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Spresser WJ, Neal TW, McLean AC, Schlieve T. A case report and diagnostic discussion of maxillofacial low-grade myofibroblastic sarcoma. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 138:e67-e72. [PMID: 38871621 DOI: 10.1016/j.oooo.2024.04.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 04/15/2024] [Accepted: 04/27/2024] [Indexed: 06/15/2024]
Affiliation(s)
- Wyatt J Spresser
- Department of Surgery, Division of Oral and Maxillofacial Surgery, UT Southwestern/Parkland Memorial Hospital, Dallas, TX.
| | - Timothy W Neal
- Department of Surgery, Division of Oral and Maxillofacial Surgery, UT Southwestern/Parkland Memorial Hospital, Dallas, TX
| | - Anne C McLean
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Thomas Schlieve
- Department of Surgery, Division of Oral and Maxillofacial Surgery, UT Southwestern/Parkland Memorial Hospital, Dallas, TX
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2
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Arcovito G, Crucitta S, Del Re M, Caporalini C, Palomba A, Nozzoli F, Franchi A. Recurrent USP6 rearrangement in a subset of atypical myofibroblastic tumours of the soft tissues: low-grade myofibroblastic sarcoma or atypical/malignant nodular fasciitis? Histopathology 2024; 85:244-253. [PMID: 38651320 DOI: 10.1111/his.15196] [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: 02/11/2024] [Revised: 03/24/2024] [Accepted: 04/06/2024] [Indexed: 04/25/2024]
Abstract
AIMS Low-grade myofibroblastic sarcoma (LGMS) is a rarely metastasizing myofibroblastic tumour mostly affecting extremities and the head and neck of adults. Histologically, it shows long infiltrative fascicles of spindle cells with moderate nuclear atypia. By immunohistochemistry, it stains positive for smooth muscle actin (SMA) and sometimes for desmin. To date, no recurrent genetic abnormalities have been described. Ubiquitin-specific peptidase 6 (USP6) gene rearrangement is typically found in some benign bone and soft-tissue tumours including nodular fasciitis (NF), among others. Nevertheless, rare cases of USP6-rearranged tumours resembling NF with atypical features have been reported. METHODS AND RESULTS One index case of LGMS of the deltoid in a 56-year-old man presented the THBS2::USP6 translocation by RNA sequencing (Archer FusionPlex Sarcoma v2 panel). Further screening of 11 cases of LGMS using fluorescent in situ hybridization (FISH) analysis with a USP6 break-apart probe identified two additional cases. These cases were investigated with RNA-sequencing, and a RRBP1::USP6 translocation was detected in one. The other case was not assessable because of low-quality RNA. Noteworthy, rearranged LGMSs presented distinctive features including variable multinodular/plexiform architecture, prominent vasculature with occasional wall thickening, scattered osteoclast-like multinucleated giant cells, and peripheral lymphoid aggregates. CONCLUSION Our findings support the notion that among soft-tissue neoplasms with fibroblastic/myofibroblastic phenotype, USP6 rearrangement is not limited to benign tumours, and warrants further investigation of genetic changes in myofibroblastic sarcomas.
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Affiliation(s)
- Giorgia Arcovito
- Section of Pathology, Department of Translational Research, University of Pisa, Pisa, Italy
| | - Stefania Crucitta
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marzia Del Re
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Annarita Palomba
- Unit of Histopathology and Molecular Diagnostic, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Filippo Nozzoli
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Alessandro Franchi
- Section of Pathology, Department of Translational Research, University of Pisa, Pisa, Italy
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3
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Mydlak A, Ścibik Ł, Durzynska M, Zwoliński J, Buchajska K, Lenartowicz O, Kucharz J. Low-grade myofibrosarcoma of the maxillary sinus: Two case reports. World J Clin Oncol 2024; 15:566-575. [PMID: 38689628 PMCID: PMC11056867 DOI: 10.5306/wjco.v15.i4.566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/20/2024] [Accepted: 03/20/2024] [Indexed: 04/22/2024] Open
Abstract
BACKGROUND Low-grade myofibroblastic sarcoma (LGMS) is an extremely rare tumor characterized by the malignant proliferation of myofibroblasts. LGMS most commonly develops in adults, predominantly in males, in the head and neck region, oral cavity, especially on the tongue, mandible, and larynx. This article presents 2 cases of LGMS localized to the maxillary sinus and provides an overview of the available literature. CASE SUMMARY Two patients with LGMS located in the maxillary sinus underwent surgery at the Department of Head and Neck Surgery. Case 1: A 46-year-old patient was admitted to the clinic with suspected LGMS recurrence in the right maxillary sinus (rT4aN0M0), with symptoms of pain in the suborbital area, watering of the right eye, thick discharge from the right nostril, and augmented facial