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A 50-year-old man presented with an asymptomatic, 1.5 x 1.5 cm, dark-brown noduloplaque with a rubbery consistency (Fig. 1) on the lateral aspect of the left lower leg of uncertain duration. His general condition was healthy, and he did not recall any trauma or insect bite at this site. No similar skin lesions were found elsewhere and no lymphadenopathy was observed. The lesion revealed a nonencapsulated, but well-circumscribed, deep dermal nodule with several lymphoid aggregates and germinal center-like structures within the tumor and also at the periphery, when examined microscopically at scanning power (Fig. 2a). The epidermis showed no remarkable changes, except for basal hyperpigmentation. At higher power, a mixed inflammatory infiltrate composed of histiocytes, foamy histiocytes (Fig. 2b), lymphocytes, and abundant plasma cells (Fig. 2c) with Russell bodies was revealed. The stroma contained mainly hyalinized and sclerotic collagen fibers (Fig. 2d). Prominent venules were noted, especially in the sclerotic areas, and some were surrounded by dense collagen fibers. No vasculitis or emperipolesis was found. No foreign materials were observed by polarization microscopy, and no organisms could be identified by periodic acid-Schiff (PAS), Grocott methenamine silver (GMS), Giemsa, Gram, acid-fast, or fite stains. The results of testing for infection by Epstein-Barr virus (EBV) (latent membrane protein 1, LMP-1) were negative. No spindle cells were found in the lesion. Immunohistochemical studies demonstrated mature plasma cells stained with CD138, and polyclonality was confirmed by the expression of both kappa and lambda light chains. The germinal center-like lymphoid aggregates were found to be B cells, which reacted positively with CD20. Scarce S100-positive cells and even rarer CD1a-positive cells were detected. Test results for smooth muscle actin (SMA) and anaplastic lymphoma kinase (ALK) were negative. Abundant CD68+ macrophages were observed within the lesion (Fig. 3a), and about 50-75% of the inflammatory cells were found to express cyclooxygenase-2 (COX-2) (Fig. 3b). The patient's condition was diagnosed as cutaneous plasma cell granuloma (CPCG). One year after excision, no evidence of recurrence was observed.
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PMID:Cutaneous plasma cell granuloma: report of a case with novel histologic and immunohistochemical findings. 1933 29

The purpose of this study was to investigate the expression of platelet-derived growth factor receptor-alpha (PDGFR-alpha) in the myofibroblasts of corneas with stromal haze. Central corneal sections from rabbit eyes that had -9 diopter PRK were analyzed by immunocytochemistry (IHC) for the expression of PDGFR-alpha at 4 week after surgery. PDGFR-alpha was expressed immediately beneath the epithelial basement membrane in the anterior stroma. Double IHC studies revealed the expression of PDGFR-alpha in the anterior stroma co-localized with alpha-smooth muscle actin (SMA) marker for myofibroblasts. In vitro studies have suggested that PDGF is important in the development and viability of myofibroblasts after corneal injury. Expression of PDGFR-alpha in myofibroblasts supports these findings.
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PMID:Expression of PDGF receptor-alpha in corneal myofibroblasts in situ. 1934 13

The purpose of the study was to examine the specific features of morphological manifestations and molecular mechanisms of controlling the processes of proliferation, apoptosis, cell differentiation, neoangiogenesis, and fibrosis, which result in lung tissue rearrangement in different types of idiopathic fibrosing alveolitis (IFA). Open and transbronchial biopsy specimens obtained from 103 patients with IFA and intact lung tissue biopsy specimens taken from those clinically diagnosed as having sarcoidosis as a control group were examined. The serial paraffin sections immunohistochemically revealed the following antigens: cytokeratins 5, 6, 7, 8, 19 (Uni-Heidelberg, DAKO), MMP 1, MMP 2, MMP 7, and TIMP 4, Apo-protein (Novocastra), Ki67, PCNA, PDGF, EGFR, CD34, SMA (smooth muscle actin), FGFb (LabVision). Biotin-conjugated antibodies to murine and rabbit immunoglobulins (Dako LSAB + KIT, PEROXIDASE) were used as secondary antibodies. The nuclei were stained with hematoxylin. Positive and negative control tests were carried out. The results of immunohistochemical tests were estimated in percentage of cells showing positive reactions (Ki67, PCNA), as well as those of a semiquantitative analysis in scores and statistical analyses (Mann-Whitney U-test, Fisher's test, and Spearman's rank correlation coefficient) were employed. OIP was ascertained to differ from other IFA in higher values of the cytokines under study, as well as in the predominant rearrangement of the lung interstice and dysregeratory epithelial changes at the site of respiratory bronchiolar transformation. At the same time there was an intensive proliferation of the epithelium and stromal cells (high expression of PCNA, PDGF by hyperplastic alveolocytes, alveolar macrophages, fibroblasts and myofibroblasts), and neogenesis (the high density of newly formed vessels with endothelial expression of CD34). Elevated alveolocytic apoptosis (from Apo-protein expression) was also observed. Cell proliferation and neoangiogenesis was attained by high MMPs expression. The practical value of the study is that the expression of the study markers may serve as a criterion for differential diagnosis and determination of prognosis in different types of IFA.
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PMID:[Molecular bases for the development of variants of idiopathic fibrosing alveolitis]. 1951 52

