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Dahl V, Lee Y, Rate W, Guertin MP, Pretell-Mazzini J. Epidemiology and survival factors of appendicular myxofibrosarcoma: a SEER-retrospective study. Rep Pract Oncol Radiother 2024; 28:711-719. [PMID: 38515824 PMCID: PMC10954266 DOI: 10.5603/rpor.97733] [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: 05/17/2023] [Accepted: 10/02/2023] [Indexed: 03/23/2024] Open
Abstract
Background The low incidence of myxofibrosarcoma (MFS) makes high power studies difficult to perform. Demographic and prognostic factors for MFS and how they differ from all extremity soft tissue sarcomas (STS) are not well understood. The purpose of this study was to characterize a large cohort of patients with MFS and evaluate epidemiologic and survival factors when compared to all STS. Materials and methods We performed a retrospective review of the Surveillance, Epidemiology, and End Results (SEER) database from 2000 to 2015 to identify 1,440 patients diagnosed with MFS and 12,324 with STS. Survival curves were creased using Kaplan-Meier, and Cox regression analyses were performed to identify hazard ratios (HRs). Results Overall survival was greater for STS than MFS (79% vs. 67%). Patients with MFS had a higher average age at diagnosis than STS (62 vs. 56), and older age was strongly associated with decreased survivorship for MFS (HR = 7.94). A greater proportion of patients under 30 diagnosed with MFS were female when compared to STS (49.6% vs. 45.4%). The incidence of MFS and STS increased over the 15-year period, with MFS increasing at a greater rate than STS (1.25% vs. 2.59%). Survival increased for patients diagnosed after 2008 for both STS (9.4%) and MFS (13.2%). Conclusions There are differences between patient demographics and survival factors when comparing MFS to all STS. Monitoring changes in demographic and survival trends for rare STS subtypes like MFS is important to improve diagnostic algorithms and treatment options.
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Affiliation(s)
- Victoria Dahl
- Miller School of Medicine, University of Miami, Miami, United States
| | - Yonghoon Lee
- Miller School of Medicine, University of Miami, Miami, United States
| | - William Rate
- Department of Orthopedic Surgery, Jackson Memorial Hospital, University of Miami, Miami, United States
| | | | - Juan Pretell-Mazzini
- Department of Orthopedic Oncology, Baptist Health South Florida, Miami, United States
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Kumari J, Das K, Patil A, Babaei M, Cockerell CJ, Goldust M. Clinical update on cutaneous and subcutaneous sarcomas. J Cosmet Dermatol 2023; 22:402-409. [PMID: 36074118 DOI: 10.1111/jocd.15369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 08/31/2022] [Accepted: 09/06/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cutaneous sarcomas are uncommon cancers that can have a wide range of clinical symptoms and lead to considerable cutaneous as well as systemic morbidity. AIM The objective of this review article is to discuss epidemiology, clinical features, diagnosis, and therapy of different types of cutaneous sarcomas. MATERIAL AND METHODS Literature was screened to retrieve articles from PubMed/Medline and Google Scholar and related websites. Cross-references from the relevant articles were also considered for review. Review articles, clinical studies, systematic reviews, meta-analyses, and relevant information from selected websites were included. RESULTS AND DISCUSSION Cutaneous sarcomas have a negative effect on the quality of life. In their diagnosis, clinical presentation and histological evaluation are crucial. Complete surgical removal is the solution for more or less all cutaneous and subcutaneous sarcomas. The prognosis for cutaneous sarcomas is generally favorable since they tend to recur locally with distant metastases only on rare occasions. Patients having advanced disease should be treated in the setting of clinical trials if possible; choices include radiation therapy and systemic medicines. The value of innovative immunotherapy cannot be determined decisively at this time due to a paucity of relevant trials. CONCLUSION As cutaneous sarcomas are rarely diagnosed based on clinical findings, histology plays an important role in the diagnosis. They have a relatively favorable prognosis if treated properly. Patients should be treated at specialized centres.
