Intravascular papillary endothelial hyperplasia of the lower lip: surgical approach and review of the literature

Objective: A review of the literature for intravascular papillary endothelial hyperplasia is presented along with a case report of a geriatric patient. Review of the literature: Intravascular papillary endothelial hyperplasia (IPEH) is a reactive benign lesion of vascular origin, which is caused by an excessive proliferation of endothelial cells. Only a few cases with IPEH in the oral cavity have been recorded in the literature, reporting the lower lip as the main site. The treatment of choice mentioned in the literature is simple excision. Case report: In this case, an IPEH of the lower lip of a 79‐year‐old male was treated by a sclerosing agent, which was injected into the lesion, causing compression and fibrosis of the blood vessels, followed by a careful dissection and excision. Intra‐operatively no bleeding occurred. Post‐operatively an excellent aesthetic result was achieved, without recurrence. Conclusion: The use of sclerotherapy followed by surgery in mixed type intravascular papillary endothelial hyperplasia can provide an acceptable aesthetic result with minimal intra‐operative bleeding.     

Fine needle aspiration cytology of papillary endothelial hyperplasia. A case report.

BACKGROUND: Papillary endothelial hyperplasia is an intravascular or rarely extravascular proliferation of endothelial cells. It is considered an unusual form of thrombus organization. CASE: A 41-year-old, healthy male presented with a neck mass, which was aspirated. The cytomorphologic features were interpreted as consistent with squamous cell carcinoma. Subsequent workup failed to reveal a primary lesion, and the mass was surgically excised. Histopathology showed papillary endothelial hyperplasia associated with a hematoma. Immunocytochemical staining for factor VIII-related antigen on a destained, alcohol-fixed smear from the fine needle aspirate confirmed the endothelial nature of the cells. CONCLUSION: A vascular lesion should be considered in a fine needle aspiration biopsy of a head and neck mass, in particular when the clinical features are not consistent with a metastatic malignancy. The absence of cytoplasmic orangeophilia and immunoreactivity for factor VIII-related antigen may be helpful in establishing the diagnosis.     

Visual impairment from fibrous dysplasia in a middle-aged African man: a case report

Introduction

Fibrous dysplasia is a benign tumour of the bones and is a disease of unknown aetiology. This report discusses a case of proptosis and visual deterioration with associated bony mass involving the right orbit.

Case presentation

A 32-year-old Nigerian man of Yoruba ethnic origin presented to the eye clinic of our hospital with right-eye proptosis and visual deterioration of 7-year duration. Presentation was preceded by a history of trauma. Proptosis was preceded by trauma but was non-pulsatile with no thrill or bruit but was associated with bony orbital mass. The patient reported no weight loss. Examination of his right eye showed visual acuity of 6/60 with relative afferent pupillary defect. Fundal examination revealed optic atrophy. Computed tomography showed an expansile bony mass involving all the walls of the orbit. The bony orbital mass was diagnosed histologically as fibrous dysplasia. Treatment included orbital exploration and orbital shaping to create room for the globe and relieve pressure on the optic nerve.

Conclusion

Fibrous dysplasia should be considered in the differential diagnosis of slowly developing proptosis with associated visual loss in young adults.

     

Orbital tumors in children

Unilateral proptosis in a young child can often be the presenting sign of an orbital mass. Appropriate management of these lesions requires a thorough knowledge of the types of orbital tumors which may present in the pediatric age group, as well as knowing the most appropriate work-up necessary to obtain an accurate diagnosis. This paper will describe a case of a 13-year-old African-American female who presented with uniocular proptosis, blackouts of her vision, dull aching pains in certain positions of gaze, resistance to retropulsion, and mild disc edema. An orbital mass was confirmed following a work-up which included an ultrasound of the orbit and a CT scan. The differential diagnoses included an orbital hemangioma or schwannoma. A diagnosis of a schwannoma involving the orbit was made following surgical removal of the lesion. A review of common orbital tumors seen in children will be presented in addition to the appropriate work-up and management of these lesions.     

