang Fang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China
| | - Wenli Zhang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China
| | - Hong Duan
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China.
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Li G, Wang X, He X. Hepatic perivascular epithelioid cell tumor with the constipation symptom: A rare case report. Asian J Surg 2024; 47:1628-1630. [PMID: 38143173 DOI: 10.1016/j.asjsur.2023.12.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/08/2023] [Indexed: 12/26/2023] Open
Affiliation(s)
| | - Xin Wang
- Gannan Medical University, China
| | - Xiao He
- First Affiliated Hospital of Gannan Medical University, China.
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7
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Zhou H, Wu X. A rare case report and literature review of splenic perivascular epithelioid cell tumor. Asian J Surg 2024; 47:1414-1416. [PMID: 38052660 DOI: 10.1016/j.asjsur.2023.11.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 11/17/2023] [Indexed: 12/07/2023] Open
Affiliation(s)
- Haihua Zhou
- Department of Hepatobiliary Surgery, The Affiliated Jinhua Hospital of Zhejiang University School of Medicine, Jinhua, Zhejiang Province, China.
| | - Xiaokang Wu
- Department of Hepatobiliary Surgery, The Affiliated Jinhua Hospital of Zhejiang University School of Medicine, Jinhua, Zhejiang Province, China.
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Rodríguez N, Pérez S, Rodríguez JN, Rodríguez J, Esquivel A, Sanabria D, Baena J. Perivascular epithelioid cell tumors (PEComas) of gynecological tract: preoperative diagnostic imaging challenge. Ultrasound Obstet Gynecol 2024; 63:286-288. [PMID: 37902722 DOI: 10.1002/uog.27520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 10/01/2023] [Accepted: 10/19/2023] [Indexed: 10/31/2023]
Affiliation(s)
- N Rodríguez
- Department of Gynecology, Obstetrics and Human Reproduction, Fundación Santa Fe de Bogotá, Bogotá, Colombia
- School of Medicine, Universidad de los Andes, Bogotá, Colombia
| | - S Pérez
- Department of Gynecology, Obstetrics and Human Reproduction, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - J N Rodríguez
- Department of Gynecology, Obstetrics and Human Reproduction, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - J Rodríguez
- Department of Gynecology, Obstetrics and Human Reproduction, Fundación Santa Fe de Bogotá, Bogotá, Colombia
- School of Medicine, Universidad de los Andes, Bogotá, Colombia
| | - A Esquivel
- Department of Gynecology, Obstetrics and Human Reproduction, Fundación Santa Fe de Bogotá, Bogotá, Colombia
- School of Medicine, Universidad de los Andes, Bogotá, Colombia
| | - D Sanabria
- Department of Gynecology, Obstetrics and Human Reproduction, Fundación Santa Fe de Bogotá, Bogotá, Colombia
- School of Medicine, Universidad de los Andes, Bogotá, Colombia
| | - J Baena
- School of Medicine, Universidad de los Andes, Bogotá, Colombia
- Department of Pathology, Fundación Santa Fe de Bogotá, Bogotá, Colombia
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Liu XL, Cui J, Tian H. Hepatic perivascular epithelioid cell neoplasm in a 58-year-old woman. Pol Arch Intern Med 2024; 134:16615. [PMID: 38019147 DOI: 10.20452/pamw.16615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
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Rekhi B, Menon S. Clinicopathological features of two ultra-rare cases of malignant perivascular epithelioid cell tumors (PEComas) involving the uterus with recent updates. INDIAN J PATHOL MICR 2024; 67:137-140. [PMID: 38358203 DOI: 10.4103/ijpm.ijpm_9_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
Malignant perivascular epithelioid tumors (PEComas) involving the uterus are uncommon. Herein, we present the clinicopathological features of two such cases, including their diagnostic implications with recent updates. A 62-year-old lady presented with vaginal bleeding. Ultrasonogram revealed a heterogeneous uterine mass. She underwent an endometrial biopsy and total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAH-BSO), which revealed a 3.2 cm-sized proliferative tumor in the fundus. A 45-year-old lady presented with recurrent abdominal pain. She underwent cytoreductive surgery twice with adjuvant chemotherapy for multiple tumors and TAH-BSO for a uterine tumor, 2 years before. Microscopic examination of both tumors revealed markedly atypical, polygonal-shaped/epithelioid tumor cells containing eosinophilic cytoplasm and arranged in a nesting pattern with intervening thin-walled blood vessels, mitotic figures (≥ 6/10 high power fields (hpfs)), and tumor necrosis. Tumor infiltration was more than half the myometrial thickness in the first tumor and pelvic nodal metastasis. The second tumor revealed rhabdoid-like and vacuolated cells along with "spider-like" giant cells. Immunohistochemically, both the tumors were positive for HMB45 and desmin, while negative for epithelial markers. Additionally, the second tumor was positive for smooth muscle actin (SMA) and TFE3. Both patients developed tumor recurrences. In view of multiple tumor deposits, the second patient was induced with a mammalian target of rapamycin (m-TOR) inhibitor (everolimus) but unfortunately died of the disease. Malignant PEComas involving the uterus are ultra-rare, aggressive tumors. An index of suspicion, based on certain histomorphological features, supported by immunohistochemical expression of myomelanocytic markers is necessary for a correct diagnosis. Certain PEComas display TFE3 positivity. A correct diagnosis has significant implications, including an aggressive clinical course and the possibility of targeted therapy, especially in recurrences or metastasis.
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Affiliation(s)
- Bharat Rekhi
- Department of Surgical Pathology, Tata Memorial Hospital, HBNI University, Mumbai, Maharashtra, India
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11
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Nogueira Sixto M, Carracedo Iglesias R, Estévez Fernández S, Rodríguez Pereira C, Sánchez Santos R. Pancreatic PEComa, a not so uncommon neoplasm? Systematic review and therapeutic update. Gastroenterol Hepatol 2024; 47:93-100. [PMID: 37230381 DOI: 10.1016/j.gastrohep.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/12/2023] [Accepted: 05/18/2023] [Indexed: 05/27/2023]
Abstract
Pancreatic PEComas are extremely rare neoplasms with malignant potential, which mostly affect middle-aged women and are characterized by presenting melanocytic and myogenic markers in immunohistochemical analysis. There are no symptoms or pathognomonic imaging tests, so the diagnosis is established with the analysis of the surgical specimen or the FNA obtained with preoperative endoscopic ultrasound. The mean treatment consists on radical excision, adapting the intervention to the location of the tumor. To date, 34 cases have been described; however, more than 80% of them have been reported in the last decade, which suggests that it is a more frequent pathology than expected. A new case of pancreatic PEComa is reported and a systematic review of the literature is carried out according to the PRISMA guidelines with the aim of divulge this pathology, deepening its knowledge and updating its management.
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Affiliation(s)
- Manuel Nogueira Sixto
- Servicio de Cirugía General y del Aparato Digestivo, Complejo Hospitalario Universitario de Vigo, Vigo, Galicia, España.
| | - Roberto Carracedo Iglesias
- Servicio de Cirugía General y del Aparato Digestivo, Complejo Hospitalario Universitario de Vigo, Vigo, Galicia, España
| | - Sergio Estévez Fernández
- Servicio de Cirugía General y del Aparato Digestivo, Complejo Hospitalario Universitario de Vigo, Vigo, Galicia, España
| | - Carlos Rodríguez Pereira
- Servicio de Anatomía Patológica, Complejo Hospitalario Universitario de Vigo, Vigo, Galicia, España
| | - Raquel Sánchez Santos
- Servicio de Cirugía General y del Aparato Digestivo, Complejo Hospitalario Universitario de Vigo, Vigo, Galicia, España
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12
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Zhou Y, Feng H, Bu L, Xie X. Perivascular epithelioid cell tumor of the pelvis mimicking urological cancer on 18 F-FDG PET/CT: A case report. Asian J Surg 2023; 46:5477-5478. [PMID: 37541877 DOI: 10.1016/j.asjsur.2023.07.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 07/16/2023] [Indexed: 08/06/2023] Open
Affiliation(s)
- Ying Zhou
- PET-CT/MRI Center & Molecular Imaging Center, Wuhan University Renmin Hospital, Wuhan, 430060, Hubei, China
| | - Hongyan Feng
- PET-CT/MRI Center & Molecular Imaging Center, Wuhan University Renmin Hospital, Wuhan, 430060, Hubei, China
| | - Lihong Bu
- PET-CT/MRI Center & Molecular Imaging Center, Wuhan University Renmin Hospital, Wuhan, 430060, Hubei, China.
| | - Xinli Xie
- Department of Nuclear Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, Henan, China.
