Four Cases of Pseudosarcomatous Carcinoma of the Larynx / 대한이비인후과학회지

Pseudosarcomatous carcinoma is a kind of squamous cell carcinoma having biphasic pattern, with both squamous and spindle cell components. Pseudosarcomatous carcinoma of head and neck mucosa is a very rare high-grade malignancy that may cause diagnostic and therapeutic controversies. The tools used for diagnosing pseudosarcomatous carcinoma are histopathological analysis and immunohistochemical analysis. We experienced four cases, a 60-year-old male patient with pseudosarcomatous carcinoma located at the left false vocal fold, a 68-year-old female patient with the same carcinoma located at both false vocal folds, 73-year-old male patient with the same carcinoma at the epiglottis, and a 69-year-old male patient with the same carcinoma at the left true vocal fold. We report these four cases with a brief review of literatures.

A Case of Proliferative Fasciitis of the Cheek / 대한피부과학회지

Proliferative fasciitis is a rare, rapidly growing, pseudosarcomatous nodule of subcutaneous tissue. It commonly occurs on the extremities. Lesions on the head and neck are exceedingly rare. Histopathologically, it is characterized by several large basophilic ganglion-like cells deposited in a myxoid stroma with spindled cells. Herein, we report a case of a 54-year-old man who noticed a nodule on his right cheek about six months before examination. At first, its size abruptly increased, and then remained without any change in size. Microscopically, many basophilic ganglion-like cells and spindled cells were deposited in a myxoid stroma. Immunohistochemically, ganglion-like cells and spindled cells were strongly positive for vimentin and weakly positive for smooth muscle actin and CD68. Although it was not radically excised, the lesion has not been found for 3 months.

A Case of Nodular Fasciitis / 대한피부과학회지

Nodular fasciitis is an uncommon nonneoplastic swelling consisting of reactive fibroblastic proliferation occurring in the subcutaneous tissue of the extremities. It is characterized by benign clinical course and aggressive histologic features mimicking soft tissue sarcoma, Herein we report a 33-year-old man with a solitary, tender, 1.2 X 1.5cm sized hard nodule on the right forearm which clinically and histologically shows a typical nodular fasciitis.

A Case of Nodular Pseudosarcomatous Fasciitis / 대한피부과학회지

Nodular pseudosarcomatous fasciitis is characterized as rapidly growing benign tumor with microscopically resembling sarcoma in the upper extremities, especially forearms. Most lesions are located in the subcutaneous tissue, although these may also be found intramuscularly, with the involvement of the adjacent fascia or periosteum and dermis.

Thymoma with Pseudosarcomatous Stroma

Thymoma with psuedosarcomatous stroma is a recently described, rare variant of thymomas that are characterized by having a biphasic histologic pattern which consists of both an epithelial and a spindle cell stromal component. So far only 11 cases having similar histologic findings have been reported world wide. At this time we report a case of this rare variant of thymoma which occurred in a 53-year-old Korean man. This previously healthy patient presented with coughing and an anterior mediastinal mass was then detected radiographically. Mediastinal exploration revealed a 9 x 8 x 8 cm-sized well- encapsulated, ovoid, cystic mass. Histological examination showed a biphasic neoplasm composed of anastomosing nests of epithelial cells and somewhat cellular stromal spindle cells that had advanced degenerative changes. Immunohistochemical staining using the antibodies for cytokeratins, EMA, e-cadherin, and p75NGFR showed a strong expression of these markers in the epithelial component but no expression in the spindle stromal cells. The epithelial tumor cells showed no reactivity to CD5 and L26 and a high proportion of the infiltrated lymphocytes were the cortical type that expressed CD99 and terminal deoxynucleotidyl transferase. Ultrastructural examinations revealed tonofilaments in the spindle cells. Follow up has been done for 5 years after the surgical excision and the patient has been free of disease during that period. Similar to previous reports, this patient had a benign clinical course that was unassociated with myasthenia gravis which appears to be a characteristic of this histologic variant of thymoma. However, our case also showed advanced degenerative features and we could demonstrate ultrastructural evidence of epithelial differentiation in the stromal spindle cells that were not mentioned in the previously reported cases. Based on the results of our studies, we suggest this entity is a distinct type of organotypic thymoma that shows cortical differentiation and abundant cellular stroma.

Pseudosarcomatous tumor of urinary bladder.

The first case in Thailand ofpseudosarcomatous tumor of the urinary bladder is reported. A 32-year-old female, presented with gross hematuria and dysuria. Cystoscopy showed large mass floating in the bladder and biopsy of the tumor showed to be leiomysarcoma. IVP was normal but CT scanning showed huge mass occupied the whole bladder and invasion outside the anterior wall was suspected. The bladder was explored and the tumor with part of the bladder around the tumor’s stalk was resected. A microscopic section revealed spindle cell proliferation exhibiting mitotic activity within myxoid stroma. The election microscopic finding showed myofibroblast. The final diagnosis was pseudosarcomatous fibromyxoid tumor. The patient was followed up for 5 years and no evidence of recurrence has been detected.

Pseudosarcomatous Variant of Transitional Cell Carcinoma of the Renal Pelvis

We report a case of pseudosarcomatous variant of transitional cell carcinoma of the renal pelvis which showed grossly and microscopically the distinct biphasic growth patterns. Grossly, most part of the tumor showed solid growth protruding into the renal pelvic cavity as well as infiltrating into the parenchyma of lower pole. The overlying pelvic mucosa was replaced by a diffuse, papillary transitional cell carcinoma, and the solid mass was composed of pleomorphic spindle cell sarcomatoid component with frequent myxoid change and a few foci of osteoid deposit. Ultrastructural study of the spindle cells revealed epithelial differentiation featured with rich cytoplasmic organelles, basal lamina and basement membrane-like structures, although immunohistochemistry failed to detect epithelial differentiation.

A Case of Nodular Pseudosarcomatous Fasciitis / 대한피부과학회지

Nodular pseudosarcornatous fasciitis is a benign, fibrohlastic proliferative disease. This case report is one of a hard nodule which a 35-year-old male suddenly discovered on his right forearm 10 days prior to being aeen. The nodule showed characteristic histological findings of nodular pseudosarcomatous fasciitis.