Cutaneous Myoepithelioma | Case Study

Cutaneous Myoepithelioma | Case Study TITLE: Cutaneous myoepithelioma: A case report of an unusual and recently recognized entity ABSTRACT: Myoepitheliomas and mixed tumors were only recently recognized to occur primarily in soft tissue, and only small case numbers have been described. The present case is of 25-year-old male who had solitary, painless mass over right middle finger, measuring 3cm in greatest dimensions and light microscopy revealed a tumor composed of a mixed population of spindle, epithelioid and plasmacytoid cells arranged around a central chondromyxoid stroma. No definite diagnosis could be reached on this morphology and initial diagnosis of benign mixed stromal tumor was considered. Immunohistochemistry(IHC) was performed and the tumor showed strong positivity for Calponin and SMA, Ki-index showed low index, weak and focal positivity for S-100 and negative for Pan-CK. The final diagnosis of benign myoepithelioma was entertained. Keywords: Myoepithelioma, Cutaneous, Soft tissue INTRODUCTION: Myoepithelioma of the skin and soft tissue is a newly recognized entity only ten years ago with fewer than 50 case reports. It has characteristic histopathologic and immunohistochemical features, which need to be differentiated from a variety of tumors CASE REPORT: Case history: A 25-year-old male presented with a solitary, painless mass over right middle finger, measuring 3cm in greatest dimension since 6months. There is no increase in size and overlying skin is smooth and unremarkable. The mass is firm, non- tender and mobile. X-ray showed a soft tissue mass with underlying bone unremarkable. Gross: Multiple tissue bits aggregate measuring 3Ãâ€"2Ãâ€"1cm and skin flap measuring 2Ãâ€"1cm. Light microscopy: Revealed a tumor in the superficial dermis composed of a mixed population of spindle , epithelioid, and plasmacytoid cells arranged around a central chondromyxoid stroma. No definite diagnosis could be reached on this morphology and diagnosis of benign mixed stromal tumor was considered. Immunohistochemistry(IHC): IHC was performed and showed strongly positive Calponin and SMA. S-100 was weak and focally positive. Pan CK was negative. Ki 67 revealed low index (2%). The final diagnosis of Benign myoepithelioma was entertained. DIFFERENTIAL DIAGNOSIS The primary differential diagnoses considered were extraskeletal myxoid chondrosarcoma (EMC) and ossifying fibromyxoid tumor (OFMT). EMC typically shows a multinodular growth pattern with cords of cells in a myxoid matrix. The tumor cells in EMC are more spindled than those of myoepitheliomas. S-100 protein and epithelial markers are expressed in a minority of EMC and usually only focally, while both the markers are often extensively expressed in myoepitheliomas. OFMT is a lobulated tumor surrounded by a rim of metaplastic bone. The tumor cells are mostly pale-staining ovoid to round cells. Approximately 70% of OFMT show positivity for S-100 protein and vimentin and 50% of tumor cells are positive for desmin. The tumor cells in OFMT are rarely positive for epithelial markers and GFAP. Myoepitheliomas are generally negative for desmin, nearly half positive for GFAP, and nearly always show positivity for keratin and S-100 protein.[1] Other tumors that should be differentiated are, Epithelioid benign fibrous histiocytoma that usually shows a superficial dermal tumor with a well-developed epidermal collarette. Spitz nevus is characterized by a junctional component, nesting and maturation of tumor cells. In epithelioid sarcoma, multiple tumor nodules around central necrosis or even myxoid degeneration are often seen. More morphologic uniformity is observed in epithelioid sarcoma over myoepithelioma. Moreover, approximately 90% of epithelioid sarcoma are positive for vimentin, cytokeratin, and EMA, and around 60% are positive for CD34, but are generally negative for other markers typical myoepithelial differentiation (S-100 protein, GFAP, myogenic markers). Cellular neurothekeoma consists of nesting of tumor cells, and are consistently S-100 negative.[2] COMMENT Tumors comprised mostly of myoepithelial cells without obvious epithelial differentiation are designated myoepitheliomas.[1] Neoplasms of myoepithelial cells can occur in a pure form as myoepitheliomas or in association with glandular structures as mixed tumors.