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Feng R, Tao Y, Zhang T, Zhao S, Yin Z, Ke C, Wang J. Clinicopathological features of primary malignant perivascular epithelioid cell tumors of ureter: Histologic-radiologic correlation. Ann Diagn Pathol 2023; 67:152200. [PMID: 37666011 DOI: 10.1016/j.anndiagpath.2023.152200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/09/2023] [Accepted: 08/11/2023] [Indexed: 09/06/2023]
Abstract
Perivascular epithelioid cell tumor (PEComa) is a rare mesenchymal tumor that is mainly seen in middle-aged women. PEComa originating in the ureter is extremely rare it is unclear whether they display typical clinical and radiographic features seen elsewhere. Herein, we report findings from 2 cases of primary PEComa of the ureter that we classified as malignant. Case 1: A 45-year-old woman was admitted to the hospital with intermittent distension in her waist. After appropriate imaging, the right ureter and right kidney were excised under general anesthesia. The tumor measured 1.4 cm. Microscopically, the tumor displayed infiltrative growth, >2 mitoses per 10 high power fields (HPF), necrosis, and lympho-vascular invasion. Case 2: A 30-year-old woman was admitted to the hospital due to hematuria 20 days duration. The left ureter and left kidney were ultimately excised under general anesthesia. The tumor measured 2 cm. Microscopically, the tumor showed infiltrative growth and >2 mitoses/10 HPF. Our cases were diagnosed as malignant PEComa. No disease recurrence was observed in either of the two patients during the postoperative follow-up period. Malignant primary ureteral PEComa is very rare. The clinical manifestations are not specific, and it is usually misdiagnosed as a malignant neoplasm on imaging. Therefore, its diagnosis requires pathological examination and immunohistochemical analysis of the sampled or resected tumor. Treatment requires a complete surgical resection and regular clinical follow-up.
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Affiliation(s)
- Runlin Feng
- Department of Pathology, The Second Affiliated Hospital of Kunming Medical University, Yunnan, China
| | - Yanping Tao
- Department of Emergency, Kunming Third People's Hospital, Kunming Medical University, Yunnan, China
| | - Tao Zhang
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Yunnan, China; School of Clinical Medicine, Southwest Medical University, Luzhou, Sichuan, China; Department of Urology, The Affiliated Hospital of Southwest Medical University, China
| | - Shenzhao Zhao
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Yunnan, China
| | - Zhiyuan Yin
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Yunnan, China
| | - Changxing Ke
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Yunnan, China.
| | - Jiaping Wang
- Department of Radiology, The Second Affiliated Hospital of Kunming Medical University, Yunnan, China.
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Li J, Huang RP, Pang P, Guo X, Wang YH, Guo LC, Huang S. [Perivascular epithelioid cell tumor of the lung: a clinicopathological analysis of eight cases]. Zhonghua Bing Li Xue Za Zhi 2023; 52:1126-1131. [PMID: 37899318 DOI: 10.3760/cma.j.cn112151-20230504-00304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
Objective: To investigate the clinicopathological features of perivascular epithelioid cell tumor (PEComa) of the lung. Methods: Eight PEComa cases of the lung diagnosed at the First Affiliated Hospital of Soochow University, Suzhou, China from July 2008 to December 2021 were collected and subject to immunohistochemical staining, fluorescence in situ hybridization and next generation sequencing. The relevant literature was reviewed and the clinicopathological features were analyzed. Results: There were 5 males and 3 females, aged from 18 to 70 years (mean 39 years). There were 3 cases of the right upper lung, 3 cases of the left lower lung, 1 case of the left upper lung and 1 case of the right middle lung. Seven cases were solitary and 1 case was multifocal (4 lesions). Seven cases were benign while one was malignant. The tumors were all located in the peripheral part of the lung, with a maximum diameter of 0.2-4.0 cm. Grossly, they were oval and well circumscribed. Microscopically, the tumor cells were oval, short spindle-shaped, arranged in solid nests, acinar or hemangiopericytoma-like patterns, with clear or eosinophilic cytoplasm. The stroma was rich in blood vessels with hyalinization. Coagulated necrosis and high-grade nuclei were seen in the malignant case, and calcification was seen in 2 cases. Immunohistochemically, the tumor cells were positive for Melan A (8/8), HMB45 (7/8), CD34 (6/8), TFE3 (4/7), and SMA (3/8). All cases were negative for CKpan and S-100. TFE3 (Xp11.2) gene fusion was examined using the TFE3 break-apart fluorescence in situ hybridization in 5 cases, in which only the malignant case was positive. The next generation sequencing revealed the SFPQ-TFE3 [t(X;1)(p11.2;p34)] fusion. Follow-up of the patients ranged from 12 to 173 months while one patient was lost to the follow-up. The malignant case had tumor metastasis to the brain 4 years after the operation and then received radiotherapy. Other 6 cases had no recurrence and metastasis, and all the 7 patients survived. Conclusions: Most of the PEComas of the lung are benign. When there are malignant morphological features such as necrosis, high-grade nuclei or SFPQ-TFE3 gene fusion, close follow-up seems necessary.
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Affiliation(s)
- J Li
- Department of Pathology, the First Affiliated Hospital of Soochow University, Suzhou 215000, China
| | - R P Huang
- Department of Pathology, the First Affiliated Hospital of Soochow University, Suzhou 215000, China
| | - P Pang
- Department of Pathology, the First Affiliated Hospital of Soochow University, Suzhou 215000, China
| | - X Guo
- Department of Pathology, the First Affiliated Hospital of Soochow University, Suzhou 215000, China
| | - Y H Wang
- Department of Pathology, the First Affiliated Hospital of Soochow University, Suzhou 215000, China
| | - L C Guo
- Department of Pathology, the First Affiliated Hospital of Soochow University, Suzhou 215000, China
| | - S Huang
- Department of Pathology, the First Affiliated Hospital of Soochow University, Suzhou 215000, China
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Zheng Y, Shi H, Zhang J. Malignant PEComa located in ureter with a positive TFE3 immunohistochemical staining: A case report. Asian J Surg 2023; 46:4560-4562. [PMID: 37198095 DOI: 10.1016/j.asjsur.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 05/02/2023] [Indexed: 05/19/2023] Open
Affiliation(s)
- Yanghuang Zheng
- The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, 650101, PR China
| | - Hongjin Shi
- The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, 650101, PR China
| | - Jinsong Zhang
- The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, 650101, PR China.
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Lim BJ, Roh SG, Shin JY, Lee NH, Chung YK, Jang KY. Treatment of malignant perivascular epithelioid cell tumor (PEComa) on the knee with an anterolateral thigh free flap: A case report. Medicine (Baltimore) 2023; 102:e34679. [PMID: 37565900 PMCID: PMC10419433 DOI: 10.1097/md.0000000000034679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/20/2023] [Indexed: 08/12/2023] Open
Abstract
RATIONALE The World Health Organization defines a perivascular epithelioid cell tumor (PEComa) as a mesenchymal neoplasia composed of perivascular epithelioid cells with characteristic morphological and immunohistochemical features. Although PEComas have the potential to behave in a malignant fashion, malignant PEComas are extremely rare. PATIENT CONCERNS An 83-year-old man visited our clinic presented with palpable, painless, and movable mass in the right knee area. DIAGNOSES Malignant PEComa was diagnosed by incisional biopsy. No metastases was confirmed by radiologic imaging including PET/CT, magnetic resonance imaging, high resolution computed tomography. INTERVENTIONS We performed wide excision of the mass and used an anterolateral thigh free flap to reconstruct the defect on the right knee. OUTCOMES The permanent histopathology showed malignant PEComa was totally resected. The flap which was performed to cover the defect was survived and the patient discharge without any complications. LESSONS PEComa can metastasize to various anatomical regions. Although there is no established standardized treatment, radical resection is still considered the cornerstone of treatment. Rapid and appropriate defect coverage is important to improve the patient's prognosis.
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Affiliation(s)
- Beom Jin Lim
- Department of Plastic and Reconstructive Surgery, Medical School of Jeonbuk National University, Jeonju, Republic of Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Si-Gyun Roh
- Department of Plastic and Reconstructive Surgery, Medical School of Jeonbuk National University, Jeonju, Republic of Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Jin Yong Shin
- Department of Plastic and Reconstructive Surgery, Medical School of Jeonbuk National University, Jeonju, Republic of Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Nae-Ho Lee
- Department of Plastic and Reconstructive Surgery, Medical School of Jeonbuk National University, Jeonju, Republic of Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Yoon Kyu Chung
- Department of Plastic and Reconstructive Surgery, Medical School of Jeonbuk National University, Jeonju, Republic of Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Kyu Yun Jang
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
- Department of Pathology, Medical School of Jeonbuk National University, Jeonju, Republic of Korea
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Wang B, Xu X, Zhao Z. Clear cell "sugar" tumor of the lung: Diagnostic characteristics of a rare pulmonary tumor: A case report and review of literature. Medicine (Baltimore) 2023; 102:e33035. [PMID: 36800595 PMCID: PMC9936011 DOI: 10.1097/md.0000000000033035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
INTRODUCTION Clear cell tumors of the lung (CCTLs), also known as "sugar tumors" for an abundant cellular glycogen concentration, are an extremely rare type pulmonary neoplasm. Often, they are incidentally found on chest roentgenogram or computed tomography scan during routine examination. CCTLs usually present with nonspecific symptoms that pose a diagnostic challenge to clinicians. Accordingly, histopathology remains the gold standard for diagnosing. Moreover, some of them can present with either appearances or histopathological features similar to other pulmonary neoplasms under the light microscope, including pulmonary malignancy, thereby causing misdiagnosis prior to or after surgery. Accordingly, herein, we describe a rare case of CCTL, review the literature has been published, and then discuss the benign versus malignant nature of this rare tumor. PATIENT CONCERNS A 59-year-old man presented due to a high-density chest nodule in the left diaphragm. The patient's medical history was unremarkable and he also denied smoking in the past. DIAGNOSIS Physical examination, there were no noted signs. A new chest contrast-enhanced computed tomography revealed a 3.2 × 2.5 cm, solitary, circular nodule with a smooth edge located in the beside of the left thoracic aorta. Postoperative pathological and immunohistochemical examinations of the surgical specimens revealed a final diagnosis of CCTLs. INTERVENTIONS The patient underwent video-assisted thoracoscopic surgery. A wedge resection of left lower lung lobe was carried out and the tumor node was successfully removed alongside normal surrounding parenchyma. OUTCOMES The operation was successful. Then the patient recovered completely and continued to do well on postsurgical thoracic surgical clinic visits. The tumor was a benign tumor, and the patient did not require any additional treatment. The patient had been followed-up regularly for 4 years after surgery; she did not experience any complications and remained disease-free. CONCLUSION CCTLs should be considered in the differential diagnosis if a patient shows a solitary, circular chest nodule with a smooth edge. They are extremely rare lung tumors that must be differentiated from other lung tumors, especially the malignant tumors. Although pathological and immunohistochemical findings are important for making the diagnosis, the varying histopathological features on microscope make diagnosis difficult. The current case highlights the importance of physicians being aware of and suspecting CCTLs in similar cases, along with knowing the characteristics of CCTLs for the diagnosis and differential diagnosis.
