Breast implant-associated anaplastic large cell lymphoma (BI-ALCL) is a rare T-cell lymphoma that arises around breast implants. Most patients manifest with periprosthetic effusion, whereas a subset of patients develops a tumor mass or lymph node involvement (LNI). The aim of this study is to describe the pathologic features of lymph nodes from patients with BI-ALCL and assess the prognostic impact of LNI. Clinical findings and histopathologic features of lymph nodes were assessed in 70 patients with BI-ALCL. LNI was defined by the histologic demonstration of ALCL in lymph nodes. Fourteen (20%) patients with BI-ALCL had LNI, all lymph nodes involved were regional, the most frequent were axillary (93%). The pattern of involvement was sinusoidal in 13 (92.9%) cases, often associated with perifollicular, interfollicular, and diffuse patterns. Two cases had Hodgkin-like patterns. The 5-year overall survival was 75% for patients with LNI and 97.9% for patients without LNI at presentation (P=0.003). Six of 49 (12.2%) of patients with tumor confined by the capsule had LNI, compared with LNI in 8/21 (38%) patients with tumor beyond the capsule. Most patients with LNI achieved complete remission after various therapeutic approaches. Two of 14 (14.3%) patients with LNI died of disease compared with 0/56 (0%) patients without LNI. Twenty percent of patients with BI-ALCL had LNI by lymphoma, most often in a sinusoidal pattern. We conclude that BI-ALCL beyond capsule is associated with a higher risk of LNI. Involvement of lymph nodes was associated with decreased overall survival. Misdiagnosis as Hodgkin lymphoma is a pitfall.

Angiomyofibroblastoma represents a rare, benign mesenchymal tumor with a predilection for the vulvovaginal region. Lipomatous change may occur but rarely comprises a substantial component of the lesion. There are only eight reports in the English language literature describing the lipomatous variant of this tumor. We describe a further lipomatous angiomyofibroblastoma that occurred on the labium majus of a 49-year-old woman. The histopathologic and immunohistochemical features are described, and the collective experience in the literature is reviewed.

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We report a case of a cutaneous myoepithelioma in a 69-year-old, right-hand dominant, gentleman with an 18-month history of a progressively, enlarging mass on the volar aspect of his left middle finger over the proximal phalanx. The lesion measured 2 × 2 cm in dimensions (Fig. 1a); there was no associated neurosensory deficit, vascular compromise or involvement of the flexors of the affected finger. The patient underwent pre-operative magnetic resonance imaging (MRI), revealing a lobulated lesion with increased vascularity. It had a predominantly high signal on T1 (Fig. 1b), with no involvement of the flexor synovium or bone. The lesion was given a provisional diagnosis of a giant cell tumour (GCT), but that a vascular anomaly or a synovial sarcoma could not be excluded.Surgical excision of this lesion was performed, with dissection of the lesion off the skin and flexor sheath, preserving the neurovascular bundles (Fig. 1c). The tissue was sent fresh for histology, and the wound was directly closed.The specimen did not have the typical clinical appearance of a GCT, and was diagnosed as a myoepithelioma.Histology revealed an un-encapsulated tumour composed of nests of mildly pleomorphic histiocytoid/plasmacytoid cells within a vascularized myxoid fibrous stroma. The lesion was diagnosed as a myoepithelioma, associated with a low mitotic count of 1 per 10 high power fields and with no necrosis. Foci of squamous associated keratin formation were noted (Fig. 2a), with expression of both low (Fig. 2b) and high (Fig. 2c) molecular weight cytokeratins, vimentin (Fig. 2d) and S100 (Fig. 2e). There was no expression of smooth muscle actin, CD68 (histiocytic marker), vascular markers (CD34), and melanocytic markers (HMB-45 and melan A). The lesion was completely but narrowly excised.Post-surgical recovery was uneventful. A discussion of the diagnosis at a complex hand meeting and with our oncology colleagues reached an overall consensus for long-term follow-up as further surgery would involve significant functional compromise with no role for either chemo/radiotherapy.Cutaneous myoepithelioma (CM) tumours, also known as parachordomas, are rare primary tumours of the soft tissues, 1 proposed to arise from either the eccrine or the apocrine glands. 2 There have been just over 100 cases reported in the literature with only 10 in the hand. 1,3 CMs are typified by a mixed myxoid, chondroid and epithelial histological phenotype with plasmatoid or spindle cell features. 3 Although CMs share similarities with GCTs, the lack of expression of CD68, as is typically seen in the mononuclear fraction of GCTs, 4 was not evident in this case.They are considered benign tumours yet are associated with high rates of local recurrence of close to 20%, 3,5 but are distinct from the more aggressive myoepithelial carcinomas, with higher rates of metastasis and increased cellular atypia. 3 With regard to metastasis, a review by Clark et al. 1 of 22 cases of upper limb CMs revealed 10 cases in the hand. There was only one case in the forearm that h...