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Ene R, Dimitriu AL, Peride I, Țigliș M, Popescu EG, Georgescu EC, Neagu TP, Checherita IA, Niculae A. Giant Myxofibrosarcoma in the Lower Limb: An Overview of Diagnostic and Clinical Management. Diagnostics (Basel) 2024; 14:1298. [PMID: 38928713 PMCID: PMC11202561 DOI: 10.3390/diagnostics14121298] [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: 05/14/2024] [Revised: 06/08/2024] [Accepted: 06/15/2024] [Indexed: 06/28/2024] Open
Abstract
Myxofibrosarcoma (MFS), an aggressive soft tissue sarcoma, is one of the undifferentiated pleomorphic sarcomas; it has a low incidence, affecting people in the sixth to eighth decades of life. It usually involves the extremities and is painless with a slow-growing pattern. Based on the case of a 52-year-old female patient who presented with a painful, massive, rapid-growing, ulcerated tumor of the anterior surface of the left thigh, we performed a literature review regarding the current standard of care for patients with MFS. Computed tomography examination, followed by magnetic resonance imaging and surgical biopsy with histopathological examination, confirmed the diagnosis and the presence of lung and inguinal lymph node metastases. Due to the rapid-growing pattern and the local aggressiveness, our tumor board team recommended emergency excisional surgery, with subsequent reconstructive procedures followed by referral to an oncological center. This review emphasizes the importance of proper and rapid diagnosis, followed by multidisciplinary management, for MFS cases with atypical presentation and distal metastases to improve overall outcomes.
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Affiliation(s)
- Răzvan Ene
- Clinical Department No. 14, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Alexandru Lisias Dimitriu
- Clinical Department No. 14, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Ileana Peride
- Clinical Department No. 3, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Mirela Țigliș
- Department of Anesthesia and Intensive Care, Emergency Clinical Hospital of Bucharest, 014461 Bucharest, Romania
| | - Elisa Georgiana Popescu
- Clinical Department No. 14, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Eduard Cătălin Georgescu
- Clinical Department No. 14, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Tiberiu Paul Neagu
- Clinical Department No. 11, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
| | | | - Andrei Niculae
- Clinical Department No. 3, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
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Zhang B, Bai M, Tian R, Hao S. Idiopathic and radiation-induced myxofibrosarcoma in the head and neck-case report and literature review. Chin Neurosurg J 2021; 7:48. [PMID: 34823603 PMCID: PMC8620227 DOI: 10.1186/s41016-021-00267-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 11/08/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Myxofibrosarcoma (MFS), especially radiation-Induced MFS (RIMFS) in the head and neck, is an extremely rare malignant fibroblastic tumor. The diagnosis and treatment of MFS remain great challenges. In the present study, we presented one case of RIMFS. Combined with previous literature, the clinical features, essentials of diagnosis, and treatment modalities of MFS in the head and neck were reviewed to better understand this rare entity. CASE PRESENTATION We reported a case of RIMFS under the left occipital scalp in a 20-year-old girl with a history of medulloblastoma surgery and radiotherapy in 2006. A total tumor resection was performed with preservation of the overlying scalp the underlying bone, and no adjuvant therapy was administered after the first operation. The postoperative pathological diagnosis was high-grade MFS. The tumor relapsed 6 months later, and then, a planned extensive resection with negative surgical margins was carried out, followed by radiotherapy. No relapse occurred in a 12-month postoperative follow-up. CONCLUSIONS Planned gross total resection (GTR) with negative margins is the reasonable choice and footstone of other treatments for MFS. Ill-defined infiltrated borders and the complicated structures make it a great trouble to achieve total resection of MFS in the head and neck, so adjuvant radiotherapy and chemotherapy seem more necessary for these lesions.
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Affiliation(s)
- Bin Zhang
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, People's Republic of China
| | - Miao Bai
- Department of Neurology, Tang Du Hospital, Air Force Medical University, Xi'an, China
| | - Runfa Tian
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, People's Republic of China
| | - Shuyu Hao
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, People's Republic of China.
