Difference between revisions of "Large epithelioid tumours"
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'''Large epithelioid tumours''' are common and represent a large [[differential diagnosis]] when viewed generally. | [[Image:Epithelioid angiosarcoma - very high mag.jpg|thumb|200px|right|A large epithelioid tumour ([[epithelioid angiosarcoma]]). [[H&E stain]].]] | ||
'''Large epithelioid tumours''' are common and represent a large [[differential diagnosis]] when viewed generally. | |||
[[Malignant]] epithelioid lesions are often [[carcinoma]]s... but may be a large number different tumours. | |||
A more general discussion of epithelioid lesions is in the ''[[epithelioid cell lesions]]'' article. Small epithelioid lesions are dealt with in the ''[[small round cell tumours]]'' article. | |||
==General differential diagnosis== | ==General differential diagnosis== | ||
Adapted from ''Miller'' with modifications:<ref name=miller>Miller RT. (Sep 2013). ''Atlantic Diagnostic Immunohistochemistry Symposium''. St. John's, NL, Canada.</ref> | |||
{| class="wikitable sortable" | {| class="wikitable sortable" | ||
! Tumour | ! Tumour | ||
| Line 41: | Line 47: | ||
| [[Myoepithelioma of soft tissue]] | | [[Myoepithelioma of soft tissue]] | ||
| Epithelial tumours | | Epithelial tumours | ||
| may mimic [[extraskeletal myxoid chondrosarcoma]] or proximal variant of [[ | | may mimic [[extraskeletal myxoid chondrosarcoma]] or proximal variant of [[epithelioid sarcoma]] | ||
|- | |- | ||
| [[Acinar cell carcinoma]] | | [[Acinar cell carcinoma]] | ||
| Line 63: | Line 69: | ||
| <ref name=pmid11224605>{{Cite journal | last1 = Kutzner| first1 = H.| last2 = Mentzel| first2 = T.| last3 = Kaddu| first3 = S.| last4 = Soares| first4 = LM.| last5 = Sangueza| first5 = OP.| last6 = Requena| first6 = L.| title = Cutaneous myoepithelioma: an under-recognized cutaneous neoplasm composed of myoepithelial cells.| journal = Am J Surg Pathol| volume = 25| issue = 3| pages = 348-55| month = Mar| year = 2001| doi = | PMID = 11224605 }}</ref> | | <ref name=pmid11224605>{{Cite journal | last1 = Kutzner| first1 = H.| last2 = Mentzel| first2 = T.| last3 = Kaddu| first3 = S.| last4 = Soares| first4 = LM.| last5 = Sangueza| first5 = OP.| last6 = Requena| first6 = L.| title = Cutaneous myoepithelioma: an under-recognized cutaneous neoplasm composed of myoepithelial cells.| journal = Am J Surg Pathol| volume = 25| issue = 3| pages = 348-55| month = Mar| year = 2001| doi = | PMID = 11224605 }}</ref> | ||
|- | |- | ||
| | | Cutaneous adnexal tumours ([[spiradenoma]], [[acrospiroma]]) | ||
| Epithelial tumours | | Epithelial tumours | ||
| | | | ||
| Line 107: | Line 113: | ||
| high grade | | high grade | ||
|- | |- | ||
| [[Lipid | | [[Lipid cell tumour of ovary]] | ||
| Germ- cell / Sex-Cord Stromal | | Germ- cell / Sex-Cord Stromal | ||
| | | | ||
|- | |- | ||
| [[Sertoli | | [[Sertoli cell tumour]] | ||
| Germ- cell / Sex-Cord Stromal | |||
| also [[Sertoli-Leydig cell tumour]] | |||
|- | |||
| [[Leydig cell tumour]] | |||
