Bronchogenic cyst of the stomach masquerading as benign stromal tumor

Gastric bronchogenic cyst is an extremely rare lesion. A 62-year-old Korean woman presented with an incidentally found perigastric nodule. An abdominal ultrasonogram and computed tomography showed a 1.5 cm solid, homogeneous, low-density nodule in the hepatogastric ligament near the gastric lesser curvature. At the time of surgery, a soft 1.7 cm nodule was found in the lesser curvature side just below the gastroesophageal junction, and a gelatinous mass was protruded from the nodule during the resection. Microscopically, the gastric subserosa showed cystic structures lined by pseudostratified ciliated columnar epithelium, seromucinous gland, connective tissue and complete layers of smooth muscle bundles. Neither cartilage nor gastrointestinal epithelium was identified. A mucocele was found near the cyst and foamy cells and faintly bluish mucinous substances were found near the cystic structures. All the mucinous substances were stained by alcian blue at pH 2.5 with varying degrees of staining intensity. The present case is the smallest reported cyst among the gastric bronchogenic cysts, and these lesions are unusually located at the lesser curvature side of the stomach. Although these lesions are very rare, gastric bronchogenic cyst should be included in the differential diagnosis of gastric wall mass.     

Carcinoid tumor arising in a thymic bronchogenic cyst associated with thymic follicular hyperplasia

Bronchogenic cysts are congenital malformations of the embryonic tracheobronchial tree and are the most common cause of mediastinal cysts, encountered mainly in pediatric patients and young adults. Conservative treatment has been proposed for asymptomatic patients. However, malignant transformation occurs occasionally and the clinicopathological features of secondary malignancy are not well characterized. In this report, we present a carcinoid tumor found in the thymic bronchogenic cyst of a 41-year-old female complaining of mild chest pain. The thymic tissue also shows follicular lymphoid hyperplasia. Atypical imaging features were found in her chest computed tomography. Additional 22 cases of bronchogenic cysts with malignant transformation were also reviewed from the literature. The clinicopathological data were summarized. The tumorigenesis of these tumors is unclear, but bronchogenic cysts of the lung may undergo malignant changes at a younger patient age and more frequently than mediastinal ones. Carcinoid tumors were also seemingly overrepresented in mediastinal cases. Some atypical imaging features may serve as clues for early detection and guide clinical management.     

Retroperitoneal bronchogenic cyst: Report of a case and literature review

A large cystic mass was found in the subdiaphragmatic region of a 46-year-old woman who had complained of continuous pain in the left flank . The cyst was located in the retroperitoneum just below the diaphragm and was adhered to the diaphragmatic skeletal muscle and abdominal aorta, but was separate from the spleen, pancreas, left adrenal gland and left kidney. The surgically resected cyst measured 8 x 8 x 7 cm and was filled with protein-rich fluid, which contained amylase and embryonal proteins such as carcinoembryonic antigen, CA125 and CA19-9. Histologically, the cyst wall was composed of a fibrovascular connective tissue containing thin smooth muscle layers and mucus-secreting glands and was lined by a ciliated pseudostratified or tall columnar epithelium without dysplastic changes. Thus, a diagnosis of bronchogenic cyst, which is usually discovered in the posterior part of the mediastinum, was made. A rare case of bronchogenic cyst and a literature review is presented.     

Bronchogenic cyst of the conus medullaris with spinal cord tethering: a case report and review of the literature

Bronchogenic cysts (BCs) are congenital malformations that originate from remnants of the primitive foregut. Intraspinal BCs, especially those of the conus medullaris are rare with only one case reported until now. To date, a bronchogenic cyst with spinal cord tethering has not been previously reported. We reviewed the clinical course of a 44-year-old woman, who presented with low back pain and leg weaknesss as well as sphincter disturbance. Magnetic resonance imaging showed an intradural oval mass located at the conus medullaris. A tethered cord was also observed, as well as a dermal sinus tract. The mass was totally removed after an L3-L4 laminectomy without detethering during operation. Pathologic examination confirmed the diagnosis of bronchogenic cyst. By six months after treatment, the patient had experienced nearly complete recovery. The review of literature indicated that detethering was performed in most reported cases of neurenteric cysts with spinal cord tethering, and one of six patients was diagnosed with a postoperative recurrence. The co-existence of bronchogenic cyst and a tethered spinal cord would imply associated developmental errors in embryogenesis. It is worth noting that whether detethering is necessary after the cyst removal.     

