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Clinical Problem Solving: Pathology
September 15, 2008

Pathology Quiz Case 1: Diagnosis

Author Affiliations

Copyright 2008 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2008

Arch Otolaryngol Head Neck Surg. 2008;134(9):1014. doi:10.1001/archotol.134.9.1014-a

Histologic examination showed proliferation of uniform spindle cells near the deep margin of the biopsy specimen (Figure 3), as well as areas with similar spindle cells more loosely arranged amid a myxoid background with occasional nuclear pleomorphism and hyperchromasia, representing degenerating cells (Figure 4). Such degenerative characteristics have been termed ancient change.1,2The tumor cells stained diffusely positive with S100 protein. Ancient change was originally coined by Ackerman and Taylor2to denote hypercellularity, nuclear pleomorphism, hyperchromasia, and degenerative changes that were thought to represent the prolonged course of these tumors. Such changes can be suggestive of malignancy initially, but thorough examination of the specimen will confirm a lack of mitotic activity and demonstrate a well-defined capsule without invasion of surrounding tissue.3