Masson’s tumor of the kidney: a case report

Background

Intravascular papillary endothelial hyperplasia (known also as Masson’s tumor) is a benign vascular lesion that commonly occurs in the skin and is rarely found in solid organs, especially in the kidney. In what follows, we will look into the first case of an unexpectedly diagnosed Masson’s tumor of the kidney presenting as a suspicious renal cyst.

Case presentation

A 61-year-old Arab man presented with a left renal cyst, incidentally revealed by ultrasonography. The laboratory values were unremarkable. Computed tomography and magnetic resonance imaging demonstrated a 38 mm left renal midportion Bosniak IV cyst. Our patient underwent a radical nephrectomy. Histopathology revealed the diagnosis of intravascular papillary endothelial hyperplasia. There was no recurrence detected after 9 years of follow-up.

Conclusions

Renal intravascular papillary endothelial hyperplasia is a rare benign tumor which can mimic a suspicious renal mass on radiological findings. Thus, this entity should be considered more often in the thick of the diagnostic possibilities in order to avoid unnecessary nephrectomies.

     

Orbital mass in a cancer patient: is this metastatic disease?

The most common signs and symptoms of an orbital mass include proptosis, diplopia and choroidal folds. Laboratory testing, ultrasonography, neuro-imaging and in some cases surgical biopsy is required to make an accurate diagnosis of an orbital mass. In this case, a 45-year-old male presented with unilateral proptosis and a prior history of rectal carcinoma. It was not until the surgical biopsy was completed that the mass was revealed to be a hematoma with no evidence of malignancy.     

Orbital Rosai-Dorfman disease: report of a case with fine needle aspiration cytology and histopathology

BACKGROUND: Rosai-Dorfman disease, or sinus histiocytosis with massive lymphadenopathy (SHML), is a rare, nonhereditary, benign histiocytic proliferative disorder, affecting mainly the lymph nodes. Orbital involvement in the absence of lymphadenopathy is relatively uncommon. CASE: A 50-year-old woman presented to our hospital with gradual proptosis of the left eye for 5 years. Physical examination revealed no abnormalities, including lymphadenopathy. Ultrasonography and magnetic resonance imaging showed a soft tissue mass in the intraconal retroorbital region of the left eye. Fine needle aspiration cytology of the mass yielded a good number of mature lymphocytes, a few neutrophils, plasma cells and many histiocytes exhibiting emperipolesis. A provisional diagnosis of SHML was suggested and later confirmed by histology of the excised mass. CONCLUSION: Though the orbit is a rare site of extranodal SHML, the disease should be entertained in the differential diagnosis of orbital swellings. To the best of our knowledge, this is the fourth case of SHML involving the orbit exclusively, with no nodal involvement.     

Cytologic diagnosis of metastatic hepatocellular carcinoma presenting as an orbital mass. A case report

BACKGROUND: Hepatocellular carcinoma (HCC) metastasizing to the orbit is extremely rare. In the 13 cases reported in the English-langnage literature, the diagnosis was confirmed by fine needle aspiration (FNA) cytology only once. This is the second such case to be diagnosed by FNA cytology and the first to be reported from the Indian subcontinent. CASE: A 76-year-old woman presented with progressive proptosis, bulging of the globe and loss of vision in the right eye. Clinical and radiologic evidence favored a primary orbital tumor with liver metastasis. Cytologic examination of aspirated material from the orbital and liver masses showed features similar to those of HCC. CONCLUSION: Recognition of the cytologic features of HCC permits its diagnosis in metastatic sites. FNA can be employed as an effective tool for diagnosing HCC at metastatic sites, especially when biopsy is technically difficult.     

