Fine needle aspiration of parapharyngeal space adult rhabdomyoma: a case report.

BACKGROUND: Rhabdomyomas are rare benign tumors of striated muscle and include cardiac and extracardiac types. Extracardiac rhabdomyomas are divided in three subtypes (adult, fetal, genital). The adult type is usually found in the head and neck regions of elderly persons. Misinterpretations in initial diagnosis of adult rhabdomyomas on fine needle aspiration have been reported. CASE: A 64-year-old man presented with gurgling and difficulty swallowing for approximately 3 months. Computed tomography and magnetic resonance imaging showed a 5.8-cm solid mass located in the right parapharyngeal space. Fine needle aspiration smears were cellular, showing cohesive clusters of cells with scattered individual cells. Cells had abundant eosinophilic glassy cytoplasm, peripherally placed round nuclei, and prominent nucleoli. Many traversing vessels were noted, but cross-striations were not seen. The cell block demonstrated clusters of cells with abundant eosinophilic granular cytoplasm, some with clear and/or vacuolated cytoplasm, and possible cross-striations. Tumor cells were positive for desmin. The lesion closely resembled normal muscle tissue. Electron microscopy showed many cells containing actin and myosin filaments with Z-band material. CONCLUSION: Correct diagnosis can be achieved with a combination of awareness of the lesion, familiarity with the characteristic cytologic features, and application of appropriate immunohistochemistry markers. Classic electron microscopic findings can support the diagnosis.

Retropharyngeal superficial angiomyxoma.

OBJECTIVE: To describe the first published case of superficial angiomyxoma with an epithelial component occurring in the retropharynx. METHOD: Case report of a patient with swallowing difficulties caused by a rare case of superficial angiomyxoma in the retropharynx. RESULTS: Superficial angiomyxoma is a distinct entity among the dermal myxomatous lesions. Superficial angiomyxoma is poorly circumscribed, and local recurrence is common unless the tumour is excised with clear margins. Distinctive histological features include a myxoid mass composed of spindle and stellate-shaped cells and occasional multinucleated cells. There is prominent vasculature and a mixed inflammatory infiltrate in the stroma, particularly by neutrophil polymorphs. Epithelial structures are seen in about one-third of cases. A case of retropharyngeal tumour with morphological features of superficial angiomyxoma is reported. The tumour cells, including multinucleated ones, were negative for soft tissue differentiation markers. The inflammatory cells included lymphocytes, histiocytes and neutrophil polymorphs. CONCLUSION: This case demonstrates that a cutaneous type of angiomyxoma with epithelial-lined structures can occur in deep soft tissue, such as the retropharynx.

Follicular dendritic cell sarcoma of the pharyngeal region: histologic, cytologic, immunohistochemical, and ultrastructural study of three cases.

Follicular dendritic cell sarcoma is a tumor of recent description and characterization; it is often underdiagnosed because it is easily confused with other entities. Three cases of follicular dendritic cell sarcoma are described in the present article. The first occurred in the parapharyngeal space in a 29-year-old woman who developed multiple recurrences over the span of 10 years. The second was located in the left tonsil in a 48-year-old man, and the third case developed in the parapharyngeal space in a 26-year-old man. All cases were positive for CD21 and CD35 and ultrastructurally they displayed a morphologic spectrum. The first case featured spindle cells with interdigitated long cell processes joined by well-developed desmosomes. In the other two cases there were round to ovoid cells with interwoven processes connected by occasional desmosomes. Including these three cases, a total of 20 follicular dendritic cell sarcoma of the pharyngeal region have been reported to date. The clinical behavior of these tumors is similar to other low-grade sarcomas.

Chondroid chordoma: fine-needle aspiration cytology with histopathological, immunohistochemical, and ultrastructural study of two cases.

Chondroid chordoma is a controversial and confusing entity that was originally described by Heffelfinger et al. (Cancer 1973; 32:410-420) as a biphasic malignant neoplasm possessing elements of both chordoma and cartilaginous tissue. Fine-needle aspiration (FNA) cytology of chondroid chordoma has not been described. The aim of our investigation was to characterize the chondroid area of chondroid chordoma and to compare the FNA features with those of well-differentiated chondrosarcoma. Clival and cervical spine chondroid chordomas were studied with light microscopy, immunohistochemistry, and electron microscopy. Chondroid chordomas demonstrated an epithelial nature by immunohistochemistry and ultrastructural studies. The FNA smears showed low cellularity, with loosely arranged or dispersed round cells in a myxoid background. Although the smears were similar to those of well-differentiated chondrosarcomas, they showed a positive reaction for epithelial markers. These findings reveal that chondroid chordoma is a variant of chordoma which possesses a hyaline matrix. Immunohistochemical demonstration of epithelial markers is useful to distinguish it from chondrosarcoma. Diagn. Cytopathol. 1999; 21:335-339.

