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Nodular fasciitis of the parotid gland, masquerading as pleomorphic adenoma.

Hwang CS, Lee CH, Kim A, Shin N, Park WY, Park MG, Park do Y - Korean J Pathol (2014)

Bottom Line: Subsequently, parotidectomy was performed and NF was diagnosed based on histologic and immunohistochemical findings.The clinical history of rapid growth and the presence of mitoses and inflammatory cells help to distinguish NF from PA.In addition, immunohistochemical stains for smooth muscle actin and CD68 are useful to confirm the diagnosis of NF.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.

ABSTRACT
It is difficult to distinguish nodular fasciitis (NF) from other neoplasm of the parotid gland, especially pleomorphic adenoma (PA) by fine needle aspiration cytology. A 39-year-old female noticed a mass in the parotid region. The aspirate material showed cohesive parts composed of the cells that had oval or spindle-shaped nuclei and relatively abundant cytoplasm and some cells with plasmacytoid features. The background substance was fibromyxoid. PA was diagnosed based on the cytologic findings. Subsequently, parotidectomy was performed and NF was diagnosed based on histologic and immunohistochemical findings. NF in the parotid region is rare and may be misdiagnosed as other benign or malignant tumors of the parotid gland. The clinical history of rapid growth and the presence of mitoses and inflammatory cells help to distinguish NF from PA. In addition, immunohistochemical stains for smooth muscle actin and CD68 are useful to confirm the diagnosis of NF.

No MeSH data available.


Related in: MedlinePlus

The histologic and immunohistochemical findings of the parotid mass. (A) The tumor is composed of relatively uniform spindle-shaped cells arranged in short fascicles. (B) The stroma focally shows loose myxoid features and diffusely scattered extravasated erythrocytes are also noted. (C) A mitotic cell (*) is present. The spindle cells are positive for alpha-smooth muscle actin (D), and negative for S-100 (E). (F) Ki-67 nuclear labeling cells are mildly increased.
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f3-kjpathol-48-5-366: The histologic and immunohistochemical findings of the parotid mass. (A) The tumor is composed of relatively uniform spindle-shaped cells arranged in short fascicles. (B) The stroma focally shows loose myxoid features and diffusely scattered extravasated erythrocytes are also noted. (C) A mitotic cell (*) is present. The spindle cells are positive for alpha-smooth muscle actin (D), and negative for S-100 (E). (F) Ki-67 nuclear labeling cells are mildly increased.

Mentions: Histologically, the mass was predominantly composed of relatively uniform spindle cells which showed moderate cellularity. These spindle-shaped cells were arranged in short fascicles arranged in haphazard pattern. Focally, a storiform growth pattern was also noted. The tumor cells had centrally located round to oval nuclei with finely granular chromatin and one or two inconspicuous nucleoli. The stromal part was predominantly collagenous with focal myxoid areas. Glands or squamous structures were not noted. Some inflammatory cells including lymphocytes, neutrophils, and histiocytes were found. Many small thin-walled vessels and extravasated erythrocytes were scattered diffusely. Regarding mitotic count, about 8 per 10 high power fields were found, but no atypical mitotic figure was identified (Fig. 3A–C). There was no necrosis. Combined with these histologic findings, NF was diagnosed. Additionally, immunohistochemical staining was performed. The spindle cells showed positivity to vimentin (1:1,000, V9, Zymed, South San Francisco, CA, USA), smooth muscle actin (1A4, 1:400, Dako, Glostrup, Denmark), but negativity to S-100 (1:1,000, polyclonal antibody, Novocastra, Newcastle Upon Tyne, UK), desmin (1:200, D33, Dako), CD34 (1:400, QBEnd-10, Dako), and pan-cytokeratin (1:500, AE1&AE3, Labvision, Fremont, CA, USA) (Fig. 3D–F). The results of immunohistochemical staining supported the diagnosis of NF


Nodular fasciitis of the parotid gland, masquerading as pleomorphic adenoma.