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Affiliation(s)
- Jyoti Kumari
- Silchar Medical College and Hospital, Silchar, Assam, India
| | - Kinnor Das
- Department of Dermatology Venereology and Leprosy, Silchar Medical College, Silchar, Assam, India
| | - Anant Patil
- Department of Pharmacology, Dr. DY Patil Medical College, Navi Mumbai, India
| | - Mahsa Babaei
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Clay J Cockerell
- Departments of Dermatology and Pathology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Cockerell Dermatopathology, Dallas, Texas, USA
| | - Mohamad Goldust
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
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Malignant fibrous histiocytoma of the floor of mouth: a case report and review of the literature. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 123:e106-e111. [PMID: 34224923 DOI: 10.1016/j.jormas.2021.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/23/2021] [Accepted: 06/29/2021] [Indexed: 11/22/2022]
Abstract
Malignant fibrous histiocytoma (MFH) is the most common soft tissue sarcoma in late adulthood and usually occurs in the limbs, trunk, and peritoneum. Less than 10% of MFH cases occur in the head and neck region. The clinical manifestations and pathological features of MFH are atypical, and it is difficult to make a clinical diagnosis. We describe a rare case of MFH of the floor of mouth and provide our diagnosis and treatment experiences. Through this review, we also evaluate the origin, World Health Organization (WHO) classification, clinical presentations, pathological features, treatment methods, and prognosis of MFH. MFH may originate from fibroblasts or primitive mesenchymal cells. MFH was defined as undifferentiated pleomorphic sarcoma in the 2002 WHO classification of bone and soft tissue tumors. The most common manifestation of MFH is a painless enlarging nodule, often without overlying epidermal ulcers. Jaw lesions are usually found after displays of swelling, pain, paresthesia, and loose teeth. MFH is composed of pleomorphic spindle cells, usually with hemorrhage, necrosis, and lymphocyte infiltration. The main treatment method is surgical resection. Moreover, radiotherapy and chemotherapy have certain auxiliary effects. The local recurrence and distant metastasis of MFH are common, and the prognosis is poor. Therefore, determining the histopathological features of MFH and conducting appropriate immunohistochemical examinations are crucial in establishing the correct diagnosis. In-depth study is required in order to have a better understanding of head and neck MFH.
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Soleymani T, Aasi SZ, Novoa R, Hollmig ST. Atypical Fibroxanthoma and Pleomorphic Dermal Sarcoma. Dermatol Clin 2019; 37:253-259. [DOI: 10.1016/j.det.2019.02.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Winchester D, Lehman J, Tello T, Chimato N, Hocker T, Kim S, Chang J, Markey J, Yom SS, Ryan W, Mully T, Hodge D, Otley C, Arron ST. Undifferentiated pleomorphic sarcoma: Factors predictive of adverse outcomes. J Am Acad Dermatol 2018; 79:853-859. [DOI: 10.1016/j.jaad.2018.05.022] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 03/20/2018] [Accepted: 05/15/2018] [Indexed: 11/24/2022]
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Conception and Management of a Poorly Understood Spectrum of Dermatologic Neoplasms: Atypical Fibroxanthoma, Pleomorphic Dermal Sarcoma, and Undifferentiated Pleomorphic Sarcoma. Curr Treat Options Oncol 2018; 18:50. [PMID: 28762020 DOI: 10.1007/s11864-017-0489-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OPINION STATEMENT Atypical fibroxanthoma (AFX) and pleomorphic dermal sarcoma (PDS) tumors share many clinical, etiologic, and histologic features and likely represent components of a tumor spectrum. In dermatologic oncology, differentiating between AFX and PDS is pivotal as tumors with histological features consistent with PDS are more likely to behave in a clinically aggressive manner. Importantly, the term "pleomorphic dermal sarcoma" (PDS) is a more appropriate designation than "undifferentiated pleomorphic sarcoma" (UPS) for describing deeper, more aggressive, histologically high-grade cutaneous tumors that otherwise resemble AFX. Surgery remains the gold standard for treatment. In the setting of AFX, excision with the Mohs micrographic technique appears to offer superior tumor control rates while maintaining greater tissue preservation over wide local excision and should be considered first line. In the setting of PDS, optimal management is less clear given the paucity of available data. However, due to its greater propensity to recur and metastasize, extirpation with complete tumor margin control appears paramount. The roles of imaging and SLNB in management and clinical outcomes of AFX and PDS are unclear given the lack of available data. In reality, these tools are unlikely to be helpful in most cases of AFX. However, in the setting of PDS, emerging literature indicates that these tumors are inherently higher risk, and thus, imaging and SLNB may be helpful in select cases. Additionally, radiation therapy may be of adjuvant benefit for these tumors when clear surgical margins cannot be obtained. While traditional chemotherapy has been largely ineffectual, the recent discovery of key oncogenetic mutations has allowed for the identification of several potential molecular drug targets that may have a therapeutic role with future study. In the unfortunate setting of metastatic disease, a multidisciplinary approach is optimal. Further studies are needed to establish definitive conclusions regarding risk stratification and best management practices.
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Prewett S, Horan G, Hatcher H, Ajithkumar T. Borderline Sarcomas and Smooth Muscle Tumours of Uncertain Malignant Potential. Clin Oncol (R Coll Radiol) 2017; 29:528-537. [PMID: 28595873 DOI: 10.1016/j.clon.2017.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 05/11/2017] [Accepted: 05/11/2017] [Indexed: 12/22/2022]
Abstract
Borderline sarcomas and smooth muscle tumours of uncertain malignant potential (STUMP) have an unpredictable clinical behaviour with frequent local recurrences and rarely, metastases. We review the current management of common subtypes of borderline sarcomas and STUMP.
