Difference between revisions of "Intranodal palisaded myofibroblastoma"

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{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Intranodal palisaded myofibroblastoma - very high mag.jpg
| Width      = 200
| Caption    = IPM. [[H&E stain]].
| Micro      = spindle cells with nuclear palisading, RBC extravasation
| Subtypes  =
| LMDDx      = [[schwannoma]], [[leiomyoma]]
| Stains    =
| IHC        = SMA +ve, S-100 -ve.
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Site      = [[lymph node]].
| Assdx      =
| Syndromes  =
| Clinicalhx =
| Signs      = mass lesion
| Symptoms  =
| Prevalence = very rare.
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  =
| Other      =
| ClinDDx    = [[lymphoma]], metastatic carcinoma.
}}
'''Intranodal palisaded myofibroblastoma''', abbreviated '''IPM''', is a rare tumour that classically presents as an inguinal mass.<ref name=pmid17284119>{{Cite journal  | last1 = Nguyen | first1 = T. | last2 = Eltorky | first2 = MA. | title = Intranodal palisaded myofibroblastoma. | journal = Arch Pathol Lab Med | volume = 131 | issue = 2 | pages = 306-10 | month = Feb | year = 2007 | doi = 10.1043/1543-2165(2007)131[306:IPM]2.0.CO;2 | PMID = 17284119 }}</ref>
'''Intranodal palisaded myofibroblastoma''', abbreviated '''IPM''', is a rare tumour that classically presents as an inguinal mass.<ref name=pmid17284119>{{Cite journal  | last1 = Nguyen | first1 = T. | last2 = Eltorky | first2 = MA. | title = Intranodal palisaded myofibroblastoma. | journal = Arch Pathol Lab Med | volume = 131 | issue = 2 | pages = 306-10 | month = Feb | year = 2007 | doi = 10.1043/1543-2165(2007)131[306:IPM]2.0.CO;2 | PMID = 17284119 }}</ref>


==General==
==General==
*Rare.
*Rare ~ 55 cases in the world literature.<ref name=pmid21718465/>
 
Demographics:
*Male:female = 2:1.
*Male:female = 2:1.
*Adults - middle age.
*Adults - middle age.
Location:
*Usually inguinal lymph node.
*Reported in retroperitoneum.<ref name=pmid21718465>{{Cite journal  | last1 = Sagar | first1 = J. | last2 = Vargiamidou | first2 = A. | last3 = Manikkapurath | first3 = H. | title = Intranodal palisaded myofibroblastoma originating from retroperitoneum: an unusual origin. | journal = BMC Clin Pathol | volume = 11 | issue =  | pages = 7 | month =  | year = 2011 | doi = 10.1186/1472-6890-11-7 | PMID = 21718465 | PMC = 3146916 }}</ref>
Treatment:
*Simple excision; rare recurrences have been reported.<ref name=pmid10235504>{{Cite journal  | last1 = Creager | first1 = AJ. | last2 = Garwacki | first2 = CP. | title = Recurrent intranodal palisaded myofibroblastoma with metaplastic bone formation. | journal = Arch Pathol Lab Med | volume = 123 | issue = 5 | pages = 433-6 | month = May | year = 1999 | doi = 10.1043/0003-9985(1999)1230433:RIPMWM2.0.CO;2 | PMID = 10235504 }}</ref>


==Microscopic==
==Microscopic==
Features:
Features:
#Rim of peripheral lymphoid tissue.
#Rim of peripheral lymphoid tissue.
#spindle cells with nuclear palisading
#*Remnant of [[lymph node]].
#RBC extravasation/hemorrhage.
#Spindle cells with nuclear palisading - '''key feature'''.
#Amianthoid fibers
#[[RBC extravasation]]/hemorrhage.
#intracellular and extracellular fuchsinophilic bodies that stain positive for smooth muscle actin.
#Amianthoid fibers - blood vessel surrounded by collagen with (fine) peripheral spokes.<ref name=pmid1918406>{{Cite journal  | last1 = Bigotti | first1 = G. | last2 = Coli | first2 = A. | last3 = Mottolese | first3 = M. | last4 = Di Filippo | first4 = F. | title = Selective location of palisaded myofibroblastoma with amianthoid fibres. | journal = J Clin Pathol | volume = 44 | issue = 9 | pages = 761-4 | month = Sep | year = 1991 | doi =  | PMID = 1918406 }}</ref>
#*Paucicellular regions.<ref>URL: [http://path.upmc.edu/cases/case121/micro.html http://path.upmc.edu/cases/case121/micro.html]. Accessed on: 3 January 2012.</ref>
#Intracellular and extracellular fuchsinophilic bodies.
#*Smooth muscle actin +ve.
 
