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In this section we have spot diagnoses posted on a daily basis since June 2010, now over 1700! You can review the archived cases and read the suggested diagnoses by users and the final comment by Dr Uma Sundram, the Editor-in-Chief and main spot diagnosis host. Case are uploaded each week day by 10 a.m. UK time with the correct diagnosis will generally be posted at 8 p.m. UK time. Why not view the most recent spot diagnosis and proffer a diagnosis?

Case Number : Case 2288 - 21 March 2019 Posted By: Raul Perret

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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Raul,

Congratulation on this great study.

SMARCA4-deficient Thoracic Sarcomas

Clinicopathologic Study of 30 Cases With an Emphasis on Their Nosology and Differential Diagnoses

Perret, Raul, MSc, MD*; Chalabreysse, Lara, MD; Watson, Sarah, MD, PhD; Serre, Isabelle, MD§; Garcia, Stephane, MD, PhD; Forest, Fabien, MD, PhD; Yvorel, Violaine, MD; Pissaloux, Daniel, PhD#; Thomas de Montpreville, Vincent, MD**; Masliah-planchon, Julien, PhD, PharmD††; Lantuejoul, Sylvie, MD, PhD#,‡‡; Brevet, Marie, MD, PhD†,§§; Blay, Jean-Yves, MD, PhD§§,∥∥; Coindre, Jean-Michel, MD*,¶¶; Tirode, Franck, PhD##,***; Le Loarer, Francois, MD, PhD*,¶¶

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John Zhang

Posted

Looks like a glomus tumor. SMA please.

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vincenzo

Posted (edited)

Glomus tumor, glomangioma/mioma type

Edited by vincenzo

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vincenzo

Posted (edited)

Yes, Glomus tissue...but not tumor, I was wrong. This is a normal glomus body! Nearby there is some hyperplastic change.

Edited by vincenzo

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Agree, I would go with angiomyofibroblastoma too

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John Zhang

Posted

Alright. You guys are good. Angiomyofibroblastoma. Nice case.

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Angiomyofibroblastoma could be a correct spot. Odd lobulated pattern and no alternating cellular and hypocellular areas ...why not a cellular angiofibroma?

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Alex-Ventura-Leon

Posted

Angiomyofibroblastoma, the ropy collagen is a good clue i think

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vincenzo

Posted (edited)

Polypoid lesion? What's the silhouette? Also the cellular angiofibroma could be desmin+. And the fibroepithelial stroma polyp too. Cellula angiofibroma is my favorite diagnosis, because of the hyalinized vessels.

Edited by vincenzo

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Cytologically, the tumor cells are sort of epithelioid and have a tendency to distributed around the vessels. That's quite typical for angiomyofibroblastoma. Cellular angiofibroma can be positive for desmin but the cells are spindle and do not cluster around the vessels. RB1 would help in difficult cases.

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Raul Perret

Posted

This was a typical case of angiomyofibroblastoma. In this entity, cells are spindled to epithelioid and tend to aggregate around blood vessels and form clusters. They typically express desmin a marker that is rarely positive in spindle cell lipoma and cellular angiofibroma. However, those 3 neoplasms share genomic profiles with deletions in 13q (including RB1 locus) so they can sometimes have overlapping morphological and phenotypical features. Interestingly, superficial acral fibromyxoma has been recently found to present 13q deletions (at least in a subset of cases), hence, enlarging the Rb1 deleted family of neoplasms. Thanks for the comments

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Raul Perret

Posted

On 21/03/2019 at 02:26, anh said:

Raul,

Congratulation on this great study.

SMARCA4-deficient Thoracic Sarcomas

Clinicopathologic Study of 30 Cases With an Emphasis on Their Nosology and Differential Diagnoses

Perret, Raul, MSc, MD*; Chalabreysse, Lara, MD; Watson, Sarah, MD, PhD; Serre, Isabelle, MD§; Garcia, Stephane, MD, PhD; Forest, Fabien, MD, PhD; Yvorel, Violaine, MD; Pissaloux, Daniel, PhD#; Thomas de Montpreville, Vincent, MD**; Masliah-planchon, Julien, PhD, PharmD††; Lantuejoul, Sylvie, MD, PhD#,‡‡; Brevet, Marie, MD, PhD†,§§; Blay, Jean-Yves, MD, PhD§§,∥∥; Coindre, Jean-Michel, MD*,¶¶; Tirode, Franck, PhD##,***; Le Loarer, Francois, MD, PhD*,¶¶

Thank you very much Anh. This was the product of teamwork as everything in life

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Raul, 

 

You are welcome. I enjoyed reading that very much. Although I got to say I don't really know what it is. But I will keep that in the back of my mind if I see something weird in the mediastinum. My experience is sometimes you just read it, and you see one the next day. 

 

Anh

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