Intranodal Palisaded Myofibroblastoma: Radiological and Cytological Overview

Abstract

Background: Intranodal palisaded myofibroblastoma is a benign and very rare mesenchymal neoplasm of the lymph nodes originating from differentiated smooth muscle cells and myofibroblasts.

Case report: We report a case of intranodal palisaded myofibroblastoma in an 84-year-old woman with Parkinson's disease that presented as a left inguinal mass. The diagnosis was made using ultrasound-guided fine needle aspiration biopsy and consequent cytopathological examination that included immunohistochemical analysis. Herein, we discuss the presentation of a rare intranodal palisaded myofibroblastoma with emphasis on its ultrasonographic and cytopathologic features.

Conclusions: Intranodal palisaded myofibroblastoma should be considered in the differential diagnosis of inguinal lymphadenopathy and the diagnosis is possible with cytopathologic exam and immunohistochemical analysis using ultrasound-guided FNA biopsy, guiding the clinician to nodal excision rather than aggressive measures.

Keywords: Biopsy, Fine-Needle; Histocytological Preparation Techniques; Lymphatic Abnormalities; Ultrasonography.

Figure 1

A well-demarcated ovoid-shaped mass with mixed echogenicity in the left inguinal area on ultrasound (A). Power Doppler imaging revealed minimal vascularity within the mass (B).

Figure 2

B-mode sonographic image showing a hypoechoic mass with a regular shape (left). Sonoelastographic image showing a predominantly blue lesion (blue color denotes the hardness) (A). Elastographic exam [Q-Analysis by GE Healthcare machine, E-Index (Elasticy Index)] revealed features of hard tissue characteristics with a 4.6 score (measurement range: 0–6; high scores denote the hardness) (B). The mass has a hardness of 8.8 fold compared with subcutaneous fat tissue on elastographic measurement (E-Ratio) (C).

Figure 3

Spindle tumor cells showing a vaguely palisaded pattern in the collagenous matrix (cytologic feature) (A). Spindle cells showing a palisading arrangement in the collagenous background (cellblock histology) (B).