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Wu H, Laskin WB. Myxoinflammatory Fibroblastic Sarcoma. Surg Pathol Clin 2024; 17:83-96. [PMID: 38278610 DOI: 10.1016/j.path.2023.07.003] [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] [Indexed: 01/28/2024]
Abstract
MIFS is a low-grade fibroblastic sarcoma that predilects to superficial distal extremity soft tissue. It is composed of plump spindled and epithelioid cells, inflammatory infiltrates, and mucin deposits in a fibrosclerotic stroma. Large epithelioid cells harboring bizarre nuclei and virocyte-like macronucleoli and pleomorphic pseudolipoblasts are characteristic. While conventional MIFS has locally recurrent potential but minimal metastatic risk, tumors with high-grade histologic features have a greater risk for recurrence and metastasis. Wide local excision is the recommended treatment.
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Affiliation(s)
- Hao Wu
- Department of Pathology, Yale University School of Medicine, New Haven, CT 06520, USA
| | - William B Laskin
- Department of Pathology, Yale University School of Medicine, New Haven, CT 06520, USA.
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Rekhi B. Fine needle aspiration cytology of a superficial CD34-positive fibroblastic tumour, including differential diagnoses and recent updates. Cytopathology 2023; 34:66-71. [PMID: 36151940 DOI: 10.1111/cyt.13181] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/30/2022] [Accepted: 09/13/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Superficial CD34-positive fibroblastic tumor is recognized as a distinct tumor of fibroblastic lineage in the recent World Health Organization (WHO) classification of tumors of soft tissues. There is an occasional report on cytomorphologic features of this rare tumor. CASE REPORT A 28-year-old male presented with swelling in his left thigh of 3 years duration, that was diagnosed as a pleomorphic sarcoma, elsewhere. Radiological imaging showed a well-defined lesion measuring 2.8 cm along the anteromedial aspect of the left mid-thigh in the subcutaneous location. Review of FNAC smears revealed a hypercellular tumor composed of spindle and pleomorphic cells with fine to more vesicular chromatin, and moderate to abundant granular to characteristic "glassy" cytoplasm including cells showing intranuclear pseudo inclusions, devoid of mitotic figures. Interspersed was pink stroma and several inflammatory cells including lymphocytes. Immunohistochemically, tumor cells were diffusely positive for CD34 and focally for AE1/AE3. A diagnosis of superficial CD34-positive fibroblastic tumor was finally offered. CONCLUSIONS This constitutes one of the first reports of cytomorphologic features of Superficial CD34-positive fibroblastic tumor. Its differential diagnoses, molecular updates and treatment-associated implications are discussed herewith.
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Affiliation(s)
- Bharat Rekhi
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI) University Mumbai, Maharashtra, India
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Wangsiricharoen S, Ali SZ, Wakely PE. Cytopathology of myxoinflammatory fibroblastic sarcoma: a series of eight cases and review of the literature. J Am Soc Cytopathol 2021; 10:310-320. [PMID: 33431307 DOI: 10.1016/j.jasc.2020.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/28/2020] [Accepted: 12/09/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Myxoinflammatory fibroblastic sarcoma (MIFS) is a rare low-grade sarcoma presenting as a slow-growing mass that occurs mainly in the distal extremities of adults. Relatively little is known about the cytopathology of MIFS. We evaluated cytologic characteristics of MIFS on fine-needle aspiration (FNA). MATERIALS AND METHODS A search was made of our cytopathology and surgical pathology databases for cases diagnosed as MIFS. FNA biopsy smears and cell-block were performed and examined using standard technique. RESULTS Eight cases were retrieved from patients aged 22-90 years (mean, 56 years), and M:F ratio of 1:1. Six tumors (75%) were primary, and 2 (25%) locally recurrent. Distal lower limb was involved in all but one case (88%). One (13%) recurrent case was correctly diagnosed cytologically as MIFS; remaining single diagnoses were varied: myxofibrosarcoma, low-grade sarcoma, malignant neoplasm, myxoid neoplasm, atypical fibrohistiocytic neoplasm, atypical cells with chronic inflammation, and spindle cells with atypia. Among 7 cases with available cytologic slides for review, common features were spindle cells with variable atypia (100%), rare virocyte/Reed-Sternberg -like cells (86%), background mixed inflammation (71%), and variable myxoid stroma (57%). Pseudolipoblasts and multinucleated giant cells were rare. Hemosiderin and branching capillaries were largely absent. Immunohistochemistry was non-specific. CONCLUSION MIFS was accurately interpreted in only 13% of cases; remaining cases were diagnosed as atypical or malignant, which would lead to proper management. A specific cytologic diagnosis of MIFS using FNA is extremely difficult in our experience due to an absence of distinctive cytomorphology and specific immunophenotype.