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Affiliation(s)
- S Prewett
- Cambridge University Hospital, Cambridge, UK
| | - G Horan
- Cambridge University Hospital, Cambridge, UK
| | - H Hatcher
- Cambridge University Hospital, Cambridge, UK
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Rat malignant fibrous histiocytoma (MFH)-derived cloned cell lines (MT-8 and MT-9) show different differentiation in mesenchymal stem cell lineage. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.etp.2015.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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9
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Green B, Godden D, Brennan PA. Malignant cutaneous adnexal tumours of the head and neck: an update on management. Br J Oral Maxillofac Surg 2015; 53:485-90. [PMID: 25911053 DOI: 10.1016/j.bjoms.2015.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 03/12/2015] [Indexed: 10/23/2022]
Abstract
Adnexal tumours form a heterogeneous group of relatively rare neoplasms. Many of them have a poor prognosis and treatment can sometimes be difficult and controversial. We summarise the latest publications relating to malignant cutaneous adnexal tumours of the head and neck, and give an update on their management. We discuss Merkel cell carcinoma and other rare malignant adnexal tumours including dermatofibrosarcoma protuberans and atypical fibroxanthoma.
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Affiliation(s)
- B Green
- Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK.
| | - D Godden
- Department of Oral & Maxillofacial Surgery, Gloucestershire Royal Hospital, UK.
| | - P A Brennan
- Department of Oral & Maxillofacial Surgery, Queen Alexandra Hospital, Portsmouth, UK.
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Tong L, Wang Y, Zhou Y, Zheng X, Liu H, Sun J, Li X, Yan X. Surgical management of giant secondary malignant fibrous histiocytoma following radiotherapy for nasopharyngeal carcinoma: A case report and literature review. Oncol Lett 2014; 8:72-76. [PMID: 24959221 PMCID: PMC4063623 DOI: 10.3892/ol.2014.2069] [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: 09/19/2013] [Accepted: 03/27/2014] [Indexed: 12/02/2022] Open
Abstract
Malignant fibrous histiocytoma (MFH) is rare in the chest wall, particularly in patients who have undergone radiotherapy for primary nasopharyngeal cancer. In the present study, a case of MFH of the upper chest wall that appeared four years after initial radiotherapy for squamous cell carcinoma of the nasopharynx is reported. Furthermore, two-step surgical management was successfully performed consisting of i) tumor-reductive excision and ii) limb salvage surgery, including wide resection of the tumor mass, defect reconstruction of the chest wall using left latissimus dorsi myocutaneous flap and dermatoplasty of the flap-supplied region. The progress of the clinical characteristics, the reasons for radiation-induced carcinogenesis, the treatment options and the prognostic factors of MFH are also reviewed. Finally, the importance of prevention and follow-up of this malignancy are highlighted and specific advice is offered.
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Affiliation(s)
- Liping Tong
- Department of Thoracic Surgery, Tangdu Hospital of the Fourth Military Medical University, Xi'an, Shaanxi 710038, P.R. China
| | - Yong Wang
- Department of General Surgery, Weinan Center Hospital, Weinan, Shaanxi 714000, P.R. China
| | - Yongan Zhou
- Department of Thoracic Surgery, Tangdu Hospital of the Fourth Military Medical University, Xi'an, Shaanxi 710038, P.R. China
| | - Xiaoqing Zheng
- Department of Thoracic Surgery, Tangdu Hospital of the Fourth Military Medical University, Xi'an, Shaanxi 710038, P.R. China
| | - Honggang Liu
- Department of Thoracic Surgery, Tangdu Hospital of the Fourth Military Medical University, Xi'an, Shaanxi 710038, P.R. China
| | - Jianyong Sun
- Department of Thoracic Surgery, Tangdu Hospital of the Fourth Military Medical University, Xi'an, Shaanxi 710038, P.R. China
| | - Xiaofei Li
- Department of Thoracic Surgery, Tangdu Hospital of the Fourth Military Medical University, Xi'an, Shaanxi 710038, P.R. China
| | - Xiaolong Yan
- Department of Thoracic Surgery, Tangdu Hospital of the Fourth Military Medical University, Xi'an, Shaanxi 710038, P.R. China
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A primary malignant fibrous histiocytoma of the scalp and intracranial tumor bleeding: a case report. J Med Case Rep 2014; 8:50. [PMID: 24524377 PMCID: PMC3996084 DOI: 10.1186/1752-1947-8-50] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 01/10/2014] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION A malignant fibrous histiocytoma occurring on the scalp near a primary operation site is extremely rare. CASE PRESENTATION A 74-year-old Chinese man presented with a one-month history of recurrent headaches, vomiting and left limb atony. He had undergone a successful clipping operation through the pterional approach for an anterior communicating aneurysm five years previously. One month before presentation, he developed a headache without apparent cause that was especially severe in the right frontal region. He also had a small tumor on the right side of his forehead at the original incision site. The tumor had gradually increased from soybean size to egg size in one month; this growth was accompanied by nausea, projectile vomiting of gastric contents and left limb atony. The subcutaneous tumor was totally resected along with some affected cranial tissues. Our patient's postoperative recovery was good, and he was safely discharged 20 days after the surgery. He was free of recurrence over two years of follow-up. CONCLUSIONS Dissection of the temporal muscles and deep fascia using electric resection and electrocoagulation through the pterional approach may cause tissue degeneration, which may in turn lead to cancer development. In our patient's case, the reason for the development of the tumor five years after his surgical aneurysm repair was unclear; it may have represented a primary malignant fibrous histiocytoma of the scalp that had no relationship to the operation. We followed up our patient for two years and he had no tumor recurrence. Because malignant fibrous histiocytoma of the scalp has a high degree of malignancy and readily recurs in situ, early diagnosis and radical surgical resection are key to a successful outcome.