asymmetry. After open biopsy-confirmed LGMS, the patient underwent expanded maxillectomy of the right side with immediate palate reconstruction using a microvascular skin flap harvested surgically from the middle arm. The patient qualified for adjuvant radiotherapy for the postoperative bed, with an additional margin. Currently, the patient is under 1.5 years of observation with no evidence of disease. Case 2: A 45-year-old man was admitted to our clinic with facial asymmetry, strabismus, exophthalmos, and visual impairment in the right eye. Six months earlier, the patient had undergone partial jaw resection at another hospital for fibromatosis. A contrast-enhanced computed tomography scan revealed a tumor mass in the postoperative log after an earlier procedure. An open biopsy confirmed low-grade fibrosarcoma (rT4aN0M0). The patient qualified for an extended total right maxillectomy with orbital excision and right hemimandibulectomy with immediate microvascular reconstruction using an anterolateral thigh flap. The patient subsequently underwent adjuvant radiotherapy to the postoperative area. After 9 months, recurrence occurred in the right mandibular arch below the irradiated area. The lesion infiltrated the base of the skull, which warranted the withdrawal of radiotherapy and salvage surgery. The patient qualified for palliative chemotherapy with a regimen of doxorubicin + dacarbazine + cyclophosphamide and palliative radiotherapy for bone metastases. The patient died 26 months after surgical treatment. The cases have been assessed and compared with cases in the literature. CONCLUSION No specific diagnostic criteria or treatment strategies have been developed for LGMS. The treatment used for LGMS is the same as that used for sinonasal cancer radical tumor excision; adjuvant radiotherapy or chemoradiotherapy should also be considered. They have low malignant potential but are highly invasive, tend to recur, and metastasize to distant sites. Patients should undergo regular follow-up examinations to detect recurrence or metastasis at an early stage. Patients should be treated and observed at the highest referral centers.
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Affiliation(s)
- Anna Mydlak
- Department of Head and Neck Cancer, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw 02-781, Poland
| | - Łukasz Ścibik
- Department of Otolaryngology and Head and Neck Oncological Surgery, The 5th Military Clinical Hospital with Polyclinic, Krakow 30-901, Poland
| | - Monika Durzynska
- Department of Pathology, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw 02-781, Poland
| | - Jakub Zwoliński
- Department of Head and Neck Cancer, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw 02-781, Poland
| | - Karolina Buchajska
- Department of Head and Neck Cancer, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw 02-781, Poland
| | - Olga Lenartowicz
- Department of Head and Neck Cancer, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw 02-781, Poland
| | - Jakub Kucharz
- Department of Genitourinary Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw 02-781, Poland
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Jot K, Nayyar V, Surya V, Mishra D, Sowmya SV, Augustine D, Indu M, Haragannavar VC. A multicentric case study of fibroblastic and myofibroblastic oral spindle cell lesions. J Oral Maxillofac Pathol 2023; 27:629-641. [PMID: 38304501 PMCID: PMC10829460 DOI: 10.4103/jomfp.jomfp_282_23] [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: 06/26/2023] [Revised: 11/18/2023] [Accepted: 11/20/2023] [Indexed: 02/03/2024] Open
Abstract
Context Spindle cell lesions comprise a vast plethora of benign and malignant lesions with similar clinical and radiographic features. Their overlapping histopathologic features ensure a diagnostic dilemma. Aim The current multicentric study aims to delineate fibroblastic and myofibroblastic oral spindle cell lesions based on cytomorphology and comprehensive immunohistochemical analysis. Settings and Design The experimental study was conducted at MS Ramaiah University of Applied Sciences, Bangalore, and All India Institute of Applied Sciences, Delhi. Methods and Material A comprehensive histological scoring criteria and panel of immunohistochemical makers (STAT6, CD31, CD34, S100, SMA, vimentin, pan-CK, HHF-35, Ki67, ALK, desmin, HMB-45, SATB2, ERG, EMA and CD99) were employed concurrently for the first time for fibroblastic and myofibroblastic oral spindle cell lesions. The data obtained was tabulated and studied. Statistical Analysis Used NA. Results: Using cytological scoring criteria and panel of immunohistochemical makers, the cases analysed and characterized were desmoplastic fibroma, fibrosarcoma, leiomyosarcoma, nodular fasciitis, neurofibroma and epithelioid inflammatory myofibroblastic sarcoma (EIMS). Conclusions The diagnostic strategies need to be upgraded for the diagnosis of spindle cell lesions. Emphasis must be placed on cytomorphology, an immunohistochemistry (IHC) panel of markers is imperative for the accurate diagnosis of fibroblastic and myofibroblastic oral spindle cell lesions.
