Angiomatoid fibrous histiocytoma: clinicopathological and molecular characterisation with emphasis on variant histomorphology

Kao, Yu-Chien; Lan, Jui; Tai, Hui Chun; Li, Chien‐Feng; Liu, Kai Wen; Tsai, Jen Wei; Fang, Fu Min; Yu, Shih Chen; Huang, Hsuan Ying

doi:10.1136/jclinpath-2013-201857

Cited by 57 publications

(61 citation statements)

References 27 publications

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“…3,4,[7][8][9]11,17,19,20 However, it may be assumed from the available descriptions that only a minority of these cases qualify as "myxoid AMFH" as defined by myxoid areas comprising at least 60% of the tumor. The fact that the present cases were identified in the biased setting of consultation material underscores the rarity of this variant, and in reality the frequency is likely much less.…”

Section: Discussionmentioning

confidence: 99%

“…1,4,6 Forming a solitary mass, the tumors are usually located in the subcutis or deep dermis of the extremities, followed by the trunk and head and neck region. 3,4,[7][8][9] Immunohistochemically, AMFH typically shows expression of desmin and epithelial membrane antigen (EMA) in around 50% of cases, often CD99, and occasionally CD68. Myxoid morphology of varying extent has been reported only very occasionally.…”

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confidence: 99%

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Myxoid Variant of So-called Angiomatoid “Malignant Fibrous Histiocytoma”

Schaefer

Fletcher

2014

American Journal of Surgical Pathology

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Angiomatoid "malignant fibrous histiocytoma" (AMFH) is a tumor of intermediate malignancy and undefined lineage, mostly arising in the extremities of young patients. Examples with a prominent myxoid matrix are very uncommon. Twenty-one cases of myxoid AMFH (among a total of 414) identified in consult files are described, including clinicopathologic features, fluorescence in situ hybridization analysis in a subset of cases, and follow-up. Thirteen patients were female and 8 male, ranging in age from 2 to 51 y (median 17 y). These circumscribed tumors arose in subcutaneous or deep somatic soft tissue, with a median size of 2.5 cm (range, 1 to 8 cm), being located in the extremities (14/21), trunk (4/21), and upper limb girdle (3/21). Characteristic features included a fibrous pseudocapsule (20/21), peritumoral lymphoplasmacytic infiltrates (20/21), blood-filled cystic spaces (17/21), and prominent myxoid morphology comprising 60% to 100% of the tumor surface area examined. Histiocytoid or spindled tumor cells exhibited vesicular nuclei, inconspicuous nucleoli, palely eosinophilic cytoplasm, and multinodular growth without necrosis. Mucin pools and scattered multinucleate giant cells were observed in a subset of cases. Mild to moderate atypia was observed in 4 cases; 1 tumor showed a pseudochondroid matrix. Immunohistochemically, 14/21 cases expressed desmin, 12/21 expressed EMA, and 4/7 exhibited EWSR1 rearrangement. Follow-up, available for 11 patients (median, 43 mo), revealed that 3 developed local recurrence after 2, 7, and 48 months, respectively. All patients were alive without metastases. AMFH may present with prominent myxoid features making diagnosis difficult and causing possible confusion with other myxoid tumors including low-grade fibromyxoid sarcoma, extraskeletal myxoid chondrosarcoma, and myxoid liposarcoma.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Myxoid Variant of So-called Angiomatoid “Malignant Fibrous Histiocytoma”

Schaefer

Fletcher

2014

American Journal of Surgical Pathology

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“…Approximately one-third show completely solid histology without pseudoangiomatoid spaces. 38 The stroma may be myxoid (Figure 3, B) (and can rarely account for the predominant portion of the neoplasm) 39 or occasionally sclerotic or desmoplastic-like (Figure 2, F), giving an appearance resembling poorly differentiated carcinoma. 6 Occasionally, tumoral giant cells are seen (Figure 2, E) and rarely reactive osteoclast-like giant cells within pseudoangiomatoid spaces.…”

Section: Histopathologymentioning

confidence: 99%

“…6 Occasionally, tumoral giant cells are seen (Figure 2, E) and rarely reactive osteoclast-like giant cells within pseudoangiomatoid spaces. 38 Unusual morphologic features, reported in smaller numbers of AFHs, include nuclear grooving, clear cells, rhabdomyoblast-like cells, groups of small cells with scanty cytoplasm reminiscent of Ewing sarcoma, and pulmonary edema-like and reticular patterns of cells in myxoid stroma. 6,40 In addition, some cases show schwannoma-like features, including nuclear palisading and stroma containing prominently hyalinized vessels.…”