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Affiliation(s)
- Bo Wang
- Department of Pathology, Xingtai People’s Hospital Affiliated to Hebei Medical University, Xingtai, Hebei, P.R. China
- * Correspondence: Bo Wang, Department of Pathology, Xingtai People’s Hospital Affiliated to Hebei Medical University, 16 Red Star Street, Xingtai, Hebei 054001, P.R. China (e-mail: )
| | - Xin Xu
- Department of Pathology, Xingtai People’s Hospital Affiliated to Hebei Medical University, Xingtai, Hebei, P.R. China
| | - Zhenya Zhao
- Department of Pathology, Xingtai People’s Hospital Affiliated to Hebei Medical University, Xingtai, Hebei, P.R. China
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Lin C, Liang S, Wang Y, Liang A, Qin W, Huang J, Meng H, Liu H, Chen M, Meng L. Laparoscopic radical nephroureterectomy in the oblique supine lithotomy integrative position for rare renal malignant perivascular epithelioid cell tumor with renal vein cancerous thrombosis: A case report and literature review. Medicine (Baltimore) 2022; 101:e30653. [PMID: 36197208 PMCID: PMC9509118 DOI: 10.1097/md.0000000000030653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
RATIONALE Perivascular epithelioid cell tumor (PEComa) is a mesenchymal tumor that arises from perivascular epithelioid cells and can differentiate into melanocytes and smooth muscle cells. Malignant renal perivascular epithelioid cell tumor is extremely rare. Due to the lack of specific clinical manifestations and imaging features, diagnosing PEComa depends on postoperative pathology and immunohistochemistry. Surgery is the primary treatment for malignant PEComa because the efficacy of radiotherapy and chemotherapy is uncertain. There is still a lack of unified diagnostic criteria and treatment guidelines for renal malignant PEComa, especially with vascular invasion. Hence, the treatment experience depends on a small number of cases reported worldwide. PATIENT CONCERNS A 68-year-old woman was admitted to our hospital due to intermittent hematuria for over 8 months. The color Doppler ultrasound and computed tomography scan revealed a mass in the lower middle part of the left kidney. DIAGNOSIS Rare renal malignant perivascular epithelioid cell tumor with renal vein cancerous thrombosis. INTERVENTIONS A laparoscopic radical left nephroureterectomy in the oblique supine lithotomy position was performed. OUTCOMES The operation process went smoothly, and no pulmonary embolism occurred after the operation. The final pathological diagnosis was a renal malignant perivascular epithelioid cell tumor. After a 12-month follow-up, no recurrence or metastasis was found. LESSONS Renal malignant PEComa is an extremely rare mesenchymal tumor diagnosed mainly based on pathology. Surgery is currently the effective treatment for malignant PEComa. For the surgical treatment of malignant renal PEComa with vascular invasion, laparoscopic radical nephroureterectomy in the oblique supine lithotomy integrative position has many benefits, as exemplified by our current case.
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Affiliation(s)
- Canbin Lin
- Department of Urology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, PR China
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, PR China
| | - Shulin Liang
- Department of Urology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, PR China
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, PR China
| | - Yongxing Wang
- Department of Urology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, PR China
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, PR China
| | - Aidi Liang
- Department of Traditional Chinese Medicine, Jinan University, Guangzhou, Guangdong, PR China
| | - Weiting Qin
- Department of Urology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, PR China
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, PR China
| | - Jiapeng Huang
- Department of Urology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, PR China
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, PR China
| | - Hao Meng
- Department of Urology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, PR China
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, PR China
| | - Hong Liu
- Department of Urology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, PR China
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, PR China
| | - Ming Chen
- Department of Urology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, PR China
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, PR China
- *Correspondence: Ming Chen or Lei Meng, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, No. 16 Yard, Airport Road, Baiyun, Guangzhou, Guangdong 510405, PR China (e-mail: ; )
| | - Lei Meng
- Department of Urology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, PR China
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, PR China
- *Correspondence: Ming Chen or Lei Meng, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, No. 16 Yard, Airport Road, Baiyun, Guangzhou, Guangdong 510405, PR China (e-mail: ; )
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19
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Liu B, Zhou WY, Xiao YT, Cheng YH, Ge YH, Nie SD, Lyu P. [Analysis of the diagnosis and treatment of 24 cases of hepatic perivascular epithelioid cell tumor]. Zhonghua Gan Zang Bing Za Zhi 2022; 30:889-894. [PMID: 36207947 DOI: 10.3760/cma.j.cn501113-20201013-00551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Objective: To investigate hepatic perivascular epithelioid cell tumor (PEComa) diagnosis and treatment plan. Methods: 24 cases diagnosed with PEComa clinical manifestations, serum alpha fetoprotein (AFP), carcinoembryonic antigen (CEA), carbohydrate antigen 199 (CA199), imaging findings, surgical methods, postoperative hospital stay, pathological results and prognosis were analyzed retrospectively from September 2015 to September 2020. Results: Majority of patients were females (79.2%), aged 41.5±11.4 years. Tumors were predominantly located in the right liver (50.0%). 76.7% of the cases were mostly clinically asymptomatic. AFP, CEA and CA199 indices were all negative. CT mostly showed low density tumor in the plain scan phase, enhanced in the enhancement phase, and enhanced and weakened in portal venous and equilibrium phase (66.7%). MRI manifestations of most tumors were hypointense on T1WI and hyperintense on T2WI (72.7%). B-ultrasound mostly showed hyperechoic mass in the tumor area with punctate vascular shadow (52.9%). Postoperative hospital stay was 9.0±2.4 days for laparoscopic surgery patients (n=13), 13.4±6.3 days for traditional laparotomy (hereinafter referred to as laparotomy, n=10), and 3 days for 1 patient with microwave ablation. All postoperative pathological results were positive for HMB45 and Melan-A. Follow-up results: 21 cases survived normally, with no tumor recurrence in the recent physical examination; two cases had tumor recurrence and they died two and three years after surgery, and one case was lost to follow-up. Conclusion: Hepatic PEComa more commonly occurs in middle-aged women, with no specific features for tumor markers and clinical manifestations. Some imaging findings are specific, so its features can be combined as a basis for diagnosis. Postoperative pathological examination results can confirm the diagnosis. Therefore, surgery remains the initial treatment plan. Microwave ablation and laparoscopic surgery are recommended as the preferred option because of shorter hospital stays and less trauma than open surgery.
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Affiliation(s)
- B Liu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Hunan Normal Hospital of Hunan Normal University/Hunan Provincial People's Hospital,changsha 410005, China
| | - W Y Zhou
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Hunan Normal Hospital of Hunan Normal University/Hunan Provincial People's Hospital,changsha 410005, China
| | - Y T Xiao
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Hunan Normal Hospital of Hunan Normal University/Hunan Provincial People's Hospital,changsha 410005, China
| | - Y H Cheng
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Hunan Normal Hospital of Hunan Normal University/Hunan Provincial People's Hospital,changsha 410005, China
| | - Y H Ge
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Hunan Normal Hospital of Hunan Normal University/Hunan Provincial People's Hospital,changsha 410005, China
| | - S D Nie
- Clinical trial research Center, The First Affiliated Hospital of Hunan Normal Hospital of Hunan Normal University/Hunan Provincial People's Hospital, changsha 410005, China
| | - P Lyu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Hunan Normal Hospital of Hunan Normal University/Hunan Provincial People's Hospital,changsha 410005, China
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20
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Siddiqi S, Mesropyan L. Perivascular epithelioid cell tumour-mimicking retroperitoneal leiomyosarcoma. BMJ Case Rep 2022; 15:e250252. [PMID: 35985749 PMCID: PMC10580274 DOI: 10.1136/bcr-2022-250252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A young man in his 40s was evaluated in the emergency department for abdominal and right flank pain. A CT scan of the abdomen and pelvis showed a solid, well-circumscribed lesion measuring 7.1×8.1×5.4 cm, which was arising from the retroperitoneum and extending from the third portion of the duodenum towards the right kidney. A percutaneous core biopsy was obtained, demonstrating an atypical smooth muscle neoplasm suggestive of a low-grade leiomyosarcoma. The patient underwent surgery for an en-block resection of the mass and the final pathology confirmed a perivascular epithelioid cell neoplasm without significant pleomorphism, mitosis or necrosis. Our case adds to the small number of perivascular epithelioid cell tumour cases reported in the literature and we present it in order to increase our understanding of this tumour and to assist in its appropriate diagnosis and management.