Inflammatory myofibroblastic tumor of the liver is an uncommon lesion of uncertain pathogenesis that has a unique histological appearance. Symptomatology and clinical findings in most cases suggest malignancy, and despite the advances in imaging techniques, the preoperative diagnosis of this tumor is difficult. We describe herein a case of inflammatory myofibroblastic tumor of the liver with a review of the literature. A mass occupying the right lobe of the liver was excised in a 48-year-old woman, who previously presented with weakness, fever, progressive weight loss, and right upper abdominal pain. The lesion was an unencapsulated light brown tumor (largest diameter 6 cm) without necrosis or hemorrhage. The characteristic histopathological features and the presence of spindle cells expressing smooth muscle actin and anaplastic lymphoma kinase allowed the diagnosis of inflammatory myofibroblastic tumor. The present case and the review revealed that inflammatory myofibroblastic tumor of the liver is not limited to younger age groups and males. Moreover, the rare occurrence of inflammatory myofibroblastic tumor of the liver and the lack of diagnostic clinical signs and symptoms do not exclude consideration of inflammatory myofibroblastic tumor in the differential diagnosis of liver tumors, especially in patients with tumor markers in normal ranges.
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PMID:Inflammatory myofibroblastic tumor of the liver: a case report. 1953 46

Breast cancers of basal phenotype have been identified by molecular profiling and are associated with a poor prognosis. This review describes the morphological characteristics of these tumors and focuses on their profiling using immunohistochemistry: absence of detectable hormone receptors and HER2, expression of basal cytokeratins (CK5/6, CK14), myoepithelial markers (p63, smooth muscle actin) and HER1. This phenotype may be encountered in all histological types of breast cancer and is further divided into three subtypes according to prognosis and protein profiling. Pure basal and basal/myoepithelial subtypes have a poor prognosis in contrast to the myoepithelial subtype.
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PMID:[Basal-like breast cancer: a review]. 1961 22

A great majority of gastric mesenchymal tumors are gastrointestinal stromal tumor (GIST). A rare group of non-GISTs include myxoid mesenchymal neoplasms. In this report, we describe 12 cases of a distinctive gastric tumor, named here as plexiform fibromyxoma. These tumors occurred in 5 men and 7 women of ages 7 to 75 years (median, 41 y). All tumors were located in the gastric antrum and 6 of them also extended into extragastric soft tissues or into the duodenal bulb. The tumors measured from 3 to 15 cm (median, 5.5 cm). Histologically typical was a plexiform intramural growth with multiple micronodules containing paucicellular to moderately cellular myxoid to collagenous and fibromyxoid neoplastic elements. A prominent, sometimes plexiform capillary pattern was typically present. Extramural components included subserosal nodules, and sometimes more cellular, solid nonplexiform spindle cell proliferation. The tumor cells varied from oval to spindled and had limited atypia and mitotic activity < 5/50 high-power fields. Frequent ulceration, mucosal invasion, and vascular invasion (4 cases) had no adverse significance in these tumors. Immunohistochemically, the tumor cells were positive for alpha smooth muscle actin, and variably for CD10, and were consistently negative for KIT, DOG1, CD34, desmin, and S100 protein. No KIT or platelet-derived growth factor receptor alpha mutations were present in the 3 examined cases. None of the 4 patients who were followed from 9 to 20 years (median, 19 y) developed recurrences or metastases. Additional 3 patients survived 14 to 25 years with unknown tumor status. Review of large numbers of mesenchymal tumors in the esophagus and intestines did not reveal similar tumors. Plexiform fibromyxoma is a distinctive benign gastric antral neoplasm that should be separated from GIST, nerve sheath tumors, and other fibromyxoid neoplasms.
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PMID:Plexiform fibromyxoma: a distinctive benign gastric antral neoplasm not to be confused with a myxoid GIST. 1967 52

