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Klubíčková N, Michal M, Agaimy A, Zidar N, Pavlovský M, Yorita K, Grossmann P, Hájková V, Ptáková N, Šteiner P, Michal M. TIMP3::ALK fusions characterize a distinctive myxoid fibroblastic tumor of the vocal cords: a report of 7 cases. Virchows Arch 2022; 481:721-729. [PMID: 35925390 DOI: 10.1007/s00428-022-03389-2] [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: 05/27/2022] [Revised: 07/13/2022] [Accepted: 07/25/2022] [Indexed: 10/16/2022]
Abstract
We report 7 cases of an indolent, variably myxoid tumor of the vocal cords, characterized by overt cellular atypia with large cells containing intranuclear and intracytoplasmic vacuoles, delicate curvilinear vessels, and sparse inflammatory infiltrate. Six patients were male, aged 15 to 65 years, and 1 patient was a 54-year-old female. All tumors were located in the superficial portion of the vocal cord. One patient suffered a recurrence that was completely resected; all patients with available follow-up data currently have no evidence of disease. The tumors contained alternating areas with myxoid stroma and more compacted regions with tumor cells organized in short fascicles, interwoven with delicate curvilinear vasculature. Overt cellular atypia with large cells containing intranuclear and intracytoplasmic vacuoles or resembling ganglion cells was present in all cases but mitoses and necrosis were absent. ALK immunostaining was positive in all cases, while most tumors were negative for smooth muscle actin. Targeted RNA-sequencing revealed an identical TIMP3::ALK fusion with exon 1 of TIMP3 gene being fused with exon 12 of ALK gene in all analyzable cases. For various reasons discussed, it remains unclear whether this tumor represents a mere subtype of IMT or a separate entity. Nevertheless, it is a morphologically distinct and diagnostically challenging lesion that needs to be recognized by surgical pathologists in order to prevent overdiagnosis in this clinically very delicate area.
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Affiliation(s)
- Natálie Klubíčková
- Department of Pathology, Charles University, Faculty of Medicine in Pilsen, Alej Svobody 80, 323 00, Pilsen, Czech Republic. .,Bioptical Laboratory, Ltd., Pilsen, Czech Republic.
| | - Michael Michal
- Department of Pathology, Charles University, Faculty of Medicine in Pilsen, Alej Svobody 80, 323 00, Pilsen, Czech Republic.,Bioptical Laboratory, Ltd., Pilsen, Czech Republic
| | - Abbas Agaimy
- Institute of Pathology, Friedrich-Alexander University Erlangen-Nürnberg, University Hospital Erlangen (UKER), Erlangen, Germany
| | - Nina Zidar
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Michal Pavlovský
- Department of Pathology, Regional Hospital Most, Most, Czech Republic
| | - Kenji Yorita
- Department of Diagnostic Pathology, Japanese Red Cross Kochi Hospital, Kochi, Japan
| | | | | | | | - Petr Šteiner
- Bioptical Laboratory, Ltd., Pilsen, Czech Republic
| | - Michal Michal
- Department of Pathology, Charles University, Faculty of Medicine in Pilsen, Alej Svobody 80, 323 00, Pilsen, Czech Republic.,Bioptical Laboratory, Ltd., Pilsen, Czech Republic
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Li H, Wang H, Wang D. Sinonasal/basicranial myxofibrosarcoma: a report of 6 surgical cases combined with a literature review. Braz J Otorhinolaryngol 2022; 88 Suppl 5:S171-S178. [PMID: 35256287 PMCID: PMC9801034 DOI: 10.1016/j.bjorl.2022.02.001] [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: 05/26/2021] [Revised: 01/14/2022] [Accepted: 02/02/2022] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE The aim of this study was to report 6 cases of sinonasal/basicranial myxofibrosarcoma and review demographic data, clinical symptoms, diagnostic methods, therapeutic methods, and prognosis on this subject in the literature. METHODS We conducted a retrospective analysis of six patients referred to our hospital during a 10-year period from 2010 to 2020. RESULTS In this series, there were four males and two females. The tumours originated from the maxillary sinus in all six cases. The symptoms were nonspecific, and all patients underwent endoscopic resection alone or combined with open resection. The postoperative period was uneventful. All patients were diagnosed with myxofibrosarcoma. After a median follow-up period of 36 (6-52) months, the recurrence rate of MFS was 66.7% (4/6), and the mortality rate was 50% (3/6). CONCLUSION Sinonasal/basicranial MFS is a rare neoplasm, and the most common primary site is the maxillary sinus. When diagnosing MFS, osteolysis may help rule out benign lesions. So far surgery is the mainstay of treatment for sinonasal/basicranial MFS. Our surgical strategy using endoscopic resection or endoscopic resection combined with open resection to achieve a negative surgical margin and using re-excision operations to treat relapsed cases may be recommended to rhinologists who treat MFS. Prospective randomised trials are needed to study the role of chemotherapy, radiotherapy, and our surgical strategy for sinonasal/basicranial MFS. Diagnosing patients at an earlier stage and better patient compliance with follow-up plans may improve the prognosis of patients.