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Affiliation(s)
- Kiran Jot
- Department of Oral Pathology and Microbiology, Fifth Floor, Centre for Dental Education and Research, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Vivek Nayyar
- Department of Oral Pathology and Microbiology, Fifth Floor, Centre for Dental Education and Research, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Varun Surya
- Department of Oral Pathology and Microbiology, Fifth Floor, Centre for Dental Education and Research, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Deepika Mishra
- Department of Oral Pathology and Microbiology, Fifth Floor, Centre for Dental Education and Research, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - SV Sowmya
- Department of Oral Pathology and Microbiology, Faculty of Dental Sciences, Ramaiah University of Applied Sciences, MSR Nagar, Bengaluru, Karnataka, India
| | - Dominic Augustine
- Department of Oral Pathology and Microbiology, Faculty of Dental Sciences, Ramaiah University of Applied Sciences, MSR Nagar, Bengaluru, Karnataka, India
| | - M Indu
- Department of Oral Pathology, Government Dental College, Kottayam, Kerala, India
| | - Vanishri C. Haragannavar
- Department of Oral Pathology and Microbiology, Faculty of Dental Sciences, Ramaiah University of Applied Sciences, MSR Nagar, Bengaluru, Karnataka, India
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5
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Chatterjee D, Mitra S, Jolly S, Sinha A. Low-grade myofibroblastic sarcoma of the mandible: A rare tumour of childhood. J Oral Maxillofac Pathol 2023; 27:S10-S14. [PMID: 37082294 PMCID: PMC10112689 DOI: 10.4103/jomfp.jomfp_256_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 07/19/2022] [Indexed: 03/15/2023] Open
Abstract
Low-grade myofibroblastic sarcoma is a rare and indolent tumour of soft tissue. This tumour is relatively common in the head and neck region followed by extremities. Primary low-grade myofibroblastic sarcoma of the mandible is very rarely reported and the occurrence of this tumour in a child is very unusual. A 7-year-old male child presented with a swelling in right angle of mandible. X-ray and computed tomography scan showed a lytic lesion. The lesion was excised and the tissue was sent for histopathological evaluation, which revealed a cellular spindle cell neoplasm arranged in fascicles. The tumour was partly circumscribed and lobulated. On immunohistochemistry (IHC), these tumour cells showed cytoplasmic positivity for vimentin, and smooth muscle actin showed 'tram-track' pattern of positivity. The case was diagnosed as low-grade myofibroblastic sarcoma. There are no definite clinical features or pathognomonic radiological appearances of this tumour that can differentiate this rare tumour from other commonly encountered gnathic bone tumours, such as osteosarcoma, inflammatory myofibroblastic tumour, etc., Histopathological diagnosis coupled with ancillary investigations such as IHC is important to establish a definite diagnosis and rule out the differentials. The exact biological behaviour of this tumour is not known.
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Ab Rahman N, Harun MH, Sharif SET. Myofibroblastic sarcoma of the oral cavity: a diagnostic dilemma and report of two cases. JOURNAL OF ORAL MEDICINE AND ORAL SURGERY 2022. [DOI: 10.1051/mbcb/2022010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Introduction: Myofibroblastic sarcoma is designated as a low-grade malignancy, commonly affecting the deep soft tissue of the head and neck. Despite being classified as low-grade, myofibroblastic sarcoma with high-grade features have been reported. Observations: Two such cases affecting the oral cavity, which were diagnosed as different entities upon biopsy, were observed. Case 1 presented as multiple, well-circumscribed soft tissue swellings of the tongue and alveolar mucosa and was diagnosed as synovial sarcoma. Case 2 manifested as a large extensive osseous lesion of the maxilla and was diagnosed as an inflammatory myofibroblastic tumour. Conclusion: Myofibroblastic sarcoma with high-grade features remains a diagnostic dilemma due to its overlapping features with other spectra of fibroblastic/myofibroblastic tumours and lack of consensus regarding its classification as a separate entity. Establishing the definitive diagnosis requires adequate tumour sampling and a systematic clinicopathological approach.
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Jayasooriya PR, Athukorala C, Attygalla M, Mendis BRRN, Lombardi T. Low-Grade Myofibroblastic Sarcoma of the Oral Cavity: A Report of Three Cases Illustrating an Emerging Disease in Children. Dermatopathology (Basel) 2021; 8:1-9. [PMID: 33401376 PMCID: PMC7838777 DOI: 10.3390/dermatopathology8010001] [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: 11/16/2020] [Revised: 12/04/2020] [Accepted: 12/23/2020] [Indexed: 11/16/2022] Open
Abstract
Low-grade myofibroblastic sarcoma (LGMS) is a mesenchymal tumor of myofibroblasts that occurs more frequently in adults. A series of three cases is presented to illustrate that LGMS may also occur within the oral cavity in children and adolescents. The first case (Case 1) occurred intra-osseously in the mandible, while the remaining two presented as gingival swellings and were purely restricted to soft tissue (Cases 2 and 3). The intra-osseous lesion arose in a 7-year-old girl, whereas the gingival lesions were observed in a 12-year-old girl (Case 2) and a 13-year-old boy (Case 3). Histopathologically, all cases were composed of spindle shaped cells arranged into long fascicles showing mild to moderate degree of nuclear atypia. Ki-67 (MIB-1) proliferation activity was relatively low, amounting to 3–5% in all cases. Immunohistochemically, all cases showed smooth muscle actin (SMA) positivity in spindle cells, while desmin, beta catenin, cytokeratin, and CD34 were negative, resulting in a diagnosis of LGMS. In conclusion, current series of three cases of LGMSs that occurred in the oral cavity in a child and two adolescent patients is presented to highlight an emerging disease that requires additional data for further characterization.