[2] Myoepitheliomas of the skin and soft tissue were recognized only 10 years ago.[3] Myoepithelial cells can exhibit dual epithelial and myoid differentiation. They may also show divergent metaplasia, including squamous, adipocytic, bone and cartilaginous differentiation.[4,5] As a consequence, proliferating myoepithelial cells in neoplasms display a variety of histologic and immunohistochemical expression patterns. It has been postulated that cutaneous myoepitheliomas are related to mixed tumors of skin and that soft tissue myoepitheliomas are derived from deeply located adnexal structures. Cutaneous myoepitheliomas of the head and neck may be derived from salivary gland tissue, as has been reported in two parotid gland myoe pitheliomas presenting as infra- auricular subcutaneous masses.[6] Therefore, the possibility of an underlying primary salivary gland neoplasm should be considered in myoepitheliomas presenting in the head and neck. Myoepithelial tumors were described only recently in soft tissue, and, to date, fewer than 50 cases have been reported. Kilpatrick et al [3] reported a study of 19 patients with mixed tumors and myoepitheliomas of soft tissue in 1997. Michal et al [7] reported 12 additional cases of myoepitheliomas of the skin and soft tissues in 1999, Hornick and Fletcher conducted a study of 14 cutaneous myoepitheliomas. There were 11 males and 3 females. The study indicated that cutaneous myoepitheliomas occur with peaks in childhood (7 patients were between 10 and 20 years of age) and middle age and are most common on the extremities, in contrast to mixed tumors of the skin, which typically occur on the head and neck in middle aged or elderly adults.[1,3,4] Myoepitheliomas of soft tissue are often lobulated, and the most frequent architectural pattern is reticular or trabecular with chondromyxoid or hyalinized stroma. These lesions display the same wide range of histologic features as those of salivary gland origin. Many tumors are heterogeneous, containing an admixture of epithelioid and spindled cells, reticular areas merging with solid areas, at least focally prominent stroma, and occasional foci of cartilaginous or osseous differentiation. [8] A small subset of tumors approximately 10% are predominantly solid proliferations of spindled or plasmacytoid myoepithelial cells. Occasional tumors display features of so-called parachordoma, namely, large epithelioid cells with eosinophilic epitheliomas. Initially, myoepitheliomas were only recognized to contain spindled or plasmacytoid cells growing in solid sheets. [9]Current classifications therefore include all of these patterns within the spectrum of myoepithelioma, simply separating those tumors with ductal differentiation into the mixed tumor category.[10,11] Whereas some investigators allow up to 5% or 10% ductal differentiation in myoepitheliomas, others classify tumors with any ducts as mixed tumors. In any event, it is now widely thought that myoepitheliomas and mixed tumors fall along a spectrum of tumors with overlapping histologic appearances and similar clinical behavior. Because the immunophenotype of these lesions overlaps with myoepithelioma, and otherwise typical myoepithelioma s can show focal areas with â€Å"parachordoma†-like features, it is becoming increasingly clear that parachordoma probably falls within the spectrum of myoepithelioma of soft tissue, as is reflected in the new WHO classification.[11] The only apparent difference in immunophenotype is GFAP and SMA negativity in parachordomas, because few cases of parachordoma have been studied and only about 50% of otherwise convincing soft tissue myoepitheliomas are GFAP positive and only around 40% are SMA-positive, then this distinction seems very questionable. Awareness of the wide morphologic range of myoepitheliomas is necessary to perform confirmatory immunohistochemical stains and thereby to arrive at the correct diagnosis.[12] In salivary glands, myoepitheliomas are generally positive for cytokeratins and S-100 protein, whereas immunostaining for actin and GFAP is variable. We therefore required immunoreactivity for either keratin or EMA, in conjunction with detection of S-100 protei n or myogenic markers, for the diagnosis of myoepithelioma and inclusion in this series. Neoplastic myoepithelial cells of all morphologic types often expressed myogenic markers.