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A case of primary subpleural pulmonary microcystic myxoma coincidentally occurred with pulmonary adenocarcinoma.

Ahn J, Kim NR, Ha SY, Kim KW, Park KY, Sung YM - J Pathol Transl Med (2015)

View Article: PubMed Central - PubMed

Affiliation: Departments of Pathology, Gachon University Gil Medical Center, Incheon, Korea.

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Myxoma occurs most commonly in the heart, which is regarded as the origin of primitive mesenchymal cells that differentiate into multiple tissues... Up to 18% of cardiac myxomas are located in the right atrium and are frequently diagnosed after recurrent pulmonary embolism... Extracardiac myxomas have been reported in the subcutaneous tissue, muscle, and lung... Cracking and a pleated pattern were observed on thickly smeared slides... Sparse capillaries were also found... Stellate cells with vacuolated bubbly cytoplasm were observed... Neither mitosis nor cytologic atypia was found in the stellate cells... Amorphous flocculent and granular proteinaceous material and some collagen fibrils were observed in the extracellular spaces... Macrophages, mature lymphocytes, and some mast cells were also found... No hyaline cartilaginous differentiation is seen... Mitoses are rarely found... Half of the cases presented with nonspecific symptoms; hemoptysis, dyspnea, shortness of breath, chest pain or exacerbation of underlying chronic obstructive pulmonary disease... The remaining lesions were found incidentally... Due to rarity and the subsequent lack of cumulative data on pulmonary microcystic myxoma, we suggest that cysts negative for both vascular markers and epithelial markers may be related to increased MMP activity in a microcystic variant of pulmonary myxoma, as in cardiac myxoma, showing excessive degradation of extracellular matrix and resulting in increased potential risk for metastatic embolism... Accumulating prospective data on MMP-2 and MMP-9 immunoreactivities in pulmonary myxomas is necessary in order to evaluate the prognostic correlation.

No MeSH data available.


(A–C) Touch imprint cytology. (A) Hypocellular smear shows many scattered inflammatory cells and macrophages. Note the background amorphous mucin-like metachromatic materials. (B) High-power view shows round to spindle cells having a moderate amount of granular cytoplasm and euchromatic round nuclei. (C) Note rare intranuclear inclusions (left, arrow) and cytoplasmic globular materials (right, arrow) (A–C, Papanicolaou stain). (D–F) Histologic findings. (D) Low-power view shows a well-demarcated bluish mass, and the mass is composed of predominantly chondromyxoid stroma. Arrow indicates normal pulmonary parenchyma. (E) High-power view shows that the mass is composed of abundant bluish chondromyxoid stroma and the paucicellular elements including scattered spindle cells, intermixed macrophages, mature lymphocytes, and some eosinophils. (F) Microcysts are surrounded by attenuated flattened cells or no lining (left, H&E stain; right, Vimentin immunostain).
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f2-jptm-49-3-274: (A–C) Touch imprint cytology. (A) Hypocellular smear shows many scattered inflammatory cells and macrophages. Note the background amorphous mucin-like metachromatic materials. (B) High-power view shows round to spindle cells having a moderate amount of granular cytoplasm and euchromatic round nuclei. (C) Note rare intranuclear inclusions (left, arrow) and cytoplasmic globular materials (right, arrow) (A–C, Papanicolaou stain). (D–F) Histologic findings. (D) Low-power view shows a well-demarcated bluish mass, and the mass is composed of predominantly chondromyxoid stroma. Arrow indicates normal pulmonary parenchyma. (E) High-power view shows that the mass is composed of abundant bluish chondromyxoid stroma and the paucicellular elements including scattered spindle cells, intermixed macrophages, mature lymphocytes, and some eosinophils. (F) Microcysts are surrounded by attenuated flattened cells or no lining (left, H&E stain; right, Vimentin immunostain).

Mentions: Grossly, the wedge-resected lung showed a well-delineated, glistening, round, and gray subpleural mass (Fig. 1B). The cut surface of the mass was gelatinous mucoid, grayish yellow without a capsule. Intraoperative touch imprints were made using Papanicolaou and hematoxylin and eosin stains. The smears were paucicellular showing copious amounts of viscous pinkish mucoid material and scattered inflammatory cells (Fig. 2A). Scattered inflammatory cells such as macrophages containing foamy granular cytoplasm with occasional hemosiderin-laden macrophages were found. Cracking and a pleated pattern were observed on thickly smeared slides. Sparse capillaries were also found. There were a few loose aggregates of bland, monomorphic spindle cells with oval nuclei and no distinct nucleoli, and these spindle cells had long, thin, and tapered cytoplasmic processes (Fig. 2B). The nuclei were round to oval with indistinct nucleoli, and the cytoplasm was vacuolated and granular with a well-delineated cell border (Fig. 2C). Differential diagnoses for the frozen section were myxoid tumors including pulmonary hamartoma.


