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Superficial myofibroblastoma is a rare benign mesenchymal tumor which predominantly occurs in the female lower genital tract. Here we present a case of a 42-year-old female patient with prolonged vaginal bleeding. Radiological imaging revealed a well circumscribed mass in the vagina with a stalk. The patient underwent surgery and the tumor was histologically diagnosed as superficial myofibroblastoma. Notably, this is the first report of the radiological imaging of a superficial myofibroblastoma harboring a stalk arising from the vaginal wall. We compared the radiological images with histological findings and discuss major differential diagnosis of vaginal tumors. Despite the challenging nature of preoperative diagnosis of mesenchymal vaginal tumors, radiological features may aid in differentiating them from other more aggressive entities or malignant tumors.

Myofibroblastoma (MFB) of the breast is an uncommon entity of benign spindle neoplasms of the breast. This tumour possesses a broad spectrum of histomorphological patterns. Distinguishing of myofibroblastoma variants from malignant mimics of this benign neoplasm is essential for pathologists to avoid further invasive surgical procedures. In this article, we report the clinical, morphological, and immunohistochemical features of three cases, including two females and one male patient with mammary myofibroblastoma with emphasis on the histomorphological findings. As there is not yet enough information about MFB, more reports of MFB are still required to more clarify the pathogenesis and potential predisposing factors of this rare type of breast tumours.

The Inflammatory Myofibroblastic Tumor (IMT) is a rare benign pathology of the head and neck region that tends to mimic a malignancy on account of its aggressive clinical and radiographic features. There are various descriptive terms for this lesion due to the uncertainty of the biologic nature of the lesion, namely: Fibrous Xanthoma, Plasma Cell Granuloma, Pesudosarcoma, Lymphoid Hamartoma, Myoxid Hamartoma, Inflammatory Pseudotumor and Benign Myofibroblastoma. Inflammatory Myofibroblastic Pseudotumor occurs throughout the body, most frequently in the peritoneal cavity, retroperitoneal space and lungs, among extra pulmonary lesions 15% accounts for the head and neck region. Most commonly, they are located in the region of the orbit. Inflammatory Myofibroblastic tumor presentation in maxillary sinus is rare and has an invasive potential. We have presented a case report of Inflammatory Myofibroblastic tumor of maxillary sinus, correlating Clinical, radiographic, and histopathologic along with immunohistochemical profile to arrive at a diagnosis, with special emphasis on the disputed nosology of this lesion and the latest therapeutic update.

Myofibrolastoma of the breast (MFB) is a rare and benign stromal tumor. Although MFB is a benign entity, in radiologic evalu-ation, there is no specific diagnostic feature. Conventional breast imaging findings have been published before. Sonoelas-tography has been used as an imaging method that allows us to evaluate tissue stiffness in vivo and increases the specificity of B-mode ultrasonography in the discrimination of benign-malignant lesions. In this case report, it was shown that MFB is of high stiffness in shear wave elastography (SWE) evaluation. SWE findings of MFB, which is a benign lesion, have been described for the first time in the literature.

We describe a case of a 37-year-old man with painless left inguinal bulging due to a 5-cm solid mass adjacent to spermatic cord. Ultrasound-guided core needle biopsy was performed and histopathological examination revealed a mammary-type myofibroblastoma. Despite being rare, this is an emblematic case of a spermatic cord tumor which could be managed with marginal surgical excision, preserving spermatic cord, because of preoperative diagnosis.

Cellular angiofibroma (CA) is a rare, benign mesenchymal tumor with a predilection to the distal female and male genital tract. Extragenital examples of CA, including anorectal CAs, are exceedingly rare and documented mainly as single case reports. Herein, we analyze the clinicopathological and immunohistochemical features of 5 anorectal CAs. There were 4 males and one female ranging in age from 45 to 70 (median, 58) years at the time of surgery. Tumors arose in the superficial tissues of the anorectal (n = 3) and perianal (n = 2) regions. The tumors were well circumscribed ranging from 2 to 6.7 (median, 5.4) cm. All demonstrated a low to moderately cellular proliferation of cytologically bland spindled cells within a variably dense collagenous and focally myxocollagenous stroma and small- to medium-sized vessels featuring perivascular collagen deposition. Two cases showed degenerative and/or inflammatory changes. All 5 tumors strongly expressed CD34 and androgen receptor proteins, more variably expressed estrogen (n = 5) and progesterone (n = 4) receptor proteins and desmin (n = 3), and focally expressed alpha-smooth muscle actin (n = 3), GATA-3 (n = 2), and p16 (n = 1). Retinoblastoma protein expression was reduced (n = 4) (compared with expression in endothelial cells) or completely lost (n = 1). All patients were treated with simple surgical excision, and the 2 study members with follow-up data showed no evidence of local recurrence over a postoperative follow-up interval of 23 and 73 months. In comparison with conventional genital tract CA, our 5 anorectal CAs occurred mostly in males, were generally less cellular, and appear to follow a similar uneventful clinical course.

Mammary-type myofibroblastoma is a rare benign neoplasm of mesenchymal origin. Presentation outside of the embryological mammary crest is exceedingly rare. This case report documents the presentation of a 40 year old male who presented with a painless infra-auricular swelling. We discuss histological, clinical and radiological findings as well as the challenges of managing spindle cell lesions within the head and neck region.