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Affiliation(s)
- Primali Rukmal Jayasooriya
- Department of Oral Pathology, Faculty of Dental Sciences, University of Peradeniya, Peradeniya 20400, Sri Lanka;
| | - Chamara Athukorala
- Oral and Maxillofacial Surgery Unit, Base Hospital, Badulla 9000, Sri Lanka;
| | - Manjula Attygalla
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, University of Peradeniya, Peradeniya 20400, Sri Lanka;
| | - Balapuwaduge Ranjit Rigobert Nihal Mendis
- Laboratory of Oral and Maxillofacial Pathology, Unit of Oral Medicine & Oral Maxillofacial Pathology, University Hospitals of Geneva and Faculty of Medicine, University of Geneva, 1211 GE 4 Geneva, Switzerland;
| | - Tommaso Lombardi
- Laboratory of Oral and Maxillofacial Pathology, Unit of Oral Medicine & Oral Maxillofacial Pathology, University Hospitals of Geneva and Faculty of Medicine, University of Geneva, 1211 GE 4 Geneva, Switzerland;
- Correspondence: ; Tel.: +41-(0)22-3794034; Fax: +41-(0)22-3794082
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8
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Wen J, Zhao W, Li C, Shen JY, Wen TF. High-grade myofibroblastic sarcoma in the liver: A case report. World J Gastroenterol 2017; 23:7054-7058. [PMID: 29097878 PMCID: PMC5658323 DOI: 10.3748/wjg.v23.i38.7054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 06/18/2017] [Accepted: 08/15/2017] [Indexed: 02/06/2023] Open
Abstract
Only two cases of myofibroblastic sarcoma in the liver have been reported in the literature. Here, we report the case of a male patient with high-grade myofibroblastic sarcoma mimicking echinococcosis in the liver. The 25-year-old male patient complained of right upper quadrant swelling pain for one week and was initially diagnosed with echinococcosis. He was then scheduled for an exploratory laparotomy. During the operation, a huge mass exceeding 16 cm in diameter was found to occupy nearly the entire right trisegment of the liver, with a clear boundary and a round shape, and the mass was resected by right hepatic trisegmentectomy. Immunohistochemical staining revealed that the tumor tissue was positive for desmin, α-smooth muscle actin, CD56, and vimentin and negative for ALK-1, myogenin, calponin, β-catenin, S100, and glypican-3, with a Ki-67 (MIB-1) index of approximately 20%. Based on the histological manifestations and immunohistochemical staining, a diagnosis of myofibroblastic sarcoma was established. The postoperative recovery was uneventful. There was no evidence of recurrence or metastasis through the last follow-up, 6 mo after surgery, despite a lack of postoperative chemotherapy or radiotherapy. To the best of our knowledge, the present case is the first reported case of high-grade myofibroblastic sarcoma in the liver, and it is also the first reported case in a male patient.
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Affiliation(s)
- Jun Wen
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- Department of General Surgery, The Third People’s Hospital of Chengdu, Chengdu 610031, Sichuan Province, China
| | - Wei Zhao
- Department of Pathology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Chuan Li
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Jun-Yi Shen
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Tian-Fu Wen
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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9
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Yu Y, Xiao J, Wang L, Yang G. Low-Grade Myofibroblastic Sarcoma in the Mandibular Canal: A Case Report. J Oral Maxillofac Surg 2016; 74:1505.e1-5. [PMID: 27020841 DOI: 10.1016/j.joms.2016.02.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 02/25/2016] [Accepted: 02/25/2016] [Indexed: 11/25/2022]
Abstract
Low-grade myofibroblastic sarcoma (LGMS) represents an atypical myofibroblastic tumor characterized by a diffusely infiltrating pattern of spindle-shaped tumor cells. It was classified as a distinct soft tissue tumor by the World Health Organization in 2002. LGMS occurs mostly in adult patients and has a predilection for the head and neck region. So far, only a few cases of LGMS located in the mandible have been reported. Aggressive surgical resection with clear margins is the primary treatment for LGMS. Because of its rarity, reports of radiation therapy are limited, and the therapeutic effect is still controversial. We present the case of an 8-year-old girl with LGMS of the mandibular canal to highlight the clinical features and rarity and to improve the understanding of the therapeutic effect of radiotherapy on LGMS.
