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Presented by Jonathan Epstein, M.D. and prepared by Sharon Swierczynski, M.D., Ph.D.
Case 5: 45-year-old male with 20-year history of a cystic soft tissue mass immediately anterior to the sacrum
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Week 148: Case 5
45-year-old male with 20-year history of a cystic soft tissue mass immediately anterior to the sacrumimages/082503case5fig1.jpg
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images/082503case5fig5.jpgCorrect
Answer: Carcinoid tumor arising in teratoma
Histology: Most of the lesion has the classic histological appearance of a carcinoid tumor. The tumor consists of ribbons and cords of relatively bland cells. The nuclei have a “salt and pepper” appearance. Cytoplasm is slightly amphophilic. Separating the ribbons and nests is a prominent thin vascular network, typical of endocrine tumors. Focally within this lesion are glandular structures, lined by cuboidal epithelium, which in some areas is ciliated.
Discussion: This tumor was keratin positive and S-100 negative, ruling out paraganglioma and melanoma. The presence of these tubular structures suggests that this lesion either arose within a cystic teratoma or within a tailgut cyst (retrorectal cystic hamartoma). The distinction between these two lesions cannot be made based on the small residual amount of the glandular epithelium present. As only a few of such lesions have been reported, one cannot predict the clinical behavior of this lesion.
Incorrect
Answer: Carcinoid tumor arising in teratoma
Histology: Most of the lesion has the classic histological appearance of a carcinoid tumor. The tumor consists of ribbons and cords of relatively bland cells. The nuclei have a “salt and pepper” appearance. Cytoplasm is slightly amphophilic. Separating the ribbons and nests is a prominent thin vascular network, typical of endocrine tumors. Focally within this lesion are glandular structures, lined by cuboidal epithelium, which in some areas is ciliated.
Discussion: This tumor was keratin positive and S-100 negative, ruling out paraganglioma and melanoma. The presence of these tubular structures suggests that this lesion either arose within a cystic teratoma or within a tailgut cyst (retrorectal cystic hamartoma). The distinction between these two lesions cannot be made based on the small residual amount of the glandular epithelium present. As only a few of such lesions have been reported, one cannot predict the clinical behavior of this lesion.