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Mesenchymal tumours of the thorax: CT findings and pathological features.

Mesenchymal tumours of the thorax are uncommon and may originate from the muscle, bone, cartilage, vessel, nerves, fat and fibrous tissue. These tumours occur at different sites including the lung, pleura, mediastinum or chest wall. Mesenchymal tumours tend to show protean and non-specific imaging characteristics. However, in some instances, the imaging characteristics of the tumour may allow a specific diagnosis to be made, such as with lipoid or vascular tumours.

Adolescent↗

Desmoid fibromatosis is a clonal process.

Desmoid fibromatosis is a locally aggressive proliferative soft tissue lesion of controversial nature. The authors investigated the clonality of this process by molecular genetic analysis of DNA methylation pattern at a polymorphic site at the human androgen-receptor gene (HUMARA) to examine the inactivation pattern of the X chromosome. Twenty desmoid fibromatoses including primary and recurrent lesions from 11 female patients were studied. Sixteen lesions from eight patients showed nonrandom X inactivation, consistent with a clonal origin and, therefore, a true neoplastic nature. Furthermore, multiple recurrent lesions from two patients exhibited the same inactivation pattern as the corresponding primary lesions, suggesting that they were derived from the same cell clone as the primary lesion. One patient was homozygous at the HUMARA locus, and two patients had the same skewed pattern in their normal and lesional tissues. The authors also found that digestion with HpaII, but not HhaI, failed to generate a nonrandom X inactivation pattern in some of the cases, suggesting that the methylation status at the HpaII sites was altered in some lesions, and that HhaI should be used to verify results and to avoid incorrect conclusions.

Adolescent↗

[Importance of immunohistochemistry of skin tumors].

Immunohistological demonstration of cell- and tissue-specific antigens in microscopic slides has remarkably influenced the classification of certain cutaneous neoplasms. The following markers are of particular interest in dermatopathology: cell surface antigens of lymphocyte subpopulations, intracytoplasmic immunoglobulins, intermediate filaments, neural markers, epithelial cell membrane antigens, and endothelial products. During the last years, these methods have contributed to our understanding of histogenesis and classification especially of cutaneous lymphomas, epithelial neoplasms, neurogenic tumors, and angiosarcomas.

Antibodies, Monoclonal↗

Imaging of benign and malignant soft tissue tumors of the neck.

Soft tissue tumors of the neck are a heterogeneous group of neoplasms arising from adipose, muscular, and fibrous tissue. With the exception of lymphomas, they account for only a small fraction of neck masses. Nevertheless, accurate diagnosis is important since the behavior of these neoplasms differs markedly from each other and from other head and neck masses. Noninvasive imaging, usually with CT and MR imaging, plays an important role in diagnostic evaluation and treatment planning for these tumors. In some cases, imaging features may be suggestive of a single entity. In most cases, imaging is needed to assess the location and extent of the tumor prior to biopsy or excision. This article discusses imaging techniques used for such assessment, the imaging features that help to separate these neoplasms from other head and neck tumors, and the behavior and imaging features of each of the more common benign and malignant soft tissue tumors that occur in the neck.

Diagnostic Imaging↗

Differential diagnosis of gastrointestinal stromal tumor and other spindle cell tumors in the gastrointestinal tract based on immunohistochemical analysis.

