DOI:10.2214/AJR.07.2952
AJR 2007; 189:W383
© American Roentgen Ray Society
Reply
Ofer Benjaminov,
Suzana Fichman and
Haim Gutman
Rabin Medical Center, Petach Tikva, Israel
WEB—This is a Web exclusive article.
We thank Dr. Siegelman [1]
for his insight on our case report
[2]. It represents the
advantage of peer review in its broader aspect. After that letter, we revised
the pathologic specimen (Fig.
1). Sections showed a hypocellular lesion formed of spindle and
stellate cells in a myxoid background with areas of fresh hemorrhage and
scattered vessels of varying caliber. The tumor cells did not show significant
nuclear pleomorphism and stained positively for vimentin, desmin, progesterone
receptor, estrogen receptor, and smooth-muscle actin. Stain for S-100 was
negative. Stain for Ki-67 showed a proliferative index of less than 1%. The
findings are therefore compatible with aggressive angiomyxoma as Dr. Siegelman
rightly anticipated.
Aggressive angiomyxoma is a rare tumor that usually involves the pelvis and
perineal regions in women [3].
Our case showed a huge mass with a large retroperitoneal component, which
presented as a large buttock mass-perineal hernia
[2]. Dr. Siegelman
[1] correctly mentioned that
distinguishing between the myxoid soft-tissue tumors can be challenging. Our
initial diagnosis was made on the basis of pathology and probability (tumor
location) [2], raising the
possibility of more-common tumors in that location.
There have been arguments regarding the importance of case reports and
whether time should be spent in reading them
[4]. This case presentation
proves once again that the case report is "far from dead"
[5]. Medical knowledge is
formed case by case and these add up to form the "tissue
signature" that Dr. Siegelman
[1] referred to, which enables
us to improve ourselves as radiologists and serve as "virtual
pathologists" [6]. Last
but not least, the patient was notified regarding the change of diagnosis. We
express our gratitude and appreciation to Dr. Siegelman.
References
- Siegelman ES. Myxoid sarcoma versus aggressive angiomyxoma.
(letter) AJR 2007;189
:[web] Wxxx-
- Benjaminov O, Gutman H, Nyabanda R, Keinan R, Sabach G, Levavi H.
Myxoid liposarcoma: an unusual presentation. AJR2007; 188:817
-821[Free Full Text]
- Fletsch JF, Laskin WB, Lefkowitz M, Kindblom LG, Meis-Kindblom JM.
Aggressive angiomyxoma: a clinicopathological study of 29 female patients.
Cancer 1996; 78:79
-90[CrossRef][Medline]
- Vandenbroucke JP. In defense of case reports and case
series. Ann Intern Med 2001;20
: 134:330-334
- Rosselli D, Otero A. The case report is far from dead.
Lancet 2002; 359:84[Medline]
- Rogers LF. Imaging: a Sisyphean search for the elusive tissue
signature. AJR 2002;179
: 557[Free Full Text]
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