[13] As has been reported in the salivary gland, we found calponin to be the most sensitive myogenic marker, staining 86% of tumors, whereas SMA stained 36% and desmin only a small subset (14%). Interestingly, the basal cell/myoepithelial marker p63, which has shown utility in the differential diagnosis of carcinoma of breast and prostate due to the staining of myoepithelial or basal cells in in situ lesions, appears to be detectable in only one fourth of soft tissue myoepithelial tumors. Immunostaining for p63 is not specific for myoepithelial tumors, however, as this antigen has also been reported in other neoplasms, especially squamous cell and urothelial carcinomas.[13,14] Nonetheless, detection of p63 expression may provide helpful supportive evidence of myoepithelial differentiation in the proper morph ologic context. CONCLUSION: Cutaneous myoepitheliomas are relatively rare. Pathologists play an important role in reaching to accurate morphological diagnosis. Myoepitheliomas should be considered in the differential diagnosis of cutaneous and soft tissue tumors. Immunohistochemical study may aid in the diagnosis. Although most cutaneous and soft tissue myoepitheliomas behave in a benign fashion, there is a significant risk for local recurrence and a low metastatic potential. Wide excision with safe surgical margins and regular follow-up are crucial for the management of cutaneous and soft tissue myoepitheliomas. References: 1. Hornick JL,Fletche CDM. Myoepithelial tumors of soft tissue a clinicopathologic and Immunohistochemical study of 101 cases with evaluation of prognostic parameters. Am J Surg Pathol. 2003;27:1183–1196. 2. Hornick JL, Fletcher CD. Cutaneous myoepithelioma: a clinicopathologic and immunohistochemical study of 14 cases. Hum Pathol. 2004;35:14-24. 3. Kilpatrick SE, Hitchcock MG, Kraus MD, Calonje E, Fletcher CD. Mixed tumors and myoepitheliomas of soft tissue: a clinicopathologic study of 19 cases with a unifying concept. Am J Surg Pathol. 1997;21:13-22. 4. Mentzel T, Requena L, Kaddu S et al. Cutaneous myoepithelial neoplasms: clinicopathologic and immunohistochemical study of 20 cases suggesting a continuous spectrum ranging from benign mixed tumor of the skin to cutaneous myoepithelioma and myoepithelial carcinoma. J Cutan Pathol. 2003;30:294-302. 5. Fernà ¡ndez-Figueras MT, Puig L, Trias I, Lorenzo JC, Navas-Palacios JJ. Benign myoepithelioma of the skin. Am J Dermatopathol. 1998;20:208-12. 6. Lewin MR, Montgomery EA, Barrett TL. New or unusual dermatopathology tumors: a review. J Cutan Pathol. 2011;38:689-96. 7. Kutzner H, Mentzel T, Kaddu S et al. Cutaneous myoepithelioma: an under-recognized cutaneous neoplasm composed of myoepithelial cells. Am J Surg Pathol. 2001;25:348-55 8. Dix BT, Hentges MJ, Saltrick KR, Krishnamurti U. Cutaneous myoepithelioma in the foot: case report. Foot Ankle Spec. 2013;6:239-41. 9. Michal M, Miettinen M. Myoepitheliomas of the skin and soft tissues. Report of 12 cases. Virchows Arch. 1999;434:393-400. 10. Franklin G, Chen S, Sznyter LA, Morgenstern NJ. Cutaneous myoepithelioma with a plexiform pattern of growth: a case report. J Cutan Pathol. 2009;36:42-5. 11. Jo VY, Antonescu CR, Zhang L et al. Cutaneous Syncytial Myoepithelioma: Clinicopathologic Characterization in a Series of 38 Cases. Am J Surg Pathol. 2013 ; 37: 710–718. 12. Jakate K, Wong K, Sirbovan J, Hanna W. Cutaneous myoepithelioma arising within hidradenoma of the scalp. J Cutan Pathol. 2012;39:279-85. 13. Stojsic Z, Brasanac D, Boricic I, Bacetic D. Clear cell myoepithelial carcinoma of the skin. A case report. J Cutan Pathol. 2009;36:680-3. 14. Tanahashi J, Kashima K, Daa T, Kondo Y, Kuratomi E, Yokoyama S. A case of cutaneous myoepithelial carcinoma. . J Cutan Pathol. 2007;34:648-53. LEGENDS Figure 1:Myoepithelioma(100X): composed of a mixed population of spindled, epithelioid, and plasmacytoid cells arranged around a central chondromyxoid stroma. Insert shows 400X view and reveals mild nuclear atypia (coarse chromatin and prominent nucleoli) . Figurer 2:Myoepithelioma(400X): (a)shows SMA positivity in the cytoplasm of myoepithelial cells.(b) shows strong positivity for Calponin in the cytoplasm of spindle cells.(c) shows PAN CK negativity(d) showsS100 negativity. Figure 3 :Myoepithelioma(400X): shows Low Ki 67 index.

