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Presented by Risa Mann, M.D. and prepared by Ali Ansari-Lari, M.D.,Ph.D.
Case 3: 73-year-old female with perinephric mass.
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1. Question
Week 94: Case 3
73-year-old female with perinephric mass./images/3a.JPG
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/images/3c.JPGCorrect
Answer: High grade leiomyosarcoma
Histology: The tumor consists of a proliferation of spindled cells with severe cytologic atypia. The tumor has a high mitotic rate and demonstrates focal areas of necrosis. Immunoperoxidase stains demonstrated the tumor cells to be positive for smooth muscle actin and desmin and negative for cytokeratin and C-kit.
Discussion: The differential diagnosis in this case rests primarily between a high-grade sarcoma or a spindle cell carcinoma. The negative staining for cytokeratin and positive staining for smooth muscle actin and desmin established the diagnosis of a smooth muscle tumor. Leiomyosarcoma is the third most common sarcoma in the retroperitoneal area. In this region, smooth muscle tumors that contain more than 5 mitoses per high power field should be classified as leiomyosarcomas. The presence of necrosis as well as large size (tumor greater than 10 cm) are also features suggestive of malignancy.
Incorrect
Answer: High grade leiomyosarcoma
Histology: The tumor consists of a proliferation of spindled cells with severe cytologic atypia. The tumor has a high mitotic rate and demonstrates focal areas of necrosis. Immunoperoxidase stains demonstrated the tumor cells to be positive for smooth muscle actin and desmin and negative for cytokeratin and C-kit.
Discussion: The differential diagnosis in this case rests primarily between a high-grade sarcoma or a spindle cell carcinoma. The negative staining for cytokeratin and positive staining for smooth muscle actin and desmin established the diagnosis of a smooth muscle tumor. Leiomyosarcoma is the third most common sarcoma in the retroperitoneal area. In this region, smooth muscle tumors that contain more than 5 mitoses per high power field should be classified as leiomyosarcomas. The presence of necrosis as well as large size (tumor greater than 10 cm) are also features suggestive of malignancy.