Background: Deep angiomyxoma (DAM) is currently included in the category of “specific stromal tumors of the lower female genital tract”, along with angiomyofibroblastoma, cellular angiofibroma and myofibroblastoma. Given the high rate of local recurrences, it is crucial to recognize DAM from other tumors that possess indolent behaviour. In the present paper, we analyzed the morphological and immunohistochemical features of 42 surgically-resected vulvo-vaginal DAMs (36 primary and 6 recurrent lesions) in order to widen the morphological spectrum of this uncommon tumor. Methods: A series of 36 cases of surgically-resected primary vulvo-vaginal DAMs were retrospectively collected. Locally recurrent tumors were also available for six of these cases. Results: Out of the primary tumors, 25 out of 36 exhibited the classic-type morphology of DAM. In the remaining cases (11/36 cases), the following uncommon features, which sometimes coexist with one another, were observed: (i) alternating myxoid and collagenized/fibrous areas, (ii) hypercellular areas, (iii) neurofibroma-like appearance, (iv) perivascular hyalinization, (v) microcystic/reticular stromal changes, (vi) “microvascular growth pattern”, (vii) perivascular cuffing, (viii) nodular leiomyomatous differentiation, (ix) hypocellular and fibro-sclerotic stroma. Among the six locally recurrent tumors the following features were observed: (i) classic-type morphology, (ii) hypocellular fibro-sclerotic stroma, (iii) extensive perivascular hyalinization, lumen obliteration and formation of confluent nodular sclerotic masses, (iv) hypercellularity. Immunohistochemically, the neoplastic cells of classic-type DAM in both primary and recurrent tumors were diffusely stained with desmin, suggesting a myofibroblastic nature, in contrast, the neoplastic cells showing elongated fibroblastic-like morphology and set in collagenized/fibrosclerotic stroma in both primary and recurrent tumors were negative or only focally stained with desmin, which is consistent with a fibroblastic profile. Conclusion: Although diagnosis of DAM is usually straightforward if typical morphology is encountered, diagnostic problems may arise when a pathologist is dealing with unusual morphological features, especially hypercellularity, extensive collagenous/fibrosclerotic stroma or neurofibroma-like appearance.

A 52-year-old lady was seen in the breast clinic after an 8 mm lesion was found in her left breast on screening mammogram. Clinical examination was normal. The left breast mammogram showed an 8 mm rounded density posteriorly in the inner half of breast and ultrasound also showed a 7 mm, well-defined ovoid echogenic lesion (R3, U3). Biopsy confirmed the lesion was fibro-fatty tissue containing a diffuse infiltrate of lymphoid cells macroscopically (B3/4)—findings in line with a diagnosis of a myofibroblastoma. A myofibroblastoma is a rare benign mesenchymal tumour comprising of spindle cells. Most breast myofibroblastomas described in the literature have been excised by wide local excision. In this patient’s case, a vacuum-assisted technique was discussed and suggested at the multidisciplinary meeting. It was excised using ultrasound-guided Vacora® breast biopsy system. The lesion was completely excised with the encore biopsy measuring 24×17 mm. This is the first documented case of such a technique for the excision of a breast myofibroblastoma. There still is uncertainty about breast myofibroblastomas, their aetiology, associations, and how they are best investigated. Regarding management, vacuum-assisted technique, being less invasive and cheaper than local excisions, is adequate for small lesions.

Cervicovaginal myofibroblastoma (CVM) is a rare benign mesenchymal tumor of the lower female genital tract that shows chromosomal loss of 13q14 (RB1 gene located in this region). The aim of this study was to investigate the utility of immunohistochemistry (IHC) for desmin, CD34, and Rb in diagnosing CVM. All cervical polyps diagnosed from July 2016 to July 2017 were retrospectively reviewed. Cases showing morphologic myofibroblastic differentiation were evaluated by IHC for desmin, CD34, and Rb. Desmin and CD34 staining was recorded as positive or negative. Rb nuclear staining was graded as follows: 0 (10%), 1 (10%-25%), 2 (25%-50%), 3 (50%-75%), or 4 (75%). Intact nuclear expression of Rb in endothelial cells served as an internal positive control. IHC was performed on 76 cases with 14 excluded from the final cohort due to poor Rb internal control. A total of 61/62 (98.4%) cases were positive for desmin and CD34 with the following Rb distribution: grade 0 (n=53, 86.9%), grade 1 (n=5, 8.2%), grade 2 (n=2, 3.3%), and grade 3 (n=1, 1.6%). One case negative for desmin and CD34 showed grade 3 Rb staining. Upon rereview of the histology, 7/175 cases (4%) were morphologically and immunohistochemically compatible with CVM (desmin and CD34+ grade 0 Rb staining). CVM is a rare and under-recognized entity (4% of cervical polyps) for which morphology remains the mainstay of diagnosis. IHC reliance serves as a potential diagnostic pitfall as 86.9% of cases showing myofibroblastic differentiation demonstrated the staining pattern of desmin and CD34 positivity and Rb deficiency.

We reported a 65‐year‐old male with a benign mammary myofibroblastoma. This report shows that not all masses of male breast are malignant. To differentiate benign masses from malignant neoplasms, careful preoperative diagnosis should be performed. Preoperative diagnosis of the tumor prevents placing a huge financial and mental burdens on patients.

Background: Superficial myofibroblastoma (SMF) is a very rare benign mesenchymal tumor in the female lower genital tract. Only 46 cases have been reported in the English language literature, among which only 7 cases arose in the vulva. Sometimes SMF histologically mimics aggressive angiomyxoma (AA) in which massive myxoid change in stroma is characteristic. We herein report a case of vulvar SMF with prominent myxoid stroma and review the literature with the emphasis on the differential diagnosis of SMF and AA. Case presentation: a 37-year-old woman presented with a painless mass in the vulva. Magnetic resonance imaging (MRI) showed a well-circumscribed 7 cm mass in the subcutis of the vulva. The tumor was resected. Histopathologically, the tumor was characterized by sparsely populated spindle-shaped cells in the fibromyxoid stroma. Thin-walled blood vessels were detected. Mitoses or pleomorphism was not found. Tumor cells were positive for vimentin, ER, PgR, and desmin. Some cells were positive for alpha-SMA and CD34. All cells were negative for S100 protein. Conclusions: because SMF and AA show different clinical prognoses, distinguishing SMF from AA is important. However, SMF may share many common histological features with AA: superficial localization (above fascia), sharp borderline from adjacent tissue, expansive growth pattern; a specific vascular pattern will lead to an accurate diagnosis of SMF. Familiarization with the histological characteristics of the two entities will help to make a prognostic prediction.

