Intranodal palisaded myofibroblastoma

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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

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. //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.