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Shao Z, Jiao B, Yu J, Liu H. Primary low grade myxofibrosarcoma of the liver with benign presentation but malignant outcome: a case report. BMC Cancer 2019; 19:1098. [PMID: 31718576 PMCID: PMC6852919 DOI: 10.1186/s12885-019-6282-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 10/23/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Myxofibrosarcoma (MFS) is most often found on the limbs of aged male people, but extremely uncommon in the liver. CASE PRESENTATION A 52-year-old female patient with a liver mass was diagnosed as a primary MFS. It had no obvious abdominal symptoms, and the tumor was resected with an extended margin. Three years after the surgery, the patient was readmitted for peritoneal metastasis and passed away 4 months later. The tumor has a benign presentation, but malignant outcome. CONCLUSIONS Comprehensive radiological inspection, intensive preoperative evaluation, careful design of operating procedures, wide margin resection, consecutive treatment, and strict periodical follow-ups should be taken to ensure a better prognosis of this kind of neoplastic disease.
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Affiliation(s)
- Zigong Shao
- Department of General Surgery, Department of Organ Transplantation, First Affiliated Hospital, China Medical University, Shenyang, 110001, China
| | - Baoping Jiao
- Department of General Surgery, Shanxi Cancer Hospital, Taiyuan, 130013, China
| | - Juanhan Yu
- Department of Pathology, First Affiliated Hospital, China Medical University, Shenyang, 110001, China
| | - Hao Liu
- Department of General Surgery, Department of Organ Transplantation, First Affiliated Hospital, China Medical University, Shenyang, 110001, China.
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Ghazala CG, Agni NR, Ragbir M, Dildey P, Lee D, Rankin KS, Beckingsale TB, Gerrand CH. Myxofibrosarcoma of the extremity and trunk. Bone Joint J 2016; 98-B:1682-1688. [DOI: 10.1302/0301-620x.98b12.37568] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 07/08/2016] [Indexed: 11/05/2022]
Abstract
Aims Myxofibrosarcomas (MFSs) are malignant soft-tissue sarcomas characteristically presenting as painless slowly growing masses in the extremities. Locally infiltrative growth means that the risk of local recurrence is high. We reviewed our experience to make recommendations about resection strategies and the role of the multidisciplinary team in the management of these tumours. Patients and Methods Patients with a primary or recurrent MFS who were treated surgically in our unit between 1997 and 2012 were included in the study. Clinical records and imaging were reviewed. A total of 50 patients with a median age of 68.4 years (interquartile range 61.6 to 81.8) were included. There were 35 men; 49 underwent surgery in our unit. Results The lower limb was the most common site (32/50, 64%). The mean size of the tumours was 8.95 cm (1.5 to 27.0); 26 (52%) were French Fédération Nationale des Centres de Lutte Contre le Cancer grade III. A total of 21 (43%) had positive margins after the initial excision; 11 underwent further excision. Histology showed microscopic spread of up to 29 mm beyond macroscopic tumour. Local recurrence occurred in seven patients (14%) at a mean of 21 months (3 to 33) and 15 (30%) developed metastases at a mean of 17 months (3 to 30) post-operatively. Conclusion High rates of positive margins and the need for further excision makes this tumour particularly suited to management by multidisciplinary surgical teams. Microscopic tumour can be present up to 29 mm from the macroscopic tumour in fascially-based tumours. Cite this article: Bone Joint J 2016;98-B:1682–8.
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Affiliation(s)
- C. G. Ghazala
- Newcastle Upon Tyne Hospitals NHS Foundation
Trust, Freeman Hospital, Newcastle
Upon Tyne NE7 7DN, UK
| | - N. R. Agni
- Newcastle Upon Tyne Hospitals NHS Foundation
Trust, Freeman Hospital, Newcastle
Upon Tyne NE7 7DN, UK
| | - M. Ragbir
- Newcastle Upon Tyne Hospitals NHS Foundation
Trust, Freeman Hospital, Newcastle
Upon Tyne NE7 7DN, UK
| | - P. Dildey
- Newcastle Upon Tyne Hospitals NHS Foundation
Trust, Freeman Hospital, Newcastle
Upon Tyne NE7 7DN, UK
| | - D. Lee
- Newcastle Upon Tyne Hospitals NHS Foundation
Trust, Freeman Hospital, Newcastle
Upon Tyne NE7 7DN, UK
| | - K. S. Rankin
- Newcastle University, Newcastle
Upon Tyne NE1 7RU, UK
| | - T. B. Beckingsale
- Newcastle Upon Tyne Hospitals NHS Foundation
Trust, Freeman Hospital, Newcastle
Upon Tyne NE7 7DN, UK
| | - C. H. Gerrand
- Newcastle Upon Tyne Hospitals NHS Foundation
Trust, Freeman Hospital, Newcastle
Upon Tyne NE7 7DN, UK
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Epileptic seizure in primary intracranial sarcoma: a case report and literature review. Childs Nerv Syst 2016; 32:1709-14. [PMID: 27412478 DOI: 10.1007/s00381-016-3174-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 07/04/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE The aim of this study is to describe epileptic seizures in patients with primary intracranial sarcomas. METHODS We report a 17-year-old girl diagnosed with primary high-grade intracranial sarcoma with initial clinical manifestation of nonconvulsive status epilepticus. Literature reports between 2000 and 2014, relevant to primary intracranial sarcomas in children, were reviewed. The clinical presentations and neurological outcomes were analyzed. RESULTS Eleven of 29cases (38 %), 8 males and 3 females, who exhibited epileptic seizures as one of the initial symptoms and diagnosed with primary intracranial sarcomas were collected. The median age of disease onset was 5 years. The two most common seizure types were generalized seizures (45 %) and status epilepticus (36 %). Nine of 11 patients (82 %) had tumor growth involving the frontal lobe. Nine cases had the median duration of follow-up 1.7 years, of which 6 cases showed tumor recurrence and 3 cases died during the period of follow-up. CONCLUSIONS Epileptic seizures as one of the clinical manifestations are uncommon. The two most common seizure types were generalized seizures and status epilepticus. The most frequent location of primary intracranial sarcoma-related seizures was the frontal lobe. The clinical outcome varied.
