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CASE REPORT Table of Contents   
Year : 2008  |  Volume : 51  |  Issue : 3  |  Page : 413-414
Palisaded myofibroblastoma of lymph node


Department of Pathology, Swami Ramanand Teerth Rural Medical College and Hospital, Ambajogai, Beed, Maharashtra, India

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   Abstract 

A 60-year female was presented with swelling in the left inguinal region. Microscopically, the left inguinal lymph node shows typical "amianthoid" fibers (hyalinized areas), spindle cell fascicles and hemorrhagic areas in the interstitial spaces with rim of lymphoid tissue. Preoperatively, patient was non-reactive for HIV I and II. This lesion is usually mistaken as neurilemmoma and Kaposi's sarcoma.

Keywords: Leiomyoma, lymph node, myofibroblastoma

How to cite this article:
Sonwane BR, Zadke PM, Swami SY. Palisaded myofibroblastoma of lymph node. Indian J Pathol Microbiol 2008;51:413-4

How to cite this URL:
Sonwane BR, Zadke PM, Swami SY. Palisaded myofibroblastoma of lymph node. Indian J Pathol Microbiol [serial online] 2008 [cited 2022 Dec 7];51:413-4. Available from: https://www.ijpmonline.org/text.asp?2008/51/3/413/42546



   Inroduction Top


Hemorrhagic spindle cell tumor with amianthoid fibers (palisaded myofibroblastoma) is a rare benign mesenchymal tumor of lymph node with myofibroblastic/smooth muscle differentiation, often accompanied by a hemorrhagic rim and formation of amianthoid fibers. [1]

Primary spindle cell lesions of lymph node, with the exception of Kaposi's sarcoma, are extremely rare and most often these lesions were previously thought to be of schwannoma or muscle origin. [2]

Recently, a distinctive benign spindle cell neoplasm, originating at the lymph node, was described as myofibroblastoma, palisaded myofibroblastoma and intranodal hemorrhagic spindle cell tumor with amianthoid fibers. [3]

We report a case of hemorrhagic spindle cell tumor in the inguinal lymph node with "amianthoid" fibers with its rare occurrence.


   Case history Top


A 60-year female presented with swelling in the left inguinal region since 2 months. There was no history of trauma to that site. A 4 3-cm firm mass, which was not attached to the skin and underlying structure, was noted.

The ultrasonographic examination revealed hypoechoic rounded mass, measuring about 3.6 2.6 cm, having solid components. Clinically, it was diagnosed as inguinal lymphadenopathy or fibroma. The fine needle aspiration cytology (FNAC) report was suggestive of benign mesenchymal tumor.

Preoperatively, patient was non-reactive to HIV I and II. At operation, mass of size 4 3-cm, firm being round to oval in shape with smooth surface was noted. The gross specimen received was a well-encapsulated lymph node with a nodular tumor mass of size 4 3 cm, firm in consistency with grayish white cut section. The low power microscopic examination revealed a thin peripheral rim of lymphoid tissue underneath the fibro-collagenous capsule [Figure 1]. The tumor mass was composed of interlacing fascicles of uniform spindle cells. The cells were also arranged in palisading fashion with eosinophilic "amianthoid" fibers [Figure 2]. Areas of interstitial hemorrhages were also seen. The mitotic activities were absent.

Masson's trichrome reveals peripherally bristled "amianthoid" fibers. The spindle cells were immunoreactive for vimentin, muscle-specific actin and myosin but not for desmin and S-100 protein.


   Discussion Top


Intranodal myofibroblastoma was first described in May 1989. It is a solitary swelling in the groin, which is some times tender. It has most often been mistaken for a neural tumor, i.e., neurilemmoma, smooth muscle tumor, or less often, Kaposi's sarcoma involving a lymph node. [4]

Till 1989, only 32 cases of palisaded myofibroblastoma or intranodal hemorrhagic spindle cell tumor of lymph node has been reported in the literature. The origin of intranodal hemorrhagic spindle cell tumor is obscure. The cell shows myofibroblastic differentiation and may be derived from the stromal myoid cells of lymph node. [5]

The main distinguishing histological features from Kaposi's sarcoma are the presence of large areas of hyalinized collagen and the absence of extra and intracellular hyaline globules characteristic of Kaposi's sarcoma. Leiomyosarcoma can simulate this benign neoplasm but it exhibits some degree of nuclear pleomorphism and increased mitotsis. Another differential diagnosis of spindle cell tumor in lymph node is dendritic cell sarcoma in which neoplastic cells are plumper and often form nests and whorls, scattered lymphocytes are commonly seen and the distinctive interstitial hemorrhages and amianthoid fibers are lacking. The muscle-specific actin and desmin are known to be present in myofibroblastic and smooth muscle cells. It is distinguished from schwanomma by the lack of S-100 protein immuno-reactivity. Little number of cases of hemorrhagic spindle cell tumor of lymph node is reported in the literature. It is important that these tumors should not be confused as metastatic spindle cell malignancy and should avoid the inappropriate investigation and treatment of these lesions. [1],[3],[6]


   Acknowledgment Top


Authors are thankful to Professor and Head, Department of Pathology, Armed Forces Medical College, Pune, for immunohistochemistry and expert opinion in this case.

 
   References Top

1.Warnke RA, Wiss LM. Tumors of lymph node and spleen. Atlas of tumor Pathology by A.F.I.P; 1994. p. 435-7.  Back to cited text no. 1    
2.White JE, Chan YF, Millar MV. Intra-nodal leiomyoma or myofbroblastoma: An identical lesion? Histopatholgy 1995;26:188-90.  Back to cited text no. 2    
3.Alguacil-Garcia A. Intra-nodal myofibroblastoma in a submandibular lymph node: A case report. Am J Clin Pathol 1992;97:69-72.  Back to cited text no. 3  [PUBMED]  
4.Fletcher CD, Stiring RW. Intranodal myofibroblastoma presenting in the submandibular region: Evidence of a broader clinical and histological spectrum. Histopathology 1990;16:287-94.  Back to cited text no. 4    
5.Barbareschi M, Mariscotti C, Ferrero S, Pignatiello U. Intranodal haemorrhagic spindle cell tumour: A benign Kaposi-like nodal tumour. Histopatholgy 1990;17:93-6.  Back to cited text no. 5    
6.Starasolar L, Vuitch F, Albores J. Intra-nodal leiomyoma: Another distinctive primary spindle cell neoplasm of lymph node. Am J Clin Pathol 1991;95:858-62.  Back to cited text no. 6    

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Correspondence Address:
Bharat Rangnathrao Sonwane
"Sahyadri", P-7/4, Medical College Campus, Ambajogai - 431 517, Dist: Beed, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.42546

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