Angiomyofibroblastoma-like tumor (lipomatous variant) of the inguinal region of a male patient

A case of angiomyofibroblastoma-like tumor (lipomatous variant) that arose in the subcutis of the inguinal region of a 45-year-old man is presented. The maximum dimension of the tumor measured 39 mm and it was well circumscribed. Histopathological examination revealed a close admixture of plump spindle or stellate cells and mature adipocytes. These were arranged haphazardly or formed interconnecting thin cellular trabeculae on the myxoid or edematous background. The tumor was highly vascularized and contained a moderate amount of collagen fibers. Immunohistochemically, the tumor cells were positive for vimentin, CD34 and the estrogen receptor, but negative for alpha-smooth muscle actin and desmin. The differential diagnosis between the lipomatous variant of angiomyofibroblastoma and cellular angiofibroma or spindle cell lipoma is discussed, and the pathogenetic hypotheses about the occurrence of mature adipocytes within benign fibroblastic or myofibroblastic neoplasms are mentioned briefly. It is important for surgical pathologists to be acquainted with the occasional presence of adipocytes in these neoplasms to avoid misinterpretation.     

Angiomyofibroblastoma of the male genital tract. Pathological and immunohistochemical study of three cases

Angiomyofibroblastoma of the male genital tract is a rare tumor with only 20 cases reported in the literature to date. We report three cases in males aged from 23 to 44 years. They presented with painless inguinal, scrotal and perineal masses, ranging from 3 to 8 cm in diameter. On microscopic examination the tumors were composed of small spindle cells without atypia in a fibrous and myxoid stroma. There were scattered mononuclear inflammatory cells around capillaries. Immunohistochemical studies showed positive staining of the tumor cells for vimentin, and weak reactivity for CD34, bcl-2, CD99, EMA and CD117. Some tumor cells expressed estrogen receptors in all three cases, and progesterone receptors in only one case. There was no recurrence with a follow-up ranging form 12 to 21 months. Angiomyofibroblastoma of the male genital tract is a benign often hormone-dependent tumor. Its histogenesis is still unclear. It has to be distinguished from aggressive angiomyxoma and myxofibrosarcoma.     

腹股沟区的应用解剖学研究

目的为临床腹股沟疝修补术提供解剖学资料。方法选取经甲醛防腐固定的40具成人尸体(男30具,女10具),逐层解剖并用三角板、游标卡尺、量角器对其进行测量。结果腹股沟韧带长(12.0±0.5)cm,宽0.6 cm;腹股沟管长(4.7±0.6)cm;腹股沟镰长(2.2±0.8)cm。腹股沟镰表现为四种类型:联合腱型55侧、结合型12侧、腹横肌腱膜型4侧、肌-腱膜混合型9侧。腹壁下动脉的行程异常占11.3%。腹股沟管后壁可分为两层紧贴的筋膜层,并形成一个卵圆形的区域,其纵径长(2.9±0.7)cm,横径(1.4±0.38)cm。结论腹横筋膜深层较浅层薄弱,加强和重建腹股沟管后壁是腹股沟疝手术成败的关键。     

Giant cell angiofibroma of the inguinal region

Giant cell angiofibroma is a rare mesenchymal neoplasm most commonly arising in the soft tissues near the orbit. Recently, several cases of extraorbital giant cell angiofibroma have been reported. We report the light microscopic and immunohistochemical features of an additional case of extraorbital giant cell angiofibroma arising in the inguinal region that was clinically mistaken for an inguinal hernia. The patient was a 50-year-old woman who presented with a mobile, nonreducible, left inguinal mass. The tumor was 10.8 cm in greatest diameter, was well circumscribed, and appeared to be encapsulated. Histologically, the tumor was composed of a mixture of cytologically bland spindle-shaped cells and ovoid cells of varying cellularity with deposition in a variably collagenous and myxoid stroma. The tumor had prominent, various-sized blood vessels, often with perivascular hyalinization. In addition, scattered pseudovascular spaces filled with an amorphous eosinophilic material were present and lined by spindle-shaped and ovoid cells similar to those found throughout the neoplasm. Rare multinucleated floret-like giant cells were seen. Immunohistochemically, the tumor cells stained strongly and diffusely for both CD34 and bcl-2 while immunostains for S-100 protein, desmin, smooth muscle actin, and muscle-specific actin were negative. There is no evidence of local recurrence or metastasis 3 months following excision of the mass. This report emphasizes the recognition of this unusual tumor in extraorbital sites. We discuss the overlapping histologic and immunophenotypic features with giant cell fibroblastoma and solitary fibrous tumor and raise the possibility that these tumors could represent a histologic spectrum of CD34-positive dendritic interstitial cell neoplasms.     