Intraoperative diagnosis of hydatid cyst of the ovary masquerading as tumor

Hydatid disease, caused by the larval stage of Echinococcus granulosus, is found most commonly in the liver and lungs, but no organ is immune. The ovarian involvement is often secondary to a cyst's dissemination localized in a different site. Occasionally, the cyst enlarges, thus mimicking an ovarian tumor. Patients with hydatid cysts at unusual locations present with atypical presentations and pose a diagnostic dilemma. A high index of suspicion is required in order to make a correct diagnosis pre‐operatively to prevent spillage of the cyst contents during surgery. We report a case of hydatid cyst in the ovary in a young female. Diagn. Cytopathol. 2017;45:267–269. © 2016 Wiley Periodicals, Inc.     

Tenosynovial giant cell tumor arising from the posterior cruciate ligament: a case report and literature review

The localized form of tenosynovial giant cell tumor or pigmented villonodular synovitis is rarely intraarticular in the knee. We reported a 40-year-old woman with a tenosynovial giant cell tumor arising from posterior cruciate ligament (PCL). She suffered sudden knee pain and locking without any reason for two days. A mass with a size of 1.7×0.8×0.7 cm in the fossa intercondyloidea was detected on the MRI. After one time hyperextension physical examination the patients felt sudden pain relief. During the arthroscopy examination, a loose soft tissue mass was found under the lateral meniscus. Only the synovium tissue lesion on the proximal PCL was detected. The mass had a conceivable thin pedicel and the shape matched well with the tumor bed on the PCL. The histopathology of the mass demonstrated a tenosynovial giant cell tumor. At six weeks follow-up, no clinical evidence of recurrence was noted. A Literature Review of tenosynovial giant cell tumor or pigmented villonodular synovitis arising from the PCL is present.     

Peritoneal endometriosis in the broad ligament presenting as a large tumor

Peritoneal endometriosis presenting as a tumor is very rare. A case of peritoneal endometriosis in the broad ligament presenting as a large tumor is reported. A 39-year-old woman had a solid and cystic tumor with many microcysts, measuring 17 x 13 x 3.5 cm, mainly located in the right posterior broad ligament. Histologically, the tumor consisted of many endometrial glands associated with various amounts of endometrial stroma. Neither the glands nor the stromal cells had cellular atypia. We diagnosed peritoneal endometriosis presenting as a tumor. Among the six cases (five previously reported cases and our case) of tumor-like endometriosis in the peritoneum, two cases (33%) had received tamoxifen therapy and four cases (67%) had cystic or solid and cystic tumor. Among them, the tumor size ranged from 3 to 17 cm in diameter, and our case was the largest. In conclusion, this case is rare, but it is important for pathologists to be aware of the phenomenon (that extensive peritoneal endometriosis produces a large tumor) in the histological diagnosis of a tumor in the peritoneum.     

Laparoscopic resection of intra-abdominal esophageal duplication cyst near spleen: a case report

Esophageal duplication cysts (EDCs) are congenital malformations of the posterior primitive foregut and often within the thoracic esophagus. Here we describe a rare case of intra-abdominal EDC near spleen in a 20-year-old female patient with a complaint of an asymptomatic abdominal mass for 5 years. The diagnosis of intra-abdominal EDC was confirmed by the Ultrasonography (US) and Magnetic resonance imaging (MRI) as well as Histological examination. Then the patient was received the laparoscopic resection and recovered well after the operation. We conclude that the laparoscopic resection is considered to be feasible and a reasonable treatment for intra-abdominal esophageal duplication cyst.     

Gastric bronchogenic cyst presenting as a gastrointestinal stromal tumor

Bronchogenic cyst (BC) is congenital abnormality of the tracheobronchial bud derived from the primitive foregut which is predominantly found in the mediastinum. Surgery remains the most common treatment when malignancy is suspected, or when there are presenting. Only infrequently, is BC located at an extrathoracic site. Although rarely located in the stomach, BC should be considered as a differential diagnosis of gastric neoplasm. For these cases, surgery remains a common choice. Minimally invasive procedures such as endoscopic ultrasonography-guided fine needle biopsy aspiration (EUS-FNA) and endoscopic submucosal dissection (ESD) should also be considered when the diagnosis of BC is suspected. They are valuable diagnostic methods that can assess and identify the location of the lesion, and facilitate histological examination of the cyst. In some cases of more superficial lesions ESD can take the place of surgery as it avoids unnecessary complications of a more invasive procedure. Here we present a case of gastric BC located in the fundus of the stomach that resembled a gastrointestinal stromal tumor (GIST). We discuss its embryology, pathogenesis, radiological, clinical and treatment modalities. We also provide a thorough review of 14 cases (including our own case), which completely meet pathological criteria has been undertaken focusing on symptom, location, treatment, and histological features.     

