Low-grade myofibroblastic sarcoma of gastric cardia on 18F-FDG positron emission tomography/computed tomography: An extremely rare case report.

RATIONALE: Low-grade myofibroblastic sarcoma (LGMS) is a rare mesenchyme-derived tumor, which usually occurs in head, neck (especially tongue and mouth), and limbs. In this report, we described a case of gastric LGMS by F-fluoro-2-deoxy-d-glucose (FDG) positron emission tomography/computed tomography (PET/CT), which has not been reported previously. PATIENT CONCERNS: A 51-year-old female patient was admitted to our hospital with upper abdominal discomfort for 1 year and gradually increased eating difficulties over the last 3 months. From gastroscopy, an ulcer of 1.0 cm × 1.2 cm at the entrance of cardia and stiffness of peripheral mucosa were found, leading to suspicion of cardia cancer. F-FDG PET/CT was performed for further diagnosis and staging. DIAGNOSES: According to pathological findings in combination with immunohistochemical features, diagnosis of gastric LGMS was made. INTERVENTIONS: To relieve symptoms of upper gastrointestinal obstruction in the patient, proximal gastrectomy was carried out 1 week after the F-FDG PET/CT scan. OUTCOMES: The patient died due to advanced tumor. LESSONS: F-FDG PET/CT scan showed local thickening of the gastric wall, invasion of adjacent soft tissue, diaphragmatic and peritoneal metastasis at early stage, absence of regional lymph node metastasis, and increased F-FDG metabolism in primary tumor and metastatic tumor.

[Elastographic visualization of soft tissue tumors and its role in the diagnostic process].

A total of 110 patients with malignant (n=54, 49,1%), intermediate (n=24, 21.8%) or benign (n=31, 28.2%) soft tissue tumors were included in the study aimed to determine the soft tissue tumor elastographic picture and the overall role of elastographic visualization in soft-tissue tumor diagnostics. All the patients underwent grey-scale real-time elastography, colored Doppler mapping, energy Doppler mapping and ultrasonic elastography. The ultrasonic elastography included the quality assay of tissue color mapping and tissue stiffness index assay. All the tests were performed with Hitachi HI Vision 900 US scanner with 5-13 MHz US-sensors. In soft tissue tumors the elastography had 97% sensitivity equal to grey-scale US-scan sensitivity. Based on the results of the study, the elastography doesn't lead to any benefits as a stand-alone diagnostic technique. In most cases it doesn't lend any additional value compared to grey-scale US-scan. The only exceptions are the low-grade lyposarcomas, diffuse lypomas and fibrolypomas and desmoids. Nevertheless, elastography is still a useful method in surgical treatment planning as it allows to pinpoint the exact amount of involved tissues more effective than grey-scale US-scan techniques.

Penetration failure and misdiagnosis of stereotactic biopsy caused by the uncommonly firm tissue of a gliomyosarcoma.

OBJECTIVE AND IMPORTANCE: We report the very rare case of a gliomyosarcoma that caused penetration failure in stereotactic biopsy and therefore led to misdiagnosis. This complication should be considered as a potential reason for diagnostic failure with uncommonly firm tumors in frame-based stereotactic biopsy. CLINICAL PRESENTATION: An 83-year-old women presented with a 4-week history of right hemiparesis. Computed tomography (CT) demonstrated a left precentral lesion of 1 cm in diameter with moderate contrast uptake and perifocal edema. INTERVENTION: Stereotactic biopsy was performed using the Cosman-Robert-Wells (CRW) system and a side-aspirating biopsy needle. Six tissue samples were taken; however, histopathologic examination remained non-diagnostic. Because the hemiparesis had worsened, a magnetic resonance tomography (MRT) was taken four weeks later and clearly demonstrated an increase in size of the lesion. Neuronavigation-guided open surgery revealed a very firm, well-delimited tumor that was classified in the pathologic examination as a gliomyosarcoma. Repeated recalculations of the target coordinates, analysis of the CT scan that was taken 4 days after the stereotaxy, and finally, recognition of the extraordinary firmness of this gliomyosarcoma allowed us to presume with certainty that we had not penetrated the lesion with the biopsy cannula, but rather had merely pushed it ahead of the instrument while the tissue samples were taken. CONCLUSION: The reported case is both unique for its histopathologic diagnosis and for the complication it caused in stereotactic biopsy. The case also supports the implementation of image-guided interventions for diagnostic biopsy, rather than frame-based stereotaxy in the future.

Myofibrosarcoma of the bone: a clinicopathologic study.

