Epithelioid cell lesions
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Epithelioid cell lesions are very common in pathology. Malignant epithelioid lesions are usually a carcinoma.
Differential diagnosis
A short DDx
- Carcinoma (primary and metastatic).
- Malignant melanoma.
- Sarcoma.
Epithelioid sarcomas
All rules are made to be broken... some epithelioid lesions are sarcomas:[1]
- Epithelioid sarcoma.
- Epithelioid angiosarcoma.
- Alveolar soft part sarcoma.
- Rhabdoid tumour.
Others:
- Clear cell sarcoma.
- Epithelioid gastrointestinal stromal tumour.
- Synovial sarcoma, primitive round cell type.
- Sarcomas in the small round cell tumours group, e.g. Ewing sarcoma.
Note:
- A more complete list is below.
Large epithelioid tumours
The following is an exhaustive DDx for a large epithelioid tumour.
| 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 epithelial 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 | |
| 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 | |
| Epith sarcoma-like hemangioendothelioma | Vascular tumours | |
| 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 | |
| Extraskeletal myxoid chondrosarcoma, high grade | Chondro-osseous tumours | |
| Epithelioid multinodular osteoblastoma | Chondro-osseous tumours | may mimic osteosarcoma[10] |
| Radiation effect | Miscellaneous |
See also
References
- ↑ Dei Tos AP, Wagner AJ, Modena P, Comandone A, Leyvraz S (August 2009). "Epithelioid soft tissue tumors". Semin. Oncol. 36 (4): 347–57. doi:10.1053/j.seminoncol.2009.06.005. PMID 19664495.
- ↑ 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.
- ↑ 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.