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Affiliation(s)
- Yueyuan Yu
- Resident and Oral Surgeon, Department of Oral and Maxillofacial Surgery, School & Hospital of Stomatology, Wenzhou Medical University, Wenzhou, China.
| | - Jin Xiao
- Attending Physician and Oral Surgeon, Department of Oral and Maxillofacial Surgery, School & Hospital of Stomatology, Wenzhou Medical University, Wenzhou, China
| | - Lan Wang
- Clinical Professor, Department of Pathology, Second Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Guiqiang Yang
- Radiotherapy Technician, Department of Radiotherapy, First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
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10
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Tsuchiya T, Suzuki K, Hojo Y, Shiraki A, Imaoka M, Shibutani M, Mitsumori K. Low-grade myofibroblastic sarcoma of the maxillary region in a dog. J Comp Pathol 2012; 147:42-5. [PMID: 21996034 DOI: 10.1016/j.jcpa.2011.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Revised: 08/27/2011] [Accepted: 09/01/2011] [Indexed: 12/25/2022]
Abstract
A subcutaneous tumour was identified in the maxillary region of a 14-year-old mixed breed dog. This tumour had grown rapidly over 2 weeks. Microscopically, the tumour had ill-defined borders and was composed of bundles and whorls of atypical spindle cells accompanied by abundant collagen fibres. Immunohistochemically, neoplastic cells were immunoreactive for vimentin, α-smooth muscle actin and calponin and negative for S100 protein, von Willebrand factor, desmin and smoothelin. These results suggested that the neoplastic cells were derived from myofibroblasts and that the tumour was a low-grade myofibroblastic sarcoma.
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Affiliation(s)
- T Tsuchiya
- Laboratory of Veterinary Pathology, Tokyo University of Agriculture and Technology, Tokyo, Japan
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11
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Hojo Y, Tsuchiya T, Shiraki A, Suzuki K, Shibutani M, Mitsumori K. High-grade myofibroblastic sarcoma of inguinal region in a dog. J Vet Med Sci 2011; 74:625-8. [PMID: 22156390 DOI: 10.1292/jvms.11-0459] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A subcutaneous tumor in the left inguinal region was present in an 11-year-old female bloodhound. Histopathologically, the tumor showed invasive growth and extensive necroses, and it was composed of spindle-shaped, elongated, and stellate neoplastic cells accompanied by occasional giant cells arranged in fascicular, herringbone, or irregular storiform patterns with abundant production of collagen fibers. The cytoplasm of most tumor cells was positive for vimentin, alpha-smooth muscle actin, and calponin, but was negative for desmin, smoothelin, and S-100. Furthermore, most of the tumor cells were negative for Iba1 while some tumor cells were weakly positive. Thus, this tumor was diagnosed as a high-grade myofibroblastic sarcoma according to the diagnostic criteria for human myofibroblastic sarcomas.
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Affiliation(s)
- Yuri Hojo
- Laboratory of Veterinary Pathology, Tokyo University of Agriculture and Technology, Fuchu-shi, Tokyo 183-8509, Japan
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12
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Watanabe K, Tanaka M, Takashi K, Yamada H, Tajino T. Fibronexus in low-grade myofibrosarcoma: a case report. Ultrastruct Pathol 2008; 32:97-100. [PMID: 18570154 DOI: 10.1080/01913120701829301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Fibronexus (fibronexus junction) has been thought to be a characteristic ultrastructural feature of myofibroblasts, but it is controversial as to whether fibronexus is a characteristic of various myofibroblastic tumors. We report here a case of low-grade myofibrosarcoma with fibronexus arising in the right arm of an 80-year-old man. Histologically, the tumor was composed of relatively uniform and slender spindle cells arranged in fascicles. The nuclei with fusiform and tapered shapes were mildly hyperchromatic, but never exhibited pleomorphism. Mitotic figures were common, but no atypical mitosis was identified. At the tumor periphery, tumor cells had invaded into the surrounding skeletal muscle tissue. Tumor cells were positive diffusely for alpha-smooth muscle actin and less intensely for desmin, but were negative for h-caldesmon and S-100 protein. Ultrastructurally, tumor cells had well developed cytoplasmic organelles and varying amounts of peripheral or subplasmalemmal bundles of thin myofilaments with focal density. In addition, well formed, long fibronectin fibrils adjacent to the cell surface and fibronexus contacting intracellular myofilaments were easily identified. We believe that fibronexus is a useful ultrastructural feature for differentiating myofibrosarcoma from other myogenic sarcomas.
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Affiliation(s)
- Kazuo Watanabe
- Pathology Division, Fukushima Medical University Hospital, oka, Fukushima City, Fukushima, Japan.
