The Experts below are selected from a list of 180 Experts worldwide ranked by ideXlab platform
Andrew L Folpe - One of the best experts on this subject based on the ideXlab platform.
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heterotopic mesenteric ossification a distinctive Pseudosarcoma commonly associated with intestinal obstruction
The American Journal of Surgical Pathology, 2006Co-Authors: Rajiv M Patel, Sharon W Weiss, Andrew L FolpeAbstract:Abstract:Heterotopic mesenteric ossification (HMO) is a rare intraabdominal bone-producing Pseudosarcoma with fewer than 14 reported cases in the literature. We report our experience with 6 additional cases, all of which were referred to us with a diagnostic consideration of extraskeletal osteosarco
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heterotopic mesenteric ossification a distinctive Pseudosarcoma commonly associated with intestinal obstruction
The American Journal of Surgical Pathology, 2006Co-Authors: Rajiv M Patel, Sharon W Weiss, Andrew L FolpeAbstract:Heterotopic mesenteric ossification (HMO) is a rare intraabdominal bone-producing Pseudosarcoma with fewer than 14 reported cases in the literature. We report our experience with 6 additional cases, all of which were referred to us with a diagnostic consideration of extraskeletal osteosarcoma (EO) or "sarcoma" and emphasize features which distinguish HMO from EO. Six intraabdominal lesions coded as "heterotopic mesenteric ossification," "ossifying pseudotumor," or "reactive myofibroblastic proliferation with ossification" were retrieved from our consultation files. Clinical follow-up information was obtained. Lesions occurred exclusively in males, with a mean patient age of 49 years (range, 22-72 years). The tumors occurred in the mesentery (N = 4), omentum (N = 1), or both (N = 1) and were preceded by significant abdominal surgery (4 cases) or trauma (1 case) in all but 1 case. Five patients presented with bowel obstruction and 1 with abdominal sepsis. Tumors were difficult to precisely measure; the mean size of the resection specimens was 11.8 cm (range, 3.5-20 cm). Grossly, the tumors resembled fat necrosis and often cut with a gritty sensation. Microscopically, all lesions demonstrated an exuberant, reactive (myo)fibroblastic proliferation resembling nodular fasciitis, with extensive hemorrhage and fat necrosis. All tumors produced abundant bone and osteoid, often "lace-like," and 2 contained cartilage. The proliferating (myo)fibroblasts, osteoblasts, and chondroblasts were mitotically active but cytologically bland. Follow-up (4 cases; mean, 47.3 months; range, 5-120 months) showed 3 patients alive without disease and 1 dead of unrelated causes. One case was recent. HMO is a distinct intraabdominal ossifying pseudotumor that typically occurs in males, almost always after surgery or abdominal trauma, and frequently presents with symptoms of intestinal obstruction. This clinical history, presence of clearly reactive zones resembling nodular fasciitis, thick osteoid, and absence of nuclear atypia, necrosis, and atypical mitotic figures allow the distinction of HMO from its most important morphologic mimic, EO.
Rajiv M Patel - One of the best experts on this subject based on the ideXlab platform.
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heterotopic mesenteric ossification a distinctive Pseudosarcoma commonly associated with intestinal obstruction
The American Journal of Surgical Pathology, 2006Co-Authors: Rajiv M Patel, Sharon W Weiss, Andrew L FolpeAbstract:Abstract:Heterotopic mesenteric ossification (HMO) is a rare intraabdominal bone-producing Pseudosarcoma with fewer than 14 reported cases in the literature. We report our experience with 6 additional cases, all of which were referred to us with a diagnostic consideration of extraskeletal osteosarco
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heterotopic mesenteric ossification a distinctive Pseudosarcoma commonly associated with intestinal obstruction
The American Journal of Surgical Pathology, 2006Co-Authors: Rajiv M Patel, Sharon W Weiss, Andrew L FolpeAbstract:Heterotopic mesenteric ossification (HMO) is a rare intraabdominal bone-producing Pseudosarcoma with fewer than 14 reported cases in the literature. We report our experience with 6 additional cases, all of which were referred to us with a diagnostic consideration of extraskeletal osteosarcoma (EO) or "sarcoma" and emphasize features which distinguish HMO from EO. Six intraabdominal lesions coded as "heterotopic mesenteric ossification," "ossifying pseudotumor," or "reactive myofibroblastic proliferation with ossification" were retrieved from our consultation files. Clinical follow-up information was obtained. Lesions occurred exclusively in males, with a mean patient age of 49 years (range, 22-72 years). The tumors occurred in the mesentery (N = 4), omentum (N = 1), or both (N = 1) and were preceded by significant abdominal surgery (4 cases) or trauma (1 case) in all but 1 case. Five patients presented with bowel obstruction and 1 with abdominal sepsis. Tumors were difficult to precisely measure; the