Atypical fibroxanthoma: two unusual variants

Wilson, Perry; Strutton, Geoff; Stewart, Maxwell

doi:10.1111/j.1600-0560.1989.tb00017.x

Cited by 40 publications

(20 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Isolated cases of osteoclast-like giant cells in AFX have been reported over the years, but supportive evidence that the tumors are truly examples of AFX is sometimes limited. [39][40][41][42][43][44][45] Interestingly, 2 neoplasms originally retrieved from our archive as examples of AFX with osteoclast-like giant cells were subsequently proven to be squamous cell carcinomas after further scrutiny and immunohistochemistry. Keloidal change is an unusual finding in AFX, which was only very recently recognised in the literature, in a series of 9 cases.…”

Section: Discussionmentioning

confidence: 99%

Atypical Fibroxanthoma: A Histological and Immunohistochemical Review of 171 Cases

Beer¹,

Drury²,

Heenan³

2010

The American Journal of Dermatopathology

122

140

View full text Add to dashboard Cite

The clinical and histological features of 171 atypical fibroxanthomas (AFX) from a single institution in Western Australia are outlined. This area experiences high levels of solar radiation, and all assessable biopsies showed solar elastosis. Patients were aged between 41 and 97 years (median age 74), with 76% of tumors occurring in men (male to female ratio approximately 3 to 1). Most tumors were small, with a median diameter of 10 mm and a range of 4-35 mm. Only 5% exceeded 20 mm in diameter. Most AFX were well-circumscribed dermal lesions, with limited invasion of subcutis in a minority. Histological variants identified included keloidal (n = 8), clear cell (n = 3), and granular cell (n = 3), plaque like (n = 4), and myxoid (n = 1). Bland cytological appearances (spindle cell nonpleomorphic AFX) were noted in 5 tumors, with osteoclast-like giant cells in 2. Features suggesting regression were present in 22 cases. Two cases recurred locally, none metastasized. No tumors expressed melanocytic or epithelial markers. Seventy-four percent of cases expressed smooth muscle actin, typically strongly and diffusely. No AFX stained with desmin. Only 1 of 50 cases was CD117 positive. In conclusion, AFX may show a wide range of histological appearances, and a panel of immunohistochemical markers is essential to make the correct diagnosis. Histological mimics, such as poorly differentiated squamous cell carcinoma, must be carefully excluded. Specific diagnosis is important because there seems to be a very low risk of recurrence or metastasis despite the frequently alarming histology.

show abstract

Section: Discussionmentioning

confidence: 99%

Atypical Fibroxanthoma: A Histological and Immunohistochemical Review of 171 Cases

Beer¹,

Drury²,

Heenan³

2010

The American Journal of Dermatopathology

122

140

View full text Add to dashboard Cite

show abstract

“…The lesions often extend up to the epidermis, but origin from the epidermis is not present 1,5–10 . Various histologic variants have been described and these include spindle cell, 11 clear cell, 12–14 pigmented, 15 granular, 16 and AFX with osteoid, 17 chondroid 18 and osteoclast‐like giant cells 18–22 . Histologically, our cases fulfilled the criteria for AFX, namely, dermal‐based tumor consisting of a varying mix of spindle and pleomorphic cells with frequent mitoses and no apparent origin from the overlying epidermis and no involvement of the subcutaneous tissue.…”

Section: Discussionmentioning

confidence: 99%

Myxoid atypical fibroxanthoma: a previously undescribed variant

Patton¹,

Page

King

2009

J Cutan Pathol

View full text Add to dashboard Cite

show abstract

“…,32,33 or myxoid stromal change. Osteoid or chondroid formation are exceptional features 34,35. A recently reported finding is the presence of tumor regression showing areas of active regression characterized by an intense chronic inflammatory cell infiltrate adjacent to areas of chronic regression with dermal sclerosis 1,36,37.…”

mentioning

confidence: 99%

Pleomorphic Dermal Neoplasms

Brenn¹

2014

Advances in Anatomic Pathology

View full text Add to dashboard Cite

Pleomorphic neoplasms are typically associated with high-grade malignant behavior, but this does not readily apply to primary cutaneous tumors. Despite morphologic features suggestive of malignancy, atypical fibroxanthoma, the classic example of a pleomorphic dermal neoplasm, is characterized by indolent clinical behavior. Atypical fibroxanthoma is a distinctive clinicopathologic disease affecting sun-damaged skin of elderly males. Histologically, it is often ulcerated and dermal based with pushing growth, characterized by a sheet-like and fascicular growth of pleomorphic epithelioid, spindled, and multinucleated tumor cells with brisk and atypical mitotic activity. However, no positive discriminatory histologic or immunohistochemical features exist. Its diagnosis is one exclusion with a wide differential diagnosis, mainly including other mesenchymal, melanocytic, and epithelial neoplasms. Particular considerations are pleomorphic dermal sarcoma, invasive melanoma, squamous cell carcinoma, metaplastic carcinoma, poorly differentiated cutaneous angiosarcoma, cutaneous leiomyosarcoma, myxofibrosarcoma, variants of fibrous histiocytoma (FH), pleomorphic fibroma, and non-neural granular cell tumor. The behavior of these tumors is varied and ranges from outright malignant to entirely benign, requiring confident diagnosis to reliably predict behavior and guide treatment. Although challenging, because of significant clinical and pathologic overlap, it is usually possible to establish a definitive diagnosis when attention is paid to the often subtle differentiating features. This requires careful tumor sampling, recognition of the subtle distinguishing morphologic features, judicious use and analysis of immunohistochemistry, and interpretation of the findings in the appropriate clinical setting.

show abstract

Atypical fibroxanthoma: two unusual variants

Cited by 40 publications

References 22 publications

Atypical Fibroxanthoma: A Histological and Immunohistochemical Review of 171 Cases

Atypical Fibroxanthoma: A Histological and Immunohistochemical Review of 171 Cases

Myxoid atypical fibroxanthoma: a previously undescribed variant

Pleomorphic Dermal Neoplasms

Contact Info

Product

Resources

About