Cytomorphology of intraparenchymal mesenchymal chondrosarcoma in frontal lobe: report of a case

lntracranial mesenchymal chondrosarcomas (MC) and especially those that originate in brain parenchyma, are rare. A diagnosis of MC can be challenging to make on squash cytology. We describe cytomoprhology of solid cystic extraskeletal intraparenchymal MC in a 22-year-old male. The tumor was located in left frontal lobe. Cytology results demonstrated oval-to-spindled cells with high nuclear-to-cytoplasmic ratios. Cells showed perivascular arrangement. Small foci of basophilic extracellular matrix with scattered malignant chondroid component were also seen. Histologic examination of lesion demonstrated biphasic tumor, with prominent small cell population and focal atypical cartilage. Whole body survey of the patient was performed and no other extracrainal lesion was identified in the patient. The patient developed recurrence within 2 months. To the best of authors' knowledge this is the first case report describing cytomorphology of intraparenchymal MC. We discuss the differential diagnosis in light of relevant literature.     

Phosphaturic mesenchymal tumor (mixed connective tissue variant): a case report with spectral analysis

We present a further case of a rare mesenchymal neoplasm termed phosphaturic mesenchymal tumor (mixed connective tissue variant). The patient was a 42-year-old man with a long history of osteomalacia of unknown etiology with pathological bone fracture, abnormality of parathyroid glands, kyphosis, scoliosis, and spondylosis. Laboratory investigation disclosed hypophosphatemia, elevated serum alkaline phosphatase activity, and normal serum calcium level. The patient had a soft tissue mass in the right inguinal area, measuring 11×6×5 cm, which was previously interpreted as a calcified hematoma on sonography. The tumor was surgically removed. Grossly, the tumor was well circumscribed, unencapsulated, and had soft to dense consistency. The cut surface had a variegated appearance due to the presence of large hemorrhagic areas admixed with foci of grey-yellow tissue. Histologically, the tumor was composed of primitive mesenchymal cells, osteoclast-like cells, and cells showing myofibroblastic features without cytologic atypia. There were a well developed vascular network, microcystic areas, and poorly formed cartilaginous foci. Unusual and hitherto unpublished prominent features were flower-like, slate-gray crystals, widespread hemosiderin deposits and large areas of hemorrhages, with the latter comprising approximately 60% of the tumor. A spectral analysis indicated that chemically, the crystals mainly consisted of calcium phosphate and sodium nitrate.     

Carcinoid tumor arising in a duplication cyst of the duodenum

Reported herein is a case of carcinoid tumor arising in a duplication cyst of the duodenum in a 34-year-old woman. Ultrasonography at a health check-up revealed a 10 cm cystic mass located in the retroperitoneum adjacent to the third portion of the duodenum. Macroscopically, it had a smooth surface without communication with other organs and was filled with brownish necrotic fluid. More than half of the inner wall was occupied by a white, irregular, and solid nodule, which protruded into the lumen. The nodule was diagnosed as a carcinoid tumor invasive to the deep muscular layer. The non-neoplastic cyst wall had bowel structures including mucosa, submucosa and double layers of smooth muscle, indicating that the lesion was a duodenal duplication cyst. Most of the mucosa was eroded by marked inflammation. The remaining mucosa consisted of various types of epithelium, the major type having the nature of primitive gastric mucosa. Of interest was the presence of hamartomatous components in the wall. Furthermore, the non-neoplastic mucosal lining cells around the carcinoid tumor expressed neuroendocrine antigens and had minimal proliferative activity, suggesting that part of the cyst wall provided a microenvironment for accelerated differentiation of epithelial cells to an endocrine phenotype and transformation to neoplasia.     

Ovarian leiomyosarcoma: an autopsy case report

Primary non-specific sarcoma of the ovary is extremely rare, and only 22 reported cases of pure leiomyosarcoma (LMS) are known to the authors. We present an autopsy case of a primary ovarian leiomyosarcoma in a 73-year-old woman. She had noticed an abdominal mass after difficulty in defecating for several months. The excision of tumor with bilateral salpingo-oophorectomy and hysterectomy was carried out. A diagnosis of pure leiomyosarcoma of the left ovary was made on pathological examination with immunohistochemistry. Adjuvant radio-chemotherapy was not given. At 18 months' follow up, abdomino-pelvic sonography revealed an abdominal tumor and hepatic metastasis. The patient died 3.5 years after the initial surgery. The post-mortem examination revealed a peritoneal recurrent tumor and extensive distant metastases of the liver, lungs, pancreas, gastric mucosa, muscle and skin. The prognosis of the ovarian LMS is poor from the pertinent literature. Several prognostic indicators on histology including mitotic activity, proliferative activity and p53 status of the tumor are discussed.     

