Difference between revisions of "Intranodal palisaded myofibroblastoma"

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Intranodal palisaded myofibroblastoma (view source)

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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 - blood vessel surrounded by collagen with 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>
#[[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.


Images:
===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/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:
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*Desmin -ve
*Desmin -ve
*Ki-67 - low.
*Ki-67 - low.
*HMB-45 -ve.


==See also==
==See also==
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[[Category:Lymph node pathology]]
[[Category:Lymph node pathology]]
[[Category:Diagnosis]]
Mark
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