Atypical fibroxanthoma of the skin with metastasis

Abstract

Cutaneous atypical fibroxanthoma (AFX) occurs in elderly persons as a small nodule or ulceronodule in actinically damaged skin of the head and neck area. The vast majority of AFX behave in a benign manner, and metastasis is rare. Eight examples of metastasizing AFX are reported. Factors that portend aggressive behavior and metastasis are vascular invasion, recurrence, deep tissue invasion, tumor necrosis and, possibly, defective or depressed host resistance. The metastasizing primary AFX were located on the head, and the metastasis involved the structures in the region of the parotid gland.Cancer 57:368-376, 1986.UTANEOUS ATYPlCAL FIBROXANTHOMA (AFX)C usually occurs in the elderly as a small nodule or ulceronodule in actinically damaged skin of the head and neck. Histologically, an anaplastic appearance with multiplicity of cell types, marked cytologic atypia, bizarre giant cells, and abundant mitotic activity are characteri~tic.l-~ Paradoxically, the clinical course of atypical fibroxanthoma is almost always benign. Recurrent tumors are mentioned in most recorded series,2-8 but reports of metastasizing AFX are a rarity.2,R-'0 Eight cases of metastasizing AFX were studied to ascertain histologic and clinical factors that might aid in differentiating the aggressive lesions from the usual AFX. Seven are initially reported, and one was recorded previously.9 Materials and MethodsReview of the material on file at the Armed Forces Institute of Pathology revealed eight cases of AFX with clinical and histologic evidence of metastasis. All lesions met the established histologic criteria for AFX and were of dermal origin.2 Lesions that appeared to arise in the subcutaneous tissue or in deeper tissues were excluded. The cases were contributed by civilian pathologists and by pathologists of the Veterans Administration and the Military Services. Follow-up questionnaires were sent to pathologists, clinicians, and patients.

Clear Cell Atypical Fibroxantoma: A Rare Variant of Atypical Fibroxanthoma and Review of the Literature

“…However, local recurrence may occur in some cases and metastasis is also quite rare. Factors that denoted aggressive behavior and possible metastasis in AFX are vascular invasion, extension into deep tissues, tumour necrosis, local recurrence, and history of immunsupression [11]. There was no recurrence and metastasis during a one year follow-up of our case.…”

Sarcomas cutâneos primários

“…Prognostic factors related to metastases include greater invasion depth or invasion of skeletal muscles by the primary tumor, vascular or lymphatic invasion, tumoral necrosis, or recurrence. 5,50 Unfavorable prognostic factors are prior radiation of the tumor origin site and immunosuppression.…”

Atypical fibroxanthoma in a young woman: An unusual case presentation

“…Despite the presence of bizarre xanthoma cells giving rise to the name, AFX was initially described as a benign reactive process. However, once reports of metastasis appeared, the malignant potential of this low-grade form of malignant fibrous histiocytoma was recognized (2). AFX is an uncommon neoplasm that is generally found in elderly Caucasian men with sun-damaged skin, yet there is a second peak in young adults (3).…”

“…Most lesions tend to be smaller than 2 cm, although lesions larger than 10 cm have been reported (4). Despite the malignant appearance histopathologically, AFX generally follows a benign clinical course; they rarely metastasize (2). Clinically, AFX resembles other cutaneous and superficial soft tissue tumours, including squamous cell carcinoma, basal cell carcinoma, malignant melanoma, malignant fibrous histiocytoma and neurothekeoma.…”