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Tally H, Al-janabi MAH, AlDwairy H, Al-Shehabi Z, Ibrahim M. Low-grade fibromyxoid sarcoma in laryngopharynx: the first case report in the literature. J Surg Case Rep 2024; 2024:rjae141. [PMID: 38476455 PMCID: PMC10930207 DOI: 10.1093/jscr/rjae141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 02/17/2024] [Indexed: 03/14/2024] Open
Abstract
Low-grade fibromyxoid sarcoma is a rare mesenchymal neoplasm with distinctive histopathological features. Although it typically arises in the deep soft tissues of the trunk and extremities, its occurrence in the head and neck region is exceedingly rare. We present the first documented case of low-grade fibromyxoid sarcoma in the laryngopharynx, expanding the spectrum of this rare tumor's anatomical localization. The clinical, radiological, and histopathological features of this unique case are discussed, highlighting the diagnostic challenges and therapeutic considerations associated with this uncommon presentation.
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Affiliation(s)
- Hanan Tally
- Department of ENT, Tishreen University Hospital, Latakia 041, Syria
| | | | - Heba AlDwairy
- Department of Anesthesiology, Tishreen University Hospital, Latakia 041, Syria
| | - Zuheir Al-Shehabi
- Department of Pathology, Director of Cancer Research Center, Tishreen University Hospital, Latakia 041, Syria
| | - Mostafa Ibrahim
- Department of ENT, Tishreen University Hospital, Latakia 041, Syria
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Rekhi B, Qian X, Domanski HA, Klijanienko J, Field A. Pitfalls in soft tissue cytopathology. Cytopathology 2024; 35:30-47. [PMID: 37548096 DOI: 10.1111/cyt.13282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 06/28/2023] [Accepted: 07/16/2023] [Indexed: 08/08/2023]
Abstract
Fine needle aspiration biopsy (FNAB) is a diagnostic modality for the evaluation of suspicious soft tissue masses. Despite its reasonable sensitivity, specificity and positive predictive value in differentiating benign from malignant neoplasms, the exact subtyping of the primary soft tissue tumours can be challenging. Certain tumours constitute "pitfalls" and add to the diagnostic challenge. This review provides a detailed account of the diagnostic challenges in soft tissue cytopathology, including pitfalls and, more importantly, the ways to overcome these challenges by integrating clinical details, key cytomorphological features and judicious application of ancillary techniques.
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Affiliation(s)
- Bharat Rekhi
- Department of Pathology, Bone and Soft Tissues, Disease Management Group (DMG) Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Xiaohua Qian
- Department of Pathology, Cytopathology Service and Bone and Soft Tissue Service, Stanford University School of Medicine, Stanford, California, USA
| | | | | | - Andrew Field
- Department of Anatomical Pathology, St. Vincent's Hospital, University of New South Wales Sydney and Notre Dame University Sydney Clinical Medical Schools, Sydney, New South Wales, Australia
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He X, Jing W, He X, Chen M, Zhang H. Case report: Primary pleural low-grade fibromyxoid sarcoma in a 4-year-old boy with molecular confirmation. Front Oncol 2023; 13:1269078. [PMID: 38179169 PMCID: PMC10765539 DOI: 10.3389/fonc.2023.1269078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 11/23/2023] [Indexed: 01/06/2024] Open
Abstract
Low-grade fibromyxoid sarcoma (LGFMS) is a rare malignant fibroblastic tumor, principally affecting the deep tissues of the proximal trunk and extremities in young adults. However, primary pleural LGFMS is extremely rare, and only three cases have been reported in the previous English literature without genetic confirmation. Furthermore, the historical pleural LGFMS cases were all adults, and the primary pleural LGFMS in children has never been reported to date. Here, we presented a primary pleural LGFMS in a 4-year-old boy with detailed clinical, pathological, and molecular results. Histologically, the current tumor showed typical alternating collagenous and myxoid areas, containing spindled or oval tumor cells arranged in a whorled and short fascicular pattern. In some areas, the tumor cells exhibited moderate atypia, and mitotic figures were identified but without the identification of giant collagen rosettes. Immunohistochemically, all the neoplastic cells showed strong and diffuse positivity for MUC4. Genetically, FUS gene rearrangement was revealed by fluorescence in-situ hybridization (FISH), and subsequently, next-generation sequencing (NGS) and polymerase chain reaction (PCR) further demonstrated the FUS::CREB3L2 fusion transcript. To the best of our knowledge, this is the first case of primary pleural LGFMS with the identification of FUS gene rearrangement and FUS::CREB3L2 fusion in a 4-year-old child. Our study expands the age range of pleural LGFMS and highlights the combination of morphological, immunohistochemical, and molecular analyses in such challenging cases.
