Mediastinal and Pulmonary Metastases of Malignant Ossifying Fibromyxoid Tumor

Suehiro, Kotaro; Pritzwald-Stegmann, Patrick; Lee, Kenneth; Teoh, H. Heng; Alison, Peter

doi:10.1016/j.athoracsur.2005.07.098

Cited by 13 publications

(14 citation statements)

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“…Most of these lesions have had classic morphology, 1,4,7,8,11,13,14,16,[21][22][23][24][25]28,30,32,34,[36][37][38][39][40][43][44][45][46][47]49 but more emphasis has recently been placed on the recognition of atypical and clinically malignant variants. 6,12,19,25,29,35,41,48,49 In 1 large series, it was suggested that either high nuclear grade or high cellularity in combination with a mitotic rate >2 mitoses per 50 HPFs predicts malignant behavior in OFT. 12 However, less than 30% of cases in this series had fully typical morphology.…”

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confidence: 98%

Ossifying Fibromyxoid Tumor of Soft Parts—A Clinicopathologic and Immunohistochemical Study of 104 Cases With Long-term Follow-up and a Critical Review of the Literature

Miettinen

Finnell

Fetsch

2008

American Journal of Surgical Pathology

120

197

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Ossifying fibromyxoid tumor (OFT) is a unique soft tissue tumor of uncertain histogenesis. The majority of reported cases (approximately 220) have pursued a benign clinical course. However, recent literature has emphasized the existence of morphologically atypical and clinically malignant examples of this tumor and proposed guidelines for assessment of biologic potential. In the present study, we evaluated 104 cases of OFT from the Armed Forces Institute of Pathology, accessioned between the years 1970 and 2007. Herein, OFT was strictly defined as a tumor with lobular architecture, predominantly epithelioid cell morphology, a low level of atypia, corded and trabecular growth patterns, moderate amounts of myxocollagenous matrix, and often, focal peripheral metaplastic bone formation. Tumors that lacked conventional morphology were excluded. The exclusion group included cutaneous mixed tumors, low-grade fibromyxoid sarcomas, and extraskeletal osteosarcomas. The OFTs occurred in 64 men and 40 women with a median age of 50 years (range, 21 to 81 y). The tumor size ranged from 0.7 to 17 cm (median, 3 cm). The mitotic rate varied from 0 to 41 mitotic figures per 50 HPFs (median, 2/50 HPFs). Tumor cell nuclei typically contained small, distinct nucleoli, and necrosis was infrequent (11/104). The great majority of tumors (67/71, 94%) were positive for S100 protein, whereas only occasional examples had (focal) positivity for desmin, glial fibrillary acidic protein, and an AE1/AE3 keratin cocktail. Local recurrences were documented in 9 of 41(22%) living patients, usually 10 or more years after primary surgery, but there were no metastases. A mitotic rate of >2 mitotic figures/50 HPFs was a risk factor for local recurrence, but necrosis, tumor size, the presence of satellite nodules, and positive margins were not. When OFT is strictly defined by the criteria noted above, there is potential for local recurrence, but there seems to be little or no risk for metastasis.

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confidence: 98%

Ossifying Fibromyxoid Tumor of Soft Parts—A Clinicopathologic and Immunohistochemical Study of 104 Cases With Long-term Follow-up and a Critical Review of the Literature

Miettinen

Finnell

Fetsch

2008

American Journal of Surgical Pathology

120

197

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“…Local recurrence rates of 20% to 27% have been reported 5,6 . A more aggressive biologic behavior is observed in rare cases and has been associated with the development of metastases 7,12‐14 …”

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Ossifying Fibromyxoid Tumor in the Mandibular Gingiva: Case Report and Review of the