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Affiliation(s)
- Shirin Siddiqi
- Surgery, Conemaugh Health System, Johnstown, Pennsylvania, USA
| | - Lusine Mesropyan
- Surgery, Banner University Medical Center South, Tucson, Arizona, USA
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21
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Argani P, Wobker SE, Gross JM, Matoso A, Fletcher CD, Antonescu CR. PEComa-like Neoplasms Characterized by ASPSCR1-TFE3 Fusion: Another Face of TFE3-related Mesenchymal Neoplasia. Am J Surg Pathol 2022; 46:1153-1159. [PMID: 35848761 PMCID: PMC9298479 DOI: 10.1097/pas.0000000000001894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Identical TFE3-related gene fusions may be found in renal cell carcinoma and mesenchymal neoplasms such as alveolar soft part sarcoma and TFE3-rearranged perivascular epithelioid cell tumor (PEComa). Among mesenchymal neoplasms, the ASPSCR1-TFE3 gene fusion has previously been described only in alveolar soft part sarcoma. We report 3 unusual mesenchymal neoplasms harboring the ASPSCR1-TFE3 gene fusion, the morphologic phenotype of which more closely matches PEComa rather than alveolar soft part sarcoma. All 3 neoplasms occurred in females ranging in age from 18 to 34 years and were located in the viscera (kidney, bladder, and uterus). All 3 contained nests of epithelioid cells bounded by fibrovascular septa. However, all were associated with hyalinized stroma, tight nested architecture, mixed spindle cell and epithelioid pattern, clear cytoplasm, and lacked significant discohesion. Overall, morphologic features closely resembled PEComa, being distinct from the typical alveolar soft part sarcoma phenotype. While none of the neoplasms labeled for HMB45, cytokeratin, or PAX8 all showed positivity for TFE3 and cathepsin K, and all except 1 were positive for smooth muscle actin. One patient developed a liver metastasis 7 years after nephrectomy. These cases bridge the gap between 2 TFE3-rearranged neoplasms, specifically alveolar soft part sarcoma and Xp11 translocation PEComa, highlighting the relatedness and overlap among Xp11 translocation neoplasms. While most TFE3-rearranged neoplasms can be confidently placed into a specific diagnostic category such as alveolar soft part sarcoma, PEComa, or Xp11 translocation renal cell carcinoma, occasional cases have overlapping features, highlighting the potential role that the cell of origin and the specific gene fusion play in the phenotype of these neoplasms.
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Affiliation(s)
- Pedram Argani
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
- Department of Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Sara E. Wobker
- Departments of Pathology and Laboratory Medicine and Urology, University of North Carolina, Chapel Hill, NC, USA
| | - John M. Gross
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
- Department of Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Andres Matoso
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
- Department of Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
- Department of Urology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
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22
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Yang X, Wang Q, Zhou X, Zhou H, Jia W, Hu C, Chu J, Kong L. Retrospective analysis of hepatic perivascular epithelioid cell tumour (PEComa) in a single centre for clinical diagnosis and treatment clinical diagnosis and treatment of hepatic PEComa. Medicine (Baltimore) 2022; 101:e29506. [PMID: 35758391 PMCID: PMC9276247 DOI: 10.1097/md.0000000000029506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 05/06/2022] [Indexed: 12/04/2022] Open
Abstract
Our primary objective was to investigate the clinical features, diagnosis, treatment and prognosis of hepatic perivascular epithelioid cell tumour (PEComa).Thirty-five cases of pathologically proven hepatic PEComa that were treated in the Department of Hepatobiliary Centre of the First Affiliated Hospital of Nanjing Medical University from January 2008 to February 2019 were retrospectively analysed, and the literature was also reviewed.Twenty-nine females and 6 males were included in this study. The mean age of these patients was 48.0 years (range, 21-75 years). Thirteen patients complained of upper abdominal pain or discomfort, while others were accidentally discovered by imaging examination. Hepatic PEComas tended to occur in the right lobe of the liver (20 cases in the right lobe, 13 in the left lobe and 2 in the caudate lobe). Two cases were characterized by multiple tumours, and the remaining cases were single lesions (range, 1.2-12 cm). Only 8 cases were correctly diagnosed by the preoperative imaging examination, and the correct diagnosis rate was only 22.9%. The postoperative immunohistochemistry analysis showed that hepatic PEComas are positive for human melanoma black 45, Melan-A and smooth muscle actin, with the exception of 1 case that was negative for Melan-A. All patients undergoing an operation accepted regular follow-up, and the average time was 66.5 months (range, 3-132 months). Two patients who experienced tumour recurrence and 1 patient who died of cardiovascular disease, but the remaining patients showed no evidence of tumour recurrence or metastasis during the follow-up period.Hepatic PEComas are a rare type of tumours that mainly occur in young and middle-aged women. The lack of clinical manifestations and imaging findings increases the difficulty of determining a preoperative diagnosis, which mainly depends on the results of pathological examinations. Surgery is currently the only effective treatment, and long-term clinical follow-up is necessary due to the aggressive behaviour and relapse of hepatic PEComa in some patients.
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Affiliation(s)
- Xiao Yang
- Department of Hepatobiliary Centre, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences, NHC Key Laboratory of Living Donor Liver Transplantation (Nanjing Medical University), Nanjing, China
| | - Qingyuan Wang
- Department of Hepatobiliary Centre, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences, NHC Key Laboratory of Living Donor Liver Transplantation (Nanjing Medical University), Nanjing, China
| | - Xiao Zhou
- Department of Hepatobiliary Centre, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences, NHC Key Laboratory of Living Donor Liver Transplantation (Nanjing Medical University), Nanjing, China
| | - Haoming Zhou
- Department of Hepatobiliary Centre, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences, NHC Key Laboratory of Living Donor Liver Transplantation (Nanjing Medical University), Nanjing, China
| | - Wenbo Jia
- Department of Hepatobiliary Centre, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences, NHC Key Laboratory of Living Donor Liver Transplantation (Nanjing Medical University), Nanjing, China
| | - Chunyang Hu
- Department of Hepatobiliary Centre, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences, NHC Key Laboratory of Living Donor Liver Transplantation (Nanjing Medical University), Nanjing, China
| | - Jian Chu
- Department of Hepatobiliary Centre, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences, NHC Key Laboratory of Living Donor Liver Transplantation (Nanjing Medical University), Nanjing, China
| | - Lianbao Kong
- Department of Hepatobiliary Centre, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences, NHC Key Laboratory of Living Donor Liver Transplantation (Nanjing Medical University), Nanjing, China
- Department of Hepatobiliary Centre, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Sun XT, Du SQ, Ma HG, Li JM, Wang X. [TFE3 positive and pigment rich perivascular epithelioid cell tumor of stomach: report of a case]. Zhonghua Bing Li Xue Za Zhi 2022; 51:65-67. [PMID: 34979760 DOI: 10.3760/cma.j.cn112151-20210816-00571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- X T Sun
- Department of Pathology, Rushan People's Hospital, Shandong Province, Rushan 264500, China
| | - S Q Du
- Department of Pathology, Linqing People's Hospital, Shandong Province, Linqing 252600, China
| | - H G Ma
- Department of Gastroenterology, Linqing People's Hospital, Shandong Province, Linqing 252600, China
| | - J M Li
- Department of Pathology, Linqing People's Hospital, Shandong Province, Linqing 252600, China
| | - X Wang
- Department of Pathology, Qilu Hospital of Shandong University, Jinan 250012, China
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Aljehani A, Abu-Zaid A, Albadawi MI, Alomar O, Alkushi A. Uterine Perivascular Epithelioid Cell Tumor (PEComa) in A 56-year-Old Woman. Gulf J Oncolog 2022; 1:86-89. [PMID: 35156650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2020] [Indexed: 06/14/2023]
Abstract
Perivascular epithelioid cell tumors (PEComas) are infrequent mesenchymal neoplasms. Primary uterine PEComas are extremely uncommon. To the best of knowledge, around 110 cases of uterine PEComas have been documented in the English-language literature thus far. Herein, we present the case of primary uterine PEComa in a 56-year-old Saudi woman who presented to clinical attention with a six-month history of left-sided abdominal pain. Gynecological examination showed a 5-cm solid mass involving the left adnexa. Tumor markers were normal. Computed tomography scan demonstrated a 4.2 x 4.4 x 3.4 cm superior left fundal exophytic mass. Patient underwent total abdominal hysterectomy plus bilateral salpingo-oophorectomy. Final histopathological examination demonstrated benign/uncertain malignant potential PEComa. No further adjuvant therapy was administered. At six-month follow up, the patient was asymptomatic without recurrence. In conclusion, uterine PEComas are rare. Histopathological assessment establishes the definitive diagnosis. Surgery remains the gold standard in the treatment of uterine PEComas and adjuvant therapy should be guided based on clinical and histopathological risk factors. Keywords: Uterine perivascular epithelioid cell tumor; PEComa; Uterine sarcoma; hysterectomy.
