Paravaginal myxoid liposarcoma

Discussion:

Gynecological examination:

  • nodular neoformation hard - smooth, posterior in the fornix
  • speculum: epithelial portions: dystrophies, no atypical vaginal discharge

TV ultrasound:

  • rounded hypoechoic mass with well-defined margin and 25 mm in diameter at the back of the cervix (myoma of the ligament?) non-liquid swelling free endopelvic. No ovarian abnormalities.

In the MRI report it was suggested to remove the mass because there were signs that were concerning for malignancy. 

Histological findings: The neoformation shows a proliferation of elements sometimes fused in a pattern myxo-fibrosarcoma-like at the most distinct pleomorphic plurinucleates with MFH-like aspects. There are numerous lipoblasts often pleomorphic immersed in a myxoid stroma rich in capillary vessels. The mitotic index is high (> 3-4 myths xhpf), no necrosis sites are observed and the neoplasia reaches the margins of surgical excision. Immunocytochemistry proliferating elements express positive for CdK4 (clone EPR4513-32-7), CD 34 (clone QBEnd /10), MDM2 (clone IF2), S-100 (polyclonal) and Vimentina (clone V9) while negative for 1-A-2-N-EMA (clone E29), desmin (clone DE-R-11), cytokerite (clone AE1-AE3) and smooth muscle alpha-actin (clone 1A4). KI67 (clone 30-9) is expressed in 20% of proliferating elements.

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