mean size of the resection specimens was 11.8 cm (range, 3.5-20 cm). Grossly, the tumors resembled fat necrosis and often cut with a gritty sensation. Microscopically, all lesions demonstrated an exuberant, reactive (myo)fibroblastic proliferation resembling nodular fasciitis, with extensive hemorrhage and fat necrosis. All tumors produced abundant bone and osteoid, often "lace-like," and 2 contained cartilage. The proliferating (myo)fibroblasts, osteoblasts, and chondroblasts were mitotically active but cytologically bland. Follow-up (4 cases; mean, 47.3 months; range, 5-120 months) showed 3 patients alive without disease and 1 dead of unrelated causes. One case was recent. HMO is a distinct intraabdominal ossifying pseudotumor that typically occurs in males, almost always after surgery or abdominal trauma, and frequently presents with symptoms of intestinal obstruction. This clinical history, presence of clearly reactive zones resembling nodular fasciitis, thick osteoid, and absence of nuclear atypia, necrosis, and atypical mitotic figures allow the distinction of HMO from its most important morphologic mimic, EO.
Laurence T Glickman - One of the best experts on this subject based on the ideXlab platform.
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management of recurrent ischemic fasciitis a rare soft tissue Pseudosarcoma
Archives of Plastic Surgery, 2014Co-Authors: Syed M Sayeed, Richard Tyrell, Laurence T GlickmanAbstract:Ischemic fasciitis, also termed atypical decubital fibroplasia, is considered a Pseudosarcoma that usually presents as a painless mass in areas overlying bony prominences [1]. Historically, ischemic fasciitis is thought to be a condition that occurs only in the elderly and debilitated because of direct pressure on bony prominences. However, recently, ischemic fasciitis has also been detected in mobile young individuals [1,2]. Epidemiological studies have revealed a predominance of this condition in patients in their 70s and 80s [1]. Common sites of occurrence are the limb girdles, sacrum, greater trochanter, and shoulders. The other locations described include the buttocks and the posterior chest wall. Isolated lesions have also been reported in skeletal muscle [3]. Upon histological analysis, ischemic fasciitis is noted to involve the entire depth of the subcutis, including the deep dermis, muscle, and tendon. Ischemic fasciitis is characterized by a "Pseudosarcomatous proliferation of fibroblasts and myofibroblasts with a central area of fibrinoid degeneration surrounded by granulation tissue" [1]. The granulation tissue is characterized by capillary growth and plump endothelium. Further, the fibroblasts are enlarged mimicking ganglion cells [3]. Similar entities include nodular fasciitis and proliferative fasciitis. In the case of nodular fasciitis, also known as infiltrative fasciitis, lesions grow rapidly and are located typically on the volar aspect of the forearm, chest, and back. These lesions have dense cellularity with immature fibroblasts and are generally less than 3 cm in diameter [3]. In proliferative fasciitis, lesions affect the upper and lower extremities, including most commonly, the forearm, thigh, and shoulder girdle. Upon histological analysis, lesions demonstrate a mixture of proliferating cells including spindle and stellate fibroblasts, as well as ganglion-like cells. However, proliferative fasciitis lacks the central area of fibrinoid deposition and capillary growth [3]. Primary therapy for ischemic fasciitis is surgical resection, and recurrence has been reported to be limited in most studies [1,4]. We report a case of recurrent ischemic fasciitis treated successfully with bony debridement and myofascial advancement flap closure. The patient presented with pain and a firm mass in the region of the coccyx. Her history was significant for immobility resulting from transverse myelitis, a disease process leading to spinal cord inflammation from a viral or autoimmune etiology. One year prior to her initial visit, the patient had fallen and developed a sacral mass that enlarged over time causing discomfort. It is uncertain, as with many soft tissue tumors, whether trauma had any relation to the formation of the mass or whether it was noticed because of the attention paid to the area of injury. Magnetic resonance imaging demonstrated a soft tissue mass isodense to muscle on T1-weighted images in the region of the coccyx. Examination revealed a firm but mobile mass palpable at the base of the coccyx near the gluteal cleft. During the initial operation, a wide excision was performed including the involved fascia overlying the coccyx. A layered closure was then performed. The patient's immediate recovery was uneventful. Three months following the excision, the patient had what appeared to be a recurrence on physical exam. This was confirmed on reoperation. After extirpation of the mass, the surrounding tissue that was grossly clear of the tumor was further debrided. This included using a rongeur on the coccyx to create a smooth contour. The medial aspect of the gluteal muscle was undermined at the level of