My Journey: Being A Person For Others

How I Became A Person For Others A synthesis paper In partial fulfillment of the requirements in the FOP subject Submitted to: Ms. Irish E. Bobtail Submitted by: Mr.. Glenn Ian E. Patella Date Submitted: October 7, 2014 Ad Majored Die Gloria, Magic, and Persons for Others – these are the common phrases expressed and uttered along the halls of Xavier University – Atone De Canaan. I am touched by the meaning of these values and practices since I am sort of new to this kind of environment.Now I know why this Institution Is prestigious and s being looked up by other people – it's because of the values they teach coupled with the quality education they offer. Going to Xavier University is an experience I will never ever forget; It's not about the name that the school carries; It's not about how seemingly glamorous you are when you walk down the streets wearing the school uniform; it's not about being classy and smart all at the same time, it's because here, they focus more on shaping you on to becoming the best of you, in service for others, the country and for God. In this school, I became a person for others.The first four months Vie spent here In Xavier are four months filled with vibrant colors and unforgettable shades. With its cheerful and Christ-centered aura, I knew that I was called here for a cause. The moment I stepped into the school with only a few steps away from becoming an official student, gleeful faces surrounded the university and seemingly elder students are trying their very best to make us feel at home. Successfully, I felt at home, it's as if I've been to this place before. Despite the air being sizzling and all, lye managed to enjoy my stay and tried my best to be as listen as I could.One things for sure that in college: it's definitely not the same with high school and you should practice being Independent and work harder. I found out that no matter how hardworking you are and excelled somehow In high school; some of it might change in college if you've changed in a slightly different way. If I could 1 OFF what I have now; I should've scanned for more rather than being contented by what is offered inside the walls from different classrooms; I should've spent a lot more time studying rather than focusing on some other activities, I should've practiced magic long the way.I don't want to sound as if my life is full of regrets, but, I also don't want to repeat some of the things Vie encountered this semester, literally. I believe that everything happens for a reason and God has plans, that God has a specific reason why things happen. With me on my weakest point was God – he was there and helped me through my obstacle. I told him that I would rise back and give my foremost power to be a good son for him. Despite the heavy load Vie carried along the pathway, I can say that being in here t the same time makes the load go away.Here, students are taught to be concerned for the environment and as well as the community. Sincerely, I was Just thrilled and excited at the thought that I would become a person for others; someone who's willing to sacrifice and give others a hand. Who wouldn't want that? So, I grabbed the chance. Also, thanks to the OFF 10 subject, I developed my prayer life. Being able to attend the prayer session workshop was an event I will carry across my heart for the rest of my life. It was Just life-changing! Indeed, everything happens for a reason.Going to Manners and experiencing the calming and peaceful atmosphere was fantastic. There, I met new friends and strengthen my connection with God. Furthermore, visiting the magnificent divine mercy along with my block mates was another remarkable event during this semester. It was my first time to visit the beautiful place and it was special, for me, that I'm with them. Being able to pray together and Just being peaceful with each other plus the silent and tranquil ambiance, the event turned out to be as splendid as I imagined.With all the activities that packed us into a strong and compelling group, the formation groups that shaped me into who I am today, the bonding I had with other people, I found myself sharing pieces of my life to each and every one of them. I am also glad that Vie picked bits of life lessons from people Vie met along the course. We are all men and women for each other. The semester can't be complete without this significant and fun-filled activity that we had in Consolation Elementary School.Smiles and laughter of children roared round the campus of their school when all of the students under OFF arrived at their destination. It was nice seeing young Filipinos that are lively, enthusiastic and carries potentials on becoming great people someday. Witnessing them enjoy the activities we've prepared makes me want to relive my younger years. I can now feel the sentiment of an adult. We planned on including the national anthem during the opening part of our little program wit h the kids, but, they proceeded in