Thoracoscopic Resections of Bronchogenic Cysts Arising in the Posterior Mediastinum: A Report on 3 Patients

We report 3 cases of patients with bronchogenic cyst arising in the posterior mediastinum. The patients were a 19-year-old male, a 36-year-old female and a 33-year-old female, whose cysts were detected as abnormal shadows in the chest. In 2 of them, neurogenic tumors were suspected preoperatively. We performed thoracoscopic resection for the 3 tumors. Bronchogenic cysts may occur ectopically, and the posterior mediastinum must be sufficiently recognized as a rare but possible ectopic site.     

Phosphaturic mesenchymal tumor diagnosed by fine-needle aspiration and core biopsy: a case report and review of literature

Oncogenic (tumor-induced) osteomalacia is a rare paraneoplastic syndrome of phosphate wasting that is frequently associated with phosphaturic mesenchymal tumor (PMT). As the cytologic features of this tumor apparently have not been reported, we describe the fine-needle aspiration (FNA) findings for PMT that arose from the gluteal soft tissue in a patient with hypophosphatemia and multiple fractures secondary to osteomalacia. Smears from the computerized tomography (CT)-guided FNA showed groups of spindle cells having elongated nuclei, fine to moderately coarsely granular chromatin, inconspicuous nucleoli, and delicate cytoplasm. Marked nuclear atypia, mitotic figures, and necrosis were absent. The differential diagnosis included a variety of benign and malignant spindle cell neoplasms such as monophasic synovial sarcoma, leiomyoma, peripheral nerve sheath tumor, fibrosarcoma, and, less likely, metastatic melanoma and sarcomatoid carcinoma. The bland-appearing cytologic features of a spindle cell tumor in a patient with osteomalacia should suggest the diagnosis of PMT.     

Primitive myxoid mesenchymal tumor of infancy: report of two cases and review of the literature

Primitive myxoid mesenchymal tumor of infancy is a recently recognized soft tissue tumor with only a few cases reported. Here, we reported another two cases of the lesion, a 5-month-old boy presenting with a soft tissue mass in the neck region that recurred 2 months later and a 3-day-old girl with a congenital superficial dorsal lumbar mass that extended to the spinal canal 1 month later. They shared similar histological patterns, such as unusual diffuse myxoid background, delicate vascular network, small cystic spaces, low to moderate cellularity, and primitive mesenchymal tumor cells. Immunohistochemically, the tumor cells showed positive for vimentin, CD99, CD117 and nestin, negative for myoid, lipoblastic, histiocytic, and neural markers. In conclusion, primitive myxoid mesenchymal tumor of infancy is a distinctive entity with its own clinical pathological features. Expression of CD99, CD117 and nestin may be consistent with the primitive nature of the tumor and may serve as ancillary markers for differential diagnosis from the other infantile tumors.     

Ciliated cells in abdominal or pelvic fine needle aspirations: A case report and review of the literature

Ciliated cells encountered outside of an expected anatomical location (e.g., the respiratory tract, fallopian tube, etc) can represent a diagnostic difficulty for the cytopathologist, especially during preliminary assessment of a fine needle aspiration (FNA) for adequacy or malignancy. We present the cytologic and histologic features of a FNA and needle core biopsy, respectively, of an abdominal mass, likely from a gastrointestinal duplication cyst, foregut cyst or a bronchogenic cyst. We also briefly review the differential diagnosis for ciliated cells encountered in abdominal or pelvic FNAs. Diagn. Cytopathol. 2013. © 2011 Wiley Periodicals, Inc.     

Extra-abdominal desmoid tumor presenting as an intrathoracic tumor: case report and literature review

A case of an extra-abdominal desmoid tumor presenting as an intrathoracic tumor (intrathoracic desmoid tumor) in a 46-year-old woman is reported. The tumor originated in the left chest wall and protruded into the left pleural cavity. Simple resection was carried out. The tumor, measuring 13 x 9 x 7 cm, was solid, gray-tan in color, and covered with parietal pleura. Histologically, the tumor was composed of a hypocellular arrangement of spindle-shaped cells with a fibromyxoid background. In some areas, keloid-like hyalinized collagen fibers proliferated, and a perivascular hypercellular area was seen. Immunohistochemical analysis showed that the cytoplasms of the tumor cells were strongly positive for vimentin, and some tumor cells were positive for alpha-smooth muscle actin, but all tumor cells were negative for CD34. These findings were consistent with the characteristics of an intrathoracic desmoid tumor. The differential diagnoses, in particular solitary fibrous tumor and tumors with a myofibroblastic nature, are discussed.