J Korean Med Sci.  2004 Aug;19(4):619-623. 10.3346/jkms.2004.19.4.619.

Hyalinizing Spindle Cell Tumor with Giant Rosettes with Pulmonary Metastasis After a Long Hiatus: A Case Report

• Chang E
• Lee A
• Lee E
• Shin O
• Kang C
• Kim JM
• Chu YC

• KMID: 2157698
• DOI: http://doi.org/10.3346/jkms.2004.19.4.619

Abstract

"Hyalinizing spindle cell tumor with giant rosettes" (HSCTGR) is a recently described tumor, which is regarded as an unusual variant of low-grade fibromyxoid sarcoma. Proof of a metastatic potential was lacking. The patient in the report was a 35-yr-old woman who showed multiple bilateral pulmonary nodules with massive pleural effusion in the right side. She had a history of a mass excision in the right thigh 11 yrs ago at another hospital, which was reported as a "leiomyoma". Two years before this presentation, the patient received a routine chest radiograph which demonstrated bilateral multiple pulmonary nodules. A lobectomy of the left upper lung was performed. The histological findings revealed a well-circumscribed nodule that was characterized by a spindle-shaped fibrous to hyalinized stroma with criss-crossing short fascicles and giant collagen rosettes surrounded by a rim of spindle-shaped cells. Electron microscopy confirmed the fibroblastic nature of the tumor. This case, in addition to at least two other cases reported in the literature, demonstrates that the HSCTGR is a malignant neoplasm with the capacity to metastasize after a long hiatus.

Keyword

Hyalinizing Tumor; Rosettes Formation; Sarcoma; Lung; Metastasis

MeSH Terms

Adult
Female
Humans
Hyalin/metabolism
Korea
Lung Neoplasms/diagnosis/*pathology/*secondary/ultrastructure
*Neoplasm Metastasis
Pleural Effusion/pathology
Sarcoma/diagnosis/*pathology/ultrastructure
Thigh/pathology
Time Factors

Figure

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  Fig. 1 Computerized tomography of the chest reveals bilateral multiple pulmonary nodules with right massive pleurisy causing collpase of the right lung.

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  Fig. 2 A fibrous area composed of bland-looking spindle-shaped cells with a fascicular and vague storiform growth pattern. Several rosette-like structures are separated by spindle areas (H&E, ×40).

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  Fig. 3 The tumor cells in the more cellular areas shows irregular wavy nuclei with a moderate degree of nuclear atypia (H&E, ×200).

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  Fig. 4 The central eosinophilic area of the rosettes is composed of collagen fibers (H&E, ×100).

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  Fig. 5 The thigh tumor shows a moderate cellularity with spindled nuclei in abundant collagenous stroma (H&E, ×200).

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  Fig. 6 Electron microscopic findings show tumor cells with spindle nuclei containing coarse chromatin, abundant cytoplasm, and dilated rough endoplasmic reticula (×8,000).

Reference

1. Lane KL, Shannon RJ, Weiss SW. Hyalinizing spindle cell tumor with giant rosettes. A distinctive tumor closely resembling low-grade fibromyxoid sarcoma. Am J Surg Pathol. 1997. 21:1481–1488.

2. Evans HL. Low grade fibromyxoid sarcoma. A report of 12 cases. Am J Surg Pathol. 1993. 17:595–600.

3. Woodruff JM, Antonescu CR, Erlandson RA, Boland PJ. Low grade fibrosarcoma with palisaded granuloma-like bodies (giant rosettes). Report of a case that metastasized. Am J Surg Pathol. 1999. 23:1423–1428.

4. O'Sullivan MJ, Sirgi KE, Dehner LP. Low-grade fibrosarcoma (hyalinizing spindle cell tumor with giant rosettes) with pulmonary metastases at presentation: case report and review of the literature. Int J Surg Pathol. 2002. 10:211–216.

5. Magro G, Fraggetta F, Manusia M, Mingrino A. Hyalinizing spindle cell tumor with giant rosettes. A previously undescribed lesion of the lung. Am J Surg Pathol. 1998. 22:1431–1433.

6. Weiss SW, Goldblum JR. Enzinger and Weiss's soft tissue tumors. 2001. 4th ed. St. Louis: Mosby;431–435.

7. Folpe AL, Lane KL, Paull G, Weiss SW. Low-grade fibromyxoid sarcoma and hyalinizing spindle cell tumor with giant rosettes. Am J Surg Pathol. 2000. 24:1353–1360.

8. Nielsen GP, Selig MK, O'Connell JX, Keel SB, Dickersin GR, Rosenberg AE. Hyalinizing spindle cell tumor with giant rosettes. A report of three cases with ultrastructural analysis. Am J Surg Pathol. 1999. 23:1227–1232.

9. Scolyer RA, McCarthy SW, Wills EJ, Palmer AA. Hyalinising spindle cell tumor with giant rosettes: report of a case with unusual features including original histological and ultrastructural observations. Pathology. 2001. 33:101–107.

10. Ludvikova M, Michal M, Zamecnik M. Hyalinizing spindle cell tumors with giant rosette-like structures. Pathol Res Pract. 1998. 194:577–581.

11. Farinha P, Oliveira P, Soares J. Metastasizing hyalinizing spindle cell tumour with giant rosettes: report of a case with long survival. Histopathology. 2000. 36:92–93.