Case Report: Recurrence of Testicular Myofibroblastic Tumor After Surgery

Inflammatory myofibroblastic tumour (IMT), also known as plasma cell granuloma (PCG) or inflammatory pseudotumour (IPT), is a distinctive, rarely metastasizing neoplasm composed of myofibroblastic and fibroblastic spindle cells accompanied by inflammatory infiltration of plasma cells, lymphocytes and/or eosinophils. IMT predominantly affects children and young adults, and the age at presentation ranges from 3 to 89 years. We present a very rare case of recurrent testicular IMT without ALK rearrangement. This case highlights the clinical characteristics and diagnostic factors associated with primary and recurrent foci of this rare tumour, along with key therapeutic approaches.

A case of a 22-year-old man with primary synovial sarcoma of the parapharyngeal space with an AR somatic mutation: A case report and review of the literature

This case report describes a 22-year-old man with a pharyngeal foreign body sensation arising from the left side of the postpharyngeal wall. Histological examination showed a biphasic pattern of epithelioid and spindle cells including glandular differentiation. The tumour was positive for vimentin and SS18-SSX, and the spindle cells were positive for bcl-2; in contrast, the epithelioid tumour cells were positive for pan-cytokeratin, epithelial membrane antigen and CD99. There was no INI-loss in tumour cells. Then, the presence of the SYT-SSX gene fusion was demonstrated by fluorescence in situ hybridization. In addition, androgen receptor gene somatic mutations were detected by next-generation sequencing. However, 6 months postoperatively, the patient had neither developed a recurrence nor received adjuvant radiotherapy and chemotherapy. Accurate diagnosis depends on morphological and immunohistochemical examination and a proper molecular analysis, and novel technologies can detect a wide variety of genetic alterations. Although androgen receptor somatic mutations cannot provide addition treatment at present, surgical resection with a clean margin and follow-up is an appropriate approach.

Abdominal cyst of unclear aetiology: gastrointestinal stromal tumour or reactivation of abdominal tuberculosis

Differential diagnosis of a new abdominal mass is broad and includes infection, malignancy and other inflammatory processes. Definitive diagnosis may be challenging without invasive biopsy, as history, physical exam and imaging may be non-specific. A 69-year-old man with a history of abdominal tuberculosis presented with a new painful abdominal cyst consistent with reactivation of tuberculosis versus new malignancy. Investigations revealed 4+ acid-fast bacilli from the aspirate suggestive of tuberculosis, but no improvement was noted on antituberculous therapy. Core needle biopsy noted c-KIT-positive spindle cells, diagnostic for a gastrointestinal stromal tumour, while cultures grew non-tuberculous mycobacteria.

Malignant Transformation of Metaplastic Thymoma into High-Grade Sarcomatoid Carcinoma: A Case Report

The correlation of histogenesis between metaplastic thymoma and thymic sarcomatoid carcinoma is unclear. We report a case of metaplastic thymoma transformed into high-grade sarcomatoid carcinoma. A 64 × 54 × 32 mm anterior mediastinal mass in a 61-year-old woman microscopically consisted mainly of classic metaplastic thymoma, with the center dominated by high-grade sarcomatoid carcinoma. In some areas, both epithelial and spindle cell components of the metaplastic thymoma showed increased cellular atypia, mitotic activity, and focal necrosis and gradually transformed into the polygonal/pleomorphic and spindle cell components of sarcomatoid carcinoma. Immunohistochemically, the characteristics of the polygonal/pleomorphic sarcomatoid cells were similar to those of the epithelial component of metaplastic thymoma, while the spindle sarcomatoid cells were more similar to the spindle cells component of metaplastic thymoma. The Ki-67 index was less than 5% in the metaplastic thymoma areas but up to 70% in the sarcomatoid carcinoma area. Radical operation and postoperative radiotherapy were performed. Multifocal relapses at the pleura occurred 13 months after surgery.

Tiger-Striped PASH: Recognition of a Unique Morphology Allows for a Zippered-Up Diagnosis of Pseudoangiomatous Stromal Hyperplasia of Breast

Pseudoangiomatous stromal hyperplasia (PASH) of the breast is histologically characterized by anastomosing and slit-like spaces invested by collagenous stroma and lined by flattened, spindle cells. These clear spaces that may mimic microscopic vascular channels do not contain red blood cells. Immunohistochemistry (IHC) studies may also help to confirm a diagnosis of PASH, with the spindled cells marking positively with CD34 and PR while demonstrating no reactivity with more specific endothelial antigens such as CD31 and ERG. In the current case, a 39-year-old female was diagnosed with cellular PASH of the right breast with unique histological patterns showing “tiger-striped” and “zippered” histologies. To our knowledge, this is the first report of these unique variant PASH morphologies.

