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Presented by Pedram Argani, M.D. and prepared by Jeremy Vincent M.D.
Case 2: This is a 53 year old female with a retroperitoneal mass.
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Question 1 of 1
1. Question
Week 546: Case 2
This is a 53 year old female with a retroperitoneal mass.images/vincent/5661_1_low res.jpg
images/vincent/5661_2_low res.jpg
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images/vincent/5661_desmin_low res.jpgCorrect
Answer: Leiomyosarcoma
Histology: This is a cellular spindle cell lesion composed of fascicles of spindle cells with eosinophilic cytoplasm and rectangular appearing nuclei. There are areas of necrosis, marked cytologic atypia, and high mitotic activity. These lesional cells label diffusely for desmin, but not for HMB45, supporting the diagnosis of leiomyosarcoma. One can appreciate that the lesion involves and perhaps emanates from the wall of a muscular vein.
Discussion: An angiomyolipoma of spindle cell type usually demonstrates less atypia than the current lesion, and should label for melanocytic markers like HMB45. Cellular congenital mesoblastic nephroma is essentially confined to the early years of childhood, and demonstrates a fibroblastic phenotype. Angiosarcoma should label for CD34 but not for desmin.
Incorrect
Answer: Leiomyosarcoma
Histology: This is a cellular spindle cell lesion composed of fascicles of spindle cells with eosinophilic cytoplasm and rectangular appearing nuclei. There are areas of necrosis, marked cytologic atypia, and high mitotic activity. These lesional cells label diffusely for desmin, but not for HMB45, supporting the diagnosis of leiomyosarcoma. One can appreciate that the lesion involves and perhaps emanates from the wall of a muscular vein.
Discussion: An angiomyolipoma of spindle cell type usually demonstrates less atypia than the current lesion, and should label for melanocytic markers like HMB45. Cellular congenital mesoblastic nephroma is essentially confined to the early years of childhood, and demonstrates a fibroblastic phenotype. Angiosarcoma should label for CD34 but not for desmin.