Mesenchymal lesions of the breast comprise a spectrum of benign, reactive and malignant conditions. They usually present to the pathologist as spindle cell lesions and many have distinct histological and immunohistochemical findings. Characteristic molecular changes of diagnostic utility are increasingly being identified. The limited tissue available in needle core biopsy may preclude definitive diagnosis and surgical excision may be required for precise characterization. Judicious sampling, immunohistochemistry or advanced molecular tests may be required in order to reach the correct diagnosis. This article focusses on mesenchymal breast lesions which are specific to the mammary stroma. Pure primary mesenchymal lesions of the breast are frequently of fibroblastic-myofibroblastic origin. Vascular lesions comprise a varied spectrum of lesions which may often be seen in the post radiation context and will be described here in some detail. Biphasic lesions such as phyllodes tumors, metaplastic carcinomas and lesions of epithelial-myoepithelial derivation are not discussed.

Myofibroblastoma of the breast is a rare mesenchymal tumor, probably originating from stromal fibroblasts. In this case report, cyto-histopathological findings of myofibroblastoma of the breast are discussed. A 68-years-old male patient was admitted to our clinic with a rapidly growing, painless mass in the breast. Radiological examination revealed a mobile, solid mass resembling to fibroadenoma. Fine needle aspiration revealed spindle cell clusters with fibrous stroma and a clear background. Hypocellular aspirates demonstrated neoplastic cells with cyanophilic cytoplasm and mild/moderate pleomorphism, and naked elongated nuclei including fine granular chromatin, nuclear groove and inclusion. The lesion was reported as “benign spindle cell neoplasm”. Tru-cut biopsy revealed short fascicules composed of uniform benign spindle cells with hyalinized collagen bands accompanied by mast cells and patchy lymphoid infiltration. Immunoreactivity was positive with CD34, smooth muscle actin (SMA), desmin and vimentin, but negative with CD117, CD10, Epithelial Membrane Antigen, S-100, pan-cytokeratin and p53. This case was reported as “classic variant of myofibroblastoma”, and the patient was operated in another clinic. There was no recurrence during follow-up. Myofibroblastoma is a rare, benign mesenchymal tumor, usually seen in the breast parenchyma. While the tumor is diagnosed based on the fibro-myofibroblastic differentiation characteristics, other tumors and tumor-like spindle cell lesions should also be kept in mind. The cytological features of 22 cases in the literature were similar. Aspirates are generally hypercellular with mild-moderate pleopmorphism, nuclear groove and inclusions. Histopathology shows positivity for CD34, vimentin, desmin and SMA. Clinical/radiological characteristics and atypia, growth pattern, mitosis and immunohistochemistry should all be evaluated together. Cytomorphology may be the first step in diagnosis; however, immunohistochemical studies should not be ignored in differential diagnosis.

Inflammatory myofibroblastic tumor (IMT) is a rare tumor with low-grade malignant risk mainly occurring in soft tissues and lungs, and it is extremely rare in the breast. Meanwhile, imaging findings of the tumor often present with non-specific features that lead to misdiagnosis and delayed treatment. Here, we report a case of inflammatory myofibroblastic tumor in the breast with the imaging findings of mammography, magnetic resonance imaging (MRI), and pathologic findings to improve the understanding of the disease. The patient was treated by surgical operation, and was followed up for 44 months, no local recurrence and distant metastasis.

Myofibroblastoma (MFB) is a rare benign mesenchymal tumor usually occurring in the breast parenchyma. This tumor can present as a palpable nodule or can be incidentally detected as a nonpalpable mass on routine screening mammogram. We first report a rare case of histologically proven MFB of the breast revealed by fluoro‐deoxyglucose uptake on PET‐CT examination in a patient with a lung nodule. Tumor exhibited an unusual morphology, being predominantly composed of polygonal, epithelioid, and deciduoid‐like cells set in a myxoid stroma. The most striking feature was the multifocal presence of atypical/bizarre, mono/bi‐nucleated cells that, in addition to diffuse myxoid stromal changes, were a concern of malignancy, especially on core biopsy. The final diagnosis of MFB was achieved on surgically resected specimen and, similarly to other benign soft tissue tumors (especially leiomyoma and schwannoma/neurofibroma), the term “bizarre cell MFB of the breast” is proposed to emphasize the degenerative/reactive nature of the atypia.

Myofibroblastoma of the breast (MFB) is a rare benign mesenchymal tumor of the breast. A case of giant breast myofibroblastic tumor, which is rarely reported in literature, was recently diagnosed in our department. We also analyzed the clinicopathological features of MFB to improve the understanding of the tumor and avoid misdiagnosis.

Myofibroblastoma is a rare tumor that was originally described in the breast but has since been found in extra-mammary locations, where it been renamed mammary-type myofibroblastoma (MTM). We describe a case of MTM occurring in the anterior compartment of the thigh, which was initially interpreted as a possible a liposarcoma on MRI. Two subsequent biopsy samples and eventual excision revealed the tumor to have the characteristic pathology of MTM. This benign tumor, albeit rare, needs to be considered in the imaging differential diagnosis of fat containing deep soft tissue masses of the extremity.

Myofibroblastoma (MFB) is a relatively rare tumor of the breast parenchyma, which belongs to the family of the ‘benign stromal tumor of the breast’. Two cases of MFB of the breast are described. Radiological imaging is nonspecific in MFB, and pathological examination of needle biopsy or surgically resected specimen is necessary for the diagnosis. Surgery is recommended and considered curative without additional treatment; however, patients should be followed-up.