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Reconsidering the diagnostic and prognostic utility of LN-2 for undifferentiated pleomorphic sarcoma and atypical fibroxanthoma. Am J Dermatopathol 2013; 35:176-9. [PMID: 23000905 DOI: 10.1097/dad.0b013e318265fb9e] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The topic of distinguishing atypical fibroxanthoma (AFX) from undifferentiated pleomorphic sarcoma (UPS), formerly malignant fibrous histiocytoma, is highly controversial. Although their clinical behavior is disparate, AFX and UPS commonly appear nearly identical on routine histopathologic examination. Although conceptually useful, subcategorization of UPS into superficial (confined to the dermis and subcutaneous tissue) and deep (involvement of fascia and deeper structures) types has not improved our ability to differentiate UPS from AFX. Numerous authors have purported LN-2 (CD74) immunopositivity as able to distinguish UPS from AFX and to predict those rare AFX likely to behave aggressively, although only a single prior study has been dedicated to evaluating this marker. We performed LN-2 staining of 14 AFX, 8 superficial UPS, and 65 deep UPS specimens using an identical protocol as described by prior authors. Of the 73 total UPS specimens, only 1 (1.4%) stained strongly with LN-2, as compared with 3 of 14 (21%) AFX (P = 0.012). One of 2 (50%) clinically aggressive AFX tumors that later exhibited both local recurrence and metastasis stained strongly for LN-2, whereas 2 of 12 (17%) of the more indolent tumors stained strongly with this marker (P = 0.40). Our data do not replicate prior reports of LN-2 as a sensitive and specific marker for UPS, or as indicative of prognosis for AFX, and therefore does not support the use of LN-2 as either a diagnostic or prognostic marker.
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Castronovo C, Arrese JE, Quatresooz P, Nikkels AF. Myxofibrosarcoma: a diagnostic pitfall. Rare Tumors 2013; 5:60-1. [PMID: 23888215 PMCID: PMC3719110 DOI: 10.4081/rt.2013.e15] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 11/03/2012] [Indexed: 11/22/2022] Open
Abstract
Abstract Myxofibrosarcoma (MFS) is a variant of the group of malignant fibrous histiocytomas. It is one of the most aggressive types of soft tissue neoplasms. The clinical presentation is not pathognomonic and the histological aspects are highly heterogenous, frequently delaying the diagnosis or leading to misdiagnosis. Complementary histochemical and immunohistochemical stainings are mandatory to achieve the diagnosis of MFS. A 78-year-old male patient is presented illustrating this diagnostic pitfall. Extensive surgery followed by radiotherapy is the first choice treatment.
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Lee S, Joo KB, Park CK, Kim TS, Bae J. A case of atypical fibroxanthoma of subungual type: ultrasound and magnetic resonance imaging findings. Clin Imaging 2012. [PMID: 23206624 DOI: 10.1016/j.clinimag.2012.01.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Subungual atypical fibroxanthoma is a rare mesenchymal skin tumor of intermediate malignancy. It classically presents as a relatively nondescript, erythematous nodule; it may ulcerate and bleed, but pain and pruritus are uncommon. In the differential diagnoses of subungual tumors, glomus tumor, soft tissue chondroma, keratoacanthoma, hemangioma, lobular capillary hemangioma, epidermal and mucoid cysts, squamous cell carcinoma, and malignant melanoma have been suggested. But atypical fibroxanthoma has not been included in the differential diagnoses. We report a case that occurred in a 56-year-old man with subungual atypical fibroxanthoma mimicking malignant soft tissue tumor in the right fifth toe.