A case of primary subpleural pulmonary microcystic myxoma coincidentally occurred with pulmonary adenocarcinoma.

Ahn J, Kim NR, Ha SY, Kim KW, Park KY, Sung YM - J Pathol Transl Med (2015)

(A–C) Touch imprint cytology. (A) Hypocellular smear shows many scattered inflammatory cells and macrophages. Note the background amorphous mucin-like metachromatic materials. (B) High-power view shows round to spindle cells having a moderate amount of granular cytoplasm and euchromatic round nuclei. (C) Note rare intranuclear inclusions (left, arrow) and cytoplasmic globular materials (right, arrow) (A–C, Papanicolaou stain). (D–F) Histologic findings. (D) Low-power view shows a well-demarcated bluish mass, and the mass is composed of predominantly chondromyxoid stroma. Arrow indicates normal pulmonary parenchyma. (E) High-power view shows that the mass is composed of abundant bluish chondromyxoid stroma and the paucicellular elements including scattered spindle cells, intermixed macrophages, mature lymphocytes, and some eosinophils. (F) Microcysts are surrounded by attenuated flattened cells or no lining (left, H&E stain; right, Vimentin immunostain).
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f2-jptm-49-3-274: (A–C) Touch imprint cytology. (A) Hypocellular smear shows many scattered inflammatory cells and macrophages. Note the background amorphous mucin-like metachromatic materials. (B) High-power view shows round to spindle cells having a moderate amount of granular cytoplasm and euchromatic round nuclei. (C) Note rare intranuclear inclusions (left, arrow) and cytoplasmic globular materials (right, arrow) (A–C, Papanicolaou stain). (D–F) Histologic findings. (D) Low-power view shows a well-demarcated bluish mass, and the mass is composed of predominantly chondromyxoid stroma. Arrow indicates normal pulmonary parenchyma. (E) High-power view shows that the mass is composed of abundant bluish chondromyxoid stroma and the paucicellular elements including scattered spindle cells, intermixed macrophages, mature lymphocytes, and some eosinophils. (F) Microcysts are surrounded by attenuated flattened cells or no lining (left, H&E stain; right, Vimentin immunostain).
Mentions: Grossly, the wedge-resected lung showed a well-delineated, glistening, round, and gray subpleural mass (Fig. 1B). The cut surface of the mass was gelatinous mucoid, grayish yellow without a capsule. Intraoperative touch imprints were made using Papanicolaou and hematoxylin and eosin stains. The smears were paucicellular showing copious amounts of viscous pinkish mucoid material and scattered inflammatory cells (Fig. 2A). Scattered inflammatory cells such as macrophages containing foamy granular cytoplasm with occasional hemosiderin-laden macrophages were found. Cracking and a pleated pattern were observed on thickly smeared slides. Sparse capillaries were also found. There were a few loose aggregates of bland, monomorphic spindle cells with oval nuclei and no distinct nucleoli, and these spindle cells had long, thin, and tapered cytoplasmic processes (Fig. 2B). The nuclei were round to oval with indistinct nucleoli, and the cytoplasm was vacuolated and granular with a well-delineated cell border (Fig. 2C). Differential diagnoses for the frozen section were myxoid tumors including pulmonary hamartoma.

View Article: PubMed Central - PubMed

Affiliation: Departments of Pathology, Gachon University Gil Medical Center, Incheon, Korea.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Myxoma occurs most commonly in the heart, which is regarded as the origin of primitive mesenchymal cells that differentiate into multiple tissues... Up to 18% of cardiac myxomas are located in the right atrium and are frequently diagnosed after recurrent pulmonary embolism... Extracardiac myxomas have been reported in the subcutaneous tissue, muscle, and lung... Cracking and a pleated pattern were observed on thickly smeared slides... Sparse capillaries were also found... Stellate cells with vacuolated bubbly cytoplasm were observed... Neither mitosis nor cytologic atypia was found in the stellate cells... Amorphous flocculent and granular proteinaceous material and some collagen fibrils were observed in the extracellular spaces... Macrophages, mature lymphocytes, and some mast cells were also found... No hyaline cartilaginous differentiation is seen... Mitoses are rarely found... Half of the cases presented with nonspecific symptoms; hemoptysis, dyspnea, shortness of breath, chest pain or exacerbation of underlying chronic obstructive pulmonary disease... The remaining lesions were found incidentally... Due to rarity and the subsequent lack of cumulative data on pulmonary microcystic myxoma, we suggest that cysts negative for both vascular markers and epithelial markers may be related to increased MMP activity in a microcystic variant of pulmonary myxoma, as in cardiac myxoma, showing excessive degradation of extracellular matrix and resulting in increased potential risk for metastatic embolism... Accumulating prospective data on MMP-2 and MMP-9 immunoreactivities in pulmonary myxomas is necessary in order to evaluate the prognostic correlation.

No MeSH data available.