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CUTANEOUS MYCOBACTERIAL SPINDLE CELL PSEUDOTUMOR; AN EXCEEDINGLY RARE
TUMOR MIMICKING SOFT TISSUE NEOPLASM IN A TODDLER
Manahil Khan, Madiha Bilal Qureshi, Alka Rani, Muhammad Raza, Nasir Ud Din
SECTION OF HISTOPATHOLOGY,PATHOLOGY AND LABORATORY MEDICINE,
AGA KHAN UNIVERSITY HOSPITAL, KARACHI, PAKISTAN.
INTRODUCTION
Mycobacterial Spindle Cell Pseudotumor (MSCP) is arare
mass lesion associated with immunosuppression.The
immunodeficient states include AIDS, organ transplantation,
infection and prolonged immunosuppressive medications.
MSCP may rarely occur in neonates and infants after BCG
vaccination.It mainly affects lymph node but may involve any
site of the body such as skin, abdomen, lungs, spleen, nasal
cavity and brain.Histology shows aheterogenous admixture
of fibroblasts, myofibroblasts and epithelioid to spindle
shaped histiocytes containing mycobacterial organisms.Many
species of the mycobacterial organisms can be present but
atypical bacteria specifically Mycobacterium avium -
intracellulare is most common.Here, we present the case of
afemale toddler who presented with acutaneous shoulder
lesion.
To present the case of aone year nine months old female child
who presented with asingle 2.3 x 1.4 cm cutaneous shoulder
swelling.Excisional biopsy was performed with clinical
differentials of tuberculosis and leishmaniasis.
MATERIALS &METHODS
The specimen received was coded as “Shoulder mass, excisional
biopsy” and consisted of a single tan brown to yellow firm tissue of
size 2.3 x 1.5 x 1 cm.
Microscopy showed acellular lesion composed of fascicles,
whorls and vague granulomatous appearance of spindly cells
with vesicular nuclei, conspicuous nucleoli and moderate
pale eosinophilic cytoplasm (FIG 1). Abundant histiocytes
and acute inflammatory infiltrate was present (FIG 2).
Immunomarkers CD68 and CD4were positive in
histiocytes, whereas S100,ASMA, CD34,CD23,CD21,
CD1a and ALK protein were negative.Special stain ZN
(FIG 3) and Fite highlighted rod-shaped bacilli while PASD
for fungus was negative.Based on these histomorphological
features, the lesion was best diagnosed as MSCP with a
comment recommending microbiological culture studies
and complete clinical history of BCG vaccination,
immunodeficiency and tuberculosis contact.AFB culture
revealed Mycobacterium Tuberculosis Complex and
bacterial culture showed Curvularia species.Fungus culture
was negative.Patient then underwent achest X-ray which
was normal.Further history revealed positive tuberculosis
contact with sister.There was no history of
immunosuppression or BCG vaccination at the site.Patient
was started on Anti-Tuberculous Treatment and is
improving on afollow up of 3months.
OBJECTIVE
CONCLUSION
MSCP is arare tumor like lesion associated with mycobacterial
infection and should be kept in differential diagnoses of soft
tissue tumors with proliferative spindle cells admixed with
histiocytes, specifically in immunocompromised patients.
Correct diagnosis can result in timely therapy and successful
outcome.
E-mail: manahilalam.khan@gmail.com
CORRESPONDENCE
FIG 2: spindle cell lesion with histiocytes and acute
inflammation
FIG 1:Fascicles of spindle cells in a rich inflammatory background.
FIG 3: Ziehl-Neelson stain highlights rod shaped bacilli