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Affiliation(s)
| | - Syed Z Ali
- Departments of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Paul E Wakely
- The Ohio State University Wexner Medical Center, James Cancer Hospital and Solove Research Institute, Columbus, Ohio.
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Hemosiderotic Fibrolipomatous Tumor, Pleomorphic Hyalinizing Angiectatic Tumor, and Myxoinflammatory Fibroblastic Sarcoma: Related or Not? Adv Anat Pathol 2017; 24:268-277. [PMID: 28375867 DOI: 10.1097/pap.0000000000000151] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Hemosiderotic fibrolipomatous tumor is an unusual, distinctive soft tissue neoplasm with locally recurring potential, which most commonly occurs in the ankle and foot. Morphologic evidence strongly suggests that hemosiderotic fibrolipomatous tumor is related to another rare, locally aggressive tumor of the distal extremities, pleomorphic hyalinizing angiectatic tumor, with areas identical to hemosiderotic fibrolipomatous tumor seen at the periphery in most if not all pleomorphic hyalinizing angiectatic tumor. This morphologic evidence is further supported by molecular genetic data, showing recurrent TGFBR3 and/or MGEA5 rearrangements in both hemosiderotic fibrolipomatous tumor and pleomorphic hyalinizing angiectatic tumor. A possible link between hemosiderotic fibrolipomatous tumor and yet another low-grade sarcoma of the distal extremities, myxoinflammatory fibroblastic sarcoma, has also been suggested based on the occurrence of unusual examples of hemosiderotic fibrolipomatous tumor showing progression to myxoid sarcoma, demonstrating some but not all features of myxoinflammatory fibroblastic sarcoma. These "hybrid hemosiderotic fibrolipomatous tumor-myxoinflammatory fibroblastic sarcoma" also commonly show TGFBR3 and/or MGEA5 rearrangements. However, classic myxoinflammatory fibroblastic sarcoma lacks areas resembling hemosiderotic fibrolipomatous tumor, and shows a very low frequency of TGFBR3 and/or MGEA5 rearrangements in prospectively diagnosed cases. This suggests that so-called "hybrid hemosiderotic fibrolipomatous tumor-myxoinflammatory fibroblastic sarcoma" represents a form of malignant progression within hemosiderotic fibrolipomatous tumor, rather than a lesion strictly related to classic myxoinflammatory fibroblastic sarcoma. This article will review the morphologic features, genetic features, and differential diagnosis of these rare neoplasms, and discuss their interrelation, or lack thereof.
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Ozaki S, Kasashima S, Kawashima A, Ooi A. Fine needle aspiration cytology findings of myxoinflammatory fibroblastic sarcoma: A case report. Diagn Cytopathol 2017; 46:739-743. [DOI: 10.1002/dc.23762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 04/14/2017] [Accepted: 05/16/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Satoru Ozaki
- Department of Clinical Laboratory Science; Kanazawa University; Kanazawa Japan
| | - Satomi Kasashima
- Department of Pathology; National Hospital Organization, Kanazawa Medical Center; Kanazawa Japan
| | - Atsuhiro Kawashima
- Department of Pathology; National Hospital Organization, Kanazawa Medical Center; Kanazawa Japan
| | - Akishi Ooi
- Department of Molecular and Cellular Pathology; Kanazawa University; Kanazawa Japan
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Zreik RT, Carter JM, Sukov WR, Ahrens WA, Fritchie KJ, Montgomery EA, Weiss SW, Folpe AL. TGFBR3 and MGEA5 rearrangements are much more common in “hybrid” hemosiderotic fibrolipomatous tumor-myxoinflammatory fibroblastic sarcomas than in classical myxoinflammatory fibroblastic sarcomas: a morphological and fluorescence in situ hybridization study. Hum Pathol 2016; 53:14-24. [DOI: 10.1016/j.humpath.2016.02.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 01/26/2016] [Accepted: 02/04/2016] [Indexed: 11/16/2022]
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Silver AG, Baynosa RC, Mahabir RC, Wang WZ, Zamboni WA, Khiabani KT. Acral myxoinflammatory fibroblastic sarcoma: A case report and literature review. THE CANADIAN JOURNAL OF PLASTIC SURGERY = JOURNAL CANADIEN DE CHIRURGIE PLASTIQUE 2014; 21:92-4. [PMID: 24431949 DOI: 10.1177/229255031302100201] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Acral myxoinflammatory fibroplastic sarcoma is an extremely rare soft-tissue sarcoma. It typically presents as an inflammatory mass in the distal extremities of adult patients. The authors present a review of the available literature as well as a discussion on the surgical management of a patient with acral myxoinflammatory fibroplastic sarcoma who originally requested conservative management but ultimately required a two-digit ray amputation after local recurrence.
