Skip to main content
Log in

Perivascular Epithelioid Cell Tumors (PEComas) of the Head and Neck: Report of Three Cases and Review of the Literature

  • Original Paper
  • Published:
Head and Neck Pathology Aims and scope Submit manuscript

Abstract

PEComas are a family of neoplastic lesions that share overlapping morphology, immunohistochemistry, and ultrastructure that include angiomyolipoma, lymphangioleiomyomatosis, clear cell “sugar” tumor of the lung as well as similar tumors occurring in a variety of visceral, cutaneous and soft tissue sites throughout the body. The defining histopathological features are epithelioid cells with a perivascular distribution containing clear to pale eosinophilic granular cytoplasm and a round-to-oval centrally located nucleus with an inconspicuous nucleolus. Immunohistochemically, coexpression of melanocytic (HMB-45 and/or Melan-A) and myoid markers are characteristic. In the present study, we describe three PEComas occurring in the head and neck (nasal cavity and larynx) and discuss the behavior of these distinctive tumors and review the literature of head and neck PEComas. The importance of recognizing this entity will ensure its consideration in the differential diagnosis of tumors of the head and neck with a similar morphology. The histogenesis of PEComas still remains elusive and additional cases with a prolonged follow up remain important to accurately determine the behavior of these distinctive tumors. Complete surgical excision still remains the treatment of choice for histologically benign PEComas.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Bonetti F, Pea M, Martignoni G, et al. PEC and sugar. Am J Surg Pathol. 1992;16:307–8.

    Article  PubMed  CAS  Google Scholar 

  2. Vang R, Kempson RL. Perivascular epithelioid cell tumor (‘PEComa’) of the uterus: a subset of HMB-45-positive epithelioid mesenchymal neoplasms with an uncertain relationship to pure smooth muscle tumors. Am J Surg Pathol. 2002;26:1–13.

    Article  PubMed  Google Scholar 

  3. Tazelaar HD, Batts KP, Srigley JR. Primary extrapulmonary sugar tumor (PEST): a report of four cases. Mod Pathol. 2001;14:615–22.

    Article  PubMed  CAS  Google Scholar 

  4. Folpe AL, Goodman ZD, Ishak KG, et al. Clear cell myomelanocytic tumor of the falciform ligament/ligamentum teres: a novel member of the perivascular epithelioid clear cell family of tumors with a predilection for children and young adults. Am J Surg Pathol. 2000;24:1239–46.

    Article  PubMed  CAS  Google Scholar 

  5. Bonetti F, Pen M, Martignoni G, et al. The perivascular epithelioid cell and related lesions. Adv Anatom Pathol. 1997;4:343–58.

    Article  Google Scholar 

  6. Hornick JL, Fletcher CD. PEComa: what do we know so far? Histopathology. 2006;48:75–82.

    Article  PubMed  CAS  Google Scholar 

  7. Banerjee SS, Eyden B, Trenholm PW, et al. Monotypic angiomyolipoma of the nasal cavity: a heretofore undescribed occurrence. Int J Surg Pathol. 2001;9:309–15.

    Article  PubMed  CAS  Google Scholar 

  8. Lehman NL. Malignant PEComa of the skull base. Am J Surg Pathol. 2004;28:1230–2.

    Article  PubMed  Google Scholar 

  9. Iyengar P, Deangelis DD, Greenberg M, et al. Perivascular epithelioid cell tumor of the orbit: a case report and review of the literature. Pediatr Dev Pathol. 2005;8:98–104.

    Article  PubMed  Google Scholar 

  10. Folpe AL, Mentzel T, Lehr HA, et al. Perivascular epithelioid cell neoplasms of soft tissue and gynecologic origin: a clinicopathologic study of 26 cases and review of the literature. Am J Surg Pathol. 2005;29:1558–75.

    Article  PubMed  Google Scholar 

  11. Koutlas IG, Pambuccian SE, Jessurun J, et al. Perivascular epithelioid cell tumor of the oral mucosa. Arch Pathol Lab Med. 2005;129:690–3.

    PubMed  Google Scholar 

  12. Kuroda N, Goda M, Kazakov DV, et al. Perivascular epithelioid cell tumor of the nasal cavity with TFE3 expression. Pathol Int. 2009;59:769–70.

    Article  PubMed  Google Scholar 

  13. Furusato E, Cameron JD, Newsom RW, et al. Ocular perivascular epithelioid cell tumor: report of 2 cases with distinct clinical presentations. Hum Pathol. 2010;41:768–72.

    Article  PubMed  Google Scholar 

  14. Guthoff R, Guthoff T, Mueller-Hermelink HK, Sold-Darseff J, Geissinger E. Perivascular epithelioid cell tumor of the orbit. Arch Ophthalmol. 2008;126:1009–11.