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13
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Jay A, Piper K, Farthing PM, Carter J, Diwakar A. Low-grade myofibroblastic sarcoma of the tongue. ACTA ACUST UNITED AC 2007; 104:e52-8. [PMID: 17964473 DOI: 10.1016/j.tripleo.2007.06.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2006] [Revised: 06/03/2007] [Accepted: 06/04/2007] [Indexed: 10/22/2022]
Abstract
Low-grade myofibroblastic sarcoma is a neoplasm of atypical myofibroblasts with fibromatoseslike features and a predilection for head and neck sites, including the oral cavity. These lesions have only been characterized in the last 2 decades, and controversies in the concept of neoplastic myofibroblasts still exist. Lack of obvious cytological atypia may result in their being mistaken for reactive fascitislike lesions or fibromatosis and architectural similarities to fibrosarcoma or leiomyosarcoma may complicate the diagnostic process. This paper describes a spindle cell neoplasm in a 40-year-old man that was diagnosed 9 years ago as an unclassifiable myofibroblastic proliferation. The recurrent tumor, which presented 6 years following excision of the original tumor, was subsequently classified as a low-grade myofibroblastic sarcoma. The morphological, immunohistochemical, and electron microscopic features of this unusual sarcoma and the most likely differential diagnoses are discussed.
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Affiliation(s)
- Amrita Jay
- Department of Cellular Pathology, Royal London NHS Trust, London, England.
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Fujiwara M, Yuba Y, Wada A, Imaoka I, Shintaku N, Miyanishi S. Myofibrosarcoma of the nasal bone. Am J Otolaryngol 2005; 26:265-7. [PMID: 15991093 DOI: 10.1016/j.amjoto.2004.11.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Myofibrosarcoma is a recently recognized rare tumor that mainly occurs in adults. These tumors are composed of a collagenous stroma and pleomorphic stellate to spindle-shaped cells that resemble smooth muscle cells with eosinophilic cytoplasm and tapered nuclei. We present a case of myofibrosarcoma of the nasal bones in a 4-year-old girl who showed rapid enlargement of a painless glabellar swelling. Computed tomography and magnetic resonance imaging revealed an expanding solid mass with erosion of the surrounding nasal bones. After excision and histopathological examination, this tumor was identified as a myofibrosarcoma. This is the first report of such a tumor localized to the glabellar region. This case report contributes to better awareness of an extremely rare type of glabellar lesion in children.
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Affiliation(s)
- Masao Fujiwara
- Department of Plastic and Reconstructive Surgery, Tenri Hospital, Nara, Japan.
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San Miguel P, Fernández G, Ortiz-Rey JA, Larrauri P. Low-grade myofibroblastic sarcoma of the distal phalanx. J Hand Surg Am 2004; 29:1160-3. [PMID: 15576232 DOI: 10.1016/j.jhsa.2004.05.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2004] [Revised: 05/30/2004] [Accepted: 05/30/2004] [Indexed: 02/02/2023]
Abstract
Low-grade myofibroblastic sarcoma is a recently defined tumor that is part of the spectrum of malignant mesenchymal tumors, showing features of myofibroblastic differentiation. These tumors occur most commonly in the head and neck regions, especially in the tongue, and less frequently in the limbs, trunk, and abdominal/pelvic cavity. We describe a 51-year-old woman with a low-grade myofibroblastic sarcoma. The distal phalanx of the finger was amputated with a clear surgical margin. The treatment of this tumor should include a simple local excision with free surgical margins and a long clinical follow-up period with imaging studies. At the 28-month follow-up evaluation the patient was free from this tumor.
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Affiliation(s)
- Pilar San Miguel
- Departments of Pathology, Radiology, and Traumatology (Hand Unit), Centro Médico Povisa Vigo, Pontevedra, Spain
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16
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Daugaard S. Current soft-tissue sarcoma classifications. Eur J Cancer 2004; 40:543-8. [PMID: 14962721 DOI: 10.1016/j.ejca.2003.11.009] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2003] [Revised: 10/20/2003] [Accepted: 11/20/2003] [Indexed: 11/16/2022]
Abstract
In order to analyse the impact of modern sarcoma classification criteria, pathological material from 281 extremity soft-tissue sarcomas (STS) was reviewed. The cases were originally diagnosed between 1972 and 1994, and the most frequent diagnoses then were malignant fibrous histiocytoma (MFH) (26%), liposarcoma (21%), fibrosarcoma (11%), and leiomyosarcoma (10%). After reclassification, the proportions had changed significantly, with the largest group now being leiomyosarcomas (20%), liposarcomas (17%), synovial sarcomas (14%), and sarcomas "not otherwise specified" (NOS) (11%). The original diagnosis was changed in 57% of the cases; in particular, the number of fibrosarcomas was reduced from 32 to 6, and MFHs from 72 to 2, with 22 renamed as myxofibrosarcomas; 20 (7%) were found not to be sarcomas. The main reasons for these results are the recent advances in immunohistochemistry (IHC) together with changes in nomenclature. The findings have obvious implications, in particular for retrospective research.
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Affiliation(s)
- S Daugaard
- Department of Pathology 5443, Rigshospitalet, Frederik V's Vej 11, DK-2100 Copenhagen Ø, Denmark.