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Affiliation(s)
- Ala Aljehani
- Department of Pathology, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SaudiArabia
| | - Ahmed Abu-Zaid
- Department of Obstetrics and Gynecology, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Department of Pharmacology, College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | | | - Osama Alomar
- Department of Obstetrics and Gynecology, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Abdulmohsen Alkushi
- Department of Pathology, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
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Xholli A, Kratochwila C, Vellone VG, Schiaffino MG. Acute and repeated haemoperitoneum: a challenging case of lymphangioleiomyomatosis with uterine PEComa. BMJ Case Rep 2021; 14:e244257. [PMID: 34728504 PMCID: PMC8565543 DOI: 10.1136/bcr-2021-244257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2021] [Indexed: 11/03/2022] Open
Abstract
A 39-year-old woman presented in the emergency ward for abdominal pain and acute anemiation. Abdominal-thoracic CT scan showed haemoperitoneum, with a parauterine mass and a pathological pulmonary pattern suspicious for lymphangioleiomyomatosis (LAM), a systemic disease belonging to perivascular epithelioid cell tumours (PEComas). Gynaecological ultrasound showed a hypoechoic irregular solid mass of the uterine right wall. Ultrasonographic virtual organ computer-aided analysis showed the mass completely formed by arteriovenous vessels, and that allowed distinction from leiomyosarcoma. Repeated haemoperitoneum required uterine artery embolisation. Mass revascularisation occurred in the following 7 days. A laparotomic hysterectomy with removal of the uterus and right parametrium was performed in epidural analgesia. Histological features were consistent with the diagnosis of uterine PEComa of uncertain malignant features, in the presence of coexisting pulmonary LAM. In women with LAM, acute haemoperitoneum may indicate the presence of a uterine PEComa whose diagnosis can be challenging.
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Affiliation(s)
- Anjeza Xholli
- DINOGMI, Obsterics and Gynecology Clinic, IRCCS Ospedale San Martino, Genova, Italy
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Zhang S, Yang PP, Huang YC, Chen HC, Chen DL, Yan WT, Yang NN, Li Y, Li N, Feng ZZ. Hepatic perivascular epithelioid cell tumor: Clinicopathological analysis of 26 cases with emphasis on disease management and prognosis. World J Gastroenterol 2021; 27:5967-5977. [PMID: 34629813 PMCID: PMC8475011 DOI: 10.3748/wjg.v27.i35.5967] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/11/2021] [Accepted: 08/13/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Perivascular epithelioid cell tumor (PEComa) is an uncommon tumor of mesenchymal origin. Cases of PEComa in the liver are extremely rare.
AIM To analyze the clinicopathological features and treatment of hepatic PEComa and to evaluate the prognosis after different treatments.
METHODS Clinical and pathological data of 26 patients with hepatic PEComa were collected. All cases were analyzed by immunohistochemistry and clinical follow-up.
RESULTS This study included 17 females and 9 males, with a median age of 50 years. Lesions were located in the left hepatic lobe in 13 cases, in the right lobe in 11, and in the caudate lobe in 2. The median tumor diameter was 6.5 cm. Light microscopy revealed that the tumor cells were mainly composed of epithelioid cells. The cytoplasm contained heterogeneous eosinophilic granules. There were thick-walled blood vessels, around which tumor cells were radially arranged. Immunohistochemical analysis of pigment-derived and myogenic markers in PEComas revealed that 25 cases were HMB45 (+), 23 were Melan-A (+), and 22 SMA (+). TFE3 and Desmin were negative in all cases. All the fluorescence in situ hybridization samples were negative for TFE3 gene break-apart probe. Tumor tissues were collected by extended hepatic lobe resection or simple hepatic tumor resection as the main treatments. Median follow-up was 62.5 mo. None of the patients had metastasis or recurrence, and there were no deaths due to the disease.
CONCLUSION Hepatic PEComa highly expresses melanin and smooth muscle markers, and generally exhibits an inert biological behavior. The prognosis after extended hepatic lobe resection and simple hepatic tumor resection is semblable.
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Affiliation(s)
- Shan Zhang
- Department of Pathology, The Second People’s Hospital of Hefei, Hefei 230011, Anhui Province, China
| | - Pan-Pan Yang
- Department of Pathology, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui Province, China
| | - Yu-Chen Huang
- Department of Pathology, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, Anhui Province, China
| | - Hong-Chun Chen
- Department of Pathology, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, Anhui Province, China
| | - De-Li Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, Anhui Province, China
| | - Wen-Tian Yan
- Department of Pathology, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, Anhui Province, China
| | - Ning-Ning Yang
- Department of Pathology, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, Anhui Province, China
| | - Yuan Li
- Department of Pathology, The First Affiliated Hospital of University of Science and Technology of China, Anhui Provincial Hospital, Hefei 230001, Anhui Province, China
| | - Nan Li
- Department of Pathology, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, Anhui Province, China
| | - Zhen-Zhong Feng
- Department of Pathology, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui Province, China
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Huang HJ, Ye WB, Wen YQ, Zhu Y, He JF. [Pulmonary malignant perivascular epithelioid cell tumor mixed with lung adenocarcinoma components: a case report and literature review]. Zhonghua Jie He He Hu Xi Za Zhi 2021; 44:468-473. [PMID: 34865368 DOI: 10.3760/cma.j.cn112147-20201119-01104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Objective: To analyze the pathogenesis, clinical manifestations, diagnosis, treatment and prognosis of pulmonary malignant perivascular epithelioid cell tumor (PEComa) with adenocarcinoma. Methods: In August 2020, the Department of Pathology, Dongguan People's Hospital of Southern Medical University, diagnosed a case of pulmonary malignant PEComa mixed with adenocarcinoma. The clinical data, pathological diagnosis, treatment plan and prognosis of the patient were analyzed, and the literature was reviewed. Firstly, "malignant perivascular epithelioid cell tumor"+" Pulmonary "+"adenocarcinoma" was used to search CNKI and Wanfang Medical Database, but no relevant reports were found. Then, we changed the search term as "pulmonary malignant perivascular epithelioid cell tumor", and search for PubMed, Embase, Web of Science and Cochrane by combining the subject terms with "pulmonary malignant perivascular epithelioid cell tumor" and "PEComa" as subtopics. The language was Chinese or English and the search deadline was November 2020. Results: The patient, a 46-year-old male, was admitted to the hospital on August 20, 2020, due to "repeated cough and chest pain for more than 10 days, accompanied by rapid weight loss". Serology detected increased expression of lung non-small cell lung cancer related antigens. PET-CT showed a large mass of soft tissue density in the left thoracic cavity with an SUV value of 22.8. The postoperative pathological diagnosis was malignant PEComa mixed with adenocarcinoma and the lymph nodes were metastasized. Due to the detection of EGFR sensitive mutation, postoperative chemotherapy and targeted therapy were administered, and the current state was stable. A total of 12 cases of pulmonary malignant PEComa were retrieved in the literature, which were common in middle-aged and elderly people. They usually presented with cough or chest tightness. Chest CT mostly showed round masses with clear boundaries, and 8 cases had metastasis to mediastinal lymph nodes and other organs. Conclusions: Pulmonary malignant PEComa is rare. It is the first report of the same mass with lung primary adenocarcinoma. The tumor progresses rapidly. Complete surgical resection of the lesion and lymph node dissection are more appropriate treatment strategies, supplemented by postoperative chemotherapy and targeted therapy. For cases diagnosed as pulmonary PEComa, long term follow-up should be performed, even if the pathological diagnosis is benign.
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Affiliation(s)
- H J Huang
- Department of Pathology, Affiliated Dongguan People's Hospital, Southern Medical University, Dongguan 523000, China
| | - W B Ye
- Department of Pathology, Affiliated Dongguan People's Hospital, Southern Medical University, Dongguan 523000, China
| | - Y Q Wen
- Department of Pathology, Affiliated Dongguan People's Hospital, Southern Medical University, Dongguan 523000, China
| | - Y Zhu
- Department of Pathology, Affiliated Dongguan People's Hospital, Southern Medical University, Dongguan 523000, China
| | - J F He
- Department of Pathology, Affiliated Dongguan People's Hospital, Southern Medical University, Dongguan 523000, China
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Funamizu N, Omura K, Osada H, Igarashi K, Wakabayashi G. [Laparoscopic Hepatic Resection for a Hepatic Perivascular Epithelioid Cell Tumor-A Case Report]. Gan To Kagaku Ryoho 2020; 47:1229-1231. [PMID: 32829361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
A 50-year-old female who had a liver tumor was referred to our hospital for further examination. Abdominal CT and MRI revealed a 2 cm tumor in liver segment 2 that was suspected to be HCC. On the basis of the CT and MRI findings, the patient underwent needle biopsy. The pathological findings suggested the possibility of perivascular epithelioid cell tumor (PEComa). Accordingly, we performed laparoscopic liver segmentectomy. As a hepatic PEComa is relatively rare, the current case serves as an important reminder to consider PEComa in the differential diagnosis of liver tumors.
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Abstract
PURPOSE OF REVIEW Malignant PEComa are rare mesenchymal tumors characterized by genetic alterations actionable by target therapy. Indeed, they harbour loss of function of TSC1/TSC2, which lead to the activation of the mammalian target of rapamycin (mTOR) pathway, which is targetable therapeutically with mTOR inhibitors like sirolimus. A small subset of malignant PEComas instead harbor TFE3 gene fusions known to be mutually exclusive with TSC1/TSC2 loss-of-function mutations; therefore, leading to different therapeutic implication. RECENT FINDINGS mTOR inhibitors showed a response rate around 40% with a median PFS of 9 months both in retrospective case series than in phase 2 prospective clinical trials, therefore, representing the most active therapeutic drug. Up to now, the issue is the lack of further therapeutic lines in the advanced setting. Chemotherapy has a marginal role, while some responses were reported using Vascular endothelial growth factor-Tyrosine kynase inhibitors (VEGF-TKI) inhibitors. SUMMARY Malignant PEComas display some sensitivity to mTOR inhibitors. If progression thereto, no other drugs are available. Preclinical studies are ongoing to explore the potential combination of hormonal blockade in women and the potential use of PD1 checkpoint inhibitors.
