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Metastatic epithelioid angiosarcoma mimicking carcinoma: case report
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PATHOLOGY 2015 ABSTRACT SUPPLEMENT
Pathology (2015), 47(S1)
INFANTILE FIBROSARCOMA: BEWARE THE SMALL BIOPSY
PLASMABLASTIC LYMPHOMA: MAKING A DEFINITIVE DIAGNOSIS IN A PLEURAL EFFUSION
Bradley Webster, Susan Arbuckle, Nicole Graf, Luke St Heaps and Amanda Charlton Histopathology, Children’s Hospital Westmead, Westmead, NSW, Australia
Nicholas Wee Chong Koh and Clarence Hai Yi Teo Department of Pathology, Tan Tock Seng Hospital, Singapore
Aims: Infantile fibrosarcoma (IF) is a rare neoplasm occurring in infants < 2 years of age. IF presents as a rapidly growing infiltrative mass and frequently recurs but rarely metastasises. IF overlaps morphologically with other entities. A t(12;15) translocation is present in the majority of cases. IF cases at our institution were reviewed and compared to the literature. Methods: The pathology database was searched from 2000–2014 and pathology reports, slides and clinical history were reviewed. Results: Six cases were found. All patients were < 2 years old and four cases were congenital. Two cases were diagnosed clinically as vascular neoplasms and had primary resection. Four cases had initial biopsies and one case was initially diagnosed as lipofibromatosis; 5/6 cases showed a haemangiopericytomatous pattern and 4/6 cases showed focal necrosis. Both features were absent in one small biopsy case. Mitotic activity was > 10/10HPF in 3/4 cases; Ki67 index was > 20% in 4/6 cases; 3/5 cases were translocation positive. Conclusion: IF may be confused clinically with a vascular neoplasm. The diagnosis may be difficult on a small biopsy due to sampling error. The prevalence of high grade features contrast with the low grade behaviour of this tumour.
MENINGEAL MALIGNANT SOLITARY FIBROUS TUMOUR WITH CEREBROSPINAL FLUID MEDIATED DISSEMINATION Bradley Webster and Renee Chan Anatomical Pathology, Concord Repatriation General Hospital, Concord, NSW, Australia Aims: Solitary fibrous tumours (SFTs) can occur at a range of sites including the meninges. Meningeal SFTs have a predominantly benign course but may recur locally and rarely metastasise in an unpredictable fashion. Tumours with histological features predictive of aggressive behaviour have been designated malignant SFTs. We present a case of a meningeal malignant SFT with cerebrospinal fluid (CSF) mediated dissemination. Methods: A 50-year-old woman presented with a posterior fossa meningeal lesion. Two years post-resection, the patient developed a tumour involving the sigmoid sinus. Four years post-resection, the patient presented with tumours involving the lower thoracic and lumbar spine. Results: The resection specimens demonstrated a highly cellular patternless arrangement of monotonous plump oval cells. Focal intervening bands of collagen were present. Scattered branched thin-walled vessels were seen. Focal necrosis was present in the initial resection. The mitotic rate ranged from 7–24/10HPF. The Ki67 index ranged from 5–20%. The tumour stained diffusely for CD34, bcl-2, and CD99 and was negative for EMA, S100 and CK. Conclusion: Meningeal malignant SFTs are rare tumours whose biological behaviour has not been fully elicited. The tumour needs to be distinguished from meningioma and haemangiopericytoma.
Plasmablastic lymphoma is a rare and highly aggressive large B cell lymphoma, which often occurs in immunocompromised patients. Hence, rapid accurate diagnosis is essential for patient management. The cytological features of plasmablastic lymphomas have only been described in about seven cases after review of the medical literature, and only one of these cases was from a serous effusion. Here, we present a case of an immunocompromised 56-year-old Asian man who presented with increasing dyspnoea. Further investigation revealed pleural and pericardial effusions associated with mediastinal lymphadenopathy. A pleural tap was performed and the specimen revealed numerous atypical large lymphocytes with plasmablastic features. A diagnosis of a plasmablastic lymphoma was made with the aid of various immunohistochemical markers and the use of flow cytometry. A summary of the clinical and pathological findings, as well as a discussion of the issues pertaining to the diagnosis of plasmablastic lymphomas in cytology specimens is presented.