Inflammatory myofibroblastic tumor is a distinctive lesion composed of myofibroblastic spindle shaped cells accompanied by inflammatory infiltrate that may arise in various organs. It is believed to be a noneoplastic inflammatory condition, although this is still controversial. The recognition of inflammatory myofibroblastic tumor as an entity is important especially to avoid unnecessary surgery. A few cases have been reported in the oral cavity. This report primarily presents a case of inflammatory myofibroblastic tumor that arose in the floor of mouth of a 23-year-old woman. The proliferating spindle cells were immunoreactive for vimentin, smooth muscle actin, and muscle specific actin and negative for desmin, AE1/AE3, S-100, CD68, MyoD1 and caldesmon. In an attempt to assess the potential neoplastic nature of this lesion, immunohistochemical expression of ALK protein was performed, although no immunoreactivity was detected. Also, the presence of well differentiated myofibroblasts identified by fibronectin is discussed, as well as the importance in establishing an immunoprofile to better consolidate the diagnosis. We conclude that the study of fibronectin in case series may aid the diagnosis as well as the prediction of the tumor course.
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PMID:Fibronectin as an adjuvant in the diagnosis of oral inflammatory myofibroblastic tumor. 1968 Jan 89

This report describes 3 cases of a distinctive, hitherto unreported gastric epitheliomesenchymal biphasic tumor that differs from other biphasic tumors of the stomach and elsewhere: carcinosarcoma, biphasic synovial sarcoma, teratoma, and mixed tumor. The tumors occurred in young adults, 2 males and 1 female, of ages 19, 27, and 30 years. Two tumors were located in the greater curvature in the gastric body and one in the antrum. The tumors measured 5, 6, and 15 cm in maximum diameter, and their mitotic rates were 0, 4, and 30 mitoses per 50HPF. There were 2 components: uniform oval or spindled cells in diffuse sheets, and clusters or cords of epithelial cells occasionally forming glandular structures with small lumens. The epithelial elements were positive for keratin cocktail AE1/AE3, keratin 18, and partly for keratin 7, but were negative for keratins 5/6, 20 and epithelial membrane antigen. The spindle cells were positive for vimentin and CD10. All components were negative for CD34, CD99, estrogen receptor, KIT, smooth muscle actin, desmin S100 protein, p63, calretinin, chromogranin, synaptophysin, CDX2, and thyroid transcription factor 1. In situ hybridization for SS18 rearrangement was negative in all cases separating this tumor from synovial sarcoma. All 3 patients were alive after follow-up of 3.5, 5, and 14 years. Because these tumors have some resemblance to blastomas of other organs, we propose the term "gastroblastoma" for this distinctive, at least low-grade malignant epitheliomesenchymal tumor of the stomach.
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PMID:A distinctive novel epitheliomesenchymal biphasic tumor of the stomach in young adults ("gastroblastoma"): a series of 3 cases. 1971 90

Reactive nodular fibrous pseudotumor (RNFP) of the gastrointestinal tract is a distinct benign lesion, which could originate from a reactive proliferation of multipotential subserosal cells. This is the first case to be reported in the stomach. It was fortuitously discovered in a 60-year-old man with history of bulbar ulcer and gastritis. Gross examination revealed three lesions in the gastric wall and an adjacent lesion in the lesser omentum. Histologically, lesions were composed of a proliferation of spindle and stellate cells in a dense collagenic hyalinized background containing a mononuclear cell inflammatory infiltrate with numerous lymphoid aggregates and plasma cells with perivascular disposition. Immunohistochemistry showed staining for cytokeratins (AE1/AE3), vimentin and smooth muscle actin, without staining for the neurofilament and S100 proteins, synaptophysin, calretinin, CD117 (c-kit), CD34, desmin, caldesmon or anaplastic lymphoma kinase (ALK-1). Complete excision was performed, and no evidence of disease was found 4 months later. After analysing clinical, morphological and immunohistochemical features of this entity, the main differential diagnoses will be discussed, including calcifying fibrous pseudotumor, which shares morphological characteristics with RNFP, but which immunohistochemistry and the ultrastructural study suggest that it may be a result of another reactive process.
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PMID:Reactive nodular fibrous pseudotumor: a first report of gastric localization and clinicopathologic review. 1976 86

Calcifying fibrous pseudotumor is a recently described rare entity. It is considered as sclerosing end stage of inflammatory myofibroblastic tumor. An association with hyaline vascular type Castleman's disease has also been described. We report a case of a 13-year-old boy who presented with pain in epigastrium. Computed tomography scan of abdomen revealed a circumscribed mass arising from the gastric wall along the greater curvature. Histology revealed a tumor composed of spindle cells present within the dense hyalinized collagenous tissue. Lymphoplasmacytic infiltrate was seen along with lymphoid follicles, dystrophic and ossifying calcification. Tumor cells were focally positive for alpha smooth muscle actin and negative for anaplastic lymphoma kinase protein.
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PMID:Calcifying fibrous pseudotumor in association with hyaline vascular type Castleman's disease. 1980 63


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