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Penis and scrotum
Neoplastic lesions of scrotum
Calcifying fibrous pseudotumor
Editors: Antonio Cubilla, M.D. and Alcides Chaux, M.D. (see Author/Reviewers page)
Revised: 21 May 2010, last major update May 2010
Copyright: (c) 2002-2010, PathologyOutlines.com, Inc.
Definition
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● Paucicellular collagenous lesion with focal calcification and scattered chronic inflammatory cells
● Benign, first described in 1993 (Am J Surg Pathol 1993;17:502)
Epidemiology
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● Uncommon; young patients (mean age 16-19 years)
Sites
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● Extremities, trunk, scrotum (very rare), groin, neck, axilla
Clinical features
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● Tumor mass in an otherwise healthy patient, located in subcutaneous or deep soft tissue
● Very rarely multifocal
● Local recurrences in 30%
Case reports
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● 55 year old man with painless scrotal mass for 10 years (Indian J Pathol Microbiol 2007;50:577)
Treatment
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● Local excision
Gross description (Macroscopy)
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● Well-circumscribed, tan-gray, solid
● Occasionally infiltrative borders or entrapped structures
● Some cases have myxoid changes
● Tumor size 0.5-26 cm (mean 5.5 cm)
Gross images
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Not from scrotum Adrenal gland
Micro description (Histopathology)
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● Spindle cells arranged in an irregular fascicular pattern
● Abundant hyalinized collagen
● Psammomatous, ossifying or dystrophic calcification
● Occasionally foreign body giant cell reaction
● Lymphoplasmacytic infiltrate
● High microvasculature density
● Entrapment of muscle, adipose tissue and nerve bundles is a common finding
● Variable eosinophils, neutrophils, mast cells, germinal centers
● No necrosis, no atypia, no mitoses
Micro images
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Adrenal gland tumor has paucicellular Microcalcifications vary in size
fibrous proliferation with focal
microcalcifications
Lymphoplasmacytic inflammation Fig 1A, B, E, F - compared to IMT
is characteristic
Positive stains
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● Factor XIIIa, CD68, vimentin, CD34
Negative stains
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● Cytokeratin, smooth muscle actin, muscle-specific actin, desmin
● Anaplastic lymphoma kinase-1 (ALK-1), S100
Electron microscopy descriptions
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● Consistent with immature fibroblasts
● Abundant collagen fibrils in extracellular space
Electron microscopy images
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Differential Diagnosis
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● Inflammatory myofibroblastic tumor: younger patients with systemic symptoms (fever, malaise, pain, weight loss, anemia), deeper location, more prominent inflammatory infiltrate, no significant calcification, muscle specific actin+, desmin+, ALK1+
Additional references
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End of Penis and scrotum > Neoplastic lesions of scrotum > Calcifying fibrous pseudotumor
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