Case Number : Case 315 Posted By: Guest

Phillip McKee - Overseas consultations (Cave Creek, Arizona, USA) Wrote:

Firstly, many thanks to Iskander for looking after the spot diagnoses while I was away on vacation. This is a very difficult case which was kindly shared with me by Alex Lazar. I must be truthful that the diagnosis is his. I cannot take any credit. The diagnosis is intranodal palisaded myofibroblastoma with amianthoid fibers. As such is most likely has arisen within the an inguinal lymph node as this is the most common site for this rare tumor. It is a benign tumor which arises from smooth muscle cells and myofibroblasts. Fig 3 highlights the palisading and figure 4 shows the amianthoid collagenous fibers. It presents most often in middle-aged males as a painless mass. The histology in this example is characteristic. It is also characterized by SMA positive globules (not shown) and cyclin-D1 is strongly expressed. There is a relationship with HHV-8 and Epstein-Barr virus. Extravasated red blood cells are a common finding and therefore the tumor may be mistaken for Kaposi's sarcoma. Neurilemmoma is another important differential diagnosis

Submitted on 24/08/2011 11:19
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Marie MD - () Wrote:

Rosetoid schwannoma (neuroblastoma-like)

Submitted on 24/08/2011 10:37
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Shadi Rashtak - Mayo Clinic Rochester () Wrote:

Fibrosarcoma

Submitted on 24/08/2011 10:29
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Juan Carlos Garcés - Hospital Oncológico / Hospital Luis Vernaza (Guayaquil Ecuador) Wrote:

Low-grade fibromyxoid sarcoma/hyalinizing spindle cell tumor with giant rosettes.

Submitted on 24/08/2011 09:24
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Amira Tawdy - Cairo University (Egypt) Wrote:

My first impression was a neural tumor most probably cellular schwanoma but I ADMIRE also the suggestion of hyalinizing spindle cell tumor yet I never saw it before

Submitted on 24/08/2011 09:20
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Pablo Ortega-Espinosa - "Isidro Ayora" Hospital (Loja-Ecuador) Wrote:

hyalinizing spindle cell tumor with giant rosettes.

Submitted on 24/08/2011 08:24
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eva - () Wrote:

hyalinizing spindle cell tumor with giant rosettes

Submitted on 24/08/2011 07:48
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Marwa Fawzi - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:

Herring bone like pattern ,so fibrosarcoma is my 1st impression

Submitted on 24/08/2011 07:41
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Rodrigo Restrepo - UPB/CES (Mdlln/Col) Wrote:

Low-grade fibromyxoid sarcoma/hyalinizing spindle cell tumor with giant rosettes.

Submitted on 24/08/2011 06:15
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Mona Abdel Halim - Dermatology Department, Faculty of Medicine, Cairo University (Egypyt) Wrote:

This is a very difficult case. I think the clue is in the esinophilic bodies. My first thought about these structures was collagenous spherulosis: radiating esinophilic collagen fibres compressing the surrounding tumor cells. The tumor cells are arranged in hyper cellular interlacing fascicles, a herring bone like pattern is seen in the 3rd image, hyperchromasia and mitoses are also seen, I am also thinking that there might be a back ground of lymphocytes in the second image. I did some reading and I thought of cellular Shwannoma with collagenous spherulosis. (it may show atypical features such as large hyper chromatic nuclei, mitoses and may show a herring bone like arrangement thus may be confused with fibrosarcoma)...However, after reading the other comments, I liked the idea of hyalinizing spindle cell tumor with giant rosettes, could not find any image of it but I think it could be a DDx... Interesting case..

Submitted on 24/08/2011 06:07
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ANDREW DANCKWERTS - NHLS / WITS UNIVERSITY (JOHANNESBURG, RSA) Wrote:

LOW GRADE FIBROMYXOID SARCOMA / HYLANIZING SPINDLE CELL TUMOUR WITH GIANT ROSETTES / EVAN'S TUMOUR. I FEEL THERE MAY ALSO BE AREAS OF TRANSITION TO FIBROSARCOMA-LIKE AREAS (HERRING-BONE GROWTH PATTERN). NICE CASE!!

Submitted on 24/08/2011 05:13
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Eman El-Nabarawy - Cairo University (Egypt) Wrote:

Thought of congenital infantile fibrosarcoma.

Submitted on 24/08/2011 05:09
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