Journal of Pathology and Translational Medicine

Case Study

Diagnostic conundrums of schwannomas: two cases highlighting morphological extremes and diagnostic challenges in biopsy specimens of soft tissue tumors: Chankyung Kim, Yang-Guk Chung, Chan Kwon Jung; J Pathol Transl Med. 2023;57(5):278-283. Published online August 24, 2023; DOI: https://doi.org/10.4132/jptm.2023.07.13

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Schwannomas are benign, slow-growing peripheral nerve sheath tumors commonly occurring in the head, neck, and flexor regions of the extremities. Although most schwannomas are easily diagnosable, their variable morphology can occasionally create difficulty in diagnosis. Reporting pathologists should be aware that schwannomas can exhibit a broad spectrum of morphological patterns. Clinical and radiological examinations can show correlation and should be performed, in conjunction with ancillary tests, when appropriate. Furthermore, deferring a definitive diagnosis until excision may be necessary for small biopsy specimens and frozen sections. This report underscores these challenges through examination of two unique schwannoma cases, one predominantly cellular and the other myxoid, both of which posed significant challenges in histological interpretation.

Citations

Citations to this article as recorded by

Plexiform Schwannoma Over the Anterior Chest Wall: A Clinicopathological Review
Debojyoti Sasmal, Saswata Barenya, Hinglaj Saha, Pankaj Kumar Halder
Amrita Journal of Medicine.2025; 21(2): 95. CrossRef

Original Article

A Proposal for Creating a Guideline for Cancer Registration of the Fibromatosis, PEComa Group, Malignant Lymphoma In Situ and Dendritic Cell Tumors (III): Changyoung Yoo, Chang Suk Kang, Yoon La Choi, Hye Yoon Kang, Jin Man Kim, Young Hye Koh, Joo Hee Lee, Seung Sook Lee, In Sun Kim, Dong Hoon Kim, Yong Ku Park, Jin Hee Sohn; Korean J Pathol. 2012;46(5):436-442. Published online October 25, 2012; DOI: https://doi.org/10.4132/KoreanJPathol.2012.46.5.436

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Abstract PDF: Background
Understanding the biologic behavior of a tumor is a prerequisite for tumor registration code assignment. The aim of this report was to propose appropriate behavior codes of the International Classification of Disease Oncology 3 (ICD-O3) to rare, yet pathologically interesting hematopoietic and soft tissue tumors.
Methods
The Study Group for Hematopathology, the Bone and Soft Tissue Pathology Study Group, and the Cancer Registration Committee prepared the questionnaire containing provisional behavior codes of selected diseases.
Results
In situ lesions of mantle cell and follicular lymphomas, dendritic cell tumors, and neoplasms with perivascular epithelioid cell differentiation (PEComa), not otherwise specified were classified as malignant (-/3). The fibromatosis group, with the exception of lipofibromatosis, was proposed as benign (-/0). Lipofibromatosis and several diseases that belong to the PEComa group were proposed as uncertain malignant potential (-/1). For the hematologic and soft tissue tumors, 274 and 288 members of the Korean Society of Pathologists, respectively, provided opinions through questionnaire, and most responders showed agreement with the provisional behavior code proposed.
Conclusions
The determination of behavior codes for the rare diseases described in this study, especially those of the PEComa group or malignant lymphoma, could be viewed as impractical and premature, but this study provides the basis for future research on this topic.

Case Reports

Calcifying Aponeurotic Fibroma of the Elbow: A Case Report.: Mee Hye Oh, Eun Ah Jung, Ji Hye Lee, Hyun Deuk Cho, Jong Kyu Han, Yong Koo Park; Korean J Pathol. 2009;43(1):75-78.; DOI: https://doi.org/10.4132/KoreanJPathol.2009.43.1.75

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Abstract PDF: Calcifying aponeurotic fibroma is a rare soft tissue tumor that mostly occurs in the distal extremities of children and adolescents. We report here on a case of calcifying aponeurotic fibroma of the right elbow in an 8-year-old boy, and the tumor was diagnosed by surgical excision. The patient complained of painless swelling and mild limitation of the range of motion of the elbow joint. Radiologically, the mass was ill-defined and showed stippled calcification with shallow bony erosion. Microscopically, the tumor was composed of spindle cells with nodular deposits of hyalination and calcification, and these deposits were surrounded by palisading polygonal plump cells. Immunohistochemically, the tumor showed a diffuse positive expression for CD99 and negativity for smooth muscle actin, S-100 protein and CD34. The patient has been well with no signs of recurrence during the 42 months after surgery.

Dendritic Myxofibrolipoma.: Sung Nam Kim, Kye Hyun Kwon, Yeon Lim Suh; Korean J Pathol. 2001;35(5):447-450.