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Affiliation(s)
| | | | | | | | - Hongying Zhang
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
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Saoud C, Schowinsky J, Ali SZ. Myxoid Soft Tissue Tumors: A 20-Year Experience on Fine Needle Aspiration with Application of the Proposed WHO Reporting System for Soft Tissue Cytopathology. Acta Cytol 2023; 67:468-481. [PMID: 37231794 DOI: 10.1159/000531051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/08/2023] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Myxoid soft tissue tumors represent a heterogenous group of neoplasms. The study presented our experience on cytopathology of myxoid soft tissue tumors on fine needle aspiration (FNA) and aimed to apply the recently proposed WHO system for reporting soft tissue cytopathology. MATERIAL AND METHODS We performed a 20-year retrospective search of our archives to identify all FNAs performed on myxoid soft tissue lesions. All cases were reviewed, and the WHO reporting system was applied. RESULTS 129 FNAs performed in 121 patients (62 males; 59 females) showed a prominent myxoid component, accounting for 2.4% of all soft tissue FNAs. The FNAs were performed on 111 (86.7%) primary tumors, 17 (13.2%) recurrent tumors, and one (0.8%) metastatic lesion. A spectrum of non-neoplastic and neoplastic lesions including both benign and malignant neoplasms was identified. Overall, the most common tumors identified were myxoid liposarcoma (27.1%), intramuscular myxoma (15.5%), and myxofibrosarcoma (13.1%). The sensitivity and specificity of FNA regarding the nature of the lesion (benign vs. malignant) were 98% and 100%, respectively. When the WHO reporting system was applied, the frequency of the categories was as follows: benign (7.8%), atypical (34.1%), soft tissue neoplasm of uncertain malignant potential (18.6%), suspicious for malignancy (3.1%), and malignant (36.4%). The risk of malignancy calculated in each category was as follows: benign (10%), atypical (31.8%), soft tissue neoplasm of uncertain malignant potential (50%), suspicious for malignancy (100%), and malignant (100%). CONCLUSION A diverse group of non-neoplastic and neoplastic lesions can show a prominent myxoid component on FNA. The WHO reporting system for soft tissue cytopathology is easily applicable and appears to correlate well with the malignant potential of myxoid tumors.
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Affiliation(s)
- Carla Saoud
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA,
| | - Jeffrey Schowinsky
- Department of Pathology, University of Colorado Hospital, Aurora, Colorado, USA
| | - Syed Z Ali
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Kim M, Policherla RK, Linhares SM, Hui-Chou HG. Low-Grade Fibromyxoid Sarcoma of the Distal Upper Extremity: A Systematic Review. Hand (N Y) 2023:15589447221150523. [PMID: 36692100 DOI: 10.1177/15589447221150523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Low-grade fibromyxoid sarcoma (LGFMS) is a rare soft-tissue tumor that usually occurs in the proximal extremities and trunk. The purpose of this systematic review was to assess patient demographics, treatment approach, and outcomes for patients with LGFMS of the distal upper extremity. METHODS We performed a literature review of case reports and patient reports of LGFMS using Medical Literature Analysis and Retrieval System Online (MEDLINE) and PubMed. Inclusion criteria included case reports and case series of patients with LGFMS of the distal upper extremity. Animal studies, comments, and non-English publications were excluded. Data on available patient demographics, treatment regimen, recurrence, and metastasis were collected. RESULTS A total of 365 publications were reviewed. After applying the inclusion and exclusion criteria, 19 articles were included. There were 24 unique patients with LGFMS of the distal upper extremity. The median age was 32 years, and most patients were treated with a surgical excision. Of the 15 reported outcomes, 4 patients had local recurrences, and no patient had metastases or died due to the tumor. CONCLUSIONS Although LGFMS of the distal upper extremity is less common, it is critical for surgeons to consider it as a differential. The current approach is a wide excision with negative margins, and chemotherapy or radiotherapy may not be necessary. We found decreased proportions of local recurrence and metastases in the distal upper extremity compared with other anatomical regions. We recommend that surgeons follow up with their patients indefinitely given the slow mitotic rate of LGFMS.
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Affiliation(s)
- Minji Kim
- University of Miami Miller School of Medicine, FL, USA
| | | | | | - Helen G Hui-Chou
- University of Miami Miller School of Medicine, FL, USA
- DeWitt Daughtry Family Department of Surgery, Miami, FL, USA
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Abstract
Myxoid tumors of the soft tissue encompass a group of heterogenous tumors that are characterized by the presence of abundant extracellular myxoid or chondromyxoid matrix material. Fine needle aspiration (FNA) is variably used for diagnosing primary, recurrent, and metastatic myxoid soft tissue tumors. The spectrum of myxoid soft tissue tumors encountered in practice ranges from benign lesions such as simple ganglion cysts to high-grade malignant sarcomas such as myxofibrosarcoma. These myxoid tumors have clinical, cytologic, and histologic overlap. Therefore, making an accurate diagnosis by FNA alone is challenging. Despite this challenge, using a systematic cytomorphologic approach and ancillary studies, an accurate diagnosis is feasible in the majority of cases. This article provides a systematic approach to diagnosing myxoid soft tissue tumors by FNA along with a review of the literature.