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Affiliation(s)
- Seunghun Lee
- Department of Radiology, Hanyang University Hospital, Seoul 133-792, Korea
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16
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Malignant fibrous histiocytoma: Changing perceptions and management challenges. J Am Acad Dermatol 2012; 67:1335-41. [DOI: 10.1016/j.jaad.2012.04.013] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Revised: 04/04/2012] [Accepted: 04/08/2012] [Indexed: 11/17/2022]
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17
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Reinstadler DR, Sinha UK. Uncommon cutaneous neoplasms of the head and neck. Facial Plast Surg Clin North Am 2012; 20:483-91. [PMID: 23084300 DOI: 10.1016/j.fsc.2012.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
This article concentrates on the less-common cutaneous malignancies such as merkel cell, atypical fibroxanthoma, malignant fibrous histiocytoma, dermatofibrosarcoma protuberans, microcystic adnexal carcinoma, and sebaceous carcinoma. The clinical and histopathologic descriptions of each, most current and emerging etiologies, diagnosis, staging, treatment, and prognosis are discussed.
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Affiliation(s)
- David R Reinstadler
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, CA 90033, USA
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Karki B, Xu YK, Wu YK, Zhang WW. Primary malignant fibrous histiocytoma of the abdominal cavity: CT findings and pathological correlation. World J Radiol 2012; 4:151-8. [PMID: 22590669 PMCID: PMC3351683 DOI: 10.4329/wjr.v4.i4.151] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2011] [Revised: 02/27/2012] [Accepted: 03/05/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To study computed tomography (CT) features of abdominal malignant fibrous histiocytoma (MFH) in various rare locations.
METHODS: We retroprospectively identified cases of MFH involving the abdominal cavity. Particular attention was paid to details regarding imaging features and histological types.
RESULTS: The study population consisted of seven men and one woman, with a mean age of 52.5 years. Seven patients had some physical symptoms, while one was incidentally detected. The sites of origin were liver (n = 3), greater omentum (n = 1), superior mesentery (n = 1), ileum (n = 1), right psoas muscle (n = 1) and right kidney (n = 1). With the exception of the ileum lesion, all were of huge size. The contour of the lesions was more or less clear. Foci of necrosis were present in six lesions (n = 6). On plain CT scan, all lesions were hypo to iso dense. The lesion in the greater omentum was cystic. One lesion (n = 1) showed significant enhancement and the cystic lesion showed mild peripheral enhancement. An abundance of blood vessels surrounding the mass was seen in two lesions (n = 2) and both were of the inflammatory variety. Pathological examination revealed storiform-pleomorphic variety (n = 4), inflammatory variety (n = 3) and myxoid variety (n = 1). Two of the patients with inflammatory MFH had a clinical presentation of fever and one was afebrile, however, blood investigations in all three showed leukocytosis.
CONCLUSION: Primary MFHs of the abdominal viscera and gastrointestinal tract are generally huge soft tissue masses containing areas of low attenuation and mild to moderate contrast enhancement.
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Withers AH, Brougham ND, Barber RM, Tan ST. Atypical fibroxanthoma and malignant fibrous histiocytoma. J Plast Reconstr Aesthet Surg 2011; 64:e273-8. [PMID: 21664889 DOI: 10.1016/j.bjps.2011.05.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2010] [Revised: 03/12/2011] [Accepted: 05/11/2011] [Indexed: 10/18/2022]
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Management of Unusual Cutaneous Malignancies: Atypical Fibroxanthoma, Malignant Fibrous Histiocytoma, Sebaceous Carcinoma, Extramammary Paget Disease. Dermatol Clin 2011; 29:201-16, viii. [DOI: 10.1016/j.det.2011.02.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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21
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Bucerius J, Buchholz B, Strunk H, Palmedo H, Biersack HJ. Avoidance of Invasive Diagnostic and Harmful Therapeutic Measures in a Patient With Malignant Fibrous Histiocytoma and Extensive Clinically Occult Metastases. J Natl Med Assoc 2009; 101:953-5. [DOI: 10.1016/s0027-9684(15)31044-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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22
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Veness MJ. The important role of radiotherapy in patients with non-melanoma skin cancer and other cutaneous entities. J Med Imaging Radiat Oncol 2008; 52:278-86. [PMID: 18477123 DOI: 10.1111/j.1440-1673.2008.01956.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Non-melanoma skin cancer is the commonest malignancy worldwide and a significant public health issue. Although most non-melanoma skin cancers are small and easily excised or ablated, a recommendation of definitive radiotherapy is often made in patients where the outcome (cosmetic and/or functional) will probably be better with radiotherapy compared to surgery. The aim of adjuvant radiotherapy is to reduce the risk of loco-regional recurrence and the role of palliative radiotherapy is important in improving the quality of life in patients with advanced and/or incurable disease. The aim of this review article is to broadly discuss the various clinical settings in which a recommendation of radiotherapy may be made and also includes a discussion on less frequently encountered cutaneous entities (e.g. in situ squamous cell carcinoma, keratocanthoma, lentigo maligna, cutaneous lymphomas and malignant fibrous tumours).