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Abstract PDF: Dendritic myxofibrolipoma is a recently described disease entity that represents a distinctive benign soft tissue neoplasm showing the combined features of spindle cell lipoma and the solitary fibrous tumor. Immunohistochemical stains reveal a strong positivity for vimentin, CD34 and bcl-2, which highlight the dendritic nature of the tumor cells by demonstrating slender complex cytoplasmic prolongations. There have been 12 cases of dendritic myxofibrolipomas reported in literature. In Korea, none of the cases have been described. We report such a case with a 28-year-old man who had a palpable subcutaneous mass on his right shoulder for 4 months. Grossly, the removed mass measured 11X7X5 cm and appeared to be a well-encapsulated, lipomatous tumor with marked myxoid appearance. Microscopically, this tumor consisted of spindle cells admixed with dense collagen fibers and mature adipocytes in abundant myxoid stroma with high vascularity. Immunohistochemically, the tumor cells were strongly reactive for vimentin and CD34 and weakly reactive for bcl-2, and negative for S-100 protein.

Pleomorphic Hyalinizing Angiectatic Tumor of Soft Parts: A Case Report.: Young Chae Chu, Sun Keun Choi, In Suh Park, Hye Seung Han, Jee Young Han, Joon Mee Kim; Korean J Pathol. 2002;36(3):195-198.

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Abstract PDF: A case of rare pleomorphic hyalinizing angiectatic tumor (PHAT) of soft parts is reported. A 35-year-old woman presented with a subcutaneous solid mass in the left inguinal area, which had been present for 3 months, was presented to us. The tumor was histologically characterized by sheets of mitotically inactive oval and pleomorphic cells, mono-and multinucleated giant cells, intranuclear cytoplasmic inclusions, and prominent clusters of thinwalled ectatic vessels with perivascular hyalinization. A focal hemangiopericytoma-like vascular pattern, pseudovascular spaces, stromal collagen with degenerative change and abundant mast cells were observed. The tumor cells were reactive for vimentin and CD34. This tumor shared several features with malignant fibrous histiocytoma, ancient schwannoma, giant cell angiofibroma, giant cell fibroblastoma and solitary fibrous tumor. The patient was well with no evidence of disease for 10 months.

Cytological Features of Low Grade Fibromyxoid Sarcoma : Report of a Case with a Review of the Literature.: Mi Seon Kwon; Korean J Cytopathol. 2006;17(2):153-158.

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Abstract PDF: Low-grade fibromyxoid sarcoma (LGFMS) is a rare soft tissue tumor. There have been only a few prior fine-needle aspiration (FNA) cytological reports. Recognition of this tumor is important because of its potential for metastasis despite its indolent nature and its deceptively bland cytologic appearance. A 60-year-old male presented with a slowly growing mass in the left calf detected 10 years ago. The patient underwent surgical excision. FNA cytology was performed directly on the mass. The smears showed low cellularity composed of hypercellular tissue fragments, hypocellular loose aggregates, and stripped nuclei. The cytoplasm was seen as either collagenous material or very thin fibrillary collagen strands. Tumor cells had spindle, ovoid, or irregular nuclei, fine chromatin, and small nucleoli. Focally slight degree of nuclear pleomorphism is noted. There were no mitotic figures. Blood vessels were frequently seen. Immunocytochemically, tumor cells were negative for S-100 protein, desmin, smooth muscle actin, and CD34. The diagnosis of LGFMS is rarely possible by cytology alone; however, LGFMS should be included in the differential diagnosis of spindle-cell tumors consisting of hypercellular and hypocellular components with some capillary-sized vessels arising in the deep soft tissue of the lower extremities, particularly the thigh. The immunocytochemical findings are of help in the differential diagnosis.

A Well-Differentiated Extraskeletal Osteosarcoma: A Case Report.: Jung Wook Yang, Dae Hyun Song, Dong Hee Kim, Gyung Hyuck Ko; Korean J Pathol. 2008;42(4):247-250.

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Abstract PDF: A well-differentiated extraskeletal osteosarcoma is very rare, and only seven cases have been reported in the English language clinical literature. We report an additional case of this rare tumor. A 71-year-old man had noticed a mass in the left pubic area for ten years. A CT scan demonstrated the presence of a lobulated calcified mass within the soft tissue. A 5 cm-sized well-circumscribed mass was excised. Histologically the tumor was composed of mature collagenous tissue and bony trabeculae rimmed by osteoblasts. After 43 months, the tumor recurred at the same site and was re-excised. The re-excised tumor contained focal areas of higher cellularity and atypism. We believe that this is the first case of well-differentiated extraskeletal osteosarcoma reported in Korea.

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