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Affiliation(s)
- Chiara Fabbroni
- Medical Oncology Unit 2, Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan
| | - Marta Sbaraglia
- Department of Pathology, Azienda Ospedale Università, Padova, Italy
| | - Roberta Sanfilippo
- Medical Oncology Unit 2, Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan
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Erickson LA. Malignant Epithelioid Angiomyolipoma of the Kidney (Malignant Perivascular Epithelioid Cell Neoplasm). Mayo Clin Proc 2020; 95:205-206. [PMID: 31902422 DOI: 10.1016/j.mayocp.2019.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 11/18/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Lori A Erickson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
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Giuliani A, Romano L, Vicentini V, Di Sibio A, Calvisi G, Ciuffetelli V, Schietroma M, Carlei F. Sporadic perivascular epithelioid cell tumor of the wall of the jejunum A case report. Ann Ital Chir 2019; 8:S2239253X19030767. [PMID: 31310242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Perivascular epithelioid cell tumors are rare mesenchymal tumors composed of histologically and immunohistochemically distinctive perivascular epithelioid cells. They are considered ubiquitous tumors and have been described in different organs, but gastro-intestinal PEComas are diseases of extreme rarity. METHODS We report a case of a 51-year-old woman, without a medical history of tuberous sclerosis complex, affected by abdominal PEComa, adhering tightly to the jejunal loop and to the spleen. RESULTS During the surgical operation, a large abdominal mass was found, and surgical resection was carried out. Definitive histologic and ultrastructural findings were consistent with PEComa. CONCLUSION Given the rarity of GI-PEComas and the lack of cases reported in the literature, we want to emphasize the importance of conducting further studies in this regard, to better describe their biological behaviour. KEY WORDS Gastro-intestinal tumor, PEComa, Perivascular epithelioid cell tumors.
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Adhikari P, Hankinson A, Cook DL, Pierson J. Asymptomatic nodule on the back. Cutis 2019; 103:E18-E20. [PMID: 31039237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Prajesh Adhikari
- Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington, USA
| | - Andrew Hankinson
- Division of Dermatology, University of Vermont Medical Center, Burlington, USA
| | - Deborah L Cook
- Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington, USA
| | - Joseph Pierson
- Division of Dermatology, University of Vermont Medical Center, Burlington, USA
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Affiliation(s)
- Fábio Muradás Girardi
- Department of Head and Neck Surgery, Hospital Ana Nery, Santa Cruz
do Sul (RS), Brazil
| | - Angelina Bopp Nunes
- Medical Student, Universidade de Santa Cruz do Sul, Santa Cruz do
Sul (RS), Brazil
| | - Luiz Alberto Hauth
- Department of Head and Neck Surgery, Hospital Ana Nery, Santa Cruz
do Sul (RS), Brazil
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Mitchell A, Jordan A, Lewit R, Kruse E. Perivascular Epithelioid Cell Tumor of the Liver. Am Surg 2018; 84:e428-e430. [PMID: 30269733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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35
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Lin KH, Chang NJ, Liou LR, Su MS, Tsao MJ, Huang ML. Successful management of perivascular epithelioid cell tumor of the rectum with recurrent liver metastases: A case report. Medicine (Baltimore) 2018; 97:e11679. [PMID: 30075560 PMCID: PMC6081099 DOI: 10.1097/md.0000000000011679] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
RATIONALE The perivascular epithelioid cell tumor (PEComa) is rare in young man and rarely occurs in the large intestine. PATIENT CONCERNS The clinical characteristics, diagnosis, and managements in a 28-year-old boy who presented with sudden onset of cramping and abdominal pain and intermittent melena with a blood pressure of 74/39 mm Hg was retrospectively reviewed. CT scan of the abdomen revealed a 8.9 × 7.2 cm mass in the pelvic floor. DIAGNOSES Given the difficulty of obtaining a diagnostic specimen, surgical resection was performed. The pathology report of lower anterior resection was malignant PEComa of the rectum in 2006. INTERVENTIONS Treatment consisted of surgical resection only without additional adjuvant therapy. Over the next 49 months (until 2010) after surgery, abdominal CT showed a 0.6-cm hypodense mass over the liver with suspected liver metastasis. He refused any further evaluation and treatment. After 4 years (2014), abdominal CT showed that the original mass had increased from 0.6 to 1.5 cm and the number of tumors had increased from 1 to 3. In August 2014, he underwent a metastatic hepatectomy without additional chemotherapy or radiotherapy. OUTCOMES We noted that the metastatic progression was slow in the 4 years after the first operation. At 28 months after metastatic hepatectomy, the patient was doing well. There was also no recurrence of the PEComa of the rectum at the 120-month follow-up in 2016. LESSONS To the best of our knowledge, this is the first report of a PEComa of the rectum with liver metastases treated with only surgical resection. At approximately 8.8 cm, this is the largest PEComa of the rectum reported in the recent literature.
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Affiliation(s)
| | - Nai-Jen Chang
- Division of Pathology, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Taiwan, Republic of China
| | - Li-Ren Liou
- Department of Surgery, Division of General Surgery
| | - Ming-Shan Su
- Department of Surgery, Division of General Surgery
| | - Min-Jen Tsao
- Department of Surgery, Division of General Surgery
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Kirste S, Kayser G, Zipfel A, Grosu AL, Brunner T. Unresectable hepatic PEComa: a rare malignancy treated with stereotactic body radiation therapy (SBRT) followed by complete resection. Radiat Oncol 2018; 13:28. [PMID: 29463266 PMCID: PMC5819697 DOI: 10.1186/s13014-018-0974-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 02/11/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Perivascular epithelioid cell tumors (PEComas) are rare mesenchymal tumors occurring in various anatomic regions. Although diagnostic criteria and treatment management are not established, current treatment options consist of surgery and chemotherapy including mTOR inhibitors. Stereotactic body radiation therapy (SBRT) is a non-invasive ablative treatment which has shown excellent control rates for more common types of unresectable liver tumors and metastases. In this report we present a rare case of PEComa of the liver that was treated by stereotactic radiotherapy followed by resection. Staging and evaluation of treatment response was done by FDG-PET/CT. This case highlights the potential of SBRT as a neoadjuvant treatment even for rare liver malignancies. It is the first case of liver PEComa treated by SBRT and resection. CASE PRESENTATION A 52-year-old woman presented at an external hospital with abdominal pressure and pain in the right upper abdominal quadrant. A CT scan showed a 700 cm3 liver lesion in segment IV. In repeated biopsy in July 2015 histopathological workup showed a pleomorphic epitheloid tumor with small to medium sized cells expressing vimentin and melan-A while being negative for cytokeratin establishing the diagnosis of PEComa of the liver. To achieve high, ablative doses a stereotactic body radiotherapy (SBRT) technique was chosen consisting of 60Gy (biologically effective dose 105Gy) in 8 fractions of 7.5Gy. Radiotherapy planning was based on MRI resulting in a planning target volume (PTV) of 1944 cm3. Treatment toxicity was limited to a slight elevation of transaminases (grade 1 and 3). A complete resection was performed 21 weeks after radiotherapy confirmed by negative surgical margins. At last follow-up 21 months after therapy, MRI showed neither local nor distant tumor recurrence. The patient was in stable condition (ECOG 1) and without late radiation toxicity. CONCLUSIONS This is the first documented case of liver PEComa treated by SBRT and resection. A favorable post-treatment course demonstrates that SBRT is a potential neoadjuvant treatment that is capable of reducing an inoperable rare liver tumor to a resectable lesion.
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Affiliation(s)
- Simon Kirste
- Department of Radiation Oncology, University Medical Center Freiburg, Robert-Koch-Str. 6, 79106 Freiburg, Germany
- German Cancer Consortium, Partner Site Freiburg (DKTK), Freiburg, Germany
| | - Gian Kayser
- Department of Surgical Pathology, University Medical Center Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Anne Zipfel
- Department of Radiation Oncology, University Medical Center Freiburg, Robert-Koch-Str. 6, 79106 Freiburg, Germany
- German Cancer Consortium, Partner Site Freiburg (DKTK), Freiburg, Germany
| | - Anca-Ligia Grosu
- Department of Radiation Oncology, University Medical Center Freiburg, Robert-Koch-Str. 6, 79106 Freiburg, Germany
- German Cancer Consortium, Partner Site Freiburg (DKTK), Freiburg, Germany
| | - Thomas Brunner
- Department of Radiation Oncology, University Medical Center Freiburg, Robert-Koch-Str. 6, 79106 Freiburg, Germany
- German Cancer Consortium, Partner Site Freiburg (DKTK), Freiburg, Germany
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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: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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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.