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Zhang B, Bai M, Tian R, Hao S. Idiopathic and radiation-induced myxofibrosarcoma in the head and neck-case report and literature review. Chin Neurosurg J 2021; 7:48. [PMID: 34823603 PMCID: PMC8620227 DOI: 10.1186/s41016-021-00267-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 11/08/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Myxofibrosarcoma (MFS), especially radiation-Induced MFS (RIMFS) in the head and neck, is an extremely rare malignant fibroblastic tumor. The diagnosis and treatment of MFS remain great challenges. In the present study, we presented one case of RIMFS. Combined with previous literature, the clinical features, essentials of diagnosis, and treatment modalities of MFS in the head and neck were reviewed to better understand this rare entity. CASE PRESENTATION We reported a case of RIMFS under the left occipital scalp in a 20-year-old girl with a history of medulloblastoma surgery and radiotherapy in 2006. A total tumor resection was performed with preservation of the overlying scalp the underlying bone, and no adjuvant therapy was administered after the first operation. The postoperative pathological diagnosis was high-grade MFS. The tumor relapsed 6 months later, and then, a planned extensive resection with negative surgical margins was carried out, followed by radiotherapy. No relapse occurred in a 12-month postoperative follow-up. CONCLUSIONS Planned gross total resection (GTR) with negative margins is the reasonable choice and footstone of other treatments for MFS. Ill-defined infiltrated borders and the complicated structures make it a great trouble to achieve total resection of MFS in the head and neck, so adjuvant radiotherapy and chemotherapy seem more necessary for these lesions.
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Affiliation(s)
- Bin Zhang
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, People's Republic of China
| | - Miao Bai
- Department of Neurology, Tang Du Hospital, Air Force Medical University, Xi'an, China
| | - Runfa Tian
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, People's Republic of China
| | - Shuyu Hao
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, People's Republic of China.
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Ke XT, Yu XF, Liu JY, Huang F, Chen MG, Lai QQ. Myxofibrosarcoma of the scalp with difficult preoperative diagnosis: A case report and review of the literature. World J Clin Cases 2020; 8:2350-2358. [PMID: 32548167 PMCID: PMC7281033 DOI: 10.12998/wjcc.v8.i11.2350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/17/2020] [Accepted: 04/28/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND A myxofibrosarcoma (MFS) is a malignant fibroblastic tumor that tends to occur in the lower and upper extremities. The reported incidence of head and neck MFSs is extremely rare. We report a 46-year-old male with “a neoplasm in the scalp” who was hospitalized and diagnosed with an MFS (highly malignant with massive necrotic lesions) based on histologic and immunohistochemistry evaluations. The magnetic resonance imaging manifestations did not demonstrate the “tail sign” mentioned in several studies, which resulted in a great challenge to establish an imaging diagnosis. The treatment plan is closely associated with the anatomic location and histologic grade, and more importantly, aggressive surgery and adjuvant radiotherapy may be helpful. Hence, we report the case and share some valuable information about the disease.
