Case Number : Case 4094 - 29 September 2022 Posted By: Saleem Taibjee

The tumour has round to oval cells arranged concentrically around blood vessels. Myopericytoma is the most likely diagnosis. Angioleiomyoma is a close differential. IHC study with SMA, H caldesmon and desmin may throw more light.

Favor angioleiomyoma

46 minutes ago, Anil Patki said:

The tumour has round to oval cells arranged concentrically around blood vessels. Myopericytoma is the most likely diagnosis. Angioleiomyoma is a close differential. IHC study with SMA, H caldesmon and desmin may throw more light.

Agree.

My vote is for myopericytoma.

Will go with angioleiomyoma.

I favor myopericytoma.

Myofibroma/myopericytoma spectrum. 

I opted for myopericytoma. This is an uncommon tumour in my experience, and this was an unusual anatomical location in a recent case. The staghorn-like vessels (haemangiopericytoma-like), concentric arrangement around vessels, and also the cytology with cells showing slightly tapered ends rather than the blunt ends (cigar-shaped) of typical smooth muscle cells.

But this case certainly seems to be very much on the spectrum with angioleiomyoma. Indeed there is some patchy Desmin positivity, albeit significantly less than the SMA and H-Caldesmon. See immunos below.

There is a recent large case series published on myopericytoma Myopericytoma: A Review of Twenty-Three Cases Over Twelve Years and a Case Report of a Rare Neoplasm - PubMed (nih.gov)

The authors again allude to the spectrum of tumours which can overlap with myofibroma as well as angioleiomyoma, and some of the genetic data which further confirms that this is a muddy area.

BW, Saleem