METASTATIC EPITHELIOID ANGIOSARCOMA MIMICKING CARCINOMA: CASE REPORT T. Welham and M. Fadia Department of Anatomical Pathology, ACT Pathology, The Canberra Hospital, Woden, ACT, Australia A 66-year-old man presented to his general practitioner with bilateral groin pain for the past 2 months. The CT scan revealed a 6.5 cm adrenal mass and multiple osteolytic bone and soft tissue metastases. Histology of right adrenal biopsy showed a cytokeratin positive poorly differentiated carcinoma. However, due to small amount of biopsy sample very limited immunostains were performed. Later on, the femoral reamings obtained showed a large-cell malignancy composed sheets of pleomorphic epitheliod cells with vesicular chromatin and prominent nucleoli. On immunohistochemistry, the tumour cells expressed AE1/AE3, CD31, CD34 and ERG. The ultrastructure examination showed Weibel-Palade bodies. Overall, on histomorphology and immunoprofile this was finally diagnosed as an epithelioid angiosarcoma. The patient was discharged home with a plan for treatment, but soon passed away. Epithelioid angiosarcomas are a rare variant of angiosarcoma, which is highly aggressive, and can mimic multiple other epithelioid malignancies. It often presents a diagnositic dilemma, as no obvious vasoformative channels are present. Furthermore, the cytokeratin expression characteristic of this tumour often leads to a misdiagnosis of metastatic carcinoma. CHRONIC DECIDUITIS IS UNDERDIAGNOSED IN THE SETTING OF ACUTE CHORIOAMNIONITIS: RESULTS OF A DEPARTMENTAL AUDIT IN A TERTIARY OBSTETRIC HOSPITAL Lisa Wilkinson, Chiedza Chimbare and Rohan Lourie Mater Pathology Services, South Brisbane, Qld, Australia The poorly understood entity of chronic deciduitis is regarded as uncommon, and little literature exists regarding its significance or
Copyright © Royal College of pathologists of Australasia. Unauthorized reproduction of this article is prohibited.
PATHOLOGY 2015 ABSTRACT SUPPLEMENT
Pathology (2015), 47(S1)
INFANTILE FIBROSARCOMA: BEWARE THE SMALL BIOPSY
PLASMABLASTIC LYMPHOMA: MAKING A DEFINITIVE DIAGNOSIS IN A PLEURAL EFFUSION
Bradley Webster, Susan Arbuckle, Nicole Graf, Luke St Heaps and Amanda Charlton Histopathology, Children’s Hospital Westmead, Westmead, NSW, Australia
Nicholas Wee Chong Koh and Clarence Hai Yi Teo Department of Pathology, Tan Tock Seng Hospital, Singapore
Aims: Infantile fibrosarcoma (IF) is a rare neoplasm occurring in infants < 2 years of age. IF presents as a rapidly growing infiltrative mass and frequently recurs but rarely metastasises. IF overlaps morphologically with other entities. A t(12;15) translocation is present in the majority of cases. IF cases at our institution were reviewed and compared to the literature. Methods: The pathology database was searched from 2000–2014 and pathology reports, slides and clinical history were reviewed. Results: Six cases were found. All patients were < 2 years old and four cases were congenital. Two cases were diagnosed clinically as vascular neoplasms and had primary resection. Four cases had initial biopsies and one case was initially diagnosed as lipofibromatosis; 5/6 cases showed a haemangiopericytomatous pattern and 4/6 cases showed focal necrosis. Both features were absent in one small biopsy case. Mitotic activity was > 10/10HPF in 3/4 cases; Ki67 index was > 20% in 4/6 cases; 3/5 cases were translocation positive. Conclusion: IF may be confused clinically with a vascular neoplasm. The diagnosis may be difficult on a small biopsy due to sampling error. The prevalence of high grade features contrast with the low grade behaviour of this tumour.