MIMICKING SOFT TISSUE TUMOUR- SPINDLE CELL LIPOMA

Spindle cell lipomas (SCL) are slow-growing benign adipocyte tumours that are most commonly seen in (1) the upper back, posterior aspect of the neck, and shoulders . Both genders are affected, but it is more (1) prevalent in males between the ages of 40 and 70 . Spindle cell lipoma is a benign tumour that is frequently confused with (1) liposarcoma. SCLs account for approximately 1.5 percent of all lipomatous tumours reported, making them uncommon . They (2) have a morphology similar to other benign and malignant fatty/spindle cell or myxoid lesions . Microscopically, it is a complex mixture of lipocytes and uniform spindle cells embedded in a mucinous matrix and traversed by (2) a variable number of birefringent collagen bres . Due to the unusual presentation and similar morphology of tumours, early diagnosis is critical; thus, diagnosis is based on clinical examination and conrmed by histopathological ndings. Because SCL has a favourable prognosis, wide local (1) excision is the treatment of choice . This is a case report of a 52-year-old male with a similar presentation in the right upper limb.

Rare, disseminated Kaposi sarcoma in advanced HIV with high-burden pulmonary and skeletal involvement

We describe the case of a 30-year-old man who presented to our institution with hypoxia and widespread pulmonary infiltrates managed initially as COVID-19 before receiving a new diagnosis of HIV-associated Kaposi sarcoma (KS) with widespread pulmonary and skeletal involvement. Initial differential diagnoses included Pneumocystis jirovecii pneumonia, disseminated mycobacterial infection and bacillary angiomatosis. A bone marrow biopsy showed heavy infiltration by spindle cells, staining strongly positive for human herpes virus-8 (HHV-8) and CD34, suggesting symptomatic, disseminated KS as the unifying diagnosis. The patient commenced cytotoxic therapy with weekly paclitaxel, with a clinical and radiological response. To our knowledge, this case is among the most severe described in the literature, which we discuss, along with how COVID-19 initially hindered developing a therapeutic allegiance with the patient.

Histological and Ultrastructural Description of Benign Adipocytic Tumors in Farmed Striped Sea Bream (Lythognathus mormyrus)

Cutaneous neoplasms affecting wild striped bream (Lythognathus mormyrus) have been recorded after their introduction in a marine aquaculture farm in the Adriatic Sea. The tumors were evident on 24% of the reared fish, showing single or multiple nodules, with a diameter ranging between 0.5–4.0 cm. Histologically, all the neoplastic lesions were located in the stratum spongiosum of the dermis and were surrounded by a thin capsule of connective tissue. The tumors were predominantly composed of adipocytes grouped and surrounded by a thin net of fibroblasts and collagen fibers. In some lipomas a mixture of adipocytes and uniform spindle cells were also observed. Fibroblasts and collagen fibers, or spindle cells, showing few mitotic figures were mainly observed in other nodules. Three of the tumors showed bands of cells with elongated nuclei. Five neoplasms differed from the classic spindle cell lipoma due to the presence of scattered giant cells. These cells presented acidophilic abundant cytoplasm with multiple hyperchromatic nuclei showing a concentric “floret-like” arrangement. The tumors were further characterized by ultrastructural observations that allowed ruling out the presence of virus-like particles within the lesions. Histological features of the masses lead to the identification of four prevalent patterns of neoplasms: lipoma, fibrolipoma, spindle cell lipoma (SCL), and atypical spindle cell-like lipoma (ASCL). The different neoplasms could arise from the transformation of mesenchymal cells of dermal origin. To the author’s knowledge, this is the first report describing key differential histological and ultrastructural features of these neoplasms in striped sea bream.

Xanthogranuloma of nose in an adult: an uncommon presentation

<p class="abstract">Xanthogranuloma is a relatively rare histiocytic cutaneous disorder that typically affects the pediatric age group. Its occurrence in adulthood is still rarer with only a handful of cases on the record. The present case report describes a case of adult-onset xanthogranuloma in a 49 years old lady who presented to the otorhinolaryngology clinic with a 6 months history of a nodule on the left side of the columella. There was no history of associated pain or bleeding from the site. Local examination revealed a 0.6×0.6 cm, non-tender, soft-to-firm, pinkish dome-shaped lesion with rounded edges. No similar lesions were found elsewhere. Excisional biopsy of the lesion was performed and microscopy showed a dermal lesion comprising of sheets of histiocytes admixed with lymphoplasmacytic infiltrate, touton giant cells and few spindle cells. A diagnosis of xanthogranuloma was rendered. A number of lympho-histiocytic lesions comes in the differential diagnosis of xanthogranuloma and hence it is important to be aware of such unusual presentations in order to make correct histological diagnosis.</p>

Type I cutaneous meningioma of dorsal thoracic spine (Rudimentary Meningocele): A rare entity at an unusual site

Cutaneous meningiomas (CM) are rare variants of meningiomas which are further classified into three subtypes. Type I CM (TICM) or Rudimentary meningocele (RM) is an uncommon developmental anomaly in which meningothelial elements are displaced into the skin and soft tissue. We present a case of 11 year boy with an upper back swelling since early childhood. His MRI spine showed a lesion at T4-T7 level with a fistulous tract connecting it to dural sac. Histopathology revealed clusters of oval to spindle cells arranged in whorls amidst collagen bundles and psammoma bodies. On immunohistochemistry these cells expressed EMA and Vimentin. A diagnosis of TICM was rendered based on these characteristic clinico-radiological & histopathological features. TICM pose a diagnostic challenge clinically and histopathologically and have an excellent prognosis. This is the 4 Indian case of RM and the 1 case of RM to be located in the spine in the Indian literature.