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1/3. Aggressive giant fibroepithelial lesion with unusual vascular stroma--a case report.

    The stroma of fibroadenoma and phyllodes tumor usually consists of fibroblastic proliferation. Rarely the stroma contains bundles of smooth muscle. Pseudoangiomatous hyperplasia of the mammary stroma has been described in fibroadenomas. However, true benign vascular stroma has not been reported. We report a case of a 34-year-old Chinese woman who presented with a large mass occupying the entire left breast. Left mastectomy was performed and showed a large, well-circumscribed, lobulated, rubbery-firm tumor measuring 13 x 10 x 6 cm. Microscopic examination revealed a fibroepithelial tumor formed by an organoid pattern of ductal structures with a very striking stromal appearance composed of extensive vascular proliferation and that demonstrated strong immunoreactivity for CD31, CD34, and factor viii. Ultrastructural examination revealed intercellular junctions, basal lamina, pinocytotic vesicles, and weibel-palade bodies in the cells lining the vascular spaces, confirming their endothelial nature. These findings rule out the diagnosis of pseudoangiomatous hyperplasia. The patient developed local recurrence a year later, and the resection showed malignant phyllodes tumor with ductal carcinoma in situ.The extensive vascular stroma noted in the primary tumor may have played a role in the malignant transformation of the epithelial and stromal components in this tumor.
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2/3. An unusual cause of complete distal ureteral obstruction: giant fibroepithelial polyp.

    Fibroepithelial polyp of the ureter is a rare benign neoplasm of mesodermal origin. It is an extremely rare cause of hydronephrosis in children. It usually causes partial ureteral obstruction without loss of renal function. The preferred treatment is endoscopic or surgical resection of the polyp with preservation of the renal unit. The authors present an adolescent patient with a nonfunctioning left hydronephrotic kidney caused by complete ureteral obstruction caused by a giant fibroepithelial polyp of the distal ureter. This is an extremely rare presentation and outcome of this benign ureteral neoplasm with resultant loss of renal unit.
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3/3. Recurrent giant fibroepithelial stromal polyp of the vulva associated with congenital lymphedema.

    BACKGROUND: The relatively site-specific mesenchymal lesions of the vulvovaginal region can exhibit superficially overlapping histological features and can be diagnostically challenging. Fibroepithelial stromal polyp is generally an easily recognizable entity, but certain cases cause differential diagnostic problems. CASE: We present a case of a 16-year-old girl with a 10-cm polypoid lesion localized to the left labium. The patient has therapy resistant congenital lymphedema localized to the left arm and leg. The labial lesion was resected and recurred after 12 months and 6 years following the initial treatment. Histologically, it exhibited characteristics of a fibroepithelial stromal polyp with scattered bizarre multinucleated giant cells and ectatic tortuous lymphatic spaces. CONCLUSION: This vulvar lesion represents a unique example of giant fibroepithelial stromal polyp developed in association with Nonne-Milroy-Meiges syndrome.
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