Atypical spindle cell/pleomorphic lipomatous tumors (ASPLTs) were recently categorized as benign lipomatous tumors. However, accurate and complete preoperative diagnosis of ASPLTs may be difficult. Furthermore, diagnosis based on magnetic resonance imaging (MRI) findings is uncertain because of the varying ratios of the fat component within the tumor. Here, we report a case of ASPLT masquerading as a myxoid tumor. Although MRI findings were consistent with a myxoid liposarcoma, needle biopsy findings suggested a myxoma, and we performed marginal resection. Histopathological findings revealed infiltrating spindle cells with atypia. In addition, immunohistochemistry (IHC) showed positive staining for CD34 and heterogeneous retinoblastoma deficiency, and fluorescence in situ hybridization (FISH) showed no amplification of mouse double minute 2 homolog and no rearrangement of FUS or EWSR1. When MRI and histopathological findings suggest a myxoid tumor, IHC and FISH should be considered and performed for a precise and accurate diagnosis.
Although spindle cell lipoma (SCL) is a subtype of lipoma, the characteristics of SCL are observed in both lipomatous and non-lipomatous tumors. In this article, we present a case of SCL with ossification mimicking atypical lipomatous tumors/well-differentiated liposarcomas (ALTs/WDLs). Considering the findings of magnetic resonance imaging and needle biopsy, which exhibited ALTs/WDLs, marginal resection was performed. Histopathological findings demonstrated mature adipocytes and spindle cells without atypia and no malignant osteoid tissue in the ossified region. In addition, immunohistochemistry (IHC) showed positive staining for CD34, heterogeneous retinoblastoma protein deficiency, and negative staining for mouse double minute 2 homolog (MDM2) and cyclin-dependent kinase. Fluorescence in-situ hybridization showed negative amplification of MDM2. The final diagnosis of the tumor was established using IHC as an extremely rare SCL with ossification.
We read with great interest the article by Dr. Pang and colleagues entitled "Case Report: Primary Intraosseous Poorly Differentiated Synovial Sarcoma of the Femur," published in Frontiers in Oncology (1). The authors concluded that the primary site of poorly differentiated synovial sarcoma (SS) in this patient was not soft tissue, but bone, and that misdiagnosis between SS and Ewing sarcoma (ES) had occurred. However, we had some concerns regarding the interpretation of this unusual case, which we would like to discuss with the authors.
therapy were unfeasible. Thus, we concerned ourselves with the relief of the patient's severe stabbing pain, which despite the previous use of a wide spectrum of therapeutic regimens had never been successfully controlled. Thus, we initiated a monotherapeutic trial with oral doxazosin (Cardura; Pfizer, Athens, Greece), a specific antagonist of a-1 adrenergic receptors at a dose of 1 mg/day (gradually increasing to 2 mg/day), which is widely used in the treatment of hypertension and urinary retention. The pain completely resolved approximately 24 h after the onset of treatment and pain attacks were no longer triggered. The patient has presently completed an 8-month follow up without any recurrence of her symptoms or occurrence of any side-effects.Our Myxofibrosarcoma arising from a chronic burn scarDear Editor, The development of a malignant tumor in a chronic burn scar is a major complication of severe burns. More than 80% of these burn scar neoplasms are squamous cell carcinomas and basal cell carcinomas, whereas sarcomas comprise only 5% of cases. 1 Here, we describe an extremely rare case of myxofibrosarcoma arising in a burn scar on the right thigh.An 84-year-old man presented with a 35 mm 9 41-mm reddish nodule on his right thigh (Fig. 1a). The patient had experienced severe burns on the right thigh at 6 years of age. The region had healed with a severe scar contracture. Incisional biopsy findings were highly suggestive of fibrosarcoma. There was no evidence of distant metastasis. The lesion was excised with a 1.5-cm margin, including the surrounding burn scar. Histological examination of the specimen showed that a relatively circumscribed nodule located on scar tissue (Fig. 1b). More than half of the tumor was myxoid components. The tumor was composed of atypical spindle cells with myxoid stroma (Fig. 1c). The nuclei were hyperchromatic, slightly pleomorphic and had only rare mitotic figures (Fig. 1d). The deep part of the tumor had a tendency to spread in a longitudinal manner and demonstrate an infiltrative growth pattern (Fig. 1e). Immunohistological examination showed positive staining with vimentin and negative staining with CK5/ 6, S-100, Melan-A and CD34 (data not shown). These results were consistent with the diagnosis of myxofibrosarcoma.Three years after the operation, there was no evidence of tumor recurrence.The term myxofibrosarcoma was originally proposed by Angervall et al. to describe a group of fibroblastic lesions with a spectrum of cellularity, nuclear pleomorphism, and mitotic activity ranging from a hypocellular lesion with minimal cytological atypia to a more cellular lesion that was also considered a myxoid variant of malignant fibrous histiocytoma (MFH). 2,3These tumors most commonly arise as a slowly enlarging painless mass in the extremities of elderly patients. According to a clinicopathological analysis of 75 cases by Mentzel et al., 4 more than half of the cases (54%) developed local recurrence, and approximately 20% of cases developed metastases that led to tumor-related...
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