Pseudosarcoma de Kaposi tipo Mali unilateral en paciente con insuficiencia venosa crónica / Unilateral Mali-type Pseudo-Kaposis sarcoma in a patient with chronic venous insufficiency

Introducción: La insuficiencia venosa crónica es el conjunto de síntomas y signos derivados de una hipertensión venosa en los miembros inferiores debido a un mal funcionamiento valvular de los sistemas venosos. Se han asociado varias complicaciones a esta entidad, una de ellas es el pseudosarcoma de Kaposi, enfermedad rara y caracterizada por una proliferación reactiva vascular, con lesiones cutáneas similares a las del sarcoma de Kaposi. Objetivo: Describir el proceso diagnóstico de una paciente con pseudosarcoma de Kaposi tipo Mali unilateral como complicación de la insuficiencia venosa crónica. Presentación del caso: Se presenta una paciente femenina, piel blanca, de 51 años de edad, con lesiones cutáneas de aproximadamente 9 años de evolución, tipo placas eritematomarronáceas y papuloescamocostrosas, en el miembro inferior derecho, que progresivamente fueron extendiéndose; la paciente presentaba además insuficiencia venosa crónica. Se diagnosticó pseudosarcoma de Kaposi tipo Mali unilateral, teniendo en cuenta, fundamentalmente, los antecedentes patológicos personales, el examen clínico realizado, la biopsia de la lesión, la inmunohistoquímica para anticuerpos CD 34 y el dúplex venoso de miembro inferior derecho. Se indicó terapia compresiva de la extremidad y ungüento esteroideo en lesiones, con mejoría de estas. Conclusiones: Una de las complicaciones asociadas a la insuficiencia venosa crónica es el pseudosarcoma de Kaposi. En esta rara entidad cutánea el estudio histopatológico y la inmunohistoquímica desempeñan un papel muy importante para su correcto diagnóstico y diferenciación del sarcoma de Kaposi, principal diagnóstico diferencial a tener en cuenta(AU)

Introduction: Chronic venous insufficiency is the set of symptoms and signs derived from venous hypertension in the lower limbs due to a valvular malfunction of the venous system. Several complications have been associated with this entity; one of them is Pseudo-Kaposi's sarcoma, a rare disease characterized by reactive vascular proliferation with skin lesions similar to those of Kaposi's sarcoma. Objective: To describe the diagnostic process of a patient with unilateral Mali-type Pseudo-Kaposi's sarcoma as a complication of chronic venous insufficiency. Case presentation: Fifty-one-year-old white female patient with about 9-year history of brownish erythematosus-type and squamous, crusty plaque-like skin lesions in the right lower limb that were progressively extending. The patient also presented chronic venous insufficiency. Unilateral Mali-type Pseudo-Kaposi's sarcoma was diagnosed, mainly considering the personal pathological antecedents, the clinical examination performed, the biopsy of the lesion, the immunohistochemistry for CD34 antibodies and the venous duplex imaging of the right lower limb. Compressive therapy of the limb and steroid ointment was indicated for the lesions, with improvement of the condition. Conclusions: Pseudo-Kaposi's sarcoma is one of the complications associated with chronic venous insufficiency. In this rare skin entity, the histopathological study and immunohistochemistry play a very important role in the correct diagnosis and differentiation of Kaposi's sarcoma, being this the main differential diagnosis to take into account(AU)

Proliferative Myositis on the Tongue / 대한피부과학회지

Proliferative myositis is a rare, benign, probably pseudosarcomatous fibroblastic proliferation that typically presents as a rapidly growing soft tissue mass. Its relative rarity, fast growth rate, and unique histopathologic findings may lead to misdiagnosis as a malignant lesion and unnecessary radical surgical excision. A 57-year-old female presented with a non-tender, well-defined, indurated, solitary, hard papule on the median sulcus of the tongue for 2 weeks. Histologic examination revealed numerous fibroblastic or myofibroblastic spindle cells and large ganglion-like cells infiltrating between and around the muscle fascicles. Immunohistochemical staining showed positivity for vimentin, smooth muscle actin, and CD68 and negativity for S-100. Based on these characteristic clinical findings and histopathologic features, the patient was diagnosed with proliferative myositis. Here, we report a rare case of proliferative myositis on the tongue and recommend considering proliferative myositis in the differential diagnosis when a physician encounters a rapidly grown soft tissue mass.