To confirm the usefulness of an immunohistochemical panel of antibodies for KIT (c-kit/CD117), CD34, desmin, smooth-muscle actin (SMA), h-caldesmon (HCD), S-100 protein, neuron-specific enolase (NSE), and beta-catenin, 297 mesenchymal and peripheral nerve-sheath tumors of the gastrointestinal tract and intra-abdominal locations including 211 gastrointestinal stromal tumors (GISTs), 12 leiomyomas, 18 leiomyosarcomas, 17 solitary fibrous tumors (SFTs), 14 schwannomas, and 25 desmoid-type fibromatoses (DTFs) were analyzed immunohistochemically. Consistent (100%) immunoreactivity for KIT, CD34, desmin and S-100, and nuclear accumulation of beta-catenin were detected in GISTs, SFTs, smooth-muscle tumors, schwannomas, and DTFs, respectively. Immunoreactivity for SMA, HCD, and NSE was observed in a wide range of these tumors. In addition, 418 bone and soft tissue tumors were enrolled in this study for KIT immunostaining. As a result, a limited number of these tumors were KIT positive, including synovial sarcoma that showed morphological similarity to GISTs. These findings suggest that KIT, CD34, desmin, S-100, and beta-catenin are key markers for clinical diagnosis of GISTs and other spindle cell tumors that may involve the gastrointestinal tract, whereas SMA, HCD, and NSE have only limited value.

Antigens, CD34↗

The immunohistochemistry of gastrointestinal stromal tumors. Evidence supporting an origin from smooth muscle.

To study the histogenesis of gastrointestinal stromal tumors, 79 cases were evaluated for desmin (DES), vimentin (VIM), and S-100 protein immunoreactivity by the avidin-biotin immunoperoxidase procedure on paraffin-embedded, Bouin's-fixed tissue sections. All tumors showed weak vimentin positivity. Trapped non-neoplastic smooth muscle and nerve twigs were often noted, particularly at the tumor periphery. Significant tumor S-100 positivity was not identified in our series. Similarly, glial fibrillary acidic protein (GFAP) immunoreactivity (performed in 11 desmin-negative tumors) was not detected within either gastrointestinal stromal tumors or enteric glial cells. Fifty-three percent (53%) of all gastrointestinal stromal tumors (GIST) displayed positive tumor cell desmin immunoreactivity. All 10 esophageal and all four colorectal tumors were diffusely desmin positive and unequivocal smooth muscle lesions. In contrast, only 17 of 37 (46%) benign and six of nine (67%) malignant gastric tumors were desmin positive. Similarly, four of 10 (40%) benign and one of nine (11%) malignant small-bowel tumors expressed desmin. Several gastric neoplasms with prominent nuclear palisading resembling schwannian Antoni A regions were nonetheless desmin positive. Epithelioid gastric tumors were more frequently desmin positive than nonepithelioid tumors; however, this positivity did not attain statistical significance. Two gastrointestinal stromal tumors that were desmin negative in paraffin-embedded material had detectable antigen in frozen sections. Gastric and small-bowel tumors measuring less than 3 cm were significantly more often desmin positive than those 3 cm or greater. We conclude that the method of fixation, tissue preparation, and immunostaining may significantly affect the expression of desmin. Although the histogenesis of gastrointestinal stromal tumors remains controversial, most of these tumors show evidence of smooth muscle differentiation.

Desmin↗

Neurogenic tumors of the skin.

A classification of peripheral nerve sheath tumors in the skin is based on analysis of light-, electron microscopy, immunohistochemistry and cellular composition of the different tumor types. Not only Schwann cells, but also perineurial cells and fibroblasts may be involved in tumor formation. Schwann cell rich and connective tissue cell rich tumors are distinguished. Generally all tumors show low proliferating activity as investigated by H3-Thymidine autoradiography. Only in few connective tissue cell rich tumors higher labelling indices can be demonstrated. These findings are correlated with the clinical course and prognosis of the different tumor types. The question remains, whether connective tissue cell rich tumors are at higher risk for malignant transformation.

Humans↗

Immunohistochemical analysis of soft tissue sarcomas. Comparisons with electron microscopy.

Soft tissue sarcomas are capable of causing diagnostic bewilderment for the surgical pathologist, because of their diversity of differentiation and overlapping histologic appearances. Immunohistochemical studies provide a means whereby this confusion can be resolved in many cases, and electron microscopy also may play a useful role in this process. This overview presents a summary of results of these 2 adjuvant modalities of pathologic analysis, as applied to the spectrum of malignant soft tissue neoplasms.

Humans↗