Orbital lymphangioma

In summary, we have presented a patient with an uncommon disorder, orbital lymphangioma, with an equally uncommon outcome, restoration of normal visual acuity and ocular motility following total surgical excision. High-resolution axial thin-slice CT scanning with paraxial re-formations was used for preoperative assessment and surgical planning in the case of this 5 1/2-year-old boy with probable lymphangioma of the orbit. The tumor became symptomatic following minor local trauma. Complete excision was possible without impairment of visual or extraocular motor function.     

Papillary endothelial hyperplasia of the orbit: report of a case highlighting a pitfall on fine needle aspiration biopsy

BACKGROUND: Papillary endothelial hyperplasia (PEH) is an unusual form of thrombus organization that occurs predominantly in the extremities, including the head and neck. However, it is rare in the orbit/ocular region. Although the histologic features of PEH have been well described, the cytologic diagnosis remains difficult. CASE: A 63-year-old man presented with a left intraorbital mass that was increasing in size and associated with paresthesia and a recent history of excision of squamous cell carcinomas (SCC) from his left cheek. Fine needle aspiration biopsy (FNAB) yielded very limited material, predominantly blood. However, 1 Papanicolaou-stained slide showed groups of atypical cells with scanty but dense cytoplasm and large, hyperchromatic nuclei with prominent nucleoli. SCC was favored, and excision was performed. Histology showed PEH within an assumed cystic lymphangioma, associated with inflammatory and fibrotic change in the compressed supraorbital nerve. CONCLUSION: To our knowledge this is the third report on the cytology of PEH and the first report of FNAB in PEH of the orbit. The case was also unusual as it was the second metachronous PEH in the patient.     

The longitudinal orbital CT projection: a versatile image for orbital assessment

The newer generation of CT scanners allows reconstruction of images in coronal, sagittal, and oblique planes from a single set of axial scans. These computer-generated images are described as reformatted. We have found an oblique image reformatted along the plane connecting the apex of the orbit and the center of the globe to be especially useful in assessing orbital disorders. We have named this image the longitudinal orbital projection. This projection allows direct visualization of the inferior rectus muscle and orbital floor in acute and old orbital trauma. With the image produced life size, direct measurements of enophthalmos and proptosis can be made preoperatively and postoperatively, thereby facilitating planning and follow-up. The projection is also useful in combination with other planes of reformation for the localization of tumors. The longitudinal orbital projection is now a routine part of the CT examination of the orbit in our institution. Whereas it already has become an invaluable aid in the diagnosis and follow-up of congenital and acquired orbital lesions, the longitudinal orbital projection promises to clarify the effects of trauma on the inferior rectus muscle and globe position.     

Orbital ectopic lacrimal gland tissue simulating a neoplasm. Report of a case with fine needle aspiration biopsy diagnosis.

A case occurred of sclerosing chronic dacryoadenitis in lobules of ectopic lacrimal gland tissue diagnosed by fine needle aspiration biopsy performed under computed tomographic guidance. This choristomatous lesion caused unilateral proptosis and clinically simulated a neoplasm. This is the first report of cytologic diagnosis of orbital ectopic lacrimal gland tissue using fine needle aspiration biopsy. The potential hazard of regarding glandular inclusions derived from inadvertent use of a needle on a normal lacrimal gland or glands as indicating metastatic neoplasms is stressed.     

鼻部固定型孢子丝菌病1例

报道1例猫抓后引起的固定型孢子丝菌病.患者男,16岁,皮损表现为鼻翼部位的增生物,其上覆有脓痂.临床上易与细菌感染混淆,但根据患者的病史、临床表现、病理、真菌镜检及培养诊断为申克孢子丝菌引起的孢子丝菌病.患者在应用7个月的碘化钾结合特比萘芬软膏外用治疗后,皮损完全消失.     