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Costa DA, Barata P, Gouveia E, Mafra M. Right cardiac intracavitary metastases from a primary intracranial myxofibrosarcoma. BMJ Case Rep 2016; 2016:bcr-2015-214052. [PMID: 27013654 DOI: 10.1136/bcr-2015-214052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Primary intracranial myxofibrosarcoma is exceedingly rare, with less than 10 cases published. We present a case of a 23-year-old man with previous history of a primary low grade myxofibrosarcoma of the left parietal-occipital convexity resected in March 1999. He subsequently underwent several interventions for multiple local recurrent disease until March 2004. At that time, complete remission was documented. About 8 years later, in February 2012, the patient was admitted to the emergency room with refractory acute pulmonary oedema. On work up, sustained monomorphic ventricular tachycardia and hyperechoic myocardial mass with invasion of the right ventricular cavity were detected. Electrical cardioversion was unsuccessful and irreversible cardiac arrest followed. The autopsy confirmed multiple bilateral lung metastases, malignant pulmonary embolism and myocardial invasion by the primary tumour, with intracavitary cardiac thrombosis and absence of intracranial disease. To the best of our knowledge, this is the first report of extracranial metastases of this neoplasm.
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Affiliation(s)
- Diogo Alpuim Costa
- Department of Medical Oncology, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Lisbon, Portugal Underwater and Hyperbaric Medicine Centre, Portuguese Navy, Lisbon, Portugal Nova Medical School, Lisbon, Portugal
| | - Pedro Barata
- Nova Medical School, Lisbon, Portugal Department of Medical Oncology, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Emanuel Gouveia
- Department of Medical Oncology, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Lisbon, Portugal
| | - Manuela Mafra
- Pathology Department, Centro Hospitalar de Lisboa Central, Lisbon, Portugal Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Lisbon, Portugal
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Val-Bernal JF, García-González MR, Mayorga M, Marrero RH, Jorge-Pérez N. Primary renal myxofibrosarcoma. Pathol Res Pract 2015; 211:619-24. [PMID: 26008776 DOI: 10.1016/j.prp.2015.04.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 04/08/2015] [Accepted: 04/14/2015] [Indexed: 11/28/2022]
Abstract
Kidney sarcomas are rare, representing only 1% of malignant renal tumors. We herein report the case of a 70-year-old woman that was admitted for an episode of confusion in relation to hypertensive encephalopathy. Imaging investigations revealed a large mass in the right kidney with extension to the renal hilum. The patient underwent right open radical nephrectomy. The histopathologic study disclosed a 15-cm, myxoid and cellular, pleomorphic tumor with elongated, curvilinear, thin-walled vessels, and focal necrosis that involved the upper and middle segments of the kidney. Immunohistochemically, the tumor cells showed strong positivity for vimentin, bcl2 protein (nuclear staining pattern), CD34, CD99, and alpha-methylacyl coenzyme A racemase. The tumor was diagnosed as myxofibrosarcoma (MFS) grade 2 according to the FNCLCC system. To the best of our knowledge, this is the first report of an MFS arising from the kidney. Thus, MFS is an uncommon soft tissue tumor that can exceptionally arise from the kidney. The differential diagnosis with other myxoid tumors is of vital importance because it includes lesions with subtle differences and extremely variable biological behavior. Radical surgery is the treatment of choice. Long-term follow-up is recommended because of the tumor's capability for local recurrence and distant metastasis.