Epithelioid myofibroblastoma of the breast is a rare benign stromal tumor occurring in the postmenopausal females and elderly males. We report one such case in a 65-year-old female who underwent trucut biopsy from a well-defined right breast lump, which was misinterpreted as invasive lobular carcinoma on histology. Tumor showed mild to moderately pleomorphic tumor cells arranged in single file pattern, loosely dispersed and focally in sheets with inconspicuous nucleoli embedded in a fibrotic and hyalinized stroma. Immunohistochemistry for E-cadherin was negative further substantiating the morphological diagnosis. However, mastectomy specimen revealed it to be a case of epithelioid myofibroblastoma with the help of a large panel of immunohistochemical stains. In this report, we emphasize on the challenges of establishing this rare diagnosis mimicking lobular carcinoma, a diagnostic pitfall on trucut biopsy.

Myofibroblastomas are tumors of the breast, which can rarely present at extramammary sites. Only a few cases have been reported to appear in the head and neck. Here we discuss the first reported case of an extramammary myofibroblastoma presenting as a firm nodule on the zygomatic arch and review the literature of these rare tumors in the head and neck.

Myofibroblastoma (MFB) is a rare spindle stromal tumour of the breast that predominates in 60–80 years-old adult males. Its imaging features are nonspecific, leading to misdiagnosis. Thus, core biopsy is needed for definitive diagnosis. Macroscopically, MFB is usually a well-circumscribed, firm and rubbery, unencapsulated, pale white to grey round mass. Microscopically, it consists on spindle cells arranged in haphazardly intersecting fascicles or clusters, thick hyalinized collagen bundles and low mitotic activity with a lack of myoepithelial component and necrosis. Immunohistochemistry shows consistently positive immunoreactivity to vimentin and CD34, while expression of desmin, SMA, bcl-2 and CD99 varies. Oestrogen, progesterone and androgen receptors are usually expressed. They are constantly negative to cytokeratins, EMA, S100 protein, HMB-45 and c-kit (CD117). These differentiate them from fibroadenoma , phyllodes tumour, round pattern gynecomastia, carcinoma and sarcoma , since they present infiltrative growth and are negative to CD34. Wide local excision is curative, with no need of sentinel lymph node biopsy, since local recurrence is extremely low and has been reported to be less than 1.5%. No distant metastases have been described on the literature. We report a rare case MFB on a 73-year-old male attended at our institution presenting with a nodule on the right breast.

Un myofibroblastome de type mammaire est une tumeur molle rare; les myofibroblastomes extramammaires sont particulièrement rare. Un homme de 78 ans s'est présenté en consultation pour des douleurs pelviennes soulagées par la défécation ou les urines. Le toucher rectal retrouve une masse en avant de la paroi rectale antérieure. L'imagerie par résonance magnétique (IRM) montre une masse de 10 x 6 x 8cm, bien circonscrite et hétérogène, située en arrière de la vessie qu'elle refoule vers l'avant, en avant du recto-sigmoïde. L'immunohistochimie montre des cellules tumorales co-exprimant CD34 et la desmine de façon diffuse, expression de Rb dans la majorité des cellules, expression des récepteurs aux œstrogènes, expression intense et diffuse de la P16, un index de prolifération avec le ki67 estimé à 25%. Il n'y a pas eu de récidive après 8 mois de radiothérapie d'induction suivie de chirurgie. Un myofibroblastome de type mammaire est une tumeur rare et bénigne. La récidive n'est quasiment pas observée après traitement local. Ce cas permet de mettre en avance la possibilité d'utiliser la radiothérapie afin de faciliter la chirurgie.

Spindle cell lesions of the breast are rare entities and pose a diagnostic challenge for pathologists due to overlapping morphologic and immunohistochemical features. We evaluated EZH2 expression in various benign (fibromatosis (n = 8), myofibroblastoma (n = 7), neurofibroma (n = 1), nodular fasciitis (n = 5), benign phyllodes tumor (n = 18)) and malignant (malignant phyllodes tumor (n = 8), metaplastic breast carcinoma (n = 16) and angiosarcoma (n = 8)) spindle cell lesions as a potential diagnostic and therapeutic marker. The EZH2 expression was evaluated semi-quantitatively to categorize the cases as 'low' and 'high' expression. All benign lesions showed low EZH2 expression, whereas high EZH2 expression was observed in the majority (28/32; 88%) of malignant lesions. The study results suggest that EZH2 may be used both as an additional diagnostic tool to reach an accurate diagnosis of the spindle cell lesions of the breast and as a therapeutic target for the malignant lesions.

The diagnosis of cutaneous and subcutaneous spindle cell neoplasms in children is often challenging and has potential therapeutic and prognostic implications. Although correctly diagnosing dermatofibrosarcoma protuberans and infantile fibrosarcoma is paramount, pathologists should not ignore a number of diagnostic pitfalls linked to mostly rare tumors with completely different clinical outcomes. In the last decade, a spectrum of novel entities has been described; information from molecular biology has helped to shape this new landscape for spindle cell tumors. Here, we review the most noteworthy neoplasms in this spectrum, with a focus on their histological similarities: fibroblastic connective tissue nevus, medallion-like dermal dendrocyte hamartoma, or plaque-like CD34-positive dermal fibroma, which share features with fibrous hamartoma of infancy; lipofibromatosis and lipofibromatosis-like neural tumor; and plexiform myofibroblastoma, a recently described neoplasm that should be distinguished from plexiform fibrohistiocytic tumor. These tumors also have genetic similarities, particularly gene rearrangements involving NTRK3 or NTRK1. These genetic features are not only essential for the differential diagnosis of infantile fibrosarcoma but are also of diagnostic value for lipofibromatosis-like neural tumors. The more recently described RET, RAF1, and BRAF gene fusions are also discussed.