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Affiliation(s)
- Swati Satturwar
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Paul E Wakely
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH
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Doblan A. Low-Grade Fibromyxoid Sarcomas with the Maxillary Sinus Localization: A Case Report and Review of the Literature. Indian J Otolaryngol Head Neck Surg 2022; 74:1442-1449. [PMID: 36452748 PMCID: PMC9702248 DOI: 10.1007/s12070-021-02562-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/12/2021] [Indexed: 11/28/2022] Open
Abstract
A low-grade fibromyxoid sarcoma (LGFMS) is an extremely rare tumor first described by Evans in 1987. LGFMS is a type of soft tissue sarcoma characterized by a deceptively benign histological appearance but completely malignant behavior. LGFMS is usually seen in the deep soft tissues of the extremities and trunk. We have examined many reviews, case reports and case series previously published in PubMed and Google Scholar. To date, only five cases have been reported in the maxilla. LGFMS generally affects young adults, but it can also be seen in children and older adults. A radical surgical approach is the most recommended treatment option. LGFMS has a very low mitotic activity; therefore, it is considered that neither chemotherapy nor radiotherapy has a significant effect on long-term LGFMS prognosis. However, to date, there has been no study suggesting any protocol for the follow-up of patients with LGFMS. In this report, we present a case with LGFMS located in the maxillary sinus, in which despite radiotherapy following extensive surgical excision, the tumor recurred in a short period of three months and reached its former size.
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Affiliation(s)
- Ahmet Doblan
- Otorhinolaryngology, SBÜ Mehmet Akif İnan Training and Research Hospital, Merkez Mahallesi, Esentepe Mah, Ertuğrul Cad, 63300 Haliliye, Şanlıurfa Turkey
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Dugalic V, Ignjatovic II, Kovac JD, Ilic N, Sopta J, Ostojic SR, Vasin D, Bogdanovic MD, Dumic I, Milovanovic T. Low-grade fibromyxoid sarcoma of the liver: A case report. World J Clin Cases 2021; 9:175-182. [PMID: 33511182 PMCID: PMC7809678 DOI: 10.12998/wjcc.v9.i1.175] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 09/15/2020] [Accepted: 11/21/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Low grade fibromyxoid sarcoma (LGFMS) is a rare and benign mesenchymal tumor with indolent course, most commonly found in young or middle-aged men. The majority of the LGFMSs are located in the trunk and deep soft tissue of the lower extremities. They appear as well circumscribed, although not encapsulated, which often leads to incomplete surgical resection. Despite their seemingly benign appearance, these tumors have aggressive behavior with high metastatic and recurrence rates. Accurate histopathologic examination of the specimen and its immunohistochemical analysis are mandatory for a precise diagnosis.
CASE SUMMARY We report a case of a 38 year-old-man who presented with jaundice and upper abdominal discomfort. Multi-detector computed tomography and magnetic resonance imaging showed a large left liver tumor mass, extending to the hepatoduodenal ligament. Left hepatectomy was performed with resection and reconstruction of hepatic artery and preservation of middle hepatic vein. Histopathologic examination confirmed the tumor being a low-grade fibromyxoid sarcoma. Three and a half years after surgery, the patient died after being diagnosed with spine metastasis.
CONCLUSION Due to poor response to all modalities of adjuvant treatment, we consider that the focus of treatment should be on surgery as the only option for curing the disease.
