- Email: [email protected]
50. Pineal mixed germ cell tumour: A case report and literature riview
ABSTRACTS
49. SOLITARY FIBROUS TUMOUR OF TRANSVERSE MESOCOLON: AN UNUSUAL LOCATION Adam Scarlett1, Ross Stillwell2, David Deutscher3 and Swapna Kamal Sengupta1 1Dorevitch Pathology, Ballarat Base Hospital, Vic, 2Dorevtich Pathology, Heidelberg, Vic, and 3Division of Surgery, Ballarat Base Hospital, Vic Solitary fibrous tumours are rare spindle cell mesenchymal neoplasms, most develop in the pleura. It has been described at unusual sites including orbit, peritoneum, mediastinum, lung, liver and spinal nerve rootlets. Its occurrence in mesentery is exceptionally rare. We describe here a case of SFT originating in transverse mesocolon. A 55 year old woman presented with a painless abdominal mass which was discovered on routine examination. At laparotomy, the mass was found to arise from the transverse mesocolon. It was globoid, solid, firm, 170 mm in diameter with a heterogeneous yellow-tan cut surface. It was easily shelled out without a surface breach. Histology showed an encapsulated, compact, spindle cell tumour with a bland nuclear morphology. Immunohistochemistry showed strong CD34 and betacatenin positivity of the spindle cells. It was also positive for CD99 and bcl2 and negative for CD117, s100, smooth muscle actin and epithelial markers, thus favouring this to be a solitary fibrous tumour. To our knowledge only one previous case of SFT in mesocolon has been described in the literature. Prognosis of SFT is excellent in benign type with a very low recurrence rate. It is much more guarded in the malignant variety which has a very high recurrence rate with chance of metastasis. References 1. Bouhabel S, Leblanc G, Ferreira J, et al. Solitary fibrous tumour arising in the mesentery: a case report. World J Surg Oncol 2011; 9: 140. 2. Balaji B, Ramachandran K, Somanathan T. A rare case of solitary fibrous tumour of the sigmoid mesocolon: imaging features and review of literature. Cancer Imaging 2009; 9: 67–9.
50. PINEAL MIXED GERM CELL TUMOUR: A CASE REPORT AND LITERATURE RIVIEW Mahsa S. Ahadi, Hwei Choo Soh and Janice Brewer Anatomical Pathology, Pacific Laboratory Medical Services, Royal North Shore Hospital, St Leonards, NSW Introduction: Primary germ cell tumour in the pineal region is very rare among all primary intracranial neoplasms, accounting for approximately 2% of these tumours. Mixed germ cell tumours are one of the six histologic subtypes which account for 10–13% of pineal germ cell tumours. Case report: We present a case of mixed germ cell tumour in an 18-year-old male. He presented with a long history of confusion, memory loss, occasional headaches and diabetes insipidus. Neurological examination revealed Parinaud’s syndrome. The MRI scan demonstrated a complex pineal region lesion with a large component of fat. Histologically, the tumour was shown to be a mixed germ cell tumour with germinoma accounting for greater than 95% and mature teratoma for less than 5% of the biopsies. Discussion: In summary, a rare case of pineal mixed germ cell tumour is presented and the literature is reviewed.