Improved cytochemical methods for demonstrating cell death using LR White as an embedding medium.

A series of techniques based on LR White resin are described, which permit the use of an anti-histone antibody for the in situ localization of DNA fragmentation characteristic of apoptosis at both the light and the electron microscope level. The methods, applied to an untreated squamous carcinoma of the pharynx, allow direct comparison of light microscopic localization of exposed nucleosomal histones using 3,3'-diaminobenzidine (DAB) and silver-enhanced techniques with a colloidal gold-based anti-histone technique at the electron microscope level. Parallel histochemical localization of acid phosphatase activity is also presented.

[Pharyngeal chordoma]. / Cordoma faríngeo.

Chordoma is a neoplasm arising from embryonal notochord remnants. It is infrequent and rarely located at the cervical level. The diagnosis is histological and immunohistochemical tests are required to differentiate it from other neoplasms. We report a case of pharyngeal chordoma treated with a transmandibular approach. The diagnosis, treatment, and prognosis of these tumors are reviewed.

Clear cell rhabdomyosarcoma.

A clear cell rhabdomyosarcoma was studied by light microscopy, histochemistry, immunohistochemistry, and electron microscopy. It was a large, painful left parapharyngeal mass in a 10-year-old boy with intracranial extension and cervical metastatic enlarged lymph nodes. Tumor tissue was macroscopically grayish. At microscopic examination, the architecture was diffuse and focally alveolar. Tumor cells were of three types. Most cells were large, round or polygonal, with abundant clear vacuolated cytoplasm. Fibrils were sometimes found to be present around the nucleus. Nuclei often had irregular outlines and multiple nucleoli. Mitotic activity was high. Some round or elongated cells had eosinophilic fibrillar cytoplasm and were found to have a few double striations. A few cells were round and medium sized with a high nucleocytoplasmic ratio. Periodic acid-Schiff stain demonstrated huge amounts of intracytoplasmic glycogen in clear cells. Tumor cells showed positive immunostaining for muscle markers (desmin, muscle actins, dystrophin). Electron microscopy showed large lakes of glycogen, lipid droplets, and striated muscle features.

[Rhabdomyoma of the adult type. Apropos of a case of parapharyngeal site]. / Le rhabdomyome de type adulte. A propos d'un cas de localisation parapharyngée.

The authors report the case of an adult parapharyngeal rhabdomyoma in a-66-years old man, revealed by dysphagia. Optical and electronical microscopic aspects and immunohistochemistry are presented and compared with those of the literature. The pathogenesis of this benign striated muscle tumor is still unclear. A recent study tends to confirm that it is a really benign neoplasm.

Malignant meningioma of the parapharyngeal space: a case report.

A case of a malignant meningioma arising in the left parapharyngeal space in a 29-year-old woman is reported. Electron microscopic examination of the tumor was critical in establishing the diagnosis. Meningiomas of the parapharyngeal space are extremely rare. This constitutes the first malignant case documented in this location.

[Pharyngeal lipoma]. / Pharyngeal lipoma.

We present a 40-year-old male patient with a lump in the parapharyngeal space protruding in the oro- and hypopharynx and obstructing the airway. Diagnosis lipoma. The pathology is reviewed and the surgical approach is commented upon.

Parapharyngeal ganglioneuroma. Report of a case diagnosed by fine needle aspiration.

A case of ganglioneuroma presenting in a parapharyngeal location in a 4-year-old girl was subjected to fine needle aspiration cytology. A preoperative diagnosis of ganglioneuroma was subsequently confirmed on histopathologic examination. Only a few reports on the cytologic features of this tumor exist. The importance of considering this diagnosis for a tumor at an unusual site and in an uncommon age group is stressed.

[Lipoma of the larynx and hypopharynx]. / Tluszczak krtani i gardla dolnego.

A case of lipoma of the larynx and hypopharynx is described in 56 year female. Expiration dyspnoea and change of the voice were manifested from due years. The tumor was removed per os and complete cure was obtained. Final diagnosis lipoma was appointmented of histological examination.

Recurrent parapharyngeal rhabdomyoma. Evidence of neoplastic nature of the tumor from cytogenetic study.