CASE SUMMARY A 46-year-old male with “a neoplasm in the scalp for 6 mo” was hospitalized. Initially, the tumor was about the size of a soybean, without algesia or ulceration. The patient ignored the growth, did not seek treatment, and thus, did not receive treatment. Recently, the tumor increased to the size of an egg; there was no bleeding or algesia. His family history was unremarkable. No abnormalities were found upon laboratory testing, including routine hematologic, biochemistry, and tumor markers. Computed tomography showed an ovoid mass (6.25 cm × 3.29 cm × 3.09 cm in size) in the left frontal scalp with low density intermingled with equidense strips in adjacent areas of the scalp. Magnetic resonance imaging revealed a lesion with an irregular surface and an approximate size of 3.55 cm × 6.34 cm in the left frontal region, with clear boundaries and visible separation. Adjacent areas of the skull were damaged and the dura mater was involved. Contrast enhancement showed an uneven enhancement pattern. Surgery was performed and postoperative adjuvant radiotherapy was administered to avoid recurrence or metastasis. The post-operative pathologic diagnosis confirmed an MFS. A repeat computed tomography scan showed no local recurrence or distant metastasis 19 mo post-operatively.
CONCLUSION The case reported herein of MFS was demonstrated in an extremely rare location on the scalp and had atypical magnetic resonance imaging findings, which serves as a reminder to radiologists of the possibility of this diagnosis to assist in clinical treatment. Given the special anatomic location and the high malignant potential of this rare tumor, combined surgical and adjuvant radiotherapy should be considered to avoid local recurrence and distant metastasis. The significance of regular follow-up is strongly recommended to improve the long-term survival rate.
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Affiliation(s)
- Xiao-Ting Ke
- Department of CT/MRI, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian Province, China
| | - Xiong-Feng Yu
- Department of CT/MRI, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian Province, China
| | - Ji-Yang Liu
- Department of CT/MRI, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian Province, China
| | - Fang Huang
- Department of CT/MRI, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian Province, China
| | - Mei-Gui Chen
- Department of CT/MRI, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian Province, China
| | - Qing-Quan Lai
- Department of CT/MRI, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian Province, China
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Shao Z, Jiao B, Yu J, Liu H. Primary low grade myxofibrosarcoma of the liver with benign presentation but malignant outcome: a case report. BMC Cancer 2019; 19:1098. [PMID: 31718576 PMCID: PMC6852919 DOI: 10.1186/s12885-019-6282-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 10/23/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Myxofibrosarcoma (MFS) is most often found on the limbs of aged male people, but extremely uncommon in the liver. CASE PRESENTATION A 52-year-old female patient with a liver mass was diagnosed as a primary MFS. It had no obvious abdominal symptoms, and the tumor was resected with an extended margin. Three years after the surgery, the patient was readmitted for peritoneal metastasis and passed away 4 months later. The tumor has a benign presentation, but malignant outcome. CONCLUSIONS Comprehensive radiological inspection, intensive preoperative evaluation, careful design of operating procedures, wide margin resection, consecutive treatment, and strict periodical follow-ups should be taken to ensure a better prognosis of this kind of neoplastic disease.
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Affiliation(s)
- Zigong Shao
- Department of General Surgery, Department of Organ Transplantation, First Affiliated Hospital, China Medical University, Shenyang, 110001, China
| | - Baoping Jiao
- Department of General Surgery, Shanxi Cancer Hospital, Taiyuan, 130013, China
| | - Juanhan Yu
- Department of Pathology, First Affiliated Hospital, China Medical University, Shenyang, 110001, China
| | - Hao Liu
- Department of General Surgery, Department of Organ Transplantation, First Affiliated Hospital, China Medical University, Shenyang, 110001, China.
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Wong A, Chan Woo Park R, Mirani NM, Eloy JA. Myxofibrosarcoma of the maxillary sinus. ALLERGY & RHINOLOGY 2017; 8:95-99. [PMID: 28583233 PMCID: PMC5468762 DOI: 10.2500/ar.2017.8.0200] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background: Myxofibrosarcoma (MFS) is a common sarcoma in the extremities of older individuals but is extremely uncommon in the head and neck region. Diagnosis may be challenging but is critical to the management of the patient. We discuss the radiographic and histopathologic characteristics of this destructive tumor. The distinguishing features of MFS and its differential diagnosis are reviewed to familiarize the managing otolaryngologist with this rare entity. Methods: A 61-year-old woman presents with a 6-week history of severe left facial pain and left eye pain. Imaging demonstrates significant right and left-sided maxillary sinus opacification with destruction of the left maxillary sinus as well as the left medial and inferior orbital walls. Results: Histopathologic examination revealed spindle and stellate tumor cells of variable cellularity in myxoid stroma with cellular pleomorphism consistent with MFS of intermediate-to high grade. The patient underwent resection of the left-sided lesion with orbital exenteration and repair of the defect with microvascular free flap followed by postoperative radiotherapy. Conclusion: MFS must be differentiated from other lesions with myxoid qualities. Histopathologic examination is required for definitive diagnosis. Management includes complete tumor excision with adequate tumor margins. Adjuvant postoperative radiotherapy should be considered for larger tumors with positive resection margins or lesions of intermediate-to-high grade.
