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Vulvar and Vaginal Trauma and Bartholin Gland Disorders
Published in Botros Rizk, A. Mostafa Borahay, Abdel Maguid Ramzy, Clinical Diagnosis and Management of Gynecologic Emergencies, 2020
Malak El Sabeh, Mostafa A. Borahay
When evaluating a patient with Bartholin cyst or abscess, the patient should be asked about symptoms, their duration, presence of discharge, history of sexually transmitted diseases, and previous history of Bartholin gland cysts or abscesses. The physical exam reveals asymmetry, with a unilateral labial mass. Bartholin gland abscesses are painful, whereas Bartholin cysts are not. Abscesses are erythematous and indurated and might have an area of purulent discharge. Differential diagnosis includes other cysts (eg, Gartner, Skene, and sebaceous cysts), vulvar angiomyofibroblastoma, endometriosis, lipoma, leiomyoma, myeloid sarcoma, myxoid leiomyosarcoma, fibroma, hematoma, angiomyxoma, folliculitis, adenocarcinoma, and squamous cell carcinoma [31].
Synovial Sarcoma
Published in Dongyou Liu, Tumors and Cancers, 2017
Tumors of uncertain differentiation may be differentiated into (1) benign (intramuscular myxoma [including cellular variant], juxta-articular myxoma, deep [“aggressive”] angiomyxoma, pleomorphic hyalinizing angiectatic tumor, and ectopic hamartomatous thymoma), (2) intermediate (rarely metastasizing) (angiomatoid fibrous histiocytoma, ossifying fibromyxoid tumor [including atypical and malignant], and mixed tumor [myoepithelioma and parachordoma]), and (3) malignant (synovial sarcoma, epithelioid sarcoma, alveolar soft part sarcoma, clear cell sarcoma of soft tissue, extraskeletal myxoid chondrosarcoma [“chordoid” type], primitive neuroectodermal tumor [PNET]/extraskeletal Ewing tumor, desmoplastic small round cell tumor, extra-renal rhabdoid tumor, malignant mesenchymoma, neoplasms with perivascular epithelioid cell differentiation [PEComa], clear cell myomelanocytic tumor, and intimal sarcoma) [1].
Fibrous tumors
Published in Eckart Haneke, Histopathology of the NailOnychopathology, 2017
All fibromyxoid tumors have to be differentiated. Digital fibrokeratoma may occasionally present a myxoid stroma, but expresses factor XIIIa, is CD34 negative and exhibits a specific macroscopic shape. Superficial acral fibromyxoma and myxoid neurofibroma may be similar, but the latter lacks the prominent vasculature and is positive for protein S100, whereas there can also be focal CD34 positivity. Myxoid onychomatricoma is CD34+ and shows the characteristic microarchitecture. Sclerosing perineurioma is more a tumor of the palms than the nails; it expresses epithelial membrane antigen and CD34 is usually negative. Myxoid dermatofibrosarcoma protuberans is very rare, but was also observed on digits. It shows a storiform proliferation of CD34+ tumor cells, which also infiltrate the subcutaneous tissue. FISH reveals the typical t(17:22) translocation. Apolipoprotein D is expressed by dermatofibrosarcoma protuberans, but not by superficial acral fibromyxoma.78,79 Low-grade fibromyxoid sarcoma has once been observed on the big toe.80 It shows alternating fibrous and myxoid areas with a swirling growth pattern and the tumor cells have uniform spindle cell morphology with minimal nuclear atypia. It is consistently CD34 negative,81 but typically shows the fusion transcript FUS/CREB2L3.82,83 Superficial angiomyxoma is mainly localized in the head and neck region but may exceptionally be observed in a digit. It is commonly ill-defined, multilobular, often hypervascularized, includes an epithelial component in about 20% of the cases, and consists of a proliferation of spindle and stellate cells in a more diffusely myxoid matrix. It is surrounded by a neutrophil-rich infiltrate. CD34 is inconsistently expressed.84 Monophasic spindle cell variant of synovial sarcoma may also be considered differential diagnostically. However, it can be immunohistochemically characterized by EMA positivity and reactivity for keratins.85 Myxoinflammatory fibroblastic sarcoma occurs in the soft tissues of the extremities and is usually much larger but has no predilection for the nail apparatus. It can be distinguished thanks to its inflammatory infiltrate and the Sternberg-Reed like cells. When the myxoid component of superficial acral fibromyxoma is lacking, the histological features resemble cellular digital fibroma.86,87
Isolated intraosseous extra-gnathic orbital myxoma: a clinicopathologic case report
Published in Orbit, 2019
Fairooz P. Manjandavida, Shaifali Chahar, Brijal Dave
In our case, the tumor upon excision and gross examination was diagnosed as myxoid liposarcoma due to the presence of vascularity and bony invasion. Histopathology in combination with IHC helped in the definitive diagnosis. Angiomyxoma predominantly affects the pelvic-perineal region, and histopathologically it shows an abundance of small blood vessels. Also, angiomyxoma occurring in orbit is an extremely rare entity. Literature review reveals only four reported cases of angiomyxoma of the orbit.1,22 Myxoid liposarcoma must contain lipoblasts and complex arborizing or plexiform vascular patterns. Myxofibrosarcoma shows storiform cellular patterns and mixture of plump and spindle cells, infiltrative periphery and sends out long tentacles with frequent positive margins. Benign focal mucinosis contains fibroblastic-appearing cells embedded in a mucinous stroma. Myxolipoma is characterized by mature adipocytes and spindle cells in the myxoid stroma. IHC may be helpful in some cases. Myxomas are immunoreactive to Vimentin, CD34 (50%), SMA (10%), and factor XIIIa. It is negative for Desmin and S100. These markers differentiate myxomas from other varieties mimicking myxoma. In our case, IHC was positive for Vimentin and SMA and negative for S-100.
Incidentally detected perineal aggressive angiomyxoma in an asymptomatic patient with uterine leiomyomas
Published in Journal of Obstetrics and Gynaecology, 2021
Emre Altinmakas, Hakan Dogan, Muzaffer Temur, Serkan Guneyli
Aggressive angiomyxoma is a rare mesenchymal neoplasm that is predominantly seen in pelvic region of women (van Roggen et al. 2005). Deep pelvic soft tissues and perineum in women and periscrotal region in men are the most common locations (Amezcua et al. 2005). The tumour is called ‘aggressive’ due to deep soft tissue infiltration that causes local recurrence after surgical resection. We report a patient with aggressive angiomyxoma in the pelvic-perineal region that was incidentally detected on magnetic resonance imaging (MRI) which was performed for surgical planning of uterine fibroids.