The mesenchymal breast proliferations discussed in this chapter are unified by their fibroblastic or myofibroblastic differentiation. Some of them are specific to the mammary stroma (myofibroblastoma, pseudoangiomatous stromal hyperplasia) or are so familiar in the breast (desmoid fibromatosis) that they are recognized by most pathologists. Other tumors are much more common at extramammary soft tissue sites, such as nodular fasciitis, dermatofibrosarcoma protuberans, inflammatory myofibroblastic tumor, low-grade fibromyxoid sarcoma, myxofibrosarcoma, and low-grade myofibroblastic sarcoma. Nevertheless, these tumors may rarely arise in the breast parenchyma, the skin overlying the breast, the chest wall, or the axilla and thus come to the attention of the breast multidisciplinary team. The following discussion emphasizes both the salient clinicopathologic and molecular genetic findings of these neoplasms as well as their differential diagnostic considerations, specifically tailored to the perspective of a breast pathologist.

The mesenchymal neoplasms discussed in this chapter are generally rare and can be encountered either as a breast primary or occur in the chest wall, the soft tissue of the axilla, or the skin overlying the breast. With rare exceptions, when arising in the vicinity of the breast, these tumors share the same morphologic, immunophenotypic, and molecular genetic features as their somatic soft tissue counterparts; accordingly, for a comprehensive review of these tumors, the reader is referred to the respective chapters of dedicated soft tissue textbooks. However, select tumors are briefly discussed here from the perspective of a breast pathologist, due to their close mimicry of common breast tumors such as myofibroblastoma, metaplastic carcinoma, or malignant phyllodes tumor. Primary breast sarcomas with fibroblastic/myofibroblastic differentiation are also described in other chapters.

Objective. To study computed tomography (CT) imaging characteristics of bladder tumors, to explore the value of CT in tumor diagnosis, and to identify the relevant factors of CT missed diagnosis so that medical staff can be more accurate in the diagnosis of bladder tumors. Methods. To retrospectively analyze the CT manifestations of 153 bladder tumor cases confirmed by paraffin pathology in our hospital and to study the difference between the benign and CT imaging features. CT indicators mainly include the number, location, morphology, calcification, bladder wall smoothness, CT value, degree of enhancement, and invasion of surrounding tissues and organs. Then, we retrospectively analyze 17 cases of CT missed diagnosis of bladder tumors, analyze related factors, and discuss the role of CT in the diagnosis of bladder tumors. Results. This study has shown that with the help of CT images, the diagnosis rate of bladder tumors has been greatly improved. Of the 153 patients studied, noninvasive urothelial carcinoma accounted for 18.95% of all benign and malignant bladder tumors, invasive urothelial carcinoma accounted for 67.93%, prostatic metastatic carcinoma and inflammatory myofibroblastoma accounted for 8.47%, pheochromocytoma accounted for 1.31%, inverted papilloma accounted for 1.31%, tubular choriocarcinoma accounted for 0.63%, and endocystitis accounted for 1.31%. In addition, the blood supply level, CT index bladder wall smoothness, and CT value are also statistically significant ( P < 0.05 ). Conclusions. CT is of high value in the diagnosis of bladder tumors, and benign and malignant bladder tumors have CT and CT imaging features. The size of bladder tumors is related to the missed diagnosis rate of CT. The application of CT examination technology can improve the accuracy of diagnosis of bladder tumors.

Highlights • Superficial myofibroblastoma of the Labia Majora. • Differential diagnosis between vulvar superficial myofibroblastoma and cyst/hydrocele of Nuck duct. • Differential diagnosis between vulvar superficial myofibroblastoma and inguinal/crural hernia.

Myofibroblastoma (MFB) of the breast belongs to a benign mesenchymal tumor1, this group of solid neoplasias of the breast are uncommon, also can generate a diagnostic challenge specially in the diagnosis with de needle biopsy2. In this review we refer to a case of a male patiente with a diagnosis of a infiltratin ductal carcinoma in the core needle biopsy with a pathological diagnosis of the surgery specimen of a epitheloid cell myofibroblastoma of the breast. El miofibroblastoma de glándula mamaria es un tipo de tumor mesenquimal benigno1, este grupo de neoplasias sólidas de la mama son infrecuentes, además de poder generar problemas diagnósticos diferenciales especialmente en biopsia por aguja2. En esta revisión hacemos referencia a un caso de un paciente masculino con diagnóstico de Carcinoma ductal infiltrante en la biopsia por aguja gruesa con diagnóstico patológico de la pieza quirúrgica de miofibroblastoma epiteloide de mama.

Background: IMTs are extremely rare in eyes. This is the first report of a IMT of the ciliary body.Case presentation: A ciliary body tumor was found under slit lamp biomicroscopy in a 55-year-old male first diagnosed with cataract. Then this patient underwent trans-sclera resection via partial lamellar sclerouvectomy and par plans vitrectomy to remove the mass. Hematoxylin and eosin (HE) staining and immunohistochemistry findings showed that the characteristics of the tumor were consistent with inflammatory myofibroblastoma tumor (IMT).Conclusions: we reported a rare case of intraocular IMT, which is confirmed by H&E staining, and IHC positive staining for Vimentin, Desmin and ALK, while negative staining for SMA, S-100, ki-67, CK, CD68, and calponin.