    Article  PubMed  Google Scholar 

  15. Ghazali N, Cascarini L, Norris P, et al. Perivascular epithelioid cell tumor (PEComa) of the cheek. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010;110:e26–31.

    Article  PubMed  Google Scholar 

  16. Calder KB, Schlauder S, Morgan MB. Malignant perivascular epithelioid cell tumor (‘PEComa’): a case report and literature review of cutaneous/subcutaneous presentations. J Cutan Pathol. 2008;35:499–503.

    Article  PubMed  Google Scholar 

  17. Argani P, Aulmann S, Illei PB, et al. A distinctive subset of PEComas harbors TFE3 gene fusions. Am J Surg Pathol. 2010;34:1395–406.

    Article  PubMed  Google Scholar 

  18. Stodulski D, Stankiewicz C, Rzepko R, et al. Angiomyolipoma of the larynx: case report. Eur Arch Otorhinolaryngol. 2007;264:89–92.

    Article  PubMed  Google Scholar 

  19. Zhang LH, Sun RC, Chen Y. [A case report of epiglottic angiomyolipoma. ]. Zhonghua Bing Li Xue Za Zhi. 2005;34:645.

    PubMed  Google Scholar 

  20. Bonetti F, Pea M, Martignoni G, et al. Cellular heterogeneity in lymphangiomyomatosis of the lung. Hum Pathol. 1991;22:727–8.

    Article  PubMed  CAS  Google Scholar 

  21. Pea M, Bonetti F, Zamboni G, et al. Clear cell tumor and angiomyolipoma. Am J Surg Pathol. 1991;15:199–202.

    Article  PubMed  CAS  Google Scholar 

  22. Pea M, Bonetti F, Zamboni G, et al. Melanocyte-marker-HMB-45 is regularly expressed in angiomyolipoma of the kidney. Pathology. 1991;23:185–8.

    Article  PubMed  CAS  Google Scholar 

  23. Weeks DA, Malott RL, Arnesen M, et al. Hepatic angiomyolipoma with striated granules and positivity with melanoma–specific antibody (HMB-45): a report of two cases. Ultrastruct Pathol. 1991;15:563–71.

    Article  PubMed  CAS  Google Scholar 

  24. Bonetti F, Chiodera PL, Pea M, et al. Transbronchial biopsy in lymphangiomyomatosis of the lung. HMB45 for diagnosis. Am J Surg Pathol. 1993;17:1092–102.

    Article  PubMed  CAS  Google Scholar 

  25. Gaffey MJ, Mills SE, Zarbo RJ, et al. Clear cell tumor of the lung. Immunohistochemical and ultrastructural evidence of melanogenesis. Am J Surg Pathol. 1991;15:644–53.

    Article  PubMed  CAS  Google Scholar 

  26. Gal AA, Koss MN, Hochholzer L, et al. An immunohistochemical study of benign clear cell (‘sugar’) tumor of the lung. Arch Pathol Lab Med. 1991;115:1034–8.

    PubMed  CAS  Google Scholar 

  27. Dimmler A, Seitz G, Hohenberger W, et al. Late pulmonary metastasis in uterine PEComa. J Clin Pathol. 2003;56:627–8.

    Article  PubMed  CAS  Google Scholar 

  28. Mai KT, Belanger EC. Perivascular epithelioid cell tumour (PEComa) of the soft tissue. Pathology. 2006;38:415–20.

    Article  PubMed  Google Scholar 

  29. Longacre TA, Egbert BM, Rouse RV. Desmoplastic and spindle-cell malignant melanoma. An immunohistochemical study. Am J Surg Pathol. 1996;20:1489–500.

    Article  PubMed  CAS  Google Scholar 

  30. Henske EP, Scheithauer BW, Short MP, et al. Allelic loss is frequent in tuberous sclerosis kidney lesions but rare in brain lesions. Am J Hum Genet. 1996;59:400–6.

    PubMed  CAS  Google Scholar 

  31. Pan CC, Chung MY, Ng KF, et al. Constant allelic alteration on chromosome 16p (TSC2 gene) in perivascular epithelioid cell tumour (PEComa): genetic evidence for the relationship of PEComa with angiomyolipoma. J Pathol. 2008;214:387–93.

    Article  PubMed  Google Scholar 

  32. Folpe AL, Kwiatkowski DJ. Perivascular epithelioid cell neoplasms: pathology and pathogenesis. Hum Pathol. 2010;41:1–15.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jonathan B. McHugh.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bandhlish, A., Leon Barnes, E., Rabban, J.T. et al. Perivascular Epithelioid Cell Tumors (PEComas) of the Head and Neck: Report of Three Cases and Review of the Literature. Head and Neck Pathol 5, 233–240 (2011). https://doi.org/10.1007/s12105-011-0268-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12105-011-0268-9

Keywords

Navigation