Fine needle aspiration findings in angiofollicular hyperplasia with eosinophilia: a case report

BACKGROUND: Angiolymphoid hyperplasia with eosinophilia (ALHE) is an uncommon vascular inflammatory lesion usually involving the dermis or subcutaneous tissue of the head-neck region of middle-aged women. Histologically, this lesion shows a florid proliferation of vessels lined by particular endothelial cells and an inflammatory infiltrate composed of lymphocytes and eosinophils. CASE: A 30-year-old woman presented with multiple periauricular skin nodules. Fine needle aspiration cytology shows a mixed population of lymphoid cells with an admixture of eosinophils and large cells with vesicular nuclei and prominent nucleoli. A diagnosis of AHLE was confirmed on histopathologic examination. CONCLUSION: Various conditions, both benign and malignant, may mimic Kimura's disease clinically and on smears. These must be ruled out before making a diagnosis of Kimura's disease. The cytologic features of Kimura's disease have to be interpreted in the appropriate clinical setting in order to make a correct preoperative diagnosis.     

Fine needle aspiration cytologic findings of micropapillary carcinoma in the lung: a case report

BACKGROUND: Micropapillary carcinoma is a variant of adenocarcinoma described in many anatomic sites and most recently in the lung. The cytologic recognition of this distinct pathologic entity in transthoracic needle aspiration specimens is important in providing prognostic information and therapeutic guidance. CASE: A 58-year-old woman presented with a < 1-cm lesion in the left breast identified on screening mammogram. A core biopsy of this lesion revealed an estrogen and progesterone receptor positive tubular carcinoma. Before a hookwire localization biopsy, a chest x-ray revealed a 1.7-cm spiculated mass in the right lower lobe. The diagnosis of adenocarcinoma with micropapillary features was made by fine needle aspiration cytology (FNAC). The lobectomy specimen showed a combination of adenocarcinoma, papillary adenocarcinoma and micropapillary carcinoma. CONCLUSION: Micropapillary carcinoma is a unique variant of adenocarcinoma, having important clinical associations because of its propensity for angiolymphatic invasion and higher stage at disease presentation. This case demonstrates the cytomorphologic characteristics of micropapillary carcinoma in a transthoracic FNA of the lung.     

Fine needle aspiration cytology of sclerosing lobular hyperplasia of the breast: a case report

BACKGROUND: Sclerosing lobular hyperplasia presenting as a palpable, circumscribed nodular mass in a young female's breast is characterized histologically by prominent hyperplasia of the lobules and sclerosis of the intralobular connective tissue. The cytomorphologic features and differential diagnosis of the lesion are presented. CASE: A 14-year-old female presented with a painless, progressively increasing, nodular, firm, mobile lump measuring 5 x 5 cm in the right breast. The clinical and radiologic diagnosis was fibroadenoma. Fine needle aspiration smears showed a clean background with uniform, round to oval epithelial cells in flat sheets, round clusters and rosettelike (acinar) arrangements. A few naked nuclei were present, while stromal fragments were not seen. CONCLUSION: When analyzed in the context of the clinical findings, the cytologic features of sclerosing lobular hyperplasia help to differentiate it from other benign palpable nodular lesions of the juvenile breast.     

Juvenile pilocytic astrocytoma of the optic nerve diagnosed by fine needle aspiration biopsy

Fine needle aspiration biopsy of an orbital mass was performed under CT guidance in a nine-year-old boy presenting with rapidly increasing proptosis of the right eye with lateral displacement and no light perception. The cytologic findings consisted of bipolar astrocytes with cytoplasmic fibrillated processes intermingled with Rosenthal fibers. A cytologic diagnosis of juvenile pilocytic astrocytoma was advanced; this was confirmed by subsequent histologic study of the surgical specimen. The differential diagnosis among juvenile pilocytic astrocytoma, neurilemmoma and meningioma of the optic nerve are discussed.     

