Superficial CD34-positive fibroblastic tumor is a recently described soft-tissue tumor entity. A 48 year-old-male presented with a gradually increasing soft-tissue mass in his right forearm of 2 years' duration, along with multiple subcutaneous soft-tissue nodular lesions, and reminiscent of lipomas over his body. He underwent a wide excision of his forearm mass. Microscopic sections showed a circumscribed tumor in the dermis and subcutaneous fat, composed of spindle cells, inflammatory cells, including lymphocytes, plasma cells, and eosinophils, along with interspersed markedly pleomorphic giant cells containing moderate-to-abundant "glassy" cytoplasm, vesicular nuclei, exhibiting prominent nucleoli, and intranuclear pseudoinclusions. There were no significant mitotic figures, areas of hemorrhage, necrosis, or pigment histiocytes. By immunohistochemistry, the tumor cells were diffusely positive for CD34 while negative for cytokeratin (CK), pan CK (AE1/AE3), S100 protein, CD30, and CD31. MIB1/Ki-67 was low and highlighted 4%-5% tumor nuclei. Diagnosis of superficial CD34-positive fibroblastic tumor was offered. Sections from the various resection margins were free of tumor. Postresection, the patient is alive with no evidence of disease for the past 8 months. This constitutes as one of the first case reports of this rare tumor entity from our country. Its diagnostic and treatment implications are discussed herewith.
The rare entity of primary T-cell lymphoma of thyroid gland may pose great diagnostic and therapeutic challenges to the pathologist and clinician. There are very few case and short series reports of these tumors describing their varied clinicopathologic features in English literature. We report a case of mature T-cell lymphoma of thyroid in a 26 year old male, with unique pseudogranulomatous and lymphohistiocytic Lennert type of morphology, on a background of autoimmune thyroiditis. This man, diagnosed with Hashimoto's thyroiditis for the previous 2 years, underwent thyroidectomy for sudden onset of pressure symptoms. The diagnosis of T-cell lymphoma was made on the thyroid tissue based on histopathologic and immunophenotypic findings, in concert with the results of T-cell receptor gene rearrangement studies by polymerase chain reaction. Later, after about 3 months, similar findings were confirmed in an excision biopsy from a left cervical lymph node in the patient. The patient has been started on chemotherapy with gemcitabine, dexamethasone, and cisplatin along with involved field radiotherapy; however, he has shown a rapid upstaging of disease from stage IE to IIIE in a short period of 3 months with relatively well preserved clinical parameters until the latest follow up.
These four unusual chordomas, confirmed by brachyury immunoexpression, constitute as one of the first such documentation from our country, revealing a wide clinicopathologic spectrum of chordomas. Dedifferentiated and poorly differentiated chordomas are associated with an aggressive clinical course. Further diagnostic implications are discussed herewith.
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