腹股沟区的应用解剖及其临床意义

目的为腹腔沟斜、直疝修补术提供理论基础,方法 用肉眼观察并应用游标卡尺测量腹股沟区有关结构。结果 腹内斜肌起始有四种类型,肌腱移行处呈现三种类型：腹横肌起始,腹股沟镰各有三种类型。腹股沟韧带平均长11．65cm,宽0．58cm;髂耻束平均长6．94cm,宽0．53cm。髂耻束并不恒定存在。腹内斜肌起于髂耻束者3例,占1．17％,腹横肌起于髂耻束者占10．7％。结论 观测值为临床疝修补术提供理论基础和实用数据。     

腹股沟神经卡压征的应用解剖

目的：为腹股沟神经卡压征的防治提供解剖基础。方法：在50侧(25具)成年男性尸体标本上对腹股沟区皮神经行解剖学观测。结果：髂腹下神经皮支6％(3侧)，髂腹股沟神经皮支90％(45侧)，生殖股神经生殖支的皮支42％(21侧)，髂腹股沟神经与生殖股神经生殖支形成的吻合支12％(6侧)，生殖股神经股支的皮支8％(4侧)。结论：腹股沟区皮神经行程变异很大，解剖变异是导致神经卡压的主要原因。     

Hamartoma of an ectopic breast arising in the inguinal region

Ectopic mammary tissue in the inguinal region giving rise to a hamartoma is reported. This localization of ectopic breast is infrequent and hamartomas of the breast at this site have not been described previously. The unusual size of the lesion caused pre-operative diagnostic difficulties.     

Postirradiation sarcoma (malignant fibrous histiocytoma) in the inguinal region

A female patient who died of apparent postirradiation sarcoma at the age of 39 was reported. Following a traffic accident, she developed squamous cell carcinoma at the injured right heel 20 years later, and also metastasis to both inguinal and popliteal lymph nodes. During the period from September 1966 to May 1968, she had received Co60 irradiation to the right inguinal and para-aortic areas, 9,600 and 6,600 Roentgen, respectively. Ten years later, she manifested a huge tumor in the inguinal region which extended further to the retroperitoneum; light and electron microscopic examinations proved to be a malignant fibrous histiocytoma. She died of massive pulmonary metastasis two years later. Histological differentiation of the tumor and relationship between irradiation and sarcoma induction were briefly discussed, and the necessity of reevalution of soft part sarcomas was emphasized.     

Anatomical mythology? A study of surface markings of the inguinal region

The surface markings used by authors for structures in the inguinal region were reviewed and differences noted. In this study of 40 cadaveric limbs the surface markings of both the deep inguinal ring and the femoral artery were found to lie closer to the midinguinal point than to the midpoint of the inguinal ligament, which lay lateral to both structures considered. Usually the femoral artery was located lateral to the medial margin of the deep inguinal ring, but occasionally lay medial. In some subjects poor definition of the bony features rendered precise localisation of the positions of the pubic tubercle and anterior superior iliac spine difficult. The origin of the inferior epigastric artery, often used to identify the medial margin of the deep inguinal ring, was subject to variation. A single surface marking, namely the midinguinal point, is suggested for both the femoral artery and the deep inguinal ring on grounds of accuracy, simplicity, and ease of identification.     