MENINGEAL MALIGNANT SOLITARY FIBROUS TUMOUR WITH CEREBROSPINAL FLUID MEDIATED DISSEMINATION Bradley Webster and Renee Chan Anatomical Pathology, Concord Repatriation General Hospital, Concord, NSW, Australia Aims: Solitary fibrous tumours (SFTs) can occur at a range of sites including the meninges. Meningeal SFTs have a predominantly benign course but may recur locally and rarely metastasise in an unpredictable fashion. Tumours with histological features predictive of aggressive behaviour have been designated malignant SFTs. We present a case of a meningeal malignant SFT with cerebrospinal fluid (CSF) mediated dissemination. Methods: A 50-year-old woman presented with a posterior fossa meningeal lesion. Two years post-resection, the patient developed a tumour involving the sigmoid sinus. Four years post-resection, the patient presented with tumours involving the lower thoracic and lumbar spine. Results: The resection specimens demonstrated a highly cellular patternless arrangement of monotonous plump oval cells. Focal intervening bands of collagen were present. Scattered branched thin-walled vessels were seen. Focal necrosis was present in the initial resection. The mitotic rate ranged from 7–24/10HPF. The Ki67 index ranged from 5–20%. The tumour stained diffusely for CD34, bcl-2, and CD99 and was negative for EMA, S100 and CK. Conclusion: Meningeal malignant SFTs are rare tumours whose biological behaviour has not been fully elicited. The tumour needs to be distinguished from meningioma and haemangiopericytoma.
Plasmablastic lymphoma is a rare and highly aggressive large B cell lymphoma, which often occurs in immunocompromised patients. Hence, rapid accurate diagnosis is essential for patient management. The cytological features of plasmablastic lymphomas have only been described in about seven cases after review of the medical literature, and only one of these cases was from a serous effusion. Here, we present a case of an immunocompromised 56-year-old Asian man who presented with increasing dyspnoea. Further investigation revealed pleural and pericardial effusions associated with mediastinal lymphadenopathy. A pleural tap was performed and the specimen revealed numerous atypical large lymphocytes with plasmablastic features. A diagnosis of a plasmablastic lymphoma was made with the aid of various immunohistochemical markers and the use of flow cytometry. A summary of the clinical and pathological findings, as well as a discussion of the issues pertaining to the diagnosis of plasmablastic lymphomas in cytology specimens is presented.
METASTATIC EPITHELIOID ANGIOSARCOMA MIMICKING CARCINOMA: CASE REPORT T. Welham and M. Fadia Department of Anatomical Pathology, ACT Pathology, The Canberra Hospital, Woden, ACT, Australia A 66-year-old man presented to his general practitioner with bilateral groin pain for the past 2 months. The CT scan revealed a 6.5 cm adrenal mass and multiple osteolytic bone and soft tissue metastases. Histology of right adrenal biopsy showed a cytokeratin positive poorly differentiated carcinoma. However, due to small amount of biopsy sample very limited immunostains were performed. Later on, the femoral reamings obtained showed a large-cell malignancy composed sheets of pleomorphic epitheliod cells with vesicular chromatin and prominent nucleoli. On immunohistochemistry, the tumour cells expressed AE1/AE3, CD31, CD34 and ERG. The ultrastructure examination showed Weibel-Palade bodies. Overall, on histomorphology and immunoprofile this was finally diagnosed as an epithelioid angiosarcoma. The patient was discharged home with a plan for treatment, but soon passed away. Epithelioid angiosarcomas are a rare variant of angiosarcoma, which is highly aggressive, and can mimic multiple other epithelioid malignancies. It often presents a diagnositic dilemma, as no obvious vasoformative channels are present. Furthermore, the cytokeratin expression characteristic of this tumour often leads to a misdiagnosis of metastatic carcinoma. CHRONIC DECIDUITIS IS UNDERDIAGNOSED IN THE SETTING OF ACUTE CHORIOAMNIONITIS: RESULTS OF A DEPARTMENTAL AUDIT IN A TERTIARY OBSTETRIC HOSPITAL Lisa Wilkinson, Chiedza Chimbare and Rohan Lourie Mater Pathology Services, South Brisbane, Qld, Australia The poorly understood entity of chronic deciduitis is regarded as uncommon, and little literature exists regarding its significance or
Copyright © Royal College of pathologists of Australasia. Unauthorized reproduction of this article is prohibited.