Aggressive angiomyxoma (AA) is a rare mesenchymal neoplasm occurring almost exclusively in the vulvovaginal region and which has a wide differential diagnosis. It has previously been suggested that the nuclear transcription factor HMGA2 is a useful marker of AA, although the number of studies is limited. We investigated HMGA2 immunoreactivity in a large series (n=284) of vulvovaginal mesenchymal lesions. HMGA2 nuclear staining was classified as diffuse (≥50%), focal (

The spectrum of benign superficial fibroblastic/myofibroblastic tumors continues to expand and includes entities such as plexiform fibrohistiocytic tumor, dermatomyofibroma and fibroblastic connective tissue nevus. Here, we describe a seemingly distinctive group of lesions which we have labeled "plexiform myofibroblastoma" (PM). PM is a rare superficial mesenchymal tumor of fibroblastic/myofibroblastic lineage that predominantly occurs in children and young adults. Thirty-six cases from the consultation archives of one of the authors have been studied to characterize the clinicopathologic characteristics of PM. 19 patients (53%) were female and 17 were male, with age at presentation ranging from congenital (2 cases) to 50 years of age (median: 9.5 y). Three patients had multiple lesions. Males tended to develop tumors during childhood (median: 2 y; range: congenital-37 y), while in females the age distribution was relatively uniform from childhood through adulthood (median age: 25 y; range: 4 mo to 50 y). Most tumors occurred in truncal locations (25/40), including the back (11), anterolateral chest wall (4), axilla (4), abdominal wall (4), perineum (1) and suprapubic region (1). Other tumor sites were the neck (10/40), occiput (2), lower extremity (2) and breast (1). The average greatest dimension was 2.7±1.7 cm (range: 0.6 to 8 cm). Three male patients, 2 of whom were brothers, presented between 6 months and 1 year of age with multiple lesions variably involving the back, occiput and axillae; these lesions spontaneously regressed after being present for about 2 years, with no evidence of recurrence at a mean follow-up of 11.4±3.2 years. Histologically, PM was composed of plexiform fascicles of fibroblastic/myofibroblastic spindle cells that ramify through the subcutis and reticular dermis. The bland neoplastic cells had indistinct cell borders, palely eosinophilic cytoplasm and ovoid or tapered nuclei. There was no histiocytoid component in any case, and no cases contained osteoclast-like giant cells. Twelve of thirty-four (35%) reviewed cases showed at least focal keloidal hyalinization, 6/34 (18%) contained somewhat fasciitis-like areas and 6/34 (18%) contained focal myxoid stroma. Immunohistochemical studies were positive for SMA (27/32 cases), desmin (9/21) and CD34 (13/24) and negative for β-catenin (0/14) and S-100 (0/22). EMA was weakly positive in 2/15 cases. An FGFR2 M535L tyrosine kinase domain variant of unknown significance was detected in 1/7 sequenced cases, and no somatic alterations, copy number alterations or gene fusions were detected in the other 6. Clinical follow-up data were available for 16/36 patients (44%; median duration: 5.5 y). Although most excisions had positive margins (11/16), only 1 patient developed a local recurrence 4 years after initial excision. No tumors metastasized. PM is a benign tumor with characteristic histology, epidemiology and anatomic site distribution. Because PM rarely recurs, a watchful waiting approach would be reasonable for lesions excised with positive margins.

Myofibroblastoma (MFB) is a rare benign spindle cell tumor originating from myofibroblasts in the breast stroma. MFB typically presents as a slow-growing, well-circumscribed, solitary mass ranging from 1 to 4 cm in size. It has been reported in adults, and frequently seen in older males and in postmenopausal females. The lesion is composed of stromal cells showing fibroblastic and myofibroblastic differentiation at the morphological, immunohistochemical and ultrastructural levels. To date, the literature includes only about 24 MFB cases confirmed via fine-needle aspiration and cytological evaluation. Here, we present a patient with MFB that was diagnosed via conventional smear slides and cell block, in addition to immunohistochemical analysis.

We present a case of a 21-year-old female with a vague nontender mass in the lower inner quadrant of the left breast discovered incidentally on chest imaging following trauma. A breast ultrasound demonstrated an 8×6×8 mm irregular hyperechoic mass at the 7 o'clock position of the left breast, 9 cm from the nipple. The mass was graded Breast Imaging Reporting and Data System (BI-RADS) category 4 (suspicious finding). An ultrasound-guided biopsy of the mass showed a proliferation of monotonous spindled cells in a storiform pattern with tapered nuclei with infiltration into the adipose tissue. No normal breast elements were identified in the biopsy. Myofibroblastoma was the first differential diagnosis; however, the characteristic infiltrative pattern of the tumor mandated additional tests including fluorescence in situ hybridization to rule out a dermatofibrosarcoma protruberance (DFSP). Immunohistochemical staining showed positive staining for CD34, which can be positive in myofibroblastoma also. However, fluorescence in situ hybridization demonstrated a platelet-derived growth factor B (22q13.1) gene rearrangement confirming a diagnosis of DFSP. The patient underwent a wide local excision of the DFSP for definitive treatment. She is doing well with no recurrence reported so far, after 15 months of follow-up. Conventional DFSP does not metastasize but is prone to recurrence making wide margins imperative for definitive treatment.

Well-differentiated (WDL) and dedifferentiated liposarcomas (DL) of the pharynx, larynx and oral cavity are rare, often mimicking benign lipomatous neoplasms or non-lipogenic mesenchymal tumors. Cases of WDL/DL arising in the upper aerodigestive tract, exclusive of the cervical esophagus, were reviewed. Morphologic features, ancillary studies, including fluorescence in situ hybridization (FISH) studies for CPM/MDM2, and clinical data was catalogued. Eight WDL/DL (4 WDL, 4 DL); were identified in patients ranging from 32 to 77 years (median 52.5 years; 6 males, 2 females) with sites of origin including hypopharynx (5 cases), larynx (2 cases) and oral cavity (1 case). Six of the 8 cases were received for expert consultation, and the remaining 2 cases were initially misdiagnosed as benign lymphangiomatous or fibroepithelial polyps. Morphologically, 4 tumors had areas mimicking various non-lipomatous soft tissue tumors including nodular fasciitis, mammary-type myofibroblastoma, low-grade myofibroblastic sarcoma and undifferentiated pleomorphic sarcoma, 2 cases simulated benign hypopharyngeal polyps, and 1 lesion was notable for a dense lymphoplasmacytic infiltrate suggestive of hematolymphoid neoplasm or IgG4-related sclerosing disease. FISH showed amplification of CPM/MDM2 (8/8 cases). All cases (4/4) with longer than 1-year of follow-up recurred (45-118 months) with 1 tumor showing progression to DL. WDL/DL presenting in the upper aerodigestive tract are rare and diagnostically challenging. Awareness of the morphologic spectrum of WDL/DL coupled with appropriate use of MDM2 FISH is essential for accurate classification and management, as these tumors appear to have a high risk for local recurrence and eventual dedifferentiation in these anatomical locations.