S115
51. OXIDISED CELLULOSE (SURGICEL) GRANULOMA RADIOLOGICALLY MIMICKING RECURRENT RENAL CELL CARCINOMA: AN EXAMPLE OF IATROGENIC PATHOLOGY DEMONSTRABLE BY HISTOCHEMICAL STAINING S. Sharifi1, P. Burke2 and K. Kerr1 1Sullivan Nicolaides Pathology, Taringa, and 2Brisbane Urology Clinic Background: Local haemostatic materials such as oxidised cellulose (Surgicel) are widely used to achieve intraoperative haemostasis. Oxidised cellulose (Surgicel) is typically completely resorbed within weeks of its use. However; a Surgicel granuloma can rarely persist for months to years and can therefore mimic a recurrent neoplasm on imaging studies. Method: We present a case of a 64-year-old man who previously underwent open nephron-sparing surgery for a stage 1a clear cell renal cell carcinoma involving the posterior upper pole of the kidney with negative margins. A post-operative surgical haematoma was noted which was treated conservatively. Twelve months later, imaging studies showed a complex mass immediately anterior to pelvi-uereteric junction in the same kidney. The mass was unable to be dissected from the kidney, and a radical nephrectomy was therefore performed. Results: Macroscopically, a well circumscribed lesion was present within the perinephric fat adjacent to the pelvi-ureteric junction with associated ectasia of the pelvicalyceal system. Microscopically, there was a giant cell granulomatous reaction to scattered islands of a non-refractile weakly eosinophilic foreign material associated with fat necrosis, chronic inflammation and haemosiderin deposition. Histochemical staining for Masson Trichrome stained the foreign material intensely red which was consistent with cellulose matter. No residual clear cell carcinoma was present. Conclusion: Persistent Surgicel granuloma has been previously described in various sites as isolated case reports, all with radiological concern of recurrent neoplasm. Clinicopathological correlation is very useful in such cases. Furthermore, retained Surgicel can be demonstrated with use of histochemical staining (Masson Trichrome). To our knowledge, this characteristic histochemical property of cellulose has not been documented in prior case reports of Surgicel granulomata.
52. MIXED EPITHELIAL AND STROMAL TUMOUR OF KIDNEY WITH PROMINENT GROWTH INTO PELVICALICEAL SYSTEM MIMICKING UROTHELIAL CARCINOMA Sergey Shchelokov and Leon Vonthethoff St. George Hospital, Sydney Mixed epithelial and stromal tumour (MEST) of the kidney is rare neoplasm with low malignant potential, most commonly found in middle-aged women who had long-term history of oestrogen replacement. With complete surgical excision of the tumour the outcome is usually favourable. Nonetheless a few cases of malignant transformation of the stromal component have been described in recent literature. The unusual case of MEST was encountered in our department with prominent vegetation into pelvicalyceal system suggestive papillary urothelial neoplasm, which was the preoperative diagnosis.
Copyright © Royal College of pathologists of Australasia. Unauthorized reproduction of this article is prohibited.
49. SOLITARY FIBROUS TUMOUR OF TRANSVERSE MESOCOLON: AN UNUSUAL LOCATION Adam Scarlett1, Ross Stillwell2, David Deutscher3 and Swapna Kamal Sengupta1 1Dorevitch Pathology, Ballarat Base Hospital, Vic, 2Dorevtich Pathology, Heidelberg, Vic, and 3Division of Surgery, Ballarat Base Hospital, Vic Solitary fibrous tumours are rare spindle cell mesenchymal neoplasms, most develop in the pleura. It has been described at unusual sites including orbit, peritoneum, mediastinum, lung, liver and spinal nerve rootlets. Its occurrence in mesentery is exceptionally rare. We describe here a case of SFT originating in transverse mesocolon. A 55 year old woman presented with a painless abdominal mass which was discovered on routine examination. At laparotomy, the mass was found to arise from the transverse mesocolon. It was globoid, solid, firm, 170 mm in diameter with a heterogeneous yellow-tan cut surface. It was easily shelled out without a surface breach. Histology showed an encapsulated, compact, spindle cell tumour with a bland nuclear morphology. Immunohistochemistry showed strong CD34 and betacatenin positivity of the spindle cells. It was also positive for CD99 and bcl2 and negative for CD117, s100, smooth muscle actin and epithelial markers, thus favouring this to be a solitary fibrous tumour. To our knowledge only one previous case of SFT in mesocolon has been described in the literature. Prognosis of SFT is excellent in benign type with a very low recurrence rate. It is much more guarded in the malignant variety which has a very high recurrence rate with chance of metastasis. References 1. Bouhabel S, Leblanc G, Ferreira J, et al. Solitary fibrous tumour arising in the mesentery: a case report. World J Surg Oncol 2011; 9: 140. 2. Balaji B, Ramachandran K, Somanathan T. A rare case of solitary fibrous tumour of the sigmoid mesocolon: imaging features and review of literature. Cancer Imaging 2009; 9: 67–9.
