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Presented by Pedram Argani, M.D. and prepared by Hillary Ross, M.D.
Case 3: This is a 49 year old male with forearm mass.
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1. Question
Week 466: Case 3
This is a 49 year old male with forearm mass.images/1alex/01242011case3image1.jpg
images/1alex/01242011case3image2.jpg
images/1alex/01242011case3image3.jpgCorrect
Answer: Alveolar soft part sarcoma
Histology: This is a nested to alveolar proliferation of epithelioid cells which have eosinphilic neoplasm. The nuclei are vesicular and show prominent nucleoli. There was no evidence of a renal mass, and immunostains for PAX8 were negative in this lesion. The lesion demonstrates diffuse immunoreactivity for TFE3, supporting classification as alveolar soft part sarcoma.
Discussion: Renal cell carcinoma should not present in a metastatic site without a primary renal tumor being evident. The absence of PAX8 immunoreactivity argues against this diagnosis. Granular cell tumors label diffusely for S100 protein, and should not show staining for TFE3 in a strong fashion in the majority of cases. Paraganglioma would label for neuroendocrine markers, and should not label for TFE3.
Reference(s):
– American Journal of Surgical Pathology 2003; 27:750-761.Note: This is the 5000th case in the history of JHH Surgical Pathology Conference!
Incorrect
Answer: Alveolar soft part sarcoma
Histology: This is a nested to alveolar proliferation of epithelioid cells which have eosinphilic neoplasm. The nuclei are vesicular and show prominent nucleoli. There was no evidence of a renal mass, and immunostains for PAX8 were negative in this lesion. The lesion demonstrates diffuse immunoreactivity for TFE3, supporting classification as alveolar soft part sarcoma.
Discussion: Renal cell carcinoma should not present in a metastatic site without a primary renal tumor being evident. The absence of PAX8 immunoreactivity argues against this diagnosis. Granular cell tumors label diffusely for S100 protein, and should not show staining for TFE3 in a strong fashion in the majority of cases. Paraganglioma would label for neuroendocrine markers, and should not label for TFE3.
Reference(s):
– American Journal of Surgical Pathology 2003; 27:750-761.Note: This is the 5000th case in the history of JHH Surgical Pathology Conference!
