Download - Julenøtt nr. 6
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Julenøtt nr. 6
Pål Suhrke
Assistentlege
SiV Tønsberg
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Sykehistorie
• 42 år gammel kvinne med tumor i vulva
• Operert første gang i mai 04, reoperert august 04
• Tumor strakk seg fra vulva og innover langs venstre side av vagina, målte 7 cm i største diameter
• Snitt fra reresektatet
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Kliniske bilder fjernet fra filen førpublisering,kontakt evt. forfatter
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Makroskopisk beskrivelse
• Delvis hinnekledd, bløt vevsbit, 7 x 5 x 3,5 cm
• Fingeraktige utstikkere
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• Snittflaten er grålig, skinnende og ødematøs
Makroskopisk beskrivelse
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MIKROSKOPI
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Mikroskopiske funn• Cellefattig, ødematøst vev med blodkar av
varierende størrelse
• Plumpe, spolformede og stellate celler med sparsomt eosinofilt cytoplasma
• Glatte muskelceller rundt kar SPIN OFF
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Diagnose
Karrik stromatumor forenlig med aggressivt angiomyxom
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Diagnoseforslag
• Aggressivt angiomyxom 27
• Angiomyxom 4
• Dypt angiomyxom 1
• Karmalformasjon 1
• Myxoid fibrohistiocytær tumor 1
• Plateepitelcarcinom i Bartholins kjertel 1
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Aggressivt angiomyxom
• Første gang beskrevet i 1983 av Rosai
• Uvanlig mesenchymal tumor
• Forekommer særlig hos kvinner i fertil alder
• Oftest lokalisert vulvovaginalt, kan forekomme retroperitonealt, samt inguinoscrotalt hos menn
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Aggressivt angiomyxom
• Presenterer seg oftest som en langsomt voksende svulst
• Oppfattes klinisk som en Bartholinsk cyste
• Oftest store, mer enn 10 cm, uskarpt avgrenset
• Lokalt residiv i ca 30%
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Immunhistokjemi
Vimentin
Desmin
Desmin
MA KI 67
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Differensialdiagnoser
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Angiomyofibroblastom
• mer velavgrenset
• ofte mer cellerik, med flerkjernede celler
• tumorcellene orienteres rundt kar
• hyaliniserte karvegger
• IKKE glatte muskelceller rundt karene
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Differensialdiagnoser forts.
• Cellulært angiofibrom
• Superficielt angiomyxom
• Reaktive forandringer/ ødematøst vev
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IKKE aggressivt
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Angio IKKE myxom
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SPIN OFF
SPIN OFF
SPIN OFF
Aggressivt angiomyxom