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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
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Iwamoto R, Kataoka TR, Furuhata A, Ono K, Hirota S, Kawada K, Sakai Y, Haga H. Perivascular epithelioid cell tumor of the descending colon mimicking a gastrointestinal stromal tumor: a case report. World J Surg Oncol 2016; 14:285. [PMID: 27842558 PMCID: PMC5109728 DOI: 10.1186/s12957-016-1046-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 11/07/2016] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND We present a case of perivascular epithelioid cell tumor (PEComa), which clinically and histologically mimics a gastrointestinal stromal tumor (GIST). CASE PRESENTATION A 42-year-old woman was found to have a mass in the left flank during her annual medical checkup. Computed tomography examination revealed a submucosal tumor of the descending colon. Surgeons and radiologists suspected that the lesion was a GIST, and left hemicolectomy was performed without biopsy. Microscopic examination showed that the lesion was composed of spindle and epithelioid cells, which were immunohistochemically negative for c-kit and positive for platelet-derived growth factor receptor (PDGFR) α. Initial diagnosis of PDGFRα-positive GIST was made. However, gene analysis did not reveal mutations in PDGFRα. Additional immunohistochemistry showed that tumor cells were positive for human melanin black 45 (HMB45), melanA, and the myogenic marker calponin. A final diagnosis of PEComa was made. CONCLUSION PEComa should be included in the differential diagnosis of PDGFRα-positive spindle cell tumors in the wall of the gastrointestinal tract.
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Affiliation(s)
- Ryuta Iwamoto
- Department of Diagnostic Pathology, Kyoto University Hospital, 54 Syogoinkawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
- Department of Pathology, Japan Red Cross Society Wakayama Medical Center, 4-20 Komatsubara-dori, Wakayama, 640-8558, Japan
| | - Tatsuki R Kataoka
- Department of Diagnostic Pathology, Kyoto University Hospital, 54 Syogoinkawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Ayako Furuhata
- Department of Diagnostic Pathology, Kyoto University Hospital, 54 Syogoinkawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Kazuo Ono
- Department of Pathology, Japan Red Cross Society Wakayama Medical Center, 4-20 Komatsubara-dori, Wakayama, 640-8558, Japan
| | - Seiichi Hirota
- Department of Surgical Pathology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Kenji Kawada
- Department of Surgery, Kyoto University Hospital, 54 Syogoinkawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yoshiharu Sakai
- Department of Surgery, Kyoto University Hospital, 54 Syogoinkawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Hironori Haga
- Department of Diagnostic Pathology, Kyoto University Hospital, 54 Syogoinkawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
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40
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Abstract
INTRODUCTION Perivascular epithelioid cell tumor (PEComa) is a mesenchymal neoplasm composed of perivascular epithelioid cells with clear to eosinophilic cytoplasm. Pigmented PEComa arising from kidney is extraordinarily rare and sometimes can exhibit aggressive biological behavior. CASE REPORT We present here a rare case of pigmented renal PEComa in a 46-year-old female. The patient had complained of lumbago complicated with nausea and vomiting for 2 weeks and therefore was referred to our department. An enhanced computed scan revealed a 4 × 3 × 3 cm round-like mass in the lower pole of right kidney with inhomogeneous enhancement. The tumor cells immunestained was positive for HMB-45, focally positive for c-Kit (CD117), and negative for vimentin, S-100, AE1/AE3, CK-7, CK-18, CD-10, RCC antigen, CgA, DOG-1, EMA, smooth muscle actin, and synaptophysin. We successfully performed 3-dimensional laparoscopic resection of the neoplasm, which was then diagnosed as pigmented PEComa by postoperative pathology. No further growing lesion or metastasis was observed during a 1-year follow-up. CONCLUSION This case report shows that pigmented renal PEComa is often presented as a renal mass with nonspecific symptoms and imaging features. The gold diagnosis of renal pigmented PEComa is mainly based on the combination of histopathology and immunohistochemistry. Complete resection by 3-dimensional laparoscopic nephron-sparing surgery can be an effective therapeutic management.
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Affiliation(s)
| | | | | | | | | | - Chaozhao Liang
- Department of Urology, the First Affiliated Hospital of Anhui Medical University and Institute of Urology, Anhui Medical University, Hefei, Anhui, China
- Correspondence: Chaozhao Liang, Department of Urology, the First Affiliated Hospital of Anhui Medical University and Institute of Urology, Anhui Medical University, Hefei, China (e-mail: )
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Cheng J, Deng M, Gao J, Tao K. A recurrent perivascular epithelioid cell tumor of sigmoid colon with pancreatic metastasis: an extremely rare case report and review of the literature. Int J Colorectal Dis 2016; 31:1237-40. [PMID: 26567117 DOI: 10.1007/s00384-015-2443-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/04/2015] [Indexed: 02/04/2023]
Affiliation(s)
- Ji Cheng
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan, Hubei Province, 430022, China
| | - Meizhou Deng
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan, Hubei Province, 430022, China
| | - Jinbo Gao
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan, Hubei Province, 430022, China
| | - Kaixiong Tao
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan, Hubei Province, 430022, China.
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Jiang H, Ta N, Huang XY, Zhang MH, Xu JJ, Zheng KL, Jin G, Zheng JM. Pancreatic perivascular epithelioid cell tumor: A case report with clinicopathological features and a literature review. World J Gastroenterol 2016; 22:3693-3700. [PMID: 27053862 PMCID: PMC4814656 DOI: 10.3748/wjg.v22.i13.3693] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 12/27/2015] [Accepted: 01/11/2016] [Indexed: 02/06/2023] Open
Abstract
Perivascular epithelioid cell tumor (PEComa) of the pancreas is an unusual tumor deriving from mesenchyma. This paper described a case of pancreatic PEComa, which was initially suspected as neuroendocrine carcinoma by biopsy, and therefore surgical treatment was recommended due to undetermined diagnosis. Examination of the surgical specimen under a microscope showed that the tumor cell’s morphology was epithelioid or spindle-shaped, and ranged in a nested pattern. Additionally, these cells had a large extent of acidophilic cytoplasm, no mitotic figures, and expressed HMB-45, melan-p, and smooth muscle actin immunohistochemically. Pathological examination indicated that PEComa originated from the pancreas, but symptoms related to tuberous sclerosis were absent. Since PEComa is extremely rare in the pancreas, it is likely to be ignored in differential diagnosis. In conclusion, our article highlighted the clinicopathological features of PEComa, and we conducted a literature review focusing on PEComa so as to deepen the understanding of this tumor type.
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Colden C, Walsh NJ, Kruse EJ. Perivascular Epithelioid Cell Tumor of the Liver. Am Surg 2015; 81:e345-e346. [PMID: 26350655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Chen Z, Shi H, Peng J, Yuan Y, Chen J, Song W. Perivascular epithelioid cell tumor in the duodenum: challenge in differential diagnosis. Int J Clin Exp Pathol 2015; 8:8555-8562. [PMID: 26339433 PMCID: PMC4555761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 06/29/2015] [Indexed: 06/05/2023]
Abstract
Defined as a family of scarce mesenchymal neoplasm which distinctively co-express melanocytic markers and muscle markers, perivascular epithelioid cell tumors (PEComas) have been reported almost everybody site. Perivascular epithelioid cell tumors-not otherwise specified (PEComas-NOS) arising in the gastrointestinal (GI) tract are still restricted into sporadic case reports. Herein we present a case of GI PEComas-NOS which occurs in the duodenum of a 27-year-old male. Our initial diagnosis tended to gastrointestinal stromal tumor or smooth muscle tumor till the correct diagnosis of perivascular epithelioid cell tumor (PEComa) was established by postoperative pathological examination. We also make a literature review of GI PEComas-NOS and highlight the challenge it brings to the differential diagnosis.
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Affiliation(s)
- Zehong Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-Sen University58 Zhongshan 2nd Road, Guangzhou 510080, China
| | - Huijuan Shi
- Department of Pathology, The First Affiliated Hospital, Sun Yat-Sen UniversityGuangzhou, China
| | - Jianjun Peng
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-Sen University58 Zhongshan 2nd Road, Guangzhou 510080, China
| | - Yujie Yuan
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-Sen University58 Zhongshan 2nd Road, Guangzhou 510080, China
| | - Jianhui Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-Sen University58 Zhongshan 2nd Road, Guangzhou 510080, China
| | - Wu Song
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-Sen University58 Zhongshan 2nd Road, Guangzhou 510080, China
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Abstract
A perivascular epithelioid cell neoplasm (PEComa) in the chest is rare, let alone in the mediastinum and lung. A 63-year-old man was admitted to our hospital with chest pain for more than 2 months and was found to have an opacity in his mediastinum and lung for 3 weeks. Enhanced chest computed tomography (CT) revealed a mass in both the left upper lobe and central anterior mediastinum. To identify the disease, a CT-guided percutaneous transthoracic needle biopsy of the upper left lung lesions was performed. The pathology result was consistent with epithelioid angiomyolipoma/PEComa. After a standard preparation for surgery, the neoplasms in the mediastinum and left lung were resected. The operative findings revealed extensive mediastinal tumor invasion in parts adjacent to the pericardium, including the mediastinal pleura, left pulmonary artery and vein, and phrenic nerve. The left lung tumor had invaded the lung membranes. The final pathologic diagnosis was malignant epithelioid angioleiomyoma in the left upper lung and mediastinum. Later, the mediastinal tumor recurred. The radiography of this case resembles left upper lobe lung cancer with mediastinal lymph node metastasis. Because this tumor lacks fat, the enhanced CT indicated that it was malignant but failed to identify it as a perivascular epithelioid cell neoplasm.This case reminds clinicians that, although most PEComa are benign, some can be malignant. As the radiology indicated, chest PEComas lack fat, which makes their preoperative diagnosis difficult. Therefore, needle biopsy is valuable for a definitive diagnosis.