the fascia and advanced across the operative bed to provide additional soft tissue coverage. A histopathologic evaluation showed areas of fibrinoid necrosis surrounded by zones of granulation tissue and ganglion-like myofibroblasts consistent with ischemic fasciitis. This lesion was typical of the ischemic fasciitis described above. Further, polygonal cells with prominent nuclei are usually present as described in our specimen by ganglion-like cells [1]. The presence of granulation tissue also differentiates the lesion from that of proliferative fasciitis. This case is presented because of its uncommon pathology and its rare incidence of recurrence. Physicians should be aware of this suspicious but benign entity and the rare potential for recurrence. Careful consideration should be taken not to confuse this lesion with a sarcoma, which it closely resembles. There was no recurrence after the second operation. Debridement of the coccyx during the second operation may have eliminated the point of pressure. Moreover, the rearrangement of local tissue provided relatively bulky soft tissue coverage.
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Management of Recurrent Ischemic Fasciitis, a Rare Soft Tissue
2013Co-Authors: Syed M Sayeed, Richard Tyrell, Laurence T GlickmanAbstract:Ischemic fasciitis, also termed atypical decubital fibroplasia, is con-sidered a Pseudosarcoma that usually presents as a painless mass in areas overlying bony prominences [1]. Historically, ischemic fasciitis is thought to be a condition that occurs only in the elderly and de-bilitated because of direct pressure on bony prominences. However, recently, ischemic fasciitis has also been detected in mobile young individuals [1,2]. Epidemiological studies have revealed a predomi-nance of this condition in patients in their 70s and 80s [1]. Common sites of occurrence are the limb girdles, sacrum, greater trochanter, and shoulders. The other locations described include the buttocks and the posterior chest wall. Isolated lesions have also been reported in skeletal muscle [3]. Upon histological analysis, ischemic fasciitis is noted to involve the entire depth of the subcutis, including the deep dermis, muscle, and tendon. Ischemic fasciitis is characterized by a “Pseudosarcomatous proliferation of fibroblasts and myofibroblast
Marco Barreca - One of the best experts on this subject based on the ideXlab platform.
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carcinosarcoma and Pseudosarcoma of the esophagus two names one disease comprehensive review of the literature
World Journal of Surgery, 1999Co-Authors: C. Iascone, Marco BarrecaAbstract:In the present review we have collected 127 carcinosarcomas and 56 Pseudosarcomas of the esophagus from the literature. There were no significant differences in age, sex, symptoms, location, or stalk involvement between the two groups. Infiltrative lesions were observed in 7.5% and 4.0%, respectively. The rate of lymph node metastasis was 52.5% for carcinosarcoma and 45.0% for Pseudosarcoma. The resectability was similar in the two groups, and the recurrence rates were 38.0% and 45.5%, respectively. Although recent immunohistochemical and electron micro- scopic studies suggested that carcinosarcoma and Pseudosarcoma are a single pathologic entity of epithelial origin, no one has ever compared the clinical behavior of the two entities. Our study showed that the two neoplasms have similar clinical and behavioral outcomes. These findings support, once more, the unifying theory; and we suggest that the definition of "polypoid spindle cell carcinoma of the esophagus" be adopted. Polypoidal tumors of the esophagus are rare lesions that are difficult to differentiate clinically. Most of these tumors are benign and include fibrous polyps and leiomyomas (1). Among the malignant lesions (e.g., adenocarcinoma, leiomyosarcoma, mela- noma, carcinosarcoma, and Pseudosarcoma), the last two consti- tute a distinctive group of lesions, thought to be a mixed tumor consisting of both carcinomatous and sarcoma-like tissue (2). A different clinical behavior for the two entities was suggested by Lane (3), who believed that only the epithelial element had metastatic potential. However, in the recent past, others have reported cases of metastases of the sarcomatous component in patients with Pseudosarcoma (4 - 6). During the last 15 years pathology reports have suggested that these tumors represent varying degrees of the same entity and that the spindle cell component is an expression of bidirectional differentiation within a single neoplasm. Because of the rarity of these neoplasms, only single case reports or a few observations have appeared in the literature. We believe that the pathologic identity of the two lesions may not imply that carcinosarcoma and Pseudosarcoma necessarily have a similar clinical behavior and outcome. Our purpose was to review the literature to compare the epidemiology, behavior, and outcome of carcinosarcoma and Pseudosarcoma and to evaluate if the two tumors can be considered a single clinical entity needing a common therapeutic approach.