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Affiliation(s)
- Andrew G Silver
- Division of Plastic Surgery, Department of Surgery, University of Nevada School of Medicine, Las Vegas, Nevada
| | - Richard C Baynosa
- Division of Plastic Surgery, Department of Surgery, University of Nevada School of Medicine, Las Vegas, Nevada
| | - Raman C Mahabir
- Division of Plastic Surgery, Department of Surgery, Scott & White Memorial Hospital, Temple, Texas, USA
| | - Wei Z Wang
- Division of Plastic Surgery, Department of Surgery, University of Nevada School of Medicine, Las Vegas, Nevada
| | - William A Zamboni
- Division of Plastic Surgery, Department of Surgery, University of Nevada School of Medicine, Las Vegas, Nevada
| | - Kayvan T Khiabani
- Division of Plastic Surgery, Department of Surgery, University of Nevada School of Medicine, Las Vegas, Nevada
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Lombardi R, Jovine E, Zanini N, Salone MC, Gambarotti M, Righi A, Balladelli A, Colangeli M, Rocca M. A case of lung metastasis in myxoinflammatory fibroblastic sarcoma: analytical review of one hundred and thirty eight cases. INTERNATIONAL ORTHOPAEDICS 2013; 37:2429-36. [PMID: 24158237 DOI: 10.1007/s00264-013-2048-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Accepted: 07/20/2013] [Indexed: 12/30/2022]
Abstract
PURPOSE Myxoinflammatory fibroblastic sarcoma (MIFS) is a rare soft tissue tumour first identified at the end of the 1990s. This study presents our experience and literature reviews focusing on risk of recurrence. METHODS Rizzoli Orthopaedic Institute database and literature were searched for patients with MIFS observed from 1997 to 2012. Data were analysed in a new database. RESULTS Five patients underwent surgery at our institute, and 133 cases were retrieved from the literature. Not all clinicopathological data were available: 76/138 were men (55%), median age was 45 [interquartile range (IQR) 34-56] years, median tumour size was three (IQR two to five) centimetres. Common sites of occurrence were hand (24%), fingers (23%) and foot (20%). Pain was present at diagnosis in 14/82 patients (17%), with a median duration of seven (IQR three to 12) months. Surgery was performed for a suspected benign tumour in 88 patients (74%). Resection was incomplete in 45/71 cases (63%); re-excision was performed in 32/45 (71%). At a median follow-up of 26 months, 26/118 patients (22%) developed recurrent disease; median time to recurrence was 15 months (IQR seven to 26). Actuarial relapse-free survival (RFS) at one, three and five years was 93%, 72% and 67%, respectively. At univariate analysis, only symptom duration of six months or less was significantly associated with a worse RFS (p = 0.046). Metastatic disease to lymph nodes and/or lungs was observed in four patients (3%). CONCLUSIONS Clinicopathological findings confirm the low-grade nature of MIFS. However, local recurrence occurs, and patients may be affected by aggressive forms with a potential for distant metastases. Follow-up is strongly advised.
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Affiliation(s)
- Raffaele Lombardi
- General and Thoracic Surgery, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
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Nishio J. Updates on the cytogenetics and molecular cytogenetics of benign and intermediate soft tissue tumors. Oncol Lett 2012; 5:12-18. [PMID: 23255885 DOI: 10.3892/ol.2012.1002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 10/04/2012] [Indexed: 12/20/2022] Open
Abstract
SOFT TISSUE TUMORS ARE CLASSIFIED ACCORDING TO THEIR HISTOLOGICAL RESEMBLANCE TO NORMAL ADULT TISSUES AND CAN BE GROUPED INTO THE FOLLOWING CATEGORIES BASED ON METASTATIC POTENTIAL: benign, intermediate (locally aggressive), intermediate (rarely metastasizing) and malignant. Over the past two decades, considerable progress has been made in our understanding of the genetic background of soft tissue tumors. Traditional laboratory techniques, such as cytogenetic analysis and fluorescence in situ hybridization (FISH), can be used for diagnostic purposes in soft tissue pathology practice. Moreover, cytogenetic and molecular studies are often necessary for prognostics and follow-up of soft tissue sarcoma patients. This review provides updated information on the applicability of laboratory genetic testing in the diagnosis of benign and intermediate soft tissue tumors. These tumors include nodular fasciitis, chondroid lipoma, collagenous fibroma (desmoplastic fibroblastoma), giant cell tumor of tendon sheath (GCTTS)/pigmented villonodular synovitis (PVNS), angiofibroma of soft tissue, myxoinflammatory fibroblastic sarcoma (MIFS) and ossifying fibromyxoid tumor (OFMT).
