1/85. Renal failure resulting from infiltration by inflammatory myofibroblastic tumor responsive to corticosteroid therapy.Inflammatory myofibroblastic tumor (IMT) is a rare disease of inflammatory and spindle cell proliferative lesions in multiple sites. Most frequently reported in the lungs, a variety of extrapulmonary sites have been described. We report the first case of IMT causing renal failure by massive bilateral renal infiltration. Renal function continued to deteriorate (peak serum creatinine level, 8.4 mg/dL) despite placement of a ureteral stent. The kidneys were diffusely enlarged on computed tomographic (CT) scan. Renal biopsy showed myofibroblastic proliferation and inflammatory infiltration. Renal failure responded favorably over weeks to corticosteroid therapy (serum creatinine level, 2.8 mg/dL) with a marked reduction in bilateral renal enlargement by CT scan.- - - - - - - - - - ranking = 1keywords = spindle cell, spindle (Clic here for more details about this article) |
2/85. Inflammatory pseudotumor of the urinary bladder with aberrant expression of cytokeratin. Report of a case with cytologic, immunocytochemical and cytogenetic findings.BACKGROUND: Cytologic descriptions of inflammatory pseudotumor of the urinary bladder are exceedingly rare. We describe here an additional case of this disease, including its cytologic features and aberrant expression of cytokeratin. CASE: A 35-year-old male presented with gross hematuria but no history of bladder surgery. urine cytology revealed a few atypical spindle cells suspicious for sarcoma. Histologically, the lesion consisted of spindle cells of various sizes and shapes, proliferating in irregularly running bundles, but no severe nuclear atypia or pathologic mitosis was found. Immunocytochemically, these cells were unexpectedly positive for cytokeratin as well as for vimentin and muscle actin. All metaphase cells examined revealed a normal male karyotype. CONCLUSION: Inflammatory pseudotumor must be distinguished in particular from leiomyosarcoma and spindle cell carcinoma. To avoid an erroneous diagnosis, recognition of this entity is important, together with careful histologic examination and awareness of the possible aberrant expression of cytokeratin.- - - - - - - - - - ranking = 3keywords = spindle cell, spindle (Clic here for more details about this article) |
3/85. Inflammatory pseudotumor of the spleen associated with a cavernous hemangioma diagnosed at intra-operative cytology: report of a case and review of literature.This report presents a case of a 40 year old Caucasian female with a 15 cm inflammatory pseudotumor (IPT) of the spleen with associated areas of splenic hemangioma of the cavernous type. Abdominal CT showed a largely fatty splenic mass with enhancing septations, and scattered calcifications, and a small density in the liver. Grossly, the splenic lesion showed a lobulated cut surface with areas of myxoid change, necrosis, hemorrhage and cystic softening. The diagnosis of IPT was suggested at intraoperative consultation using cytologic smears and was, subsequently confirmed on permanent sections. Histologically, the lesion consisted of a densely collagenized spindle cell stroma with patchy aggregates of lymphocytes and plasma cells, and scattered foci showing hemosiderin-laden macrophages extracellular calcium deposits and osseous metaplasia. The stromal spindle cells were immuoreactive for smooth muscle actin and vimentin confirming their myofibroblastic phenotype. There were extensive areas of infarction within the mass. The patient, however, remained asymptomatic preoperatively. Histologic analysis in this case raises the possibility that low grade, perhaps repetitive, trauma to the hemangioma may have resulted in intralesional hemorrhages which, through a process of organization, may have evolved into this sizable inflammatory pseudotumor. In addition, this report reviews the current literature on the clinical significance and presentation, morphologic and immunohistochemical findings, prognosis, differential diagnosis, pathogenesis and therapy of the splenic IPT.- - - - - - - - - - ranking = 2keywords = spindle cell, spindle (Clic here for more details about this article) |