50. PINEAL MIXED GERM CELL TUMOUR: A CASE REPORT AND LITERATURE RIVIEW Mahsa S. Ahadi, Hwei Choo Soh and Janice Brewer Anatomical Pathology, Pacific Laboratory Medical Services, Royal North Shore Hospital, St Leonards, NSW Introduction: Primary germ cell tumour in the pineal region is very rare among all primary intracranial neoplasms, accounting for approximately 2% of these tumours. Mixed germ cell tumours are one of the six histologic subtypes which account for 10–13% of pineal germ cell tumours. Case report: We present a case of mixed germ cell tumour in an 18-year-old male. He presented with a long history of confusion, memory loss, occasional headaches and diabetes insipidus. Neurological examination revealed Parinaud’s syndrome. The MRI scan demonstrated a complex pineal region lesion with a large component of fat. Histologically, the tumour was shown to be a mixed germ cell tumour with germinoma accounting for greater than 95% and mature teratoma for less than 5% of the biopsies. Discussion: In summary, a rare case of pineal mixed germ cell tumour is presented and the literature is reviewed.
S115
51. OXIDISED CELLULOSE (SURGICEL) GRANULOMA RADIOLOGICALLY MIMICKING RECURRENT RENAL CELL CARCINOMA: AN EXAMPLE OF IATROGENIC PATHOLOGY DEMONSTRABLE BY HISTOCHEMICAL STAINING S. Sharifi1, P. Burke2 and K. Kerr1 1Sullivan Nicolaides Pathology, Taringa, and 2Brisbane Urology Clinic Background: Local haemostatic materials such as oxidised cellulose (Surgicel) are widely used to achieve intraoperative haemostasis. Oxidised cellulose (Surgicel) is typically completely resorbed within weeks of its use. However; a Surgicel granuloma can rarely persist for months to years and can therefore mimic a recurrent neoplasm on imaging studies. Method: We present a case of a 64-year-old man who previously underwent open nephron-sparing surgery for a stage 1a clear cell renal cell carcinoma involving the posterior upper pole of the kidney with negative margins. A post-operative surgical haematoma was noted which was treated conservatively. Twelve months later, imaging studies showed a complex mass immediately anterior to pelvi-uereteric junction in the same kidney. The mass was unable to be dissected from the kidney, and a radical nephrectomy was therefore performed. Results: Macroscopically, a well circumscribed lesion was present within the perinephric fat adjacent to the pelvi-ureteric junction with associated ectasia of the pelvicalyceal system. Microscopically, there was a giant cell granulomatous reaction to scattered islands of a non-refractile weakly eosinophilic foreign material associated with fat necrosis, chronic inflammation and haemosiderin deposition. Histochemical staining for Masson Trichrome stained the foreign material intensely red which was consistent with cellulose matter. No residual clear cell carcinoma was present. Conclusion: Persistent Surgicel granuloma has been previously described in various sites as isolated case reports, all with radiological concern of recurrent neoplasm. Clinicopathological correlation is very useful in such cases. Furthermore, retained Surgicel can be demonstrated with use of histochemical staining (Masson Trichrome). To our knowledge, this characteristic histochemical property of cellulose has not been documented in prior case reports of Surgicel granulomata.
52. MIXED EPITHELIAL AND STROMAL TUMOUR OF KIDNEY WITH PROMINENT GROWTH INTO PELVICALICEAL SYSTEM MIMICKING UROTHELIAL CARCINOMA Sergey Shchelokov and Leon Vonthethoff St. George Hospital, Sydney Mixed epithelial and stromal tumour (MEST) of the kidney is rare neoplasm with low malignant potential, most commonly found in middle-aged women who had long-term history of oestrogen replacement. With complete surgical excision of the tumour the outcome is usually favourable. Nonetheless a few cases of malignant transformation of the stromal component have been described in recent literature. The unusual case of MEST was encountered in our department with prominent vegetation into pelvicalyceal system suggestive papillary urothelial neoplasm, which was the preoperative diagnosis.
Copyright © Royal College of pathologists of Australasia. Unauthorized reproduction of this article is prohibited.