| Germ- cell / Sex-Cord Stromal | | Germ- cell / Sex-Cord Stromal | ||
| | | also [[Sertoli-Leydig cell tumour]] | ||
|- | |- | ||
| [[Epithelioid trophoblastic tumour]] | | [[Epithelioid trophoblastic tumour]] | ||
| Line 119: | Line 129: | ||
| <ref name=pmid10571512>{{Cite journal | last1 = Hamazaki| first1 = S.| last2 = Nakamoto| first2 = S.| last3 = Okino| first3 = T.| last4 = Tsukayama| first4 = C.| last5 = Mori| first5 = M.| last6 = Taguchi| first6 = K.| last7 = Okada| first7 = S.| title = Epithelioid trophoblastic tumor: morphological and immunohistochemical study of three lung lesions.| journal = Hum Pathol| volume = 30| issue = 11| pages = 1321-7| month = Nov| year = 1999| doi = | PMID = 10571512 }}</ref><ref name=pmid9808132>{{Cite journal | last1 = Shih| first1 = IM.| last2 = Kurman| first2 = RJ.| title = Epithelioid trophoblastic tumor: a neoplasm distinct from choriocarcinoma and placental site trophoblastic tumor simulating carcinoma.| journal = Am J Surg Pathol| volume = 22| issue = 11| pages = 1393-403| month = Nov| year = 1998| doi = | PMID = 9808132 }}</ref> | | <ref name=pmid10571512>{{Cite journal | last1 = Hamazaki| first1 = S.| last2 = Nakamoto| first2 = S.| last3 = Okino| first3 = T.| last4 = Tsukayama| first4 = C.| last5 = Mori| first5 = M.| last6 = Taguchi| first6 = K.| last7 = Okada| first7 = S.| title = Epithelioid trophoblastic tumor: morphological and immunohistochemical study of three lung lesions.| journal = Hum Pathol| volume = 30| issue = 11| pages = 1321-7| month = Nov| year = 1999| doi = | PMID = 10571512 }}</ref><ref name=pmid9808132>{{Cite journal | last1 = Shih| first1 = IM.| last2 = Kurman| first2 = RJ.| title = Epithelioid trophoblastic tumor: a neoplasm distinct from choriocarcinoma and placental site trophoblastic tumor simulating carcinoma.| journal = Am J Surg Pathol| volume = 22| issue = 11| pages = 1393-403| month = Nov| year = 1998| doi = | PMID = 9808132 }}</ref> | ||
|- | |- | ||
| [[ | | [[Placental site trophoblastic tumour]] | ||
| Germ- cell / Sex-Cord Stromal | | Germ- cell / Sex-Cord Stromal | ||
|(USCAP04, Gyn spec conf, case 3, vaginal | |(USCAP04, Gyn spec conf, case 3, vaginal | ||
| Line 147: | Line 157: | ||
| "True" histiocytic lymphoma | | "True" histiocytic lymphoma | ||
|- | |- | ||
| [[ | | [[Langerhans cell histiocytosis ]] | ||
| Hematolymphoid / Histiocytic tumours | | Hematolymphoid / Histiocytic tumours | ||
| | | | ||
| Line 183: | Line 193: | ||
| | | | ||
|- | |- | ||
| [[Extramedullary megakaryoblastic | | [[Extramedullary megakaryoblastic leukemia]] | ||
| Hematolymphoid / Histiocytic tumours | | Hematolymphoid / Histiocytic tumours | ||
| | | | ||
| Line 199: | Line 209: | ||
| also [[pheochromocytoma]] | | also [[pheochromocytoma]] | ||
|- | |- | ||
| [[ | | High grade [[olfactory neuroblastoma]] | ||
| Neural - Neuroendocrine - Neuraxis Tumours | | Neural - Neuroendocrine - Neuraxis Tumours | ||
| | | | ||
|- | |- | ||
| [[ | | Epithelioid [[MPNST]] | ||
| Neural - Neuroendocrine - Neuraxis Tumours | | Neural - Neuroendocrine - Neuraxis Tumours | ||