4/85. Inflammatory pseudotumor of carotid artery: a case report.Inflammatory pseudotumor is an uncommon round and spindle cell proliferative lesion of unknown etiology that occurs most commonly in the lung. But it also occurs in diverse extrapulmonary locations such as the abdomen, retroperitoneum, pelvis, heart, head and neck, upper respiratory tract, trunk, bladder and extremities. The extrapulmonary inflammatory pseudotumor is often larger, less well circumscribed and multinodular. Proximity of the tumor to vital structures or involvement of vital organs compromises the opportunity for complete resection, thus higher recurrence rates are often reported even after surgical treatment. The authors report a case of inflammatory pseudotumor originating from the common carotid artery in a 42-year-old female patient with a rapidly growing neck mass, treated by en-bloc resection of inflammatory pseudotumor and a long segment of common carotid artery followed by PTFE graft interposition.- - - - - - - - - - ranking = 1keywords = spindle cell, spindle (Clic here for more details about this article) |
5/85. Myofibroblastic tumours: neoplasias with divergent behaviour. Ultrastructural and flow cytometric analysis.myofibroblasts are spindle cells having ultrastructural features in common with smooth muscle cells and fibroblasts. In the last few years, tumours have been described in which myofibroblasts represent not only a reactive mechanism but also a true neoplastic component. They constitute new nosologic entities which might be termed "myofibroblastic tumours". Tumours with benign and, rarely, malignant behaviour are reported to belong to this group of lesions. Recently, a third tumour type with borderline biological course, named "inflammatory myofibroblastic tumour" (IMT), has been identified, a condition that has been regarded as a benign and reactive disorder for a long time. Only in recent reports has been demonstrated that, in spite of an apparently benign morphological pattern, some cases of IMT have a malignant course. In this connection, dna analysis by flow cytometry is a valuable diagnostic tool, because it allows identification of the ploidy status, a procedure that is often useful for predicting the nature and the biological behaviour of the lesion. In this study, 11 cases of myofibroblastic tumours were examined retrospectively by evaluating clinicopathological features and dna ploidy status by flow cytometry. The diagnosis of myofibroblastic tumour was confirmed by performing histology, immunohistochemistry, and electron microscopy in all patients. In detail, these 11 cases were composed of 1 benign myofibroblastoma, 1 myofibrosarcoma and 9 IMTs. Among these myofibroblastic tumours, all those with local recurrence or distant metastases (one myofibrosarcoma and three IMT) showed an aneuploid cell population demonstrable by flow cytometric analysis, whereas the other cases with benign course (one benign myofibroblastoma and six IMT) exhibited an euploid dna content. These data suggest the following: a) Besides the rare myofibroblastomas and myofibrosarcomas, IMTs represent a larger group of lesions with potentially different biological and clinical course. b) dna flow cytometric analysis is a reliable tool that support histopathological examination in characterizing those cases of IMT that, though being malignant, mimic benign lesions. Consequently, it establishes the basis for a different therapeutic approach according to the euploid or aneuploid dna content.- - - - - - - - - - ranking = 1keywords = spindle cell, spindle (Clic here for more details about this article) |
6/85. Inflammatory myofibroblastic tumor of the skin.We report a case of inflammatory myofibroblastic tumor (IMF) of the skin in a female with a history of Wegeners granulomatosis. The patient had a painless, erythematous, and indurated lesion of the left elbow. The resected specimen revealed a 4 cm x 3 cm nodule involving the entire dermis and superficial portions of subcutis with a stellate profile at scanning magnification. There were spindle cells in fascicles and whorls and a mixed inflammatory cell infiltrate of plasma cells, lymphocytes, neutrophils, and eosinophils. The spindle cells were immunoreactive for vimentin, muscle specific actin, and smooth muscle actin. The polyclonal and polymorphous nature of the inflammatory cells was confirmed by immunohistochemical studies. This is the first case of IMF of the skin documented by immunostaining.- - - - - - - - - - ranking = 2keywords = spindle cell, spindle (Clic here for more details about this article) |