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Affiliation(s)
- Anni Wong
- From the Department of Otolaryngology—Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Richard Chan Woo Park
- From the Department of Otolaryngology—Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Neena M. Mirani
- From the Department of Otolaryngology—Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
- Department of Pathology, Rutgers New Jersey Medical School, Newark, New Jersey
- Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Jean Anderson Eloy
- From the Department of Otolaryngology—Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
- Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey
- Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, and
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
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Qiubei Z, Cheng L, Yaping X, Shunzhang L, Jingping F. Myxofibrosarcoma of the sinus piriformis: case report and literature review. World J Surg Oncol 2012; 10:245. [PMID: 23152982 PMCID: PMC3534627 DOI: 10.1186/1477-7819-10-245] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Accepted: 09/21/2012] [Indexed: 01/07/2023] Open
Abstract
Myxofibrosarcoma is a common sarcoma in the extremities of older people, but is rare in the head and neck region. Here, we report the case of a 42-year-old male patient in whom myxofibrosarcoma generated from the sinus piriformis. Histopathologically, the tumor was characterized by spindle cellular proliferation with moderate cellular density in fibromyxoid stroma. Immunohistochemically, the tumor cells showed positive reactivity for vimentin, Ki-67, smooth muscle actin, and CD34, but negative staining for S-100. Based on these results, the tumor was diagnosed as a low-grade myxofibrosarcoma. Resection of the tumor was performed via a transcervical approach. The patient’s postoperative clinical course was uneventful and no local recurrence or distant metastasis has been found so far. The pathology, clinical characteristics, and treatment of myxofibrosarcoma are also reviewed.
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Affiliation(s)
- Zhu Qiubei
- Department of ear, nose and throat, Changzheng Hospital, No 415, Fengyang Road, Shanghai, Huangpu District, 200003, China
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Nakahara S, Uemura H, Kurita T, Suzuki M, Fujii T, Tomita Y, Yoshino K. A case of myxofibrosarcoma of the maxilla with difficulty in preoperative diagnosis. Int J Clin Oncol 2011; 17:390-4. [PMID: 21830085 DOI: 10.1007/s10147-011-0302-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Accepted: 07/22/2011] [Indexed: 02/08/2023]
Abstract
Myxofibrosarcoma (MFS) is a very rare fibroblast-derived sarcoma that occurs in the head and neck region. Here, we report the case of a 52-year-old man in whom MFS generated from the maxilla and whose beginning of treatment was considerably delayed because he was initially diagnosed as having a benign inflammatory lesion. Because a definite diagnosis was not obtained via 2 independent biopsies, total maxillectomy was used for both diagnosis and treatment. Histopathological and immunohistochemical analyses suggested that the tumor was a low-grade MFS. Because soft tissue tumors in the head and neck region are rare and a definite diagnosis is relatively difficult, surgical excision is indispensable if malignancy of the tumor is suspected.
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Affiliation(s)
- Susumu Nakahara
- Department of Otolaryngology, Head and Neck Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, 3-3, Nakamichi 1-chome, Higashinari-ku, Osaka, 537-8511, Japan.
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Park JH, Choi SY, Kwon TG, Kim CS. Low-grade myxofibrosarcoma in the mandible: a case report. J Korean Assoc Oral Maxillofac Surg 2011. [DOI: 10.5125/jkaoms.2011.37.1.67] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Ji-Hoon Park
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University, Daegu, Korea
| | - So-Young Choi
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University, Daegu, Korea
| | - Tae-Geon Kwon
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University, Daegu, Korea
| | - Chin-Soo Kim
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University, Daegu, Korea
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