| reported to have focal melanocytic differentiation in some cases{{fact}} | | reported to have focal melanocytic differentiation in some cases{{fact}} | ||
| Line 255: | Line 265: | ||
| | | | ||
|- | |- | ||
| [[ | | [[Rhabdomyosarcoma]], not otherwise specified ([[pleomorphic rhabdomyosarcoma]]) | ||
| Muscle-related tumours | | Muscle-related tumours | ||
| | | | ||
| Line 263: | Line 273: | ||
| | | | ||
|- | |- | ||
| [[Epithelioid glomus | | [[Epithelioid glomus tumour]] | ||
| Muscle-related tumours | | Muscle-related tumours | ||
| | | | ||
| Line 287: | Line 297: | ||
| | | | ||
|- | |- | ||
| [[ | | [[Epithelioid sarcoma-like hemangioendothelioma]] | ||
| Vascular tumours | | Vascular tumours | ||
| | | <ref name=pmid12502927>{{Cite journal | last1 = Billings | first1 = SD. | last2 = Folpe | first2 = AL. | last3 = Weiss | first3 = SW. | title = Epithelioid sarcoma-like hemangioendothelioma. | journal = Am J Surg Pathol | volume = 27 | issue = 1 | pages = 48-57 | month = Jan | year = 2003 | doi = | PMID = 12502927 }}</ref> | ||
|- | |- | ||
| [[Composite hemangioendothelioma]] | | [[Composite hemangioendothelioma]] | ||
| Line 323: | Line 333: | ||
|S-100 +ve | |S-100 +ve | ||
|- | |- | ||
| [[Diffuse type tenosynovial giant cell | | [[Diffuse type tenosynovial giant cell tumour]] | ||
| Hematolymphoid / Histiocytic tumours | | Hematolymphoid / Histiocytic tumours | ||
| | | | ||
| Line 395: | Line 405: | ||
| | | | ||
|- | |- | ||
| [[Inflammatory myxohyaline | | [[Inflammatory myxohyaline tumour of distal extremities with virocyte or Reed-Sternberg like cells]] | ||
| Myofibroblastic - fibroblastic tumours | | Myofibroblastic - fibroblastic tumours | ||
| | | | ||
| Line 407: | Line 417: | ||
| | | | ||
|- | |- | ||
| [[ | | Epithelioid [[osteosarcoma]] | ||
| Chondro-osseous tumours | | Chondro-osseous tumours | ||
| | | <ref>{{Cite journal | last1 = Amanatullah | first1 = DF. | last2 = Ngann | first2 = KK. | last3 = Borys | first3 = D. | last4 = Tamurian | first4 = RM. | title = Progression of aggressive metastatic carcinosarcoma after treatment of epithelioid osteosarcoma. | journal = Orthopedics | volume = 33 | issue = 6 | pages = 445 | month = Jun | year = 2010 | doi = 10.3928/01477447-20100429-26 | PMID = 20806764 }}</ref> | ||
|- | |- | ||
| [[Extraskeletal myxoid chondrosarcoma, high grade | | [[Extraskeletal myxoid chondrosarcoma]], high grade | ||
| Chondro-osseous tumours | | Chondro-osseous tumours | ||
| | | | ||
| Line 428: | Line 438: | ||
*[[Basics]]. | *[[Basics]]. | ||
*[[Pleomorphic tumours]]. | *[[Pleomorphic tumours]]. | ||
*[[Small round cell tumours]]. | |||
==References== | ==References== | ||
Latest revision as of 17:37, 30 May 2015
Large epithelioid tumours are common and represent a large differential diagnosis when viewed generally.
Malignant epithelioid lesions are often carcinomas... but may be a large number different tumours.
A more general discussion of epithelioid lesions is in the epithelioid cell lesions article. Small epithelioid lesions are dealt with in the small round cell tumours article.