Hwang CS, Lee CH, Kim A, Shin N, Park WY, Park MG, Park do Y - Korean J Pathol (2014)

The histologic and immunohistochemical findings of the parotid mass. (A) The tumor is composed of relatively uniform spindle-shaped cells arranged in short fascicles. (B) The stroma focally shows loose myxoid features and diffusely scattered extravasated erythrocytes are also noted. (C) A mitotic cell (*) is present. The spindle cells are positive for alpha-smooth muscle actin (D), and negative for S-100 (E). (F) Ki-67 nuclear labeling cells are mildly increased.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4215962&req=5

f3-kjpathol-48-5-366: The histologic and immunohistochemical findings of the parotid mass. (A) The tumor is composed of relatively uniform spindle-shaped cells arranged in short fascicles. (B) The stroma focally shows loose myxoid features and diffusely scattered extravasated erythrocytes are also noted. (C) A mitotic cell (*) is present. The spindle cells are positive for alpha-smooth muscle actin (D), and negative for S-100 (E). (F) Ki-67 nuclear labeling cells are mildly increased.
Mentions: Histologically, the mass was predominantly composed of relatively uniform spindle cells which showed moderate cellularity. These spindle-shaped cells were arranged in short fascicles arranged in haphazard pattern. Focally, a storiform growth pattern was also noted. The tumor cells had centrally located round to oval nuclei with finely granular chromatin and one or two inconspicuous nucleoli. The stromal part was predominantly collagenous with focal myxoid areas. Glands or squamous structures were not noted. Some inflammatory cells including lymphocytes, neutrophils, and histiocytes were found. Many small thin-walled vessels and extravasated erythrocytes were scattered diffusely. Regarding mitotic count, about 8 per 10 high power fields were found, but no atypical mitotic figure was identified (Fig. 3A–C). There was no necrosis. Combined with these histologic findings, NF was diagnosed. Additionally, immunohistochemical staining was performed. The spindle cells showed positivity to vimentin (1:1,000, V9, Zymed, South San Francisco, CA, USA), smooth muscle actin (1A4, 1:400, Dako, Glostrup, Denmark), but negativity to S-100 (1:1,000, polyclonal antibody, Novocastra, Newcastle Upon Tyne, UK), desmin (1:200, D33, Dako), CD34 (1:400, QBEnd-10, Dako), and pan-cytokeratin (1:500, AE1&AE3, Labvision, Fremont, CA, USA) (Fig. 3D–F). The results of immunohistochemical staining supported the diagnosis of NF

Bottom Line: Subsequently, parotidectomy was performed and NF was diagnosed based on histologic and immunohistochemical findings.The clinical history of rapid growth and the presence of mitoses and inflammatory cells help to distinguish NF from PA.In addition, immunohistochemical stains for smooth muscle actin and CD68 are useful to confirm the diagnosis of NF.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.

ABSTRACT
It is difficult to distinguish nodular fasciitis (NF) from other neoplasm of the parotid gland, especially pleomorphic adenoma (PA) by fine needle aspiration cytology. A 39-year-old female noticed a mass in the parotid region. The aspirate material showed cohesive parts composed of the cells that had oval or spindle-shaped nuclei and relatively abundant cytoplasm and some cells with plasmacytoid features. The background substance was fibromyxoid. PA was diagnosed based on the cytologic findings. Subsequently, parotidectomy was performed and NF was diagnosed based on histologic and immunohistochemical findings. NF in the parotid region is rare and may be misdiagnosed as other benign or malignant tumors of the parotid gland. The clinical history of rapid growth and the presence of mitoses and inflammatory cells help to distinguish NF from PA. In addition, immunohistochemical stains for smooth muscle actin and CD68 are useful to confirm the diagnosis of NF.

No MeSH data available.


Related in: MedlinePlus