reciting the patriotic vows of our country!We were quite stunned, but hey, they got the Filipino parity in them. Of course, we tried our very best to entertain them and stand in front of them as role models. There, I realized how crucial everything can be when handling children. You must always set a very good example for them to follow, if we want to see a bright and harmonious tomorrow ahead of us. We served them food and drinks to complete this one of a kind experience. It was clear through their eyes that they had fun as much as we did and it totally feels good to make them happy. Happiness despite being buried by heavy load.In little ways, I served my fellow Monterrey by bringing Joy to their young and youthful hearts. Being helpful and concerned for the welfare of others is something that bursts out from within you. It can't be Just taught inside the classroom and the ideas are left, trapped within the four walls. You shape your own life with the guide of God through his own creations. You become a person for others if you believe that you already are and you should act what you perceive. As I close one chapter of my story here in Xavier University, I hope that the following chapters will be as bright as the sun.The heaper did mold me into becoming the product of what the school had envisioned its students to become: men and women for others. I became closer to God and I should serve him as my father and ultimate creator; I contributed small things to other people's lives and became a part of theirs as much as they are also a part of mine; I indulged myself into setting a good example for my young fellow countrymen to follow. In the process, my life was filled with ups and downs – a sign that I am alive and I will continue to do what Vie started. And that is how I became a person for others.

Obama Perfect Union Speech – Contemporary Racism

Contemporary Racism President Obama’s speech â€Å"A More Perfect Union† was a response to many outbursts made about things that Reverend Jeremiah Wright, Obama’s former pastor, had said on issues of racism. The reverend made statements that Obama called dismissive when what the world needed most was unity to overcome the continual racism in the country. Quotes from the Reverend such as â€Å"In the  21st  century, white America got a wake-up call after 9/11/01.White America and the western world came to realize that people of color had not gone away, faded into the  woodwork  or just ‘disappeared’ as the Great White West kept on its merry way of ignoring black concerns† and â€Å"Racism is how this country was founded and how this country is still run! †¦We [in the U. S. ] believe in white supremacy and black inferiority and believe it more than we believe in God† caused an uproar in Washington.Obama used this opportunity to address race and the problems in the country relating to it. This speech relates to many of the topics we learned about in class regarding race and racism. Obama talks about his family’s background and how various people don’t like him in office for ridiculous reasons such as that he’s â€Å"too black† or â€Å"not black enough† to be the first black president. They even go as far as to say that he’s in office due to affirmative action.He goes on to talk about his white grandmother and the racist statements she would make, such as that when a black man passes her by on the street she fears him. President Obama’s speech relates to white privilege in the sense that the country has only ever had white presidents and therefore a stereotype has been formed that only the typical white collar, white male deserves to be in office. White people say things like that because they feel like power is being taken away from them and given to blac k people by having a black president in office.Obama even quotes about white privilege and the power of whites being taken away by saying, â€Å"Most working- and middle-class white Americans don't feel that they have been particularly privileged by their race†¦Ã‚  when they hear an African-American is getting an advantage in landing a good job or a spot in a good college because of an injustice that they themselves never committed; when they're told that their fears about crime in urban neighborhoods are somehow prejudiced, resentment builds over time. In his speech he also talks about institutional racism which goes all the way back to Brown vs. Board of Education which was the Supreme Court case that ruled separation of black and white students unconstitutional. Obama also talked about this in his speech saying, â€Å"Segregated schools were and are inferior schools; we still haven't fixed them,  50 years after Brown v. Board of Education. And the inferior education they provided, then and now, helps explain the pervasive achievement gap between today's black and white students. He went on to say how this gives an inferior education to blacks and how this explains the gap in the income levels of white Americans vs. black Americans which in turn doesn’t give