7/85. Inflammatory myofibroblastic tumor with extensive involvement of the bowel in a 7-year-Old child.We present a case of unusual localization of inflammatory fibroblastic tumor in the terminal ileum, cecum, and ascending colon in a 7-year-old child. Segmental resection of the terminal ileum, cecum, and ascending colon with a tumor mass up to 6 cm in diameter was performed. Pathohistological examination of biopsy specimen was performed on routine hematoxylin-eosin sections, as well as immunohistochemically with primary antibodies to CD3, CD20, CD68, factor viii, vimentin, smooth muscle actin, desmin, cytokeratin and S-100 protein, and k and l light chains. The tumor was composed of highly vascularized tissue with interlacing fascicles of elongated spindle cells admixed with plasma cells, histiocytes, lymphocytes, and eosinophils. The diagnosis of inflammatory myofibroblastic tumor was confirmed by immunohistochemistry. Inflammatory myofibroblastic tumor cannot be distinguished clinically from highly malignant neoplasm or some other conditions. Surgical resection and careful pathohistological analysis are needed, and a long-term follow-up is recommended.- - - - - - - - - - ranking = 1keywords = spindle cell, spindle (Clic here for more details about this article) |
8/85. Inflammatory myofibroblastic tumor with HMGIC rearrangement.Inflammatory pseudotumors or inflammatory myofibroblastic tumors (IMT) are lesions of extreme heterogeneity showing a highly variable mixture of bland-looking spindle cells, inflammatory cells, and collagen fibers. We describe our results of molecular cytogenetic and rapid amplification of cDNA ends (RACE-PCR) studies on an IMT characterized by a translocation involving 12q15. Chromosomal aberrations involving this region are very frequent among other benign tumors, such as lipomas, uterine leiomyomas, or pulmonary chondroid hamartomas. Recently, we have shown that, by these structural chromosomal aberrations, the HMGIC gene is affected. fluorescence in situ hybridization (FISH) analysis and 3' RACE-PCR on cells of the present case of an inflammatory myofibroblastic tumor indicated an intragenic rearrangement of HMGIC, resulting in an aberrant transcript of that gene. Clonal cytogenetic aberrations have been described in very few cases of IMT. The results presented herein indicate that this case of IMT represents a true benign mesenchymal neoplasm associated with, or due to, a rearrangement of HMGIC.- - - - - - - - - - ranking = 1keywords = spindle cell, spindle (Clic here for more details about this article) |
9/85. Inflammatory pseudotumor of urinary bladder.A previously healthy 44-year-old male was admitted with the chief complaint of intermittent gross hematuria. On initial ultrasonographic and CT examination, a grossly protruding intravesical tumor was noted and, under the impression of a malignant bladder tumor, transurethral resection was performed. The histological findings were spindle cells with elongated cytoplasm with rare mitotic figures distributed in myxoid stroma, consistent with diagnosis of inflammatory pseudotumor of the bladder. The benign nature of this tumor warrants conservative surgical management, usually consisting of transurethral resection or partial cystectomy. No reports of metastasis have been reported following complete excision. Therefore, any suspicion and recognition of this entity is imperative to avoid performing an irreversible radical procedure.- - - - - - - - - - ranking = 1keywords = spindle cell, spindle (Clic here for more details about this article) |
10/85. Specific detection of epstein-barr virus in inflammatory pseudotumor of the spleen in a patient with a high serum level of soluble IL-2 receptor.A case of inflammatory pseudotumor of the spleen is described in a 63-year-old woman who presented with an intrasplenic tumor and an elevated serum level of soluble interleukin 2 receptor (sIL-2R). Microscopic examination after removal of the spleen revealed that the tumor was composed of mixed cellular infiltrates, mainly lymphocytes and plasma cells, and spindle-cell proliferation. Epstein-Barr virus (EBV) was specifically detected in the tumor by in situ hybridization for EBV rna. The serum level of sIL-2R level was normalized after splenectomy. EBV infection may play a role in the development of splenic inflammatory pseudotumor and the elevation of sIL-2R level.- - - - - - - - - - ranking = 0.23163289592759keywords = spindle (Clic here for more details about this article) |
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