The relationship between anthropometric parameters and measurements of the human inguinal region

Summary Several reports suggest a definite relationship between inguinal hernia and pelvic measurements. In order to assess this opinion, measurements of the inguinal region, in particular of the inguinal triangle (Hesselbach) were statistically compared with 14 different anthropometric parameters in 73 white human male corpses. The correlation tests between the inguinal and anthropometric parameters showed very lower values, generally being null to three decimal places. The importance and possible etiologic role of these findings are discussed.

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Relations entre les paramètres anthropométriques et les mesures de la région inguinale humaine

Résumé Certaines études suggèrent qu'il existe un rapport étroit entre l'apparition d'une hernie inguinale et la morphologie du bassin. Dans le but de vérifier cette hypothèse, des mesures de la région inguinale, en particulier du triangle inguinal (Hesselbach) ont été comparées statistiquement avec 14 paramètres anthropométriques chez 73 cadavres mâles. Les tests de corrélation entre les paramètres inguinaux et anthropométriques se sont révélés faibles. L'importance et le rôle étiologique éventuel de ces résultats sont discutés.

     

Three-dimensional geometrical models of the inguinal region. Towards a new stereology

In this work we studied the inguinal-abdominal region and the inguinal canal using three-dimensional geometrical models. We built the models through computer aided geometric modeling techniques on the basis of observations during real dissections, operations and diagnostic medical imaging. The obtained models show in a complete modular synthesis and with a schematic iconology the structural organization of the anatomical districts in a logic sequence of layers and topographic and spatial relationships among its components. The models represent an amazing support to anatomy and clinical anatomy for teaching and research purposes on organogenesis, surgery and diagnosis.     

Angiomyofibroblastoma of the vulva: A mitotically active variant?

A case of angbmyofibrobiastoma in a 48-yearold woman is reported. The tumor occurred as a left vulval mass and was treated by simple excision. It was located in the subcutaneous tissue of the left vuiva and was well circumscribed, measuring 2.8 × 2.7 × 2.5 cm. Microscop Ically, the tumor was composed of hypocellular and cellular arees with well-developed small vessels. Spindle or polygonal cells were arranged with perlvascular accentuation In an edematous or fibrocollagenous background. Some spindle-shaped or polygonal stromal cells were also arranged in epithelioid nests. In some areas, mitosas were frequent (maximum 3/10 high-power field). lmmunohistochemicaily, the stromal cells were positive for vimentln and desmin, but negative for α-smooth muscle actin, S-100, neurofilament, estrogen receptor, progesterone remptor, CD31 and CD34. The average labeling index of Kl-67 In stromal cells was 3.1%. Ultrastructural analysis demonstrated that the stromal cells adhered with primitive Junctions and contained lntermediate filaments with no focal density In the cytoplasm. These findings were consistent with anglomyofibrobiastoma, although previously reported cases did not show so many mitoses. Therefore, this case was suggested to be a mitotically active variant.     

Angiomyofibroblastoma of the vulva: a large pedunculated mass formation

Angiomyofibroblastoma is a rare, usually small benign mesenchymal tumor that occurs in vulvar lesions of premenopausal women. A case of angiomyofibroblastoma that arose as a unique pedunculated and particularly large mass in the left vulva of a 48-year-old woman is presented herein. The patient had been aware of a gradually enlarged mass of 7 years duration without any other gynecological symptoms or signs. The maximum dimension of the tumor measured 11 cm. The resected tumor was well circumscribed with a bulging and glistening cut surface. Histological examination revealed an admixture of irregularly distributed hypercellular and hypocellular areas with spindled, plump spindled, or plasmacytoid stromal cells and abundant venular or capillary-sized vessels. Stromal cells characteristically cluster around delicate vessels within an edematous to collagenous matrix. In the present case, intralesional adipose tissue was present throughout the tumor. There was no significant nuclear atypia, and mitotic figures were very sparse. There was little stromal mucin throughout the tumor. Immunohistochemically, the stromal cells were characterized by strong reactivity for vimentin and CD34, with focal reactivity for desmin and alpha smooth muscle actin. Both estrogen and progesterone receptors were diffusely expressed in the stromal cells. These histological findings are consistent with angiomyofibroblastoma and support the hypothesis that angiomyofibroblastoma originates from perivascular stem cells with a capacity for myofibroblastic and fatty differentiation.