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carcinosarcoma and Pseudosarcoma of the esophagus two names one disease comprehensive review of the literature
World Journal of Surgery, 1999Co-Authors: C. Iascone, Marco BarrecaAbstract:In the present review we have collected 127 carcinosarcomas and 56 Pseudosarcomas of the esophagus from the literature. There were no significant differences in age, sex, symptoms, location, or stalk involvement between the two groups. Infiltrative lesions were observed in 7.5% and 4.0%, respectively. The rate of lymph node metastasis was 52.5% for carcinosarcoma and 45.0% for Pseudosarcoma. The resectability was similar in the two groups, and the recurrence rates were 38.0% and 45.5%, respectively. Although recent immunohistochemical and electron microscopic studies suggested that carcinosarcoma and Pseudosarcoma are a single pathologic entity of epithelial origin, no one has ever compared the clinical behavior of the two entities. Our study showed that the two neoplasms have similar clinical and behavioral outcomes. These findings support, once more, the unifying theory; and we suggest that the definition of "polypoid spindle cell carcinoma of the esophagus" be adopted.
Sharon W Weiss - One of the best experts on this subject based on the ideXlab platform.
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heterotopic mesenteric ossification a distinctive Pseudosarcoma commonly associated with intestinal obstruction
The American Journal of Surgical Pathology, 2006Co-Authors: Rajiv M Patel, Sharon W Weiss, Andrew L FolpeAbstract:Abstract:Heterotopic mesenteric ossification (HMO) is a rare intraabdominal bone-producing Pseudosarcoma with fewer than 14 reported cases in the literature. We report our experience with 6 additional cases, all of which were referred to us with a diagnostic consideration of extraskeletal osteosarco
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heterotopic mesenteric ossification a distinctive Pseudosarcoma commonly associated with intestinal obstruction
The American Journal of Surgical Pathology, 2006Co-Authors: Rajiv M Patel, Sharon W Weiss, Andrew L FolpeAbstract:Heterotopic mesenteric ossification (HMO) is a rare intraabdominal bone-producing Pseudosarcoma with fewer than 14 reported cases in the literature. We report our experience with 6 additional cases, all of which were referred to us with a diagnostic consideration of extraskeletal osteosarcoma (EO) or "sarcoma" and emphasize features which distinguish HMO from EO. Six intraabdominal lesions coded as "heterotopic mesenteric ossification," "ossifying pseudotumor," or "reactive myofibroblastic proliferation with ossification" were retrieved from our consultation files. Clinical follow-up information was obtained. Lesions occurred exclusively in males, with a mean patient age of 49 years (range, 22-72 years). The tumors occurred in the mesentery (N = 4), omentum (N = 1), or both (N = 1) and were preceded by significant abdominal surgery (4 cases) or trauma (1 case) in all but 1 case. Five patients presented with bowel obstruction and 1 with abdominal sepsis. Tumors were difficult to precisely measure; the mean size of the resection specimens was 11.8 cm (range, 3.5-20 cm). Grossly, the tumors resembled fat necrosis and often cut with a gritty sensation. Microscopically, all lesions demonstrated an exuberant, reactive (myo)fibroblastic proliferation resembling nodular fasciitis, with extensive hemorrhage and fat necrosis. All tumors produced abundant bone and osteoid, often "lace-like," and 2 contained cartilage. The proliferating (myo)fibroblasts, osteoblasts, and chondroblasts were mitotically active but cytologically bland. Follow-up (4 cases; mean, 47.3 months; range, 5-120 months) showed 3 patients alive without disease and 1 dead of unrelated causes. One case was recent. HMO is a distinct intraabdominal ossifying pseudotumor that typically occurs in males, almost always after surgery or abdominal trauma, and frequently presents with symptoms of intestinal obstruction. This clinical history, presence of clearly reactive zones resembling nodular fasciitis, thick osteoid, and absence of nuclear atypia, necrosis, and atypical mitotic figures allow the distinction of HMO from its most important morphologic mimic, EO.