General differential diagnosis
Adapted from Miller with modifications:[1]
| Tumour | Group | Notes/comments |
|---|---|---|
| Melanoma | Miscellaneous | |
| PEComa | Miscellaneous | esp. epithelioid angiomyolipoma |
| Perivascular epithelioid cell sarcoma | Miscellaneous | type of PEComa, looks like clear cell carcinoma[2] |
| Paraganglioma-like dermal melanocytic tumour | Miscellaneous | [3] |
| Carcinoma | Epithelial tumours | HCC and adrenal cortical carcinoma, often AE1/AE3 -ve |
| Hepatoid Adenocarcinoma | Epithelial tumours | |
| Malignant mixed Muellerian tumour | Epithelial tumours | |
| Myoepithelial carcinoma | Epithelial tumours | |
| Myoepithelioma of soft tissue | Epithelial tumours | may mimic extraskeletal myxoid chondrosarcoma or proximal variant of epithelioid sarcoma |
| Acinar cell carcinoma | Epithelial tumours | |
| Neuroendocrine carcinoma | Epithelial tumours | may have a rhabdoid morphology[4] |
| Medullary thyroid carcinoma | Epithelial tumours | |
| Thymoma | Epithelial tumours | |
| Cutaneous myoepithelioma | Epithelial tumours | [5] |
| Cutaneous adnexal tumours (spiradenoma, acrospiroma) | Epithelial tumours | |
| Hyaline-rich chondroid syringoma | Epithelial tumours | |
| Hurthle cell tumour | Epithelial tumours | |
| Mesothelioma | Epithelial tumours | "lymphohistiocytoid" variant |
| Seminoma | Germ- cell / Sex-Cord Stromal | |
| Embryonal carcinoma | Germ- cell / Sex-Cord Stromal | |
| Yolk sac tumour | Germ- cell / Sex-Cord Stromal | consider hepatoid variant |
| Choriocarcinoma | Germ- cell / Sex-Cord Stromal | |
| Epithelioid trophoblastic tumour | Germ- cell / Sex-Cord Stromal | |
| Granulosa cell tumour | Germ- cell / Sex-Cord Stromal | |
| Endometrial stromal sarcoma | Germ- cell / Sex-Cord Stromal | high grade |
| Lipid cell tumour of ovary | Germ- cell / Sex-Cord Stromal | |
| Sertoli cell tumour | Germ- cell / Sex-Cord Stromal | also Sertoli-Leydig cell tumour |
| Leydig cell tumour | Germ- cell / Sex-Cord Stromal | also Sertoli-Leydig cell tumour |
| Epithelioid trophoblastic tumour | Germ- cell / Sex-Cord Stromal | [6][7] |
| Placental site trophoblastic tumour | Germ- cell / Sex-Cord Stromal | (USCAP04, Gyn spec conf, case 3, vaginal |
| Testicular tumour of the adrenogenital syndrome | Germ- cell / Sex-Cord Stromal | Inhibin -ve, dark brown-green-black, similar to Leydig tumour |
| Extrauterine lesion of intermediate trophoblast | Germ- cell / Sex-Cord Stromal | very rare |
| Lymphoma | Hematolymphoid / Histiocytic tumours | |
| Hodgkin's lymphoma | Hematolymphoid / Histiocytic tumours | syncytial or lymphocyte-depleted |
| Extramedullary monoblastic leukemia | Hematolymphoid / Histiocytic tumours | |
| Histiocytic sarcoma | Hematolymphoid / Histiocytic tumours | "True" histiocytic lymphoma |
| Langerhans cell histiocytosis | Hematolymphoid / Histiocytic tumours | |
| Rosai-Dorfman disease | Hematolymphoid / Histiocytic tumours | |
| Crystal-storing histiocytosis | Hematolymphoid / Histiocytic tumours | |
| Erdheim-Chester disease | Hematolymphoid / Histiocytic tumours | foamy histiocytes |
| Rhinoscleroma | Hematolymphoid / Histiocytic tumours | foamy histiocytes and chronic inflammation |
| Granuloma annulare | Hematolymphoid / Histiocytic tumours | |
| Anaplastic myeloma | Hematolymphoid / Histiocytic tumours | |
| Extramedullary myeloid leukemia | Hematolymphoid / Histiocytic tumours | |
| Extramedullary lymphoid leukemia | Hematolymphoid / Histiocytic tumours | |
| Extramedullary megakaryoblastic leukemia | Hematolymphoid / Histiocytic tumours | |
| Erythroleukemia | Hematolymphoid / Histiocytic tumours | may be EMA +ve |
| Juvenile xanthogranuloma | Hematolymphoid / Histiocytic tumours | |
| Paraganglioma | Neural - Neuroendocrine - Neuraxis Tumours | also pheochromocytoma |
| High grade olfactory neuroblastoma | Neural - Neuroendocrine - Neuraxis Tumours | |
| Epithelioid MPNST | Neural - Neuroendocrine - Neuraxis Tumours | reported to have focal melanocytic differentiation in some cases[citation needed] |
| Glioblastoma | Neural - Neuroendocrine - Neuraxis Tumours | |