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Affiliation(s)
- M J Veness
- Department of Radiation Oncology, Westmead Cancer Care Centre, Westmead Hospital, Sydney, New South Wales, Australia.
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23
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Koch M, Dimmler A, Alexiou C. Rezidivierendes und metastasierendes atypisches Fibroxanthom. HNO 2007; 56:1046-51. [DOI: 10.1007/s00106-007-1636-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Dudelzak J, Sheehan DJ, Mullins SC, Peterson CM. Malignant perifollicular atypical fibroxanthoma treated with Mohs surgery. Dermatol Surg 2007; 33:364-8. [PMID: 17338699 DOI: 10.1111/j.1524-4725.2007.33075.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Jacob Dudelzak
- Division of Dermatology, Department of Medicine, Augusta, Georgia 30912, USA
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Yoshida N, Miyanari N, Yamamoto Y, Egami H. Successful treatment of malignant fibrous histiocytoma originating in the chest wall: report of a case. Surg Today 2007; 36:714-21. [PMID: 16865516 DOI: 10.1007/s00595-004-3229-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2004] [Accepted: 04/21/2004] [Indexed: 11/26/2022]
Abstract
Malignant fibrous histiocytoma (MFH) rarely originates in the chest wall, so its clinical features are not well defined. We report a case of MFH that recurred locally 3 years after primary resection. The patient, a 59-year-old woman, underwent wide excision, and is alive without recurrence 7 months after the operation. We reviewed the clinical features and treatment strategies of the total 39 cases of MFH originating in the chest wall reported from Japan. The fact that all patients who underwent wide excision with negative margins at the primary operation were alive without recurrence at the time of each report, despite a local recurrence rate as high as 40%, shows the importance of this operative strategy. Thus, early diagnosis of MFH of the chest wall is essential for improving the outcome of these patients. Neoadjuvant chemotherapy plus radiation therapy may be worthwhile for patients with advanced disease.
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Affiliation(s)
- Naoya Yoshida
- Department of Surgery II, Kumamoto University Medical School, 1-1-1 Honjyo, Kumamoto 860-8556, Japan
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26
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Malignant Perifollicular Atypical Fibroxanthoma Treated with Mohs Surgery. Dermatol Surg 2007. [DOI: 10.1097/00042728-200703000-00019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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27
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Huber GF, Matthews TW, Dort JC. Soft-tissue sarcomas of the head and neck: a retrospective analysis of the Alberta experience 1974 to 1999. Laryngoscope 2006; 116:780-5. [PMID: 16652087 DOI: 10.1097/01.mlg.0000206126.48315.85] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Soft-tissue sarcomas (STS) of the head and neck constitute a heterogeneous group of rare malignant tumors occurring in an uncommon site. The most common subtypes of STS in the head and neck are malignant fibrous histiocytoma, dermatofibrosarcoma protuberans, and fibrosarcoma. Evidence based subtype-specific treatment decisions are often not possible. METHODS The medical records of 110 patients diagnosed with head and neck sarcomas were reviewed. All were treated at one of the two major Cancer Centers in Alberta, Canada, between 1974 and 1999. Potential prognostic factors including age, sex, tumor size, histology, grade, tumor location (superficial or deep), and use of adjuvant treatment were evaluated. Cox proportional hazards models were developed to study the impact of these covariates on survival. RESULTS The median duration of follow-up was 61.5 months. Five year overall, disease specific, and relapse free survival were 65.8%, 83.4%, and 74.2%, respectively. With use of a Cox proportional-hazards model, tumor stage and grade were important prognostic factors affecting survival. CONCLUSIONS Tumor size and grade were important prognostic factors affecting survival. Tumor location in relation to the superficial fascia (depth) was the best predictor of outcome. The overall and disease-free survival in this patient group was excellent. However, this likely caused by the high proportion of patients with low-grade tumors in our study.
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Affiliation(s)
- Gerhard Frank Huber
- Department of Surgery (Otolaryngology-Head and Neck Surgery), University of Calgary, Calgary, Alberta, Canada
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28
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Abstract
The typical resolution of the smallpox vaccination site is a smooth scar, a sequela that is discussed during prevaccination counseling. In addition, other types of lesion may develop at the scar site, including short- or long-term benign and malignant changes, as reviewed below. Although current recommendations do not discuss potential scar complications or scar surveillance, healthcare providers would benefit from an awareness of these potential complications, and should consider periodic scar surveillance as part of a general physical examination.