Papillary Carcinoma of the Thyroid with Fibromatosislike Stroma: Case Report and Review of Literature

ObjectiveTo describe a case of papillary carcinoma of the thyroid with fibromatosislike stroma, emphasize the need for a diligent search for papillary thyroid cancer in the presence of a fibroproliferative lesion, highlight the peculiar hormonal response of the stromal component, and review the pertinent literature.MethodsWe present the clinical, laboratory, radiologic, and pathologic findings in a patient with papillary carcinoma of the thyroid with fibromatosislike stroma and review the related published material.ResultsA 29-year-old woman presented to our surgical department because of a large mediastinal mass. She underwent surgical removal of the mass by means of a median sternotomy and neck extension. Pathology examination revealed macroscopically tan scarlike tissue, which by histologic study consisted of a dominant fibroproliferative lesion overshadowing a minor component of papillary carcinoma of the thyroid. Further neck exploration with total thyroidectomy revealed multifocal papillary carcinoma of the thyroid. Postoperatively, the patient received radioiodine treatment. A local and aggressive recurrent tumor was observed during a subsequent pregnancy; the lesion was not amenable to complete resection but fascinatingly responded to antiestrogen therapy (orally administered tamoxifen).ConclusionThe presence of a fibroproliferative lesion could be misleading. A diligent search should be made for a papillary thyroid carcinoma component within fibromatosislike stroma. The mode of manifestation of the tumor and its response to hormonal manipulation are distinctive features of this case. (Endocr Pract. 2010;16:650-655)     

Ectopic lesions as potential pitfalls in fine needle aspiration cytology: a report of 3 cases derived from the thyroid, endometrium and breast

BACKGROUND: Ectopic lesions are rarely encountered. Those that are derived from thyroid, breast, endometrium and salivary glands present with palpable masses that can mimic malignancy. Fine needle aspiration cytology (FNAC) is a practical procedure for the differential diagnosis of such lesions but can reveal surprising images for a cytopathologist. CASES: Three cases of discrete, ectopic lesions at different locations occurred. Case 1 was a 27-year-old woman. Upon diagnosis of a submandibular mass with a diameter of 1 cm, FNAC was performed. The smears showed crowded thyroid follicular cells comprising papillary clusters. A cytologic diagnosis of papillary thyroid lesion was rendered, Histopathology revealed that this lesion was ectopic thyroid tissue with focal chronic thyroiditis. Case 2 was a 38-year-old woman who presented with a painful mass with a diameter of 2.5 cm in the abdominal wall. The patient had undergone cesarean section 3 years earlier. The case was diagnosed on FNAC as low grade malignancy in which an adenocarcinoma/mesenchymal tumor distinction could not be made. The pathologic examination revealed endometriosis. Case 3 was a 31-year old woman who presented with a palpable nodule in the axillary region with a diameter of 1 cm. The patient had given birth 1 month earlier and was nursing. An FNAC diagnosis of lactation ectopic breast tissue was made. The mass disappeared by the end of lactation. CONCLUSION: FNAC of ectopic lesions may prove to be a diagnostic pitfall for cytopathologists. A cytopathologist who encounters a cellularpicturefrom a lesion that is outside the normal anatomic location must use a cautious diagnostic approach. Unless there are clear findings, the cytopathologist must refrain from a diagnosis of malignancy.     

Clinicopathological features and the value of differential Cytokeratin 7 and 20 expression in resolving diagnostic dilemmas of ovarian involvement by colorectal adenocarcinoma and vice-versa

Introduction

Intravascular lesions of the hand comprise reactive and neoplastic entities. The clinical diagnosis of such lesions is often difficult, and usually requires pathologic examination. We present the largest series to date of intravascular lesions affecting the hand.

Methods

A retrospective review of intravascular (arterial and venous) lesions involving the hand was conducted. Data regarding clinicopathologic findings were analyzed.

Results

We identified 10 patients with intravascular lesions of their hands including thromboemboli (n = 3), reactive intravascular conditions such as papillary endothelial hyperplasia or Masson's tumor (n = 2) and fasciitis (n = 1), as well as vascular neoplasms including pyogenic granuloma (n = 2) and angioleiomyoma (n = 2).

Conclusion

Blood vessel injury and/or venous thrombosis may predispose to several intravascular lesions of the hand. Recognition of reactive entities from neoplastic conditions is important.