Extra-mammary myofibroblastomas are rare benign mesenchymal neoplasms, histologically and immune-phenotypically identical to mammary myofibroblastomas. Histologically, they are characterized by the abundance of spindle cells in hyalinized collagenous stroma with positive expression of CD 34 and desmin. We present an extremely rare case of extra-mammary myofibroblastoma of the orbit in a 29-year - old male who presented with painless proptosis of the right eye, with a description of clinical, radiological, and histological findings.

This chapter deals with some issues in the practice of breast pathology that were not dealt with fully in the previous chapters. This includes a detailed account of phyllodes tumour, benign, border-line and malignant, as well as other less common benign breast lesions. The chapter also discusses breast implant associated anaplastic large cell lymphoma and tumours arising in ectopic breast tissue.

Highlights • Mammary-type Myofibroblastoma of the Inguinal Region is very rare. • Prognosis of this disease is good after surgical resection. • The correct diagnosis and treatment is important. • We think that it is useful to share knowledge widely about this disease., Introduction Myofibroblastoma is usually occurred in the breast and extra-mammary disease is rare. Presentation of case A 38-year-old man was admitted to our hospital for further examination of the left inguinal tumour, present and enlarging for 16 months. The tumor was 50 mm in diameter, well-circumscribed, firm, and painless. Ultrasonogaphy, computed tomography(CT) and magnetic resonance imaging (MRI) could not provide the definitive diagnosis. Surgical exploration confirmed a 50 mm tumour with a clear surface with a thin capsule. Complete excision was achieved. Histopathology confirmed the tumor had oval and spindle shaped fibroblastic cells with rich collagen deposition. It stained positive for ER, CD34, desmin and CD10 but negative for -smooth muscle actin and S-100. A mammary-type myofibroblastoma was diagnosed based on these results. Discussion An extra-mammary myofibroblastoma is very rare and first reported in 2001. Since then, over 160 cases have been reported. On immunohistochemistry, these lesions are characteristically positive for CD34 and desmin, with variable staining for α-smooth muscle actin. Once the diagnosis is made, regardless of size or location, this tumour behaves in a benign fashion after surgical excision reported so far. Conclusion This case is rare, but the correct diagnosis and treatment is important for good prognosis.

An 8-month-old male Japanese Black calf was referred for the evaluation of a slow-growing conjunctival mass in the right eye. A superficial keratectomy was performed followed by recurrence on two occasions. No metastases were found in surrounding tissues. Histological, immunohistochemical, and ultrastructural investigation revealed that both the primary and the recurrent lesions were benign, conjunctival, myofibroblastomas. Interestingly, bovine papillomavirus type 2 (BPV-2) DNA was detected in both myofibroblastoma lesions. Archival bovine myofibroblastomas from the vulva and neck were also analyzed for papillomaviral genomes. BPV-2 DNA was also amplified from these lesions. To the best of our knowledge, this is the first report describing a potential causal relationship between BPV-2 infection and conjunctival myofibroblastoma.

Myofibroblastoma (MFB) of the breast is an uncommon benign stromal tumor. Herein, we present histopathologically proven MFB that hyperechoic well-defined breast mass in the ultrasonography and circumscribed high-density mass in mammography. Additionally, internal septations and hyperintense appearance on magnetic resonance imaging are very valuable findings in the differential diagnosis of MFB.

Spindle cell lesions of the breast cover a wide spectrum of diseases ranging from reactive tumor-like lesions to high-grade malignant tumors. The recognition of the benign spindle cell tumor-like lesions (nodular fasciitis; reactive spindle cell nodule after biopsy, inflammatory pseudotumor/inflammatory myofibroblastic tumor; fascicular variant of pseudoangiomatous stromal hyperplasia) and tumors (myofibroblastoma, benign fibroblastic spindle cell tumor, leiomyoma, schwannoma, spindle cell lipoma, solitary fibrous tumor, myxoma) is crucial to avoid confusion with morphologically similar but more aggressive bland-appearing spindle cell tumors, such as desmoid-type fibromatosis, low-grade (fibromatosis-like) spindle cell carcinoma, low-grade fibrosarcoma/myofibroblastic sarcoma and dermatofibrosarcoma protuberans.

The wide variety of mesenchymal lesions that occur in the vulvovaginal region can result in diagnostic difficulties for pathologists. This is because of their relative rarity and overlapping morphological features. They can be divided into those lesions which are specific to or characteristic of this site and those which can occur at any site with no predilection for the vulvovaginal region. Many of the site specific or characteristic lesions are thought to arise from the specialized subepithelial stroma of the lower female genital tract that extends from the cervix to the vulva; the stromal cells of this region are hormone responsive and, as a consequence, most of the site specific mesenchymal lesions are positive with oestrogen receptor and progesterone receptor. Immunoreactivity with desmin, CD34 and CD99 is also common and this constitutes an unusual immunophenotype. The best known of the site specific vulvovaginal mesenchymal lesions is aggressive (deep) angiomyxoma, an infiltrative neoplasm with a marked propensity for local recurrence following excision. Most of the other site specific mesenchymal lesions are well circumscribed and exhibit little tendency for local recurrence. These include fibroepithelial stromal polyp (the most common), angiomyofibroblastoma, superficial myofibroblastoma of the lower female genital tract and cellular angiofibroma. Smooth muscle tumours also occur in this region and exhibit a propensity for local recurrence. Relatively recently described mesenchymal lesions in the vulvovaginal region include vulval oedema, prepubertal vulval fibroma and reactive fibroblastic and myofibroblastic proliferation of the vulva (cyclist's nodule). A wide range of other mesenchymal lesions potentially occur in this region and it is stressed that when dealing with a vulvovaginal mesenchymal lesion, pathologists should consider a wide range of diagnoses since many mesenchymal lesions potentially occur in this region.