Notes:
*''Fuchsinophilic'' = affinity for the acid dye fuchsin.<ref>URL: [http://www.merriam-webster.com/medical/fuchsinophilic http://www.merriam-webster.com/medical/fuchsinophilic]. Accessed on: 3 October 2011.</ref>
**Image: [http://www.flickr.com/photos/53376324@N08/5387821397/in/photostream Fuchsinophilic material (flickr.com)] - red.


DDx:
DDx:<ref>{{Cite journal  | last1 = Sarma | first1 = NH. | last2 = Arora | first2 = KS. | last3 = Varalaxmi | first3 = KP. | title = Intranodal palisaded myofibroblastoma: a case report and an update on etiopathogenesis and differential diagnosis. | journal = J Cancer Res Ther | volume = 9 | issue = 2 | pages = 295-8 | month =  | year =  | doi = 10.4103/0973-1482.113395 | PMID = 23771380 }}</ref>
*[[Schwannoma]].
*[[Schwannoma]].
*[[Leiomyoma]].
*[[Leiomyosarcoma]].
*[[Malignant melanoma]].
*[[Kaposi sarcoma]].
*Metastatic carcinoma.


Image:
===Images===
<gallery>
Image: Intranodal palisaded myofibroblastoma - low mag.jpg | IPM - low mag. (WC/Nephron)
Image: Intranodal palisaded myofibroblastoma - intermed mag.jpg | IPM - intermed. mag. (WC/Nephron)
Image: Intranodal palisaded myofibroblastoma - high mag.jpg | IPM - high mag. (WC/Nephron)
Image: Intranodal palisaded myofibroblastoma - very high mag.jpg | IPM - very high mag. (WC/Nephron)
Image: Intra-nodal palisaded myofibroblastoma.jpg | IPM - high mag. (WC)
</gallery>
www:
*[http://www.surgicalpathologyatlas.com/glfusion/mediagallery/media.php?f=0&sort=0&s=20080802163636511 IPM (surgicalpathologyatlas.com)].
*[http://www.surgicalpathologyatlas.com/glfusion/mediagallery/media.php?f=0&sort=0&s=20080802163636511 IPM (surgicalpathologyatlas.com)].
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC496726/figure/F4/ Amianthoid fibers (nih.gov)].<ref name=pmid1918406>{{Cite journal  | last1 = Bigotti | first1 = G. | last2 = Coli | first2 = A. | last3 = Mottolese | first3 = M. | last4 = Di Filippo | first4 = F. | title = Selective location of palisaded myofibroblastoma with amianthoid fibres. | journal = J Clin Pathol | volume = 44 | issue = 9 | pages = 761-4 | month = Sep | year = 1991 | doi =  | PMID = 1918406 }}</ref>
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3146916/figure/F4/ Amianthoid fibers (nih.gov)].<ref name=pmid21718465/>
*[http://path.upmc.edu/cases/case121/micro.html IPM - several images (upmc.edu)].


==IHC==
==IHC==
*SMA +ve.
*SMA +ve.
*Cyclin D1 +ve.
*Vimentin +ve.
*Cyclin D1 +ve/-ve.<ref name=pmid23771380>{{Cite journal  | last1 = Sarma | first1 = NH. | last2 = Arora | first2 = KS. | last3 = Varalaxmi | first3 = KP. | title = Intranodal palisaded myofibroblastoma: a case report and an update on etiopathogenesis and differential diagnosis. | journal = J Cancer Res Ther | volume = 9 | issue = 2 | pages = 295-8 | month =  | year =  | doi = 10.4103/0973-1482.113395 | PMID = 23771380 }}</ref>


Other:
Other:
Line 31: Line 93:
*Desmin -ve
*Desmin -ve
*Ki-67 - low.
*Ki-67 - low.
*HMB-45 -ve.