| Epithelioid schwannoma / neurofibroma | Neural - Neuroendocrine - Neuraxis Tumours | |
| Benign epithelioid nerve sheath tumour | Neural - Neuroendocrine - Neuraxis Tumours | |
| Chordoma | Neural - Neuroendocrine - Neuraxis Tumours | |
| Meningioma | Neural - Neuroendocrine - Neuraxis Tumours | chordoid meningioma |
| Parachordoma | Neural - Neuroendocrine - Neuraxis Tumours | [8] |
| Ependymoma | Neural - Neuroendocrine - Neuraxis Tumours | |
| Epithelioid perineurioma | Neural - Neuroendocrine - Neuraxis Tumours | |
| Hemangioblastoma | Neural - Neuroendocrine - Neuraxis Tumours | may be extraneural |
| Rhabdoid tumour | Neural - Neuroendocrine - Neuraxis Tumours | INI1 -ve |
| Mucosal epithelioid nerve sheath tumour | Neural - Neuroendocrine - Neuraxis Tumours | |
| Neurothekeoma | Neural - Neuroendocrine - Neuraxis Tumours | |
| Rhabdomyosarcoma, not otherwise specified (pleomorphic rhabdomyosarcoma) | Muscle-related tumours | |
| Epithelioid leiomyosarcoma | Muscle-related tumours | |
| Epithelioid glomus tumour | Muscle-related tumours | |
| Granular cell tumour | Muscle-related tumours | neural, non-neural types |
| Rhabdomyoma | Muscle-related tumours | |
| Myopericytoma | Muscle-related tumours | [9] |
| Epithelioid angiosarcoma | Vascular tumours | |
| Epithelioid hemangioendothelioma | Vascular tumours | |
| Epithelioid sarcoma-like hemangioendothelioma | Vascular tumours | [10] |
| Composite hemangioendothelioma | Vascular tumours | |
| Hemangiopericytoma | Vascular tumours | |
| Cutaneous epithelioid angiomatous nodule | Vascular tumours | |
| Bacillary angiomatosis | Vascular tumours | |
| Malignant pigmented villonodular synovitis | Hematolymphoid / Histiocytic tumours | |
| Multicentric Reticulohistiocytosis | Hematolymphoid / Histiocytic tumours | |
| Follicular dendritic cell sarcoma | Hematolymphoid / Histiocytic tumours | |
| Interdigitating reticulum cell sarcoma | Hematolymphoid / Histiocytic tumours | S-100 +ve |
| Diffuse type tenosynovial giant cell tumour | Hematolymphoid / Histiocytic tumours | |
| Malakoplakia | Hematolymphoid / Histiocytic tumours | |
| Kikuchi's disease | Hematolymphoid / Histiocytic tumours | |
| Xanthogranuloma | Hematolymphoid / Histiocytic tumours | |
| Epithelioid sarcoma | Miscellaneous mesencchymal tumours | especially proximal variant |
| Synovial sarcoma | Miscellaneous mesencchymal tumours | poorly differentiated |
| Alveolar soft part sarcoma | Miscellaneous mesencchymal tumours | TFE3 +ve |
| Gastrointestinal stromal tumour | Miscellaneous mesencchymal tumours | |
| Round cell liposarcoma | Miscellaneous mesencchymal tumours | |
| Dedifferentiated liposarcoma | Miscellaneous mesencchymal tumours | |
| Epithelioid variant of pleomorphic liposarcoma | Miscellaneous mesencchymal tumours | |
| Polyphenotypic small cell tumour | Miscellaneous mesencchymal tumours | |
| Ewing Sarcoma / PNET, large cell type | Miscellaneous mesencchymal tumours | |
| Epithelioid fibrous histiocytoma | Myofibroblastic - fibroblastic tumours | |
| Inflammatory malignant fibrous histiocytoma | Myofibroblastic - fibroblastic tumours | |
| Sclerosing epithelioid fibrosarcoma | Myofibroblastic - fibroblastic tumours | |
| Epithlelioid myofibroblastoma | Myofibroblastic - fibroblastic tumours | |
| Angiomatoid malignant fibrous histiocytoma | Myofibroblastic - fibroblastic tumours | |
| Inflammatory myxohyaline tumour of distal extremities with virocyte or Reed-Sternberg like cells | Myofibroblastic - fibroblastic tumours | |
| Acral myxoinflammatory fibroblastic sarcoma | Myofibroblastic - fibroblastic tumours | |
| Angiomyofibroblastoma | Myofibroblastic - fibroblastic tumours | |
| Epithelioid osteosarcoma | Chondro-osseous tumours | [11] |
| Extraskeletal myxoid chondrosarcoma, high grade | Chondro-osseous tumours | |
| Epithelioid multinodular osteoblastoma | Chondro-osseous tumours | may mimic osteosarcoma[12] |
| Radiation effect | Miscellaneous |
See also
References
- ↑ Miller RT. (Sep 2013). Atlantic Diagnostic Immunohistochemistry Symposium. St. John's, NL, Canada.
