Acral myxoinflammatory fibroblastic sarcoma with hybrid features of hemosiderotic fibrolipomatous tumor occurring 10 years after renal transplantation

Abstract

Myxoinflammatory fibroblastic sarcoma is a rare malignant soft tissue neoplasm that typically arises on the distal extremities of adults. It usually behaves in a low-grade manner and its characteristic histology is of a lobulated proliferation of moderately atypical spindled to epithelioid cells, vacuolated cells, and enlarged or bizarre cells with prominent nucleoli, dispersed within myxoid stroma containing a mixed inflammatory cell infiltrate. The etiology of myxoinflammatory fibroblastic sarcoma remains unknown with no definite causal factors identified. We describe a case of myxoinflammatory fibroblastic sarcoma arising in the foot of a 77-year-old female, which rapidly recurred locally after initial excision and which arose 10 years after renal transplantation. The neoplasm also showed intermingled areas of hemosiderotic fibrolipomatous tumor. The patient also had multifocal areas of squamous cell carcinoma in situ of the foot and hand, in keeping with the clinical context of immune deficiency. This is the second case of myxoinflammatory fibroblastic sarcoma reported to occur after transplantation, but additionally shows hybrid features of hemosiderotic fibrolipomatous tumor, highlights immunocompromise/immunosuppressive therapy as a possible etiologic factor in their development, and adds to the growing number of myxoinflammatory fibroblastic sarcoma that has demonstrated aggressive behavior.

Report of two cases of myxoinflammatory fibroblastic sarcomas with preceding hematolymphoid neoplasms: Is there any association?

“…Only one study has reported a history of renal transplantation in one case. 8 In the macroscopic examination, consistency is myxoid to hard in subcutaneous tissue with well‐defined or infiltrative borders. 1 , 3 , 7 MIFS has variegated and heterogeneous microscopic findings and consists of a multinodular appearance with three components: inflammatory cells, areas of fibrosis or hyalinized stroma, and areas of the extracellular myxoid matrix with tumor cells.…”

“… 1 , 3 , 7 MIFS has variegated and heterogeneous microscopic findings and consists of a multinodular appearance with three components: inflammatory cells, areas of fibrosis or hyalinized stroma, and areas of the extracellular myxoid matrix with tumor cells. 2 , 8 Tumor cells are atypical epithelioid and spindle cells resembling Reed‐Sternberg cells, multivacuolated cells resembling lipoblast cells, and ganglion cells without mitosis. 2 , 3 , 8 Heterogeneous components of MIFS in small biopsy specimens may be the cause of misdiagnosis.…”

“… 2 , 8 Tumor cells are atypical epithelioid and spindle cells resembling Reed‐Sternberg cells, multivacuolated cells resembling lipoblast cells, and ganglion cells without mitosis. 2 , 3 , 8 Heterogeneous components of MIFS in small biopsy specimens may be the cause of misdiagnosis. A prominent myxoid component in biopsy specimens may be seen in myxoid malignant fibrous histiocytoma, myxofibrosarcoma, superficial acral fibrosarcoma, myxoid liposarcoma, and myxoma.…”

Myxoinflammatory Fibroblastic Sarcoma of Eyeball in an Infant: A Rare Presentation

“…The prominent inflammatory component seen in MIFS has led to the suggestion that mediators of chronic inflammation, including various cytokines, may be implicated in its development. 7,8 Histologically, MIFS is characteristically a multinodular lesion composed of hypocellular and hypercellular areas comprising of atypical spindle to epithelioid cells, vacuolated fibroblasts mimicking lipoblasts (pseudolipoblasts), and large pleomorphic virocyte-like or Reed-Sternberglike cells within prominent myxoid stroma containing a mixed inflammatory cell population, variable hemosiderin deposition, and fibrosis. [7][8][9] The mitotic activity is usually low.…”

“…5 Genetically, MIFS has been associated with a marker/ ring chromosome 3 with 3p amplicons 10 as well as with a characteristic translocation, t(1;10)(p22;q24) with rearrangements of TGFBR3 and MGEA5 on chromosomes 1p22 and 10q24. 8 Differential diagnosis includes a wide range of conditions including both benign and malignant such as tenosynovitis, giant cell tumor of the tendon sheath, inflammatory myofibroblastic tumor, liposarcoma, epithelioid sarcoma, and myxoid malignant fibrous histiocytoma. MIFS is rather difficult to diagnose due to its heterogeneous histology and therefore all the above-mentioned conditions need to be excluded before conclusion of this diagnosis.…”