Myofibroblastic tumors are fairly recently established soft tissue neoplasms. Although most of them appear to be benign, myofibrosarcoma of the soft tissue, seemingly their malignant counterpart, have been reported. We describe the clinicopathologic and radiologic features of four cases of myofibrosarcoma arising from the bone. All but one of the patients were women ranging in age from 60 to 71 years. Two tumors occurred in the metaphyses of distal femurs and the others arose in the iliac bones. On radiologic examination all tumors exhibited well-demarcated lytic destructive lesions without periosteal reaction. Two tumors were localized in the bone, whereas the other two extended into surrounding soft tissues. Histologically, all tumors were composed principally of a mixture of a cell-rich fascicular area and a hypocellular fibrous area. In the former area tumor cells had rather eosinophilic spindle-shaped wavy cytoplasm and were arranged in interlacing fascicles and small storiform patterns with variable numbers of inflammatory cells. Tumors occasionally showed prominent pleomorphism, and large cells with hyperchromatic nuclei were seen. In contrast, hypocellular areas had various features, including collagenous, hyalinous scar-like and rarely keloid-like areas. Focal coagulation necroses were present in all but one tumor. Immunohistochemically, the tumors were positive for vimentin, muscle actin (HHF35), alpha-smooth muscle actin, calponin, and desmin, whereas all of them were negative for high molecular weight caldesmon. On follow-up there was one fatal case with distant metastases, whereas the clinical courses of other cases after wide resection were excellent. Myofibrosarcoma of the bone has distinctive histopathologic features, which should be distinguished from those of other bone tumors with myoid differentiation.

Radio-immunodetection of myosarcoma using 111indium antimyosin.

Radio-labelled antimyosin-monoclonal antibodies (AMA) have been introduced to demonstrate myocardial necrosis after cardiac infarction or in cardiac allograft transplants. As rhabdomyosarcoma (RMS) and leiomyosarcoma (LMS) are tumors of myogenic origin, thus often containing myosin, we decided to use the 111In-labelled Fab fragment of AMA (Centocor) in scintigraphic tumor detection. We examined 13 children with histologically-confirmed RMS and LMS, and five other children with other types of soft tissue sarcomas. Conventional techniques were used to determine the extent of the tumor. An uptake of the tracer was observed in all known tumor sites in seven RMS patients. As the scans were negative in three RMS patients who were in complete remission (CR) and in two other patients (fibrosarcoma and haemangiopericytoma) with a measurable tumor mass, we considered them to be "true negative". In the three remaining CR patients (1 RMS, 2 LMS) the scans were positive but weak in the primary tumor site in two cases and in a distant site (bone) in the third respectively. We considered them to be "false positive" as no tumor cells were evident in the biopsy specimen. In one case, the antimyosin uptake was presumably the result of damage to the muscles after radiation. Interestingly, in three patients with other malignancies such as rhabdoid and peripheral neuroectodermal tumors there was a noticeably strong uptake of the tracer in the primary tumors and the scans turned negative after complete remission was achieved. The diagnostic AMA scanning showed no side-effects. The reason why antimyosin antibodies permeate the membrane of the tumor cells is yet undetermined.(ABSTRACT TRUNCATED AT 250 WORDS)

Lymphatic dissemination of bone and soft tissue sarcomas: a lymphographic investigation.

The series consisted of 132 patients, 61 with primary bone sarcomas and 71 with primary soft tissue sarcomas. The patients were all evaluated by lymphography. The investigation included both patients who had not yet been treated and patients with suspected or confirmed metastases. All tumour diagnoses were confirmed microscopically. The findings as regards dissemination were based on clinical examinations, laboratory tests, roentgen examinations and lymphographies. In some cases, lymph node biopsies and surgical observations were also used. A total of 151 lymphographies were performed and 281 follow-up films taken. Preoperative lymphography was performed using the technique introduced by Kinmonth. For postoperative lymphography on the stumps of amputated extremities, two simple but useful methods were developed, which are presented here. Changes in the lymphographic appearance of lymph node metastases, the occurrence of new metastases, and the results of treatment were assessed by survey films and repeat lymphography. The generally accepted criteria for metastasis were used as a basis for the analysis of the lymphographic findings. The results may be summarized as follows: 1. Incidence of lymphatic dissemination. Different sarcomas varied greatly in their clinical course, including the frequency of dissemination. The lymphatic involvement in the metastatic cases was as follows: Bone sarcomas: 16 out of 28 (Table 10); of these, 13 were to regional lymph nodes, 8 to distant nodes and 5 to both (Table 14). Soft tissue sarcomas: 24 out of 40 (Table 11). All 24 had metastases in regional nodes, and 8 in distant nodes as well (Table 15). The highest frequencies of lymphatic spread in the different metastasized tumours were found to be: Bone sarcomas: reticulosarcoma 100%, Ewing's sarcoma 50%, osteosarcoma 47%. Soft tissue sarcomas: rhabdomyosarcoma 100%, synovial sarcoma 80%, neurogenic sarcoma 78%, leiomyosarcoma 67%. 2. Time-relation between lymphatic and haematogenic dissemination; The tendency to metastasize first via the lymphatics or via the blood vessels varied. Half of the cases of Ewing's sarcoma and reticulosarcoma had evidence of lymphatic spread before blood-borne metastases were detected. In the osteosarcoma cases, however, lymphatic dissemination was always preceded by haematogenic spread (Table 12). In synovial sarcoma, rhabdomyosarcoma and neurogenic sarcoma, the first dissemination was more frequently lymphatic than haematogenic (Table 13). 3. Possible existence of special lymphographic features of sarcoma metastases. Only reticulosarcoma displayed special characteristics. The lymph node metastases of reticulosarcoma of bone had lymphographic appearances similar to those found in reticulosarcoma of soft tissue or lymph node origin (Fig. 12). The lymph node metastases of other primary bone and soft tissue sarcomas had no specific lymphographic features and were indistinguishable from carcinomatous metastases (Figs 7, 9, 13, 15, 18, 19, 20, 22, 23). 4...