Pseudosarcoma laríngeo / Laryngeal pseudosarcoma

El pseudosarcoma de laringe es un tumor poco frecuente, sobre el cual hay gran controversia a causa de su histogénesis y comportamiento biológico, de ahí la variada nomenclatura que ha recibido. Es un tumor maligno, considerado de buen pronóstico por su evolución favorable tras tratamiento, su alta supervivencia y buena calidad de vida. Se expone un caso, en el que aparece la radioterapia como factor de riesgo …

The pseudosarcoma of larynx is an infrequent tumor, who presents a great controversy in its histogenesis and biological behaviour, which explains the varied nomenclature that it has received. It is a malignant tumor, considered of good prognosis because of its favourable evolution after treatment, its high survival and good life quality. We expose a case in which the radiotherapy seems to be risk factor…

A Case of Pseudosarcomatous Change of an Inflammatory Colon Polyp Associated with Tuberculous Colitis / 대한소화기내시경학회지

"Pseudosarcomatous change" occurs when sarcoma-like atypical cell hyperplasia is grossly indistinguishable from malignant tumor. Pseudosarcoma often exists in those areas of the gastrointestinal track where ulcer or erosion commonly takes place. This may indicate atypical granulomatous cell proliferation during a period of healing, as well as benign atypical change in the mesenchyme due to chronic inflammatory reaction. Both the visual appearance and intestinal involvement of tuberculous colitis are variable, and tuberculosis may result in reactive mesenchymal change associated with ulcer or polyp, which is that's induced by chronic inflammation. We report here on a case of a young female pulmonary tuberculosis patient who suffered with a pseudosarcoma of the ascending colon, and this was associated with tuberculous colitis. The patient underwent successful sugical resection. We report on this case, along with a review of the relevant literature.

A Case of Spindle Cell Carcinoma of the Esophagus / 대한소화기내시경학회지

Spindle cell carcinoma of the esophagus containing both carcinomatous and sarcomatous elements is rare, accounting for approximately 1- 2% of all esophageal neoplasms. Terms used to describe this lesion include carcinosarcoma, pseudosarcoma, polypoid carcinoma, pseudosarcomatous squamous cell carcinoma and spindle cell variant of squamous cell carcinoma. Spindle cell carcinomas were originally classified as carcinosarcomas or pseu- dosarcomas, depending on the morphology and bilologic behavior of the particular lesian. However, pseudosarcoma and carcinosarcoma appear to be the same pathologic entity with varying degrees of anaplastic spindle cell metaplasia of the carcinomatous portion of the tumor. Thus, these lesions have been clsssified together as spindle cell carcinomas. A 59 year-old man who experienced weight loss for 4 months was hospitalized as a result of suffering from dysphagia for 2 months. A diffuse bulky protruding mass with superficial ulceration and easy friability on 25 to 35 cm from the incisors, which invaded the right intermediate bronchus and involved the right paratracheal and subcarnial lymph nodes, were obsetved in esophagogram, endoscopy and chest CT. Pathologic finding, including immunoreactivity to cytokeratin and vimentin, was consistent with spindle cell carcinoma. We report a case of spindle cell carcinoma of the esophagus.

Esophagus, Stomach & Intestine; A Case of Carcinosarcoma of Esophagus / 대한소화기내시경학회지

More than 17 different terms, including carcinosatcoma and pseudosarcoma, have been applied to the rare polypoid tumors of the esophagus that demonstrate both carcinomatous and sarcomatous components. The multiplicity in terminology seems related to the uncertain histogenesis of these tumors. A demonstration of the ultrastructure of the spindle cells (containing desmosomes and tonofilaments) is consistent with an epithelial origin. The patient was a 53 year-old man who had suffered from dysphagia and foreign body sensation in larynx. Endoscopic finding was a large polypiod mass with ulceroinfiltrative lesion at the level of 27cm from the incisor. Pathologic findings were that the covering epithelium showed well differentiated squamous carcinoma with invasive pattern and the stroma contained islands of sarcoma and squamousl cell carcinoma. Immunoreactivity to cytokeratin was not observed. Partial esophagectomy and esophagogastrostomy was done. We report a case of rare malignant esophageal carcinosarcoma.