A 64-year-old Caucasian male with a left parapharyngeal mass had a past medical history that was significant for excision of a benign rhabdomyoma of the soft palate 30 years previously. Then 25 years ago, the tumor recurred in the palate and retropharyngeal space on the left and was reexcised. Histologic examination of all three excisions showed adult rhabdomyoma. Ultrastructural and histochemical studies of the second excision of this tumor have been published previously. The present study included histologic, ultrastructural, immunohistochemical, and cytogenetic analyses. The histologic and ultrastructural features of the tumor were identical to those reported 25 years ago. Immunohistochemical studies demonstrated that the tumor cells were desmin and myoglobin positive and vimentin negative. Focal positivity for CD56 was also present. Intracellular inclusions in the tumor cells were strongly positive for desmin. Cytogenetic examination of short-term cultures of the tumor cells demonstrated clonal chromosome abnormalities in 60% of metaphases. The majority of cells showed a reciprocal translocation between chromosomes 15 and 17 as the sole abnormality. A minor clone was characterized by abnormalities of the long arm of chromosome 10. The presence of clonal structural chromosome abnormalities in extracardiac adult rhabdomyoma lends strong support to the idea that these rare tumors are true neoplasms rather than hamartomatous or regenerative lesions.

Parapharyngeal malignant ectomesenchymoma: combined malignant fibrous histiocytoma and primitive neuroectodermal tumour with neuroglial differentiation.

A parapharyngeal ectomesenchymoma consisting of mixed malignant fibrous histiocytoma and primitive neuroectodermal tumour with neuroglial differentiation occurred in a 36-year-old woman. Immunohistochemical and electron microscopic studies verified the combined mesenchymal and neuroectodermal components within the tumour. Only 9 similar cases, including the present one, are on record. The patients ranged in age from 6 months to 49 years, with an average age of 18 years. The male:female ratio was 4:5. The tumour location was widespread. All reported ectomesenchymomas were histopathologically malignant. Recurrence and/or metastasis was/were common. The neural crest has been suggested as the origin of the ectomesenchymomas.

Canine laryngopharyngeal rhabdomyoma resembling an oncocytoma: light microscopic, ultrastructural and comparative studies.

A laryngopharyngeal rhabdomyoma was diagnosed in a four-year-old dog with clinical signs of upper respiratory obstruction. In people, rhabdomyomas have a predilection for the head and neck area. Features of this tumor were compared with an oncocytoma with which it may be confused.

Invading squamous cell carcinoma can retain a basal lamina. An immunohistochemical study using a monoclonal antibody to type IV collagen.

A monoclonal antibody to human glomerular type IV collagen has been characterized and used in an immunohistochemical study of the distribution of this basement membrane protein in dysplasias, intraepithelial carcinomas, and infiltrating squamous cell carcinomas. Four squamous carcinoma cell lines established as xenografts in nude mice were also examined. In normal epidermis and mucosae, the basement membrane was clearly defined and intact. In areas of intraepidermal carcinoma, the basal lamina as defined by the antibody was usually continuous, and defects were only present in areas associated with an inflammatory infiltrate. Invasive squamous cell carcinomas, regardless of the degree of differentiation had a clearly delineated basement membrane at the epithelial stromal interphase. In areas of invasion, far removed from the in situ component, there were protrusions of tumor cells through the basement membrane into the stroma. Other abnormalities of basement membrane production such as aggregation of basement membrane and reduplication of the basal lamina were also associated with the carcinomas. There was a similar distribution of basal lamina material in involved lymph nodes and in squamous cell carcinomas that were growing as xenografts in nude mice. Our studies suggest that the loss of basement membrane type IV collagen is not generally associated with invasive squamous cell carcinomas and is not likely to be useful in the assessment of early invasion in this tumor. The similar distribution of type IV collagen in the xenografts and in the infiltrating tumors suggests that this system, in conjunction with the use of the same cell lines in vitro, will provide a model with which to study the control of deposition of type IV collagen.

Multifocal recurrent adult rhabdomyoma.

The clinical and morphologic features of a recurrent, multifocal, adult, extracardiac rhabdomyoma are reported. This benign skeletal muscle neoplasm is composed of large round to polyhedral cells containing cross striations. The ultrastructural features consist of hypertrophic Z bands, intranuclear inclusions, and numerous mitochondria with linear, intracristal inclusions. The low thymidine labeling index and long potential doubling time correspond wi th the length of time for clinical recurrence.