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Affiliation(s)
- Kirk H Waibel
- Allergy-Immunology and Dermatology Services, Department of Medicine, Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia 30905-5650, USA.
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29
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Tran TA, Muller S, Chaudahri PJ, Carlson JA. Cutaneous carcinosarcoma: adnexal vs. epidermal types define high- and low-risk tumors. Results of a meta-analysis. J Cutan Pathol 2005; 32:2-11. [PMID: 15660649 DOI: 10.1111/j.0303-6987.2005.00260.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We report four cases of cutaneous carcinosarcoma (CS) and perform a meta-analysis of the cutaneous CS literature. RESULTS CS occurred in elderly patients (mean of 80 years) on sun-damaged skin, and were keratotic papules of short duration. They did not recur after excision. CS exhibited basal cell carcinoma mixed with atypical fibroxanthoma cell populations. Immunophenotyping revealed vimentin+/keratin- spindle cells and vimentin-/keratin+ epithelial cells. Three cases exhibited p53 protein expression of both carcinomatous and sarcomatous components. Literature review identified 38 cases of cutaneous CS that could be broadly classified into two distinct groups. Epidermal-derived (basal or squamous cell carcinoma epithelial component) CS arose on the sun-damaged skin of the head and neck of elderly males (mean age 72 years) and had a 70% 5-year disease-free survival. In contrast, adnexal CS (spiradenocarcinoma, porocarcinoma, proliferating tricholemmal cystic carcinoma, or matrical carcinoma) occurred in younger patients (mean age 58 years), showed recent growth in a long-standing nodule and had a 25% 5-year disease-free survival. Age less than 65 years, recent growth, long-standing skin tumor, and tumor size greater than 2 cm significantly correlated with poor outcome. CONCLUSIONS Cutaneous CS is an aggressive skin cancer with high risk for advanced disease. Significant risk factors exist whose identification will allow for better management of CS patients.
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MESH Headings
- Aged
- Aged, 80 and over
- Biomarkers, Tumor/metabolism
- Carcinoma, Basal Cell/classification
- Carcinoma, Basal Cell/metabolism
- Carcinoma, Basal Cell/pathology
- Carcinoma, Squamous Cell/classification
- Carcinoma, Squamous Cell/metabolism
- Carcinoma, Squamous Cell/pathology
- Carcinosarcoma/classification
- Carcinosarcoma/metabolism
- Carcinosarcoma/mortality
- Carcinosarcoma/pathology
- Diagnosis, Differential
- Epithelial Cells/metabolism
- Epithelial Cells/pathology
- Female
- Humans
- Male
- Neoplasms, Adnexal and Skin Appendage/classification
- Neoplasms, Adnexal and Skin Appendage/metabolism
- Neoplasms, Adnexal and Skin Appendage/mortality
- Neoplasms, Adnexal and Skin Appendage/pathology
- PubMed
- Skin Neoplasms/classification
- Skin Neoplasms/metabolism
- Skin Neoplasms/mortality
- Skin Neoplasms/pathology
- Survival Rate
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Affiliation(s)
- Tien Anh Tran
- Department of Pathology, Florida Orlando Hospital, Orlando, FL, USA
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30
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Kim HH, Chang SE, Choi JH, Moon KC, Koh JK. A giant malignant fibrous histiocytoma on the scalp. J Dermatol 2004; 31:500-2. [PMID: 15235194 DOI: 10.1111/j.1346-8138.2004.tb00542.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2003] [Accepted: 01/27/2004] [Indexed: 11/28/2022]
Abstract
Malignant fibrosis histiocytoma (MFH) is one of the most common soft tissue sarcomas of adult life. The most common sites of origin are the proximal extremities, particularly the thigh and buttock. The tumors are multilobular fleshy masses, often apparently circumscribed on gross examination. We report a case of a MFH of the head in a 57-year-old woman. Our case is clinically unusual in that the tumor rapidly grew up to 15 cm in a very short time.
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Affiliation(s)
- Hyoung-Hun Kim
- Department of Dermatology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
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31
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Ly H, Selva D, James CL, Huilgol SC. Superficial malignant fibrous histiocytoma presenting as recurrent atypical fibroxanthoma. Australas J Dermatol 2004; 45:106-9. [PMID: 15068457 DOI: 10.1111/j.1440-0960.2004.00056.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Atypical fibroxanthoma (AFX) and malignant fibrous histiocytoma (MFH) are neoplasms of probable fibrohistiocytic lineage. The precise relationship between AFX and MFH remains controversial. We present two cases in which a lesion was excised from the face of an elderly person and reported as AFX. Both cases recurred within 12 months and were reclassified as MFH. They were excised with slow Mohs' micrographic surgery, with adjuvant radiotherapy in one case. In the other, a further recurrence was treated with orbital exenteration and radiotherapy. We review the difficulties in differentiating between AFX and MFH and the implications for treatment.