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Affiliation(s)
- José-Fernando Val-Bernal
- Department of Anatomical Pathology, Marqués de Valdecilla University Hospital, Medical Faculty, University of Cantabria and IDIVAL, Santander, Spain.
| | - M Rosa García-González
- Service of Anatomical Pathology, Doctor Negrín University Hospital, Las Palmas de Gran Canaria, Spain
| | - Marta Mayorga
- Department of Anatomical Pathology, Marqués de Valdecilla University Hospital, Medical Faculty, University of Cantabria and IDIVAL, Santander, Spain
| | - Reinaldo H Marrero
- Service of Urology, Doctor Negrín University Hospital, Las Palmas de Gran Canaria, Spain
| | - Nicolás Jorge-Pérez
- Service of Urology, Doctor Negrín University Hospital, Las Palmas de Gran Canaria, Spain
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Shih F, Yip S, McDonald PJ, Chudley AE, Del Bigio MR. Oncogenic codon 13 NRAS mutation in a primary mesenchymal brain neoplasm and nevus of a child with neurocutaneous melanosis. Acta Neuropathol Commun 2014; 2:140. [PMID: 25330907 PMCID: PMC4209081 DOI: 10.1186/s40478-014-0140-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 09/08/2014] [Indexed: 12/01/2022] Open
Abstract
A 28-month female with a clinical diagnosis of neurocutaneous melanosis and numerous intracranial abnormalities (including a right choroid plexus tumor and left hemimegalencephaly) presented with a rapidly expanding tumor in the left occipital cerebrum. Microscopic examination of the resected specimen revealed a myxoid mesenchymal neoplasm consisting of fusiform cells that were immunoreactive for vimentin, CD34, and P53 but no melanocyte markers. Focused amplicon deep sequencing on DNA extracted from the brain tumor and a cutaneous nevus revealed a heterozygous (c.37G > C; p.G13R) substitution in the NRAS gene. DNA sequencing of “normal” skin and buccal swab showed the identical NRAS change albeit at lower allelic frequency. Her parents did not harbor the NRAS mutation. The skin lesion, but not the brain tumor, had a BRAF mutation (c.1397G > T; p.G466V). A germline single nucleotide polymorphism in MET was found in the child and her father (c.3209C > T; p.T1010I). The findings suggest NRAS mosaicism that occurred sometime after conception and imply an oncogenic role of the activating NRAS mutation in both the brain and skin lesions in this child.
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Smith SC, Poznanski AA, Fullen DR, Ma L, McHugh JB, Lucas DR, Patel RM. CD34-positive superficial myxofibrosarcoma: a potential diagnostic pitfall. J Cutan Pathol 2013; 40:639-45. [PMID: 23600956 DOI: 10.1111/cup.12158] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 03/15/2013] [Accepted: 03/21/2013] [Indexed: 01/11/2023]
Abstract
BACKGROUND Myxofibrosarcoma (MFS) arises most commonly in the proximal extremities of the elderly, where it may involve subcutaneous and dermal tissues and masquerade as benign entities in limited biopsy samples. We encountered such a case, in which positivity for CD34 and morphologic features were initially wrongly interpreted as a 'low-fat/fat-free' spindle cell/pleomorphic lipoma. Case series have not assessed prevalence of CD34 reactivity among cutaneous examples of MFS. METHODS We performed a systematic review of our institution's experience, selecting from among unequivocal MFS resection specimens those superficial cases in which a limited biopsy sample might prove difficult to interpret. These cases were immunostained for CD34 and tabulated for clinicopathologic characteristics. RESULTS After review of all MFS diagnoses over 5 years (n = 56), we identified a study group of superficial MFS for comparison to the index case (total n = 8). Of these, the index and three additional cases (4 of 8, 50%; 2 low, 2 high grade) demonstrated positive staining for CD34, with diffuse staining of spindled cells including cellular processes. Four additional cases showed no or equivocal/rare staining. CONCLUSIONS CD34 positivity should be recognized as prevalent among such cases and should not be inappropriately construed as inveighing against a diagnosis of MFS in favor of benign entities.
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Affiliation(s)
- Steven C Smith
- Department of Pathology, University of Michigan, Ann Arbor, MI 48109-0602, USA
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