black men as many economic opportunities as white men. This not only relates to white privilege because they feel they are deserving of these jobs and educations but it also has a lot to do with institutional racism. By giving these economic opportunities to the better qualified person you are giving it to the one who has a better education.Through his speech, Obama illuminates the problem within our schools. Funding and quality of education go hand in hand, and since often times African Americans live in poor urban communities, schools struggle for funds to heighten the quality of their education. By talking about the dependence of schools on the income of the people living in the areas surrounding, Obama points out that privileged white kids are able to come out on top verses an African American child who grew up in an underfunded school.These white kids then get into more prestigious colleges, in turn landing more high paying jobs than the majority of their African American counterparts. Obama also goes on to talk about how people try to act like there is no racism anymore even though it is so blatantly out there. He quoted â€Å"Talk show hosts and conservative commentators built entire careers unmasking bogus claims of racism while dismissing legitimate discussions of racial injustice and inequality as mere political correctness or reverse racism. He talks about how things like this widen the gap of racism and how we need to work to close the gap instead. He calls it a racial stalemate saying, â€Å"Contrary to the claims of some of my critics, black and white, I have never been so naive as to believe that we can get beyond our racial divisions in a single el ection cycle, or with a single candidacy — particularly a candidacy as imperfect as my own. † Obama believes that only by exposing the true roots of racism can we move forward, slowly but with conviction. He encourages more debate and open discussion instead of hiding behind polite political facades. But I have asserted a firm conviction — a conviction rooted in my faith in God and my faith in the American people — that, working together, we can move beyond some of our old racial wounds, and that in fact we have no choice if we are to continue on the path of a more perfect union†. Overall, the goal of President Obama’s speech was to highlight the most taboo of topics in our society: racism. Since the era of reconstruction, white people have tried hard to ignore skin color, but Barack Obama is trying to make a point of not ignoring the color of his skin, but rather using it to his advantage by pointing out the problems we have created.White sup remacy is still very much a real idea, even in our modern 21st century society. Poor education makes finding a good job in tough economic times an almost impossible task for the African American community, simply because they never had the same opportunities as their white peers. Obama encourages Americans to forgive past grievances and instead create a â€Å" new normal† – one of racial equality and opportunity regardless of race.

The Apostles and the Early Church - 2946 Words

The Apostles and the Early Church J.Trimble GBST 164 In the Gospel of Matthew the term â€Å"apostles† is only used when introducing the list of twelve apostles commissioned to follow Christ. â€Å"Now the names of the twelve Apostles are these: the first, Simon who is called Peter, and Andrew his brother; James the son of Zebedee, and John his brother; Philip, and Bartholomew; Thomas, and Matthew the publican; James the son of Alpheus, and Lebbeus, whose surname was Thaddeus; Simon the Canaanite, and Judas Iscariot, who also betrayed him† (Matthew 10:1-4). An apostle is a person sent to accomplish a mission. An apostle represents the one sending and has authority to represent the sender in business, political, or educational situations (T.†¦show more content†¦Gigot). The change of Simon’s name by Jesus was significant. As in the case of Abram, Sarai and Jacob, the change of destiny is indicated by the change of name. This name Cephas is taken from the Aramaic vernacular and corresponds to the Greek Peter , Petros, which means a piece of rock- a mass of rock detached from the living rock (T. Butler). It is a term which becomes a natural emblem of firmness and stability. It may be hard for us to see the fitness of such a name for a man apparently so unstable; but the fitness was perceived by Christ. Peter wavered often, even while under his Master’s eye, and at least once afterward, but he continually became more and more like the â€Å"rock† that Christ wanted him to be and he was indeed a pillar of the church (W.B. Hill). We observe that all the time Christ was with the Twelve, Peter was a leader among them. Occasionally, Christ would select certain ones for special responsibilities; for example: Peter, James and John to witness the raising of Jarius’ daughter, the transfiguration, and the agony in the garden (G. Stokes). 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