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Affiliation(s)
- Jun Nishio
- Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, Fukuoka 814-0180, Japan
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Wei S, Pan Z, Siegal GP, Winokur TS, Carroll AJ, Jhala D. Complex analysis of a recurrent pleomorphic hyalinizing angiectatic tumor of soft parts. Hum Pathol 2012; 43:121-6. [DOI: 10.1016/j.humpath.2011.02.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Revised: 01/31/2011] [Accepted: 02/07/2011] [Indexed: 11/26/2022]
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Wickham MQ, Youens KE, Dodd LG. Acral myxoinflammatory fibroblastic sarcoma fine needle aspiration: A case report. Diagn Cytopathol 2011; 40 Suppl 2:E144-8. [PMID: 21548124 DOI: 10.1002/dc.21721] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Accepted: 03/15/2011] [Indexed: 12/26/2022]
Affiliation(s)
- M Quinn Wickham
- Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA
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Hybrid myxoinflammatory fibroblastic sarcoma/hemosiderotic fibrolipomatous tumor: report of a case providing further evidence for a pathogenetic link. Am J Surg Pathol 2010; 34:1723-7. [PMID: 20871391 DOI: 10.1097/pas.0b013e3181f17d51] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Myxoinflammatory fibroblastic sarcoma and hemosiderotic fibrolipomatous tumor are rare, slow-growing soft tissue tumors of the distal extremities with recurrent potential. Recent cytogenetic studies have shown a t(1;10)(p22;q24) or der(10)t(1;10) in combination with aberrations of chromosome 3 in a limited number of cases of both entities. Here we report a case of a 42-year-old female with a soft tissue tumor of the ankle showing hybrid morphologic features of myxoinflammatory fibroblastic sarcoma and hemosiderotic fibrolipomatous tumor, a der(10)t(1;10), and abnormalities of chromosome 3. This hybrid lesion provides further evidence for a close relationship between these 2 tumor types.
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Leti Acciaro A, Gabrieli R, Landi A. A rare case of acral myxoinflammatory fibroblastic sarcoma at the hand. Musculoskelet Surg 2010; 94:53-7. [PMID: 20066525 DOI: 10.1007/s12306-009-0053-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2009] [Accepted: 11/12/2009] [Indexed: 12/16/2022]
Abstract
One case of acral myxoinflammatory fibroblastic sarcoma is presented. Most of the soft tissue tumefactions of the distal extremities are benign. Sarcomas are rare and usually high grade. Acral myxoinflammatory fibroblastic sarcoma is a unique low-grade tumor described by Kindblom in 1998. This neoplasm has a propensity for digits, presents a low rate of metastasis and is characterized by a high rate of local multiple and aggressive recurrence. The clinical presentation, the frequent association with tenosynovitis and the extensive inflammatory infiltrate can lead to misdiagnosis by both the surgeon and the pathologist. Correct and early diagnosis depends on a good knowledge of histological and immunohistochemical findings. It is important to avoid recurrences recurring to an immediate wide excision of the tumor.
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Hallor KH, Sciot R, Staaf J, Heidenblad M, Rydholm A, Bauer HC, Aström K, Domanski HA, Meis JM, Kindblom LG, Panagopoulos I, Mandahl N, Mertens F. Two genetic pathways, t(1;10) and amplification of 3p11-12, in myxoinflammatory fibroblastic sarcoma, haemosiderotic fibrolipomatous tumour, and morphologically similar lesions. J Pathol 2009; 217:716-27. [PMID: 19199331 DOI: 10.1002/path.2513] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Chromosomes, Human, Pair 1/genetics
- Chromosomes, Human, Pair 10/genetics
- Chromosomes, Human, Pair 3/genetics
- Female
- Fibrosarcoma/genetics
- Fibrosarcoma/pathology
- Gene Expression Profiling/methods
- Hemosiderosis/genetics
- Histiocytoma, Malignant Fibrous/genetics
- Histiocytoma, Malignant Fibrous/pathology
- Humans
- In Situ Hybridization, Fluorescence/methods
- Karyotyping
- Lipoma/genetics
- Lipoma/pathology
- Lower Extremity
- Male
- Middle Aged
- Oligonucleotide Array Sequence Analysis/methods
- Reverse Transcriptase Polymerase Chain Reaction/methods
- Ring Chromosomes
- Soft Tissue Neoplasms/genetics
- Soft Tissue Neoplasms/pathology
- Translocation, Genetic
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Affiliation(s)
- Karolin H Hallor
- Department of Clinical Genetics, University Hospital, Lund, Sweden.
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