Liesegang Rings in an Endometrioid Adenocarcinoma of Ovary

Abstract

Liesegang rings are rarely encountered in routine histopathology practice and are generally described in benign conditions. 1 However, our description in an ovarian neoplasm expands their spectrum in malignancies. [2][3][4] Recently, round to ovoid acellular eosinophilic rings were noted in histological sections from an endometrioid ovarian neoplasm ( Figure 1A-C) of a 36-year-old woman. Interestingly, these were confined to the central necrotic regions, within large endometrioid glands, exhibiting squamous metaplasia. The rings having characteristic concentric laminations around a central amorphous nidus were identified as Liesegang rings. They were nonbirefringent on polarizing microscopy and negative for epithelial membrane antigen (EMA). Their structural details were accentuated with periodic acid-Schiff stain.The smooth walled ovarian mass measured 10 × 7 cm. The cut surface was solid-cystic and revealed blood clots. While sections from the thin cyst wall had tubal type lining, the solid region displayed lobules of proliferating endometrioid glands. Examination of multiple sections revealed only occasional foci of confluent expansile tumor growth measuring >5 mm in greatest dimension. Herein, despite relatively bland nuclear features of lining epithelium and ≤2 mitosis/high-power field, there was architectural 697821I JSXXX10.1177/1066896917697821International Journal of Surgical PathologyJain et al research-article2017 Figure 1. (A) Microscopy revealed an occasional large () expansile lobule measuring >5 mm in greatest dimension, among smaller (→) lobules (hematoxylin and eosin, 20×). (B) Higher magnification of this large lobule revealed confluent endometrioid glands, lined by mildly pleomorphic cells with only occasional mitotic figures (). There were intervening sheets of squamous metaplastic cells and Liesegang rings (→) were seen confined to dilated glands (hematoxylin and eosin, 200×). (C) These rings (→)were seen in regions of necrosis, rimmed by squamous epithelium (hematoxylin and eosin, 400×). (C inset) The characteristic concentric laminations of Liesegang rings (→) were accentuated on PAS histochemistry (periodic acid-Schiff, 400×), but (D) they stained negative for EMA (immunostain, 400×).

Liesegang Rings: Extremely Rare Structures in Malignant Lesions

“…They include an endometriotic cyst adjacent to a well differentiated endometroid adenocarcinoma of the ovary and clear cell renal cell carcinoma. 4,6,7 They have also been seen in synovium, cystic lesions of breast, female genital tract, conjunctiva, eyelid, pericardium, omentum, epididymis, paranasal sinus, and dermoid cyst, 5,6,8,9 but to the best of our knowledge never in a case of medullary carcinoma of thyroid.…”

“…Liesegang rings are a common finding in benign lesions like fibrosis, inflammation, necrosis, cysts, and so on. 1-5 Only a countable number of malignant cases have been reported to show these rings. They include an endometriotic cyst adjacent to a well differentiated endometroid adenocarcinoma of the ovary and clear cell renal cell carcinoma.…”

Liesegang structures and pseudofungi in a cystic renal cell carcinoma aspirate

“…Liesegang rings have been encountered both in surgical pathology and FNA material from various benign cysts and inflammatory processes, but especially in renal cysts, apocrine and other breast cysts, and endometriotic cysts . Their occurrence in malignant lesions is exceptional, and, in addition to the current case, Liesegang rings were reported in a single case of endometrioid ovarian carcinoma . A recent report describes Liesegang rings in a case of medullary thyroid carcinoma; however, since they stained with Congo red, they would be better classified as globular (spheroid) amyloid with concentric laminations.…”

“…21 Their occurrence in malignant lesions is exceptional, and, in addition to the current case, Liesegang rings were reported in a single case of endometrioid ovarian carcinoma. 22 A recent report describes Liesegang rings in a case of medullary thyroid carcinoma 23 ;…”

Formation of Liesegang Structures under the Conditions of the Spatiotemporal Reaction of Polymer-Analogous Transformation (Salt → Base) of Chitosan

“…Thus, the model experiment of the reaction diffusion of NaOH into a chitosan glycolate solution made it possible to visualize and obtain quantitative characteristics of the formation of periodic structures in the course of the spatiotemporal reaction of polymer-analogous transformation, which underlies the method of obtaining chitosan microtubes with a layered-oriented structure. The results obtained have common features with biophysical mechanisms of the formation of spatially ordered solid-phase structures from biological fluids, benign/malignant neoplasms, and osteons of connective tissue, − which opens new directions in the theoretical understanding of physiological processes.…”