Decubitoma: A Pseudosarcoma in Decubitus: Report of a case

Decubitus ulcer is often seen in the skin and underlying tissue of debilitated or immobilized patients as the result of prolonged pressure and impaired circulation. It manifests chiefly as an ulcer over bony prominences, but tumefaction is an extremely unusual presentation. A 53-year old male, a paralytic of the lower extremity for 18 years, developed a recurrent decubital ulcer despite repeated surgical repair, from which a rapidly growing, large fungating mass grew within a month. The last resected mass was bosselated and measured 15x9x3 cm with a major area of cicatrix-like induration, interdigitated with skeletal muscle bundles at the central area. Microscopically, the mass was composed of an upper half of active granulation tissue layer and a deeper half of dense, poorly cellular, fibrocollagenous bundles admixed with florid proliferation of atypical fibroblasts, but the absence of mitosis and the multifocal admixture of active inflammatory process-granulation tissue formation seemed to help exclude genuine fibromatosis, nodular fasciitis or proliferative myositis. We assume that this rapidly growing pseudofibromatosis is an additional manifestation of a prolonged decubitus ulcer, possibly related to the modified reparative process of decubitus ulcer following repeated excisions, for which we propose a term of decubitoma.

Carcinosarcoma of the Esophagus: A report of case

Carcinosarcoma of the esophagus is a rare neoplasm composed of both carcinoma and spindle sarcomatous area. Usually the carcinoma component is a squamous cell carcinoma but rarely adenocarcinoma or undifferentiated carcinoma is found. The histogenesis of the sarcomatous component is still unknown. A case of ulcerated polypoid lesion with a stalk in esophagus was reported. Microscopically it was composed of spindle shaped cells interminled with squamous cell carcinoma and small cell carcinoma nests. No distinct transition between spindle shaped cells and carcinoma are was observed. Immunoreactivity to cytokeratin was observed in both carcinomatous and spindle cell component, but electron microscopic examination failed to demonstrated desmosome or tonofilaments in spindle cells. Undifferentiated small cell nests were reactive to neuron specific enolase and contained membrane bounded secretory granule in electron microscopy.

Nodular fasciitis (13 cases analysis)

Nodular fasciitis is a rare and benign soft tissue tumor that can easily confused microscopically to spindle cell sarcoma. Therefore it is very important disease to the surgical pathologists. However, this lesion has been seldom reported or described in Korean literature. This paper deals with 13 Korean cases of nodular fasciitis diagnosed microscopically. It's pertinent clinicopathologic findings are described. The youngest patients among 13 cases was 18 years and the oldest was 63 years with the mean of 34 years. Nine were males and 4 were females. Pathologically, the size of the lesion at the time of diagnosis ranged from 0.7 cm to 4.0 cm in the maximum extent. Two were smaller than 1.0 cm and 8 cases were between 1.0~3.0 cm. The site distibution was; trunk(5) upper extremitiy (4), lower extremity (2) and head (2). All the lesions were located in the subcutaneous tissue. The history of recent rapid growth was noted in nearly half of the cases. Mass and tenderness were two common manifestations. In one case, multiple nodules were found in the right breast and in flank. All of the lesions except one were managed by local excision. In one case, a wide excision was done under the impression of malignant fibrous histiocytoma of frozen section. Follow up observation of all cases did not show any evidence of recurrence in all.

Pseudosarcoma of the Esophagus: A case report with mapping, immunohistochemical and ultrastructural studies

So called pseudosarcoma of the esophagus is an extremely rare polypoid malignant tumor and a number of cases, totaling 19 cases have been reported in world literatures until 1985. The presenting case is an unique one of pseudosarcoma of the esophagus and we illustrated all microscopic features with mapping, immunoperoxidase stain for cytokeratin and electron microscopic findings to clarify the histogenesis of spindle cells. It is postulated that the spindle cells of pseudosarcoma are transformed from squamous carcinoma cells based on (1) morphological similarity between squamous epithelial cells and spindle cells, (2) positive reaction of immunoperoxidase staining for cytokeratin in the adjacent normal esophageal mucosa, squamous cell carcinoma, spindle cells and giant cells and (3) presence of transformation zone.