Case Report
TFE3-expressing primary perivascular epithelioid cell tumor of the Lymph node mimicking nodal relapse of rectal cancer: A case report

https://doi.org/10.1016/j.ijscr.2019.05.002Get rights and content
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Highlights

  • TFE3-expressing PEComa has unique morphological and immunohistochemical features.

  • PEComa can mimic lymph node relapse of rectal cancer.

  • Surgical excision can aid a proper diagnosis of suspicious lesions in rectal cancer.

Abstract

Introduction

Perivascular epithelioid cell tumor (PEComa) is a rare mesenchymal neoplasm.

Presentation of case

We treated a 50-year-old woman who underwent neoadjuvant chemoradiotherapy followed by low anterior resection and adjuvant chemotherapy for ystage IIIB rectal adenocarcinoma. The patient was diagnosed with metastatic rectal adenocarcinoma in the right lower lobe of the lung after 14 months of follow-up. Later, after 3 years of follow-up, a mass in the gastrosplenic area was revealed by computed tomography, which was considered indicative of metachronous mass relapse. The patient underwent partial omentectomy, and an enlarged mass measuring 2.2 × 1.3 cm was found. Microscopic findings revealed an alveolar-like collection of epithelioid cells surrounded by a thin-wall vascular channel within a lymph node (LN). These epithelioid cells were positive for HMB45 and TFE3 but negative for Melan-A, CK, and S100. The patient was finally diagnosed with TFE3-expressing primary PEComa of LN.

Discussion

We report a rare case of TFE3-expressing primary LN PEComa that mimicked nodal recurrence of rectal cancer. Thus, imaging results in patients affected by neoplasm present a clinical diagnostic dilemma, as the presence of newly onset PEComa of LN may lead to the erroneous diagnosis of tumor recurrence or progression.

Conclusion

Suspicious isolated recurrences of rectal cancer in unusual locations may require surgical excision to confirm definitive diagnosis.

Abbreviations

LN
lymph node
PEComa
perivascular epithelioid cell tumor
TFE3
transcription factor E3
TSC
tuberous sclerosis complex

Keywords

Lymph node
Perivascular epithelioid cell tumour
Rectal cancer
Relapse
Transcription factor E3

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