==See also==
==See also==
Line 37: Line 100:


==References==
==References==
{{Reflist|1}}
{{Reflist|2}}


[[Category:Lymph node pathology]]
[[Category:Lymph node pathology]]
[[Category:Diagnosis]]

Latest revision as of 16:54, 23 September 2018

Intranodal palisaded myofibroblastoma
Diagnosis in short

IPM. H&E stain.
LM spindle cells with nuclear palisading, RBC extravasation
LM DDx schwannoma, leiomyoma
IHC SMA +ve, S-100 -ve.
Site lymph node.
Signs mass lesion
Prevalence very rare.
Clin. DDx lymphoma, metastatic carcinoma.

Intranodal palisaded myofibroblastoma, abbreviated IPM, is a rare tumour that classically presents as an inguinal mass.[1]

General

  • Rare ~ 55 cases in the world literature.[2]

Demographics:

  • Male:female = 2:1.
  • Adults - middle age.

Location:

  • Usually inguinal lymph node.
  • Reported in retroperitoneum.[2]

Treatment:

  • Simple excision; rare recurrences have been reported.[3]

Microscopic

Features:

  1. Rim of peripheral lymphoid tissue.
  2. Spindle cells with nuclear palisading - key feature.
  3. RBC extravasation/hemorrhage.
  4. Amianthoid fibers - blood vessel surrounded by collagen with (fine) peripheral spokes.[4]
    • Paucicellular regions.[5]
  5. Intracellular and extracellular fuchsinophilic bodies.
    • Smooth muscle actin +ve.

Notes:

DDx:[7]

Images

  • IPM - low mag. (WC/Nephron)

  • IPM - intermed. mag. (WC/Nephron)

  • IPM - high mag. (WC/Nephron)

  • IPM - very high mag. (WC/Nephron)

  • IPM - high mag. (WC)

www:

IHC

  • SMA +ve.
  • Vimentin +ve.
  • Cyclin D1 +ve/-ve.[8]

Other:

  • S100 -ve
  • GFAP -ve.
  • CD34 -ve.
  • Desmin -ve
  • Ki-67 - low.
  • HMB-45 -ve.

See also

References

  1. ↑ Nguyen, T.; Eltorky, MA. (Feb 2007). "Intranodal palisaded myofibroblastoma.". Arch Pathol Lab Med 131 (2): 306-10. doi:10.1043/1543-2165(2007)131[306:IPM]2.0.CO;2. PMID 17284119.
  2. ↑ 2.0 2.1 2.2 Sagar, J.; Vargiamidou, A.; Manikkapurath, H. (2011). "Intranodal palisaded myofibroblastoma originating from retroperitoneum: an unusual origin.". BMC Clin Pathol 11: 7. doi:10.1186/1472-6890-11-7. PMC 3146916. PMID 21718465. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3146916/.
  3. ↑ Creager, AJ.; Garwacki, CP. (May 1999). "Recurrent intranodal palisaded myofibroblastoma with metaplastic bone formation.". Arch Pathol Lab Med 123 (5): 433-6. doi:10.1043/0003-9985(1999)1230433:RIPMWM2.0.CO;2. PMID 10235504.
  4. ↑ 4.0 4.1 Bigotti, G.; Coli, A.; Mottolese, M.; Di Filippo, F. (Sep 1991). "Selective location of palisaded myofibroblastoma with amianthoid fibres.". J Clin Pathol 44 (9): 761-4. PMID 1918406.
  5. ↑ URL: http://path.upmc.edu/cases/case121/micro.html. Accessed on: 3 January 2012.
  6. ↑ URL: http://www.merriam-webster.com/medical/fuchsinophilic. Accessed on: 3 October 2011.
  7. ↑ Sarma, NH.; Arora, KS.; Varalaxmi, KP.. "Intranodal palisaded myofibroblastoma: a case report and an update on etiopathogenesis and differential diagnosis.". J Cancer Res Ther 9 (2): 295-8. doi:10.4103/0973-1482.113395. PMID 23771380.
  8. ↑ Sarma, NH.; Arora, KS.; Varalaxmi, KP.. "Intranodal palisaded myofibroblastoma: a case report and an update on etiopathogenesis and differential diagnosis.". J Cancer Res Ther 9 (2): 295-8. doi:10.4103/0973-1482.113395. PMID 23771380.
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