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Abstract
Although relatively common, soft tissue tumors frequently present diagnostic problems for practicing pathologists. Immunohistochemistry has facilitated the diagnosis of many mesenchymal tumors; however, there is considerable overlap in the staining profiles among cells demonstrating fibroblastic and myofibroblastic differentiation. It has been our experience that soft tissue tumors associated with abundant extracellular collagen deposition commonly cause problems in classification. One reason for this is that tumors displaying this morphology include representatives from different histogenetic families. Specifically, tumors exhibiting fibroblastic, myofibroblastic and even lipomatous differentiation may manifest as a densely collagenous mass. It is the purpose of this review to highlight these collagen-rich soft tissue tumors.
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Affiliation(s)
- G Petur Nielsen
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
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18
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MacGregor AR, Batsakis JG, El-Naggar AK. Myofibroblastoma of the larynx: a study of two cases. Head Neck 2003; 25:606-11. [PMID: 12808665 DOI: 10.1002/hed.10272] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND We describe, for the first time, the occurrence of two pure examples of spindle cell neoplasm with fibrous and smooth muscle differentiation in the larynx. MATERIALS AND METHOD Tissue sections from both tumors stained with hematoxylin and eosin were reviewed. Immunophenotypic analysis using keratin, S-100 protein, SMA, and h-Caldesmon markers was performed. RESULTS Tumors were seen as raised submucosal nodules in the glottic region of two elderly male patients. Histopathologically, the lesions were unencapsulated and composed of spindle cells that manifested variable cellular anaplasia and expressed SMA and were negative for keratin, S-100, and h-Caldesmon. CONCLUSIONS We document histologically low-grade malignant myofibroblastic tumors of the larynx. Complete excision is advised.
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Affiliation(s)
- Allison R MacGregor
- Department of Otolaryngology, The University of Texas Medical School, Houston, Texas, USA
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19
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Mentzel T, Kutzner H. Haemorrhagic dermatomyofibroma (plaque-like dermal fibromatosis): clinicopathological and immunohistochemical analysis of three cases resembling plaque-stage Kaposi's sarcoma. Histopathology 2003; 42:594-8. [PMID: 12786896 DOI: 10.1046/j.1365-2559.2003.01635.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS Dermatomyofibroma (plaque-like dermal fibromatosis) represents a distinct clinicopathological entity in the spectrum of cutaneous mesenchymal neoplasms showing a myofibroblastic line of differentiation. These benign neoplasms occur frequently, but not exclusively, in young women, and the shoulder girdle as well as the upper trunk are common locations. Histologically, dermatomyofibroma is characterized by a plaque-like proliferation of cytologically bland spindle-shaped tumour cells containing an ill-defined, pale eosinophilic cytoplasm and elongated, neuroid nuclei. Neoplastic cells are arranged in bundles and fascicles orientated parallel to the skin surface, adnexal structures are spared and elastic fibres are increased and fragmented. Immunohistochemically, tumour cells express vimentin and variably muscle actin and alpha-smooth muscle actin, but are negative for desmin, CD34, S100, and epithelial markers. The main differential diagnosis includes hypertrophic scar, dermatofibroma (fibrous histiocytoma), pilar leiomyoma, neurofibroma, adult myofibromatosis, extra-abdominal fibromatosis and plaque-stage dermatofibrosarcoma protuberans. METHODS AND RESULTS We report three cases of dermatofibroma arising in male patients aged 31, 36, and 47 years on the thigh, chest wall and back, respectively. All lesions were completely excised and no local recurrence has been reported. Histologically, the neoplasms showed classical features of dermatomyofibroma; however, in addition abundant extravasated erythrocytes, scattered inflammatory cells, numerous capillaries, and sieve- and slit-like spaces, features resembling plaque-stage Kaposi's sarcoma, were noted. In none of the cases did spindled tumour cells stain positively for CD34, and HHV8 was not detected by polymerase chain reaction. CONCLUSIONS The reported cases widen the clinicopathological spectrum of dermatomyofibroma and emphasize plaque-stage Kaposi's sarcoma as an additional differential diagnosis.
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Affiliation(s)
- T Mentzel
- Dermatopathologisches Gemeinschaftslabor, Friedrichshafen, Germany.
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Saito T, Oda Y, Tanaka K, Matsuda S, Sakamoto A, Yamamoto H, Iwamoto Y, Tsuneyoshi M. Low-grade fibrosarcoma of the proximal humerus. Pathol Int 2003; 53:115-20. [PMID: 12588441 DOI: 10.1046/j.1440-1827.2003.01440.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We present the clinical, radiographical and pathological features of low-grade fibrosarcoma of the left proximal humerus in a 23-year-old man in whom it was necessary to distinguish the tumor from desmoplastic fibroma, malignant fibrous histiocytoma and intramedullary well-differentiated osteosarcoma. The patient presented with a 10-day history of pain in his left upper arm sustained when trying to break his fall with his left hand when slipping in the street. Plain radiography revealed an expanding multilobular osteolytic lesion from the proximal metaphysis to the diaphysis of his left humerus, accompanied by a pathological fracture at the distal portion of the lesion. Open biopsy of the lesion was performed twice; however, a conclusive diagnosis could not be obtained. The patient underwent wide excision and prosthetic replacement of the left proximal humerus. Histologically, the resected tumor was composed of both cellular areas and hypocellular areas. Cellular areas revealed a proliferation of bundles of uniform fibroblastic spindle-shaped cells with minimal cellular atypia, mixed with abundant intercellular collagenization. Mitotic figures were occasionally seen. Hypocellular areas showed myxoid features with loose bundles of collagen fibers. The patient demonstrates no evidence of disease 42 months after surgery. It is important to detect the scant atypical cells for the differential diagnosis of low-grade fibrosarcoma and desmoplastic fibroma of bone.