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Affiliation(s)
- Vladimir Dugalic
- Department of Hepatobiliary & Pancreatic Surgery, Clinic for Digestive Surgery, Clinical Center of Serbia, Belgrade 11000, Serbia
| | - Igor I Ignjatovic
- Department of Hepatobiliary & Pancreatic Surgery, Clinic for Digestive Surgery, Clinical Center of Serbia, Belgrade 11000, Serbia
| | | | - Nikola Ilic
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade 11000, Serbia
| | - Jelena Sopta
- Institute of Pathology, University of Belgrade, Belgrade 11000, Serbia
| | - Slavenko R Ostojic
- Department of Hepatobiliary & Pancreatic Surgery, Clinic for Digestive Surgery, Clinical Center of Serbia, Belgrade 11000, Serbia
| | - Dragan Vasin
- Department of Radiology, Clinical Center of Serbia, Belgrade 11000, Serbia
| | - Marko D Bogdanovic
- Department of Hepatobiliary & Pancreatic Surgery, Clinic for Digestive Surgery, Clinical Center of Serbia, Belgrade 11000, Serbia
| | - Igor Dumic
- Mayo Clinic Health System, Mayo Clinic College of Medicine and Science, Rochester, NY 10029, United States
| | - Tamara Milovanovic
- Clinic for Gastroenterology and Hepatology, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade 11000, Serbia
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Cytopathology of myxofibrosarcoma: a study of 66 cases and literature review. J Am Soc Cytopathol 2020; 10:300-309. [PMID: 33041221 DOI: 10.1016/j.jasc.2020.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/20/2020] [Accepted: 09/11/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Myxofibrosarcoma is one of the more common sarcomas encountered in adults. MATERIALS AND METHODS A search was made of our cytopathology and surgical pathology databases for cases diagnosed as myxofibrosarcoma (MyxoFS). FNA biopsy smears and cell block were performed and examined using standard techniques. RESULTS Sixty-six cases were retrieved from patients aged 40 to 94 years (mean: 67 years), with a male:female ratio of 1.4:1. Forty-seven (71%) were primary neoplasms, 13 (20%) locally recurrent, and 6 (9%) metastasis. Lower extremity was the most common site 38 (58%) cases, followed by upper extremity and trunk (each 13 [20%] cases), 1 head/neck, and 1 pleural-based mass. Forty-two (64%) cases were specifically/correctly diagnosed as MyxoFS. Thirteen (20%) were diagnosed as undifferentiated pleomorphic sarcoma (UPS), 3 (4.5%) as myxoid neoplasm, 2 (3%) as myxoid sarcoma, and 1 (1.5%) sarcoma, not otherwise specified. As most were examples of high-grade (HG) MyxoFS, cytomorphology contained pleomorphic and spindled cells set in a variable amount of myxoid stroma. Arborizing capillaries were common, and pseudolipoblasts were uncommon. All cases interpreted as UPS were HG MyxoFS histologically. Five (7.5%) cases-pleomorphic liposarcoma (3), solitary fibrous tumor (1), and atypical lipoma (1)-were mistakenly diagnosed. Ancillary immunohistochemistry played a minor role in diagnostic assessment. CONCLUSION MyxoFS was accurately interpreted using FNA biopsy in about two thirds of cases. One fifth were misinterpreted as UPS due to the absence/near absence of myxoid stroma, which varies considerably in the definition of this neoplasm.
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Wakely PE. Extraskeletal myxoid chondrosarcoma: combining cytopathology with molecular testing to achieve diagnostic accuracy. J Am Soc Cytopathol 2020; 10:293-299. [PMID: 32828707 DOI: 10.1016/j.jasc.2020.07.135] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/21/2020] [Accepted: 07/21/2020] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Advances in the genetics of soft tissue neoplasia have allowed for the diagnostic recognition of specific tumor types from small biopsy specimens, including those procured using the fine needle aspiration (FNA) biopsy technique. Extraskeletal myxoid chondrosarcoma (EMC) is a malignant mesenchymal neoplasm characterized by NR4A3 and, less specifically, by EWSR1 gene rearrangements. A series of EMC cytologic specimens was examined to demonstrate the diagnostic value of incorporating fluorescence in situ hybridization (FISH) testing in cytologic cases of suspected EMC. MATERIALS AND METHODS A search was made of our cytopathology and surgical pathology databases for cases diagnosed as EMC. FNA biopsy cytology, exfoliative cytology, imprint cytology, and FISH analysis were performed and examined using standard techniques. RESULTS A total of 16 cases of EMC were retrieved from 15 patients (male/female ratio, 2.8:1; mean age, 62 years). Of the 15 patients, 10 were new patients with primary tumors, 2 had locally recurrent tumors, and 4 had metastases. The sites included the extremities in 10 cases, the trunk in 4, serous effusion in 1, and a mediastinal lymph node in 1 case. The specific cytologic diagnoses were EMC (14 cases; 88%), suspicious for EMC (n = 1), and malignant cells (n = 1). All cases for which FISH testing was successfully used were specifically recognized as EMC. Aspirates and imprint smears consisted of uniformly rounded cells set in an opaque myxoid/chondromyxoid stroma (less abundant and more diaphanous in the effusion sample), sometimes arranged in short anastomosing cords. FNA of 1 case of an EMC cellular variant mimicked a malignant small rounded cell tumor. CONCLUSION EMC can be added to the growing list of soft tissue neoplasms that are specifically recognizable using cytopathology, coupled with judicious application of ancillary molecular testing.
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Affiliation(s)
- Paul E Wakely
- Department of Pathology, James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio.
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