Purpose: Defining the risk of neoplasia associated with gender-affirming hormone therapy (GAHT) is a priority for transgender medical research. The purposes of this article are to present a unique case of breast neoplasia in a transgender individual and to review the existing evidence base on GAHT as a potential risk for breast pathology. Methods: We present the case of a 76-year-old transgender patient who developed an estrogen receptor-positive mammary myofibroblastoma (MFB) after 13 months of treatment on feminizing hormones. To our knowledge, this is the first reported case of MFB occurring in a transgender individual. A literature review was conducted to identify all reported cases of breast neoplasia among transgender individuals receiving feminizing GAHT. Information was abstracted from each of the included cases to describe the existing body of literature and to compare published cases to the case reported in this study. Results: We identified a total of 19 malignant and 3 benign cases of breast neoplasia among transgender women. Ours is the first reported case of MFB in a transgender individual receiving feminizing hormones and the first reported case of breast neoplasia associated with GAHT administered via the estradiol patch. Conclusion: This case reinforces the need for additional reporting of breast neoplasia presenting in transgender individuals treated with feminizing hormones. The relationship between estrogen exposure and breast neoplasia in the transgender population remains poorly defined, and additional research is needed to define risks and inform clinical practice.

Highlights • Hemorrhagic spindle cell tumor with amianthoid fibers is extremely rare. • The present case adds to the very limited data available on this entity. • The tumor in the present case reached a relatively large size and raised clinical suspicion for lymphoma. • This tumor is a mimicker for many benign and malignant conditions. • This tumor must be considered to avoid the misinterpretation as primary malignant spindle cell lesion or metastasis., Introduction Intranodal hemorrhagic spindle cell tumor with amianthoid fibers is extremely rare. Presentation of the case Herein, we present the case of a 58-year-old man with a 2-year history of painless left inguinal swelling. On physical examination, the mass was large, fixed, hard, and non-tender, suggesting a lymph node pathology. The mass had increased slightly in size after a short course of antibiotic treatment. The surgeon decided to perform an excisional biopsy of the left inguinal lymph node. The lesion was intraoperatively hard and suspicious for malignancy. The gross examination revealed a relatively large well-circumscribed mass with a whitish, hard, cut surface. The histomorphological and immunohistochemical findings were consistent with intranodal hemorrhagic spindle cell tumor with amianthoid fibers. There was no evidence of recurrence at 4 years post surgery. Discussion The present case adds to the very limited data available on this rare entity. Conclusion Intranodal hemorrhagic spindle cell tumor with amianthoid fibers can be a diagnostic pitfall both clinically and histopathologically. It can reach large sizes and be clinically and grossly suspicious for lymphoma. Clinicians must be made aware that such an entity exists.

Myofibroblastoma (MFB) is an extremely rare benign tumor that can arise in various organs, but commonly in the breast. Albeit it is a benign tumor, the diagnosis is frequently challenging with insurmountable difficulties as it might be erroneously diagnosed as a malignancy. Herein we are reporting a large-sized MFB presented as a non-tender, firm mass which interestingly was adherent to the skin and was initially thought as cancer. The patient underwent a wide local excision and histology confirmed MFB, and had no evidence of recurrence up to 8 months post-operatively. J Curr Surg. 2019;9(2-3):26-28 doi: https://doi.org/10.14740/jcs340

Atypical spindle cell/pleomorphic lipomatous tumor (ASPLT) is a newly accepted entity that belongs to the group of low-grade adipocytic neoplasms. ASPLT commonly manifests a soft tissue mass in both upper and lower extremities but is extremely rare in the gastrointestinal tract. Here we report a case of a gastric ASPLT in a 59-year-old male, who presented for the evaluation of new onset of dysphagia. To our best knowledge, this is the first case report of ASPLT in the upper gastrointestinal tract.

Myofibroblastic, fibroblastic and/or myoid lesions are rare in the breast but comprise the majority of mammary mesenchymal spindle cell lesions. Whereas most have similar features to their counterparts at extramammary sites, pseudoangiomatous stromal hyperplasia is considered a breast-specific myofibroblastic proliferation on the same spectrum as myofibroblastoma. Other lesions with myofibroblastic/fibroblastic differentiation include fibromatosis and nodular fasciitis, as well as more aggressive tumors such as the rarely reported myofibrosarcoma, inflammatory myofibroblastic tumor and fibrosarcoma. Lesions with myoid differentiation include benign leiomyoma, myoid hamartoma and leiomyomatous myofibroblastoma, but primary leiomyosarcoma and rhabdomyosarcoma may also rarely arise in the breast. Furthermore, fibroepithelial lesions and metaplastic carcinomas can demonstrate myoid metaplasia. Diagnosis can be challenging, particularly on core biopsy, but benign lesions with or without recurrence potential must be distinguished from more aggressive tumors, especially metaplastic carcinoma and phyllodes tumors. This article will review lesions with myofibroblastic, fibroblastic and myoid differentiation in the breast, with special emphasis on differential diagnosis.

Breast tumors with lipomatous or liposarcomatous components are infrequently encountered, but can be a source of diagnostic difficulty if the context of the fatty differentiation is not recognized. Among the true adipocytic tumors, lipoma is the most common lipomatous tumor arising in the breast. Several mammary spindle cell tumors may show adipocytic differentiation, including fibroepithelial tumors and myofibroblastoma. Liposarcomatous components most often arise in malignant phyllodes tumors, as opposed to primary liposarcomas of the breast which are believed to be uncommon. This article will review the spectrum fat-containing tumors of the breast with an emphasis on differential diagnosis and insights from recent molecular studies.