Section: Histopathologymentioning

confidence: 99%

“…6,40 In addition, some cases show schwannoma-like features, including nuclear palisading and stroma containing prominently hyalinized vessels. 38 There are no reliable histopathological parameters that predict behavior, 3 and both primary AFH and metastatic AFH are frequently morphologically typical, including the genetically documented case of metastatic AFH. 18 Angiomatoid fibrous histiocytoma lacks a specific immunoprofile, so that immunohistochemistry is supportive rather than diagnostic.…”

Section: Histopathologymentioning

confidence: 99%

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Angiomatoid Fibrous Histiocytoma: The Current Status of Pathology and Genetics

Thway

Fisher

2015

Archives of Pathology &Amp; Laboratory Medicine

117

134

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Context.-Angiomatoid fibrous histiocytoma (AFH) is a rare soft tissue neoplasm of intermediate biologic potential and uncertain differentiation, most often arising in the superficial extremities of children and young adults. While it has characteristic histologic features of nodular distributions of ovoid and spindle cells with blood-filled cystic cavities and a surrounding dense lymphoplasmacytic infiltrate, there is a significant morphologic spectrum, which coupled with its rarity and lack of specific immunoprofile can make diagnosis challenging. Angiomatoid fibrous histiocytoma is associated with 3 characteristic gene fusions, EWSR1-CREB1 and EWSR1-ATF1, which are also described in other neoplasms, and rarely FUS-ATF1. Angiomatoid fibrous histiocytoma is now recognized at an increasing number of sites and is known to display a variety of unusual histologic features.Objective.-To review the current status of AFH, discussing putative etiology, histopathology with variant morphology and differential diagnosis, and current genetics, including overlap with other tumors harboring EWSR1-CREB1 and EWSR1-ATF1 fusions.Data Sources.-Review of published literature, including case series, case reports, and review articles, in online medical databases.Conclusions.-The occurrence of AFH at several unusual anatomic sites and its spectrum of morphologic patterns can result in significant diagnostic difficulty, and correct diagnosis is particularly important because of its small risk of metastasis and death. This highlights the importance of diagnostic recognition, ancillary molecular genetic confirmation, and close clinical follow-up of patients with AFH. Further insight into the genetic and epigenetic changes arising secondary to the characteristic gene fusions of AFH will be integral to understanding its tumorigenic mechanisms.

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Fluorescence in situ hybridization in surgical pathology: principles and applications

Cheng

Zhang

Wang

et al. 2017

The Journal of Pathology CR

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Identification of recurrent tumour‐specific chromosomal translocations and novel fusion oncogenes has important diagnostic, therapeutic and prognostic implications. Over the past decade, fluorescence in situ hybridization (FISH) analysis of tumour samples has been one of the most rapidly growing areas in genomic medicine and surgical pathology practice. Unlike traditional cytogenetics, FISH affords a rapid analysis of formalin‐fixed, paraffin‐embedded cells within a routine pathology practice workflow. As more diagnostic and treatment decisions are based on results of FISH, demand for the technology will become more widespread. Common FISH‐detected alterations are chromosome deletions, gains, translocations, amplifications and polysomy. These chromosome alterations may have diagnostic and therapeutic implications for many tumour types. Integrating genomic testing into cancer treatment decisions poses many technical challenges, but rapid progress is being made to overcome these challenges in precision medicine. FISH assessment of chromosomal changes relevant to differential diagnosis and cancer treatment decisions has become an important tool for the surgical pathologist. The aim of this review is to provide a theoretical and practical survey of FISH detected translocations with a focus on strategies for clinical application in surgical pathology practice.

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Angiomatoid fibrous histiocytoma: clinicopathological and molecular characterisation with emphasis on variant histomorphology

Abstract: Molecular testing is diagnostic of variant AFHs displaying diverse histomorphological alterations in the architectural patterns, cytomorphology and extracellular matrix.

Cited by 57 publications

References 27 publications

Myxoid Variant of So-called Angiomatoid “Malignant Fibrous Histiocytoma”

Myxoid Variant of So-called Angiomatoid “Malignant Fibrous Histiocytoma”

Angiomatoid Fibrous Histiocytoma: The Current Status of Pathology and Genetics

Fluorescence in situ hybridization in surgical pathology: principles and applications

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