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Affiliation(s)
- Tsuyoshi Saito
- Department of Anatomic Pathology, Kyushu University, Graduate School of Medical Sciences, Fukuoka, Japan
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Magro G, Cavallaro V, Torrisi A, Lopes M, Dell'Albani M, Lanzafame S. Intrarenal solitary fibrous tumor of the kidney report of a case with emphasis on the differential diagnosis in the wide spectrum of monomorphous spindle cell tumors of the kidney. Pathol Res Pract 2002; 198:37-43. [PMID: 11866209 DOI: 10.1078/0344-0338-00182] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Solitary fibrous tumor (SFT) is a neoplasm that can occur in the urogenital tract, and is also reported occurring in the spermatic cord, seminal vesicles, urinary bladder, prostate, and kidney. Furthermore, it is most important to consider its existence in the kidney, because it is usually diagnosed as renal cell carcinoma pre-operatively. To our knowledge, only 10 cases of SFT have been reported in the kidney to date. We report the clinico-pathological features of an intrarenal SFT occurring in a 31-year-old woman. The tumor, measuring 8.6 cm in its greatest diameter, completely replaced the cortex and the medulla of the middle region of the right kidney, compressing the pelvis. Radiological imaging was consistent with a renal cell carcinoma. Histologically, the tumor was composed of a proliferation of bland-looking vimentin+, CD34+, bcl2+ and CD99+ spindle cells exhibiting a haphazard to storiform growth pattern, pushing borders, and a low mitotic rate (2 mitoses x 10 HPF). We placed emphasis on the differential diagnostic problems, i.e., its differentiation from other primary monomorphous benign and malignant spindle cell tumors of the kidney, such as fibroma, benign fibrous histiocytoma, hemangiopericytoma, inflammatory myofibroblastic (pseudo-)tumor, leiomyoma, angiomyolipoma with predominant spindle cell smooth muscle component, benign peripheral nerve sheath tumors, renal mixed epithelial/stromal tumors, adult type mesoblastic nephroma, fibrous type monophasic synovial sarcoma, malignant peripheral nerve sheath tumors, fibrosarcoma, and low-grade fibromyxoid sarcoma.
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Affiliation(s)
- Gaetano Magro
- Institute of Anatomic Pathology, University of Catania, Italy.
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Watanabe K, Ogura G, Tajino T, Hoshi N, Suzuki T. Myofibrosarcoma of the bone: a clinicopathologic study. Am J Surg Pathol 2001; 25:1501-7. [PMID: 11717539 DOI: 10.1097/00000478-200112000-00005] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Myofibroblastic tumors are fairly recently established soft tissue neoplasms. Although most of them appear to be benign, myofibrosarcoma of the soft tissue, seemingly their malignant counterpart, have been reported. We describe the clinicopathologic and radiologic features of four cases of myofibrosarcoma arising from the bone. All but one of the patients were women ranging in age from 60 to 71 years. Two tumors occurred in the metaphyses of distal femurs and the others arose in the iliac bones. On radiologic examination all tumors exhibited well-demarcated lytic destructive lesions without periosteal reaction. Two tumors were localized in the bone, whereas the other two extended into surrounding soft tissues. Histologically, all tumors were composed principally of a mixture of a cell-rich fascicular area and a hypocellular fibrous area. In the former area tumor cells had rather eosinophilic spindle-shaped wavy cytoplasm and were arranged in interlacing fascicles and small storiform patterns with variable numbers of inflammatory cells. Tumors occasionally showed prominent pleomorphism, and large cells with hyperchromatic nuclei were seen. In contrast, hypocellular areas had various features, including collagenous, hyalinous scar-like and rarely keloid-like areas. Focal coagulation necroses were present in all but one tumor. Immunohistochemically, the tumors were positive for vimentin, muscle actin (HHF35), alpha-smooth muscle actin, calponin, and desmin, whereas all of them were negative for high molecular weight caldesmon. On follow-up there was one fatal case with distant metastases, whereas the clinical courses of other cases after wide resection were excellent. Myofibrosarcoma of the bone has distinctive histopathologic features, which should be distinguished from those of other bone tumors with myoid differentiation.
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Affiliation(s)
- K Watanabe
- Pathology Division, Fukushima Medical University School of Medicine Hospital, Fukishima City, Japan.
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