- ↑ Bonetti, F.; Martignoni, G.; Colato, C.; Manfrin, E.; Gambacorta, M.; Faleri, M.; Bacchi, C.; Sin, VC. et al. (Jun 2001). "Abdominopelvic sarcoma of perivascular epithelioid cells. Report of four cases in young women, one with tuberous sclerosis.". Mod Pathol 14 (6): 563-8. doi:10.1038/modpathol.3880351. PMID 11406657.
- ↑ Deyrup, AT.; Althof, P.; Zhou, M.; Morgan, M.; Solomon, AR.; Bridge, JA.; Weiss, SW. (Dec 2004). "Paraganglioma-like dermal melanocytic tumor: a unique entity distinct from cellular blue nevus, clear cell sarcoma, and cutaneous melanoma.". Am J Surg Pathol 28 (12): 1579-86. PMID 15577676.
- ↑ Perez-Montiel, MD.; Frankel, WL.; Suster, S. (May 2003). "Neuroendocrine carcinomas of the pancreas with 'Rhabdoid' features.". Am J Surg Pathol 27 (5): 642-9. PMID 12717248.
- ↑ Kutzner, H.; Mentzel, T.; Kaddu, S.; Soares, LM.; Sangueza, OP.; Requena, L. (Mar 2001). "Cutaneous myoepithelioma: an under-recognized cutaneous neoplasm composed of myoepithelial cells.". Am J Surg Pathol 25 (3): 348-55. PMID 11224605.
- ↑ Hamazaki, S.; Nakamoto, S.; Okino, T.; Tsukayama, C.; Mori, M.; Taguchi, K.; Okada, S. (Nov 1999). "Epithelioid trophoblastic tumor: morphological and immunohistochemical study of three lung lesions.". Hum Pathol 30 (11): 1321-7. PMID 10571512.
- ↑ Shih, IM.; Kurman, RJ. (Nov 1998). "Epithelioid trophoblastic tumor: a neoplasm distinct from choriocarcinoma and placental site trophoblastic tumor simulating carcinoma.". Am J Surg Pathol 22 (11): 1393-403. PMID 9808132.
- ↑ Folpe, AL.; Agoff, SN.; Willis, J.; Weiss, SW. (Sep 1999). "Parachordoma is immunohistochemically and cytogenetically distinct from axial chordoma and extraskeletal myxoid chondrosarcoma.". Am J Surg Pathol 23 (9): 1059-67. PMID 10478665.
- ↑ Mentzel, T.; Dei Tos, AP.; Sapi, Z.; Kutzner, H. (Jan 2006). "Myopericytoma of skin and soft tissues: clinicopathologic and immunohistochemical study of 54 cases.". Am J Surg Pathol 30 (1): 104-13. PMID 16330949.
- ↑ Billings, SD.; Folpe, AL.; Weiss, SW. (Jan 2003). "Epithelioid sarcoma-like hemangioendothelioma.". Am J Surg Pathol 27 (1): 48-57. PMID 12502927.
- ↑ Amanatullah, DF.; Ngann, KK.; Borys, D.; Tamurian, RM. (Jun 2010). "Progression of aggressive metastatic carcinosarcoma after treatment of epithelioid osteosarcoma.". Orthopedics 33 (6): 445. doi:10.3928/01477447-20100429-26. PMID 20806764.
- ↑ Zon Filippi, R.; Swee, RG.; Krishnan Unni, K. (Aug 2007). "Epithelioid multinodular osteoblastoma: a clinicopathologic analysis of 26 cases.". Am J Surg Pathol 31 (8): 1265-8. doi:10.1097/PAS.0b013e31803402e7. PMID 17667552.