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Affiliation(s)
- Hoang Ly
- Department of Dermatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
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32
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Affiliation(s)
- Suneel Chilukuri
- Department of Dermatology, Baylor College of Medicine, Houston, Texas, USA
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CHILUKURI SUNEEL, ALAM MURAD, H. GOLDBERG LEONARD. Two Atypical Fibroxanthomas of the Ear. Dermatol Surg 2003. [DOI: 10.1097/00042728-200304000-00017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Uncommon types of cutaneous cancers are mainly cited in the literature as case reports and their etiology, pathogenesis and prognosis have to be surmised because of their rarity. Within this group exist the rare and also the unusual, for instance a relatively common carcinoma arising in a strange circumstance. Initial management of such tumors involves taking a history and performing a thorough examination, allowing a diagnosis to be made. These tend to follow one of three patterns: the lesion is confidently recognized; the lesion is unknown but a likely diagnosis can be made and; the lesion is unknown. It is within the latter two groupings that the uncommon cutaneous cancers exist. A biopsy is then performed to confirm the diagnosis. For large lesions a punch or incisional biopsy is taken which must include a portion of normal skin at the lesion edge. If the lesion is small enough to allow direct closure, an excision biopsy is performed, with a minimum margin of 2mm. Shave biopsy can be employed to confirm a diagnosis, but care must be taken that the subsequent management of the lesion is not adversely affected. With the rare tumors diagnosis can be difficult and there may not be enough tissue in a biopsy for a definitive diagnosis. The whole lesion may therefore need to be excised to obtain a confident diagnosis with further surgical treatment planned as required. Once the diagnosis is established a decision on the method of treatment can be made. The limited literature would suggest that rare skin tumors are unresponsive to radiotherapy and chemotherapy, so the mainstay of treatment is surgery. When there are no established guidelines for the treatment of a particular rare tumor a pathologist can usually provide advice as to the probable nature of the lesion. This allows surgical treatment to be positioned into one of three main groups: lesions that behave like basal cell carcinomas (BCC); lesions that behave like squamous cell carcinomas (SCC) and; lesions that behave like soft tissue sarcomas (STS). It is helpful to have a management plan into which each variety of rare tumor can be fitted, giving guidance as to the best and most appropriate management. Grouping treatment into BCC, SCC or STS-like treatment has been useful. As more becomes known regarding these malignancies their subsequent management can be adjusted accordingly. Currently, it would appear wise to treat each under a broader subgroup.
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Affiliation(s)
- Adam Topping
- Department of Plastic and Reconstructive Surgery, Chelsea and Westminster Hospital, London, UK.
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35
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Abstract
This is the first case report of atypical fibroxanthoma in the otolaryngology literature. Atypical fibroxanthoma is a rare fibrohistiocytic tumor that occurs on actinically damaged skin. The typical presentation is a nodular lesion in sun-exposed areas of the head and neck in an elderly patient. Differentiating atypical fibroxanthoma from other soft tissue sarcomas, such as dermatofibrosarcoma protuberans and malignant fibrous histiocytoma, can be difficult. Treatment should be wide local excision with a 1-cm margin. In cosmetically important regions in which tissue preservation is important, Mohs' surgery should be considered.
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Affiliation(s)
- I Hakim
- Dept of Otolaryngology-Head and Neck Surgery, Hammond Clinic, Munster, IN 46321, USA
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Moodley M, Moodley J. Dermatofibrosarcoma protuberans of the vulva: a case report and review of the literature. Gynecol Oncol 2000; 78:74-5. [PMID: 10873415 DOI: 10.1006/gyno.2000.5821] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study is to describe the management of a patient with dermatofibrosarcoma protuberans (DFSP) of the vulva and to review the literature. METHODS A 39-year-old was referred by a district hospital for incomplete excision of a vulval mass. The lesion involved the left labium major and measured 8 x 12 cm. The lesion was reexcised with a 3-cm margin of normal skin. RESULTS The patient made an uneventful postoperative recovery. Histology confirmed a diagnosis of DFSP with clear margins. Immunohistochemistry was positive for CD34 glycoprotein. CONCLUSIONS DFSP of the vulva is a rare fibrous tumor of intermediate grade malignancy, with a tendency for local recurrence. However, it rarely metastasizes. Management should be multidisciplinary and Mohs' micrographic surgery is generally advocated to ensure precise margin control. Survival rates range from 91 to 100%, and local recurrence rates of 20 to 49% have been reported. Therefore close follow-up is recommended.
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Affiliation(s)
- M Moodley
- Department of Obstetrics and Gynaecology, University of Natal Medical School, Durban, South Africa.
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