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Affiliation(s)
- Wenjie Liang
- Form the Department of Radiology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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Maebayashi T, Abe K, Aizawa T, Sakaguchi M, Ishibashi N, Abe O, Takayama T, Nakayama H, Matsuoka S, Nirei K, Nakamura H, Ogawa M, Sugitani M. Improving recognition of hepatic perivascular epithelioid cell tumor: Case report and literature review. World J Gastroenterol 2015; 21:5432-5441. [PMID: 25954119 PMCID: PMC4419086 DOI: 10.3748/wjg.v21.i17.5432] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 03/31/2015] [Indexed: 02/06/2023] Open
Abstract
A 58-year-old man presented with the chief complaint of abdominal bloating and was incidentally found to have a liver tumor. As diagnostic imaging studies could not rule out malignancy, the patient underwent partial resection of segment 3 of the liver. The lesion pathologically showed eosinophilic proliferation, in addition to immunohistochemical positivity for human melanoma black 45 and Melan-A, thereby leading to the diagnosis of a hepatic perivascular epithelioid cell tumor (PEComa). A PEComa arising from the liver is relatively rare. Moreover, the name ‘PEComa’ has not yet been widely recognized, and the same disease entity has been called epithelioid angiomyolipoma (EAML), further diminishing the recognition of PEComa. In addition, PEComa imaging findings mimic those of malignant liver tumors, and clinically, this tumor tends to enlarge. Therefore, a PEComa is difficult to diagnose. We conducted a systematic review of PEComa and EAML cases and discuss the results, including findings useful for differentiating perivascular epithelioid cell tumors from malignant liver tumors.
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Pant L, Kalita D, Chopra R, Das A, Jain G. Malignant Perivascular Epithelioid Cell Tumor (PEComa) of the Adrenal Gland: Report of a Rare Case Posing Diagnostic Challenge with the Role of Immunohistochemistry in the Diagnosis. Endocr Pathol 2015; 26:129-34. [PMID: 25724713 DOI: 10.1007/s12022-015-9360-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Histological diagnosis of adrenal tumors is often challenging as diverse groups of tumors, both primaries and metastatic, may be seen in the adrenal gland with overlapping morphological features. Immunohistochemistry (IHC) plays the most important role in their diagnosis. Perivascular epithelioid cell tumor (PEComa), a rarely reported tumor in the adrenal gland, shares many features with another rare tumor sarcomatoid adrenocortical carcinoma (ACC). Extensive immunohistochemical study is required to distinguish this tumor from adrenocortical carcinoma and from other morphologically similar tumors. The unique combination of immunoreactivity for melanocytic markers, such as HMB-45 and Melan A, and myogenic markers, such as smooth muscle actin, is the hallmark of PEComas biological behavior, and prognosis of malignant PEComas is yet to be fully understood. Few cases of malignant PEComa have been reported in the adrenal gland. We report a case of malignant PEComa of the adrenal gland posing diagnostic challenge and compare its morphological and immunohistochemical features with those of sarcomatoid ACC.
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Affiliation(s)
- Leela Pant
- Department of Pathology, North DMC Medical College and Hindu Rao Hospital, Delhi, 110007, India
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Ellebæk SB, Bjerring OS, Mandi B, Detlefsen S. [Perivascular epithelioid cell tumours in the liver]. Ugeskr Laeger 2015; 177:V10140527. [PMID: 25749290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The PEComa family is a group of tumours having perivascular epithelioid cells (PEC) as the predominating component. PEComas occur in various organs and are considered to be benign tumours. However, rare cases showing pleomorphic morphology, atypical mitoses or necrosis should be considered malignant sarcomas. The precise incidence is unknown but PEComas are reported with increasing frequency. Standard treatment is surgery but there are no guidelines on further follow-up or treatment. PEComa in the liver is a rare tumour, and to our knowledge this is the first published case from Denmark.
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Shi H, Cao Q, Li H, Zhen T, Lai Y, Han A. Malignant perivascular epithelioid cell tumor of the kidney with rare pulmonary and ileum metastases. Int J Clin Exp Pathol 2014; 7:6357-6363. [PMID: 25337291 PMCID: PMC4203262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 08/23/2014] [Indexed: 06/04/2023]
Abstract
AIMS To report one case of malignant perivascular epithelioid cell tumor (PEComa) of the kidney with rare pulmonary and ileum metastases and analyze its clinicopathological features. METHODS We analyzed the clinicopathological features of one case of malignant PEComa of the kidney with pulmonary and ileum metastases. Immunohistochemistry staining was performed. RESULTS The patient was a 48-year-old man with a renal mass approximately 14 cm × 11 cm × 8 cm in size. Microscopically, the tumor was mainly composed of polygonal epithelioid cells with dense eosinophilic cytoplasm and round nuclei with small nucleoli. Focal tumor cells showed pleomorphism with multinucleated giant cells and prominent nucleoli. The tumor cells nests were surrounded by thick-walled irregular blood vessels. Focal fat cells were found within the tumor. Hemorrhage and coagulative necrosis were also present. The tumor cells were positive for vimentin, HMB45, and Melan-A, and focally positive for SMA and S-100 protein. After 5 years and 5.6 years of nephrectomy, the tumor metastasized to the right lung and ileum, respectively. CONCLUSION We first reported one case of malignant PEComa of the kidney with pulmonary and ileum metastases. Metastatic PEComa of the lung and ileum should differentiate from primary carcinoma, metastatic carcinoma, malignant melanoma, and gastrointestinal stromal tumor.
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Affiliation(s)
- Huijuan Shi
- Department of Pathology, The First Affiliated Hospital, Sun Yat-Sen University Guangzhou, China
| | - Qinghua Cao
- Department of Pathology, The First Affiliated Hospital, Sun Yat-Sen University Guangzhou, China
| | - Hui Li
- Department of Pathology, The First Affiliated Hospital, Sun Yat-Sen University Guangzhou, China
| | - Tiantian Zhen
- Department of Pathology, The First Affiliated Hospital, Sun Yat-Sen University Guangzhou, China
| | - Yingrong Lai
- Department of Pathology, The First Affiliated Hospital, Sun Yat-Sen University Guangzhou, China
| | - Anjia Han
- Department of Pathology, The First Affiliated Hospital, Sun Yat-Sen University Guangzhou, China
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Liu F, Zhang R, Wang ZY, Xia Q, Shen Q, Shi S, Tu P, Shi Q, Zhou X, Rao Q. Malignant perivascular epithelioid cell tumor (PEComa) of cervix with TFE3 gene rearrangement: a case report. Int J Clin Exp Pathol 2014; 7:6409-6414. [PMID: 25337301 PMCID: PMC4203272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 08/23/2014] [Indexed: 06/04/2023]
Abstract
In this study, we reported the first PEComa arising within the cervix with TFE3 gene rearrangement and aggressive biological behavior. Morphologically, the tumor showed infiltrative growth into the surrounding parenchyma. The majority of tumor cells were arrayed in sheets, alveolar structures, or nests separated by delicate fibrovascular septa. There was marked intratumoral hemorrhage, necrosis, and stromal calcifications. The tumor cells had abundant clear cytoplasm, focally containing finely granular dark brown pigment, morphologically considered to be melanin. Immunohistochemically, the tumor cells demonstrated moderately (2+) or strongly (3+) positive staining for TFE3, HMB45, and Melan A but negative for CKpan, SMA, S100, PAX8, and PAX2. The presence of Ki-67 protein demonstrated a moderate proliferation rate, with a few Ki-67-positive nuclei. Using a recently developed TFE3 split FISH assay, the presence of TFE3 rearrangement was demonstrated. All these clinicopathologic features are suggestive of TFE3-rearranged PEComas of the cervix. Our results both expand the known characteristics of primary cervix PEComas and add to the data regarding TFE3 rearrangement-associated PEComas.
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Affiliation(s)
- Feifei Liu
- Department of Pathology, Nanjing Jinling Hospital, Nanjing University School of MedicineNanjing, China
- Department of Pathology, Affiliated Hospital of Jining Medical UniversityJining, China
| | - Renya Zhang
- Department of Pathology, Affiliated Hospital of Jining Medical UniversityJining, China
| | - Zi-Yu Wang
- School of Basic Medical Sciences, Nanjing University of Traditional Chinese MedicineNanjing, China
| | - Qiuyuan Xia
- Department of Pathology, Nanjing Jinling Hospital, Nanjing University School of MedicineNanjing, China
| | - Qin Shen
- Department of Pathology, Nanjing Jinling Hospital, Nanjing University School of MedicineNanjing, China
| | - Shanshan Shi
- Department of Pathology, Nanjing Jinling Hospital, Nanjing University School of MedicineNanjing, China
| | - Pin Tu
- Department of Pathology, Nanjing Jinling Hospital, Nanjing University School of MedicineNanjing, China
| | - Qunli Shi
- Department of Pathology, Nanjing Jinling Hospital, Nanjing University School of MedicineNanjing, China
| | - Xiaojun Zhou
- Department of Pathology, Nanjing Jinling Hospital, Nanjing University School of MedicineNanjing, China
| | - Qiu Rao
- Department of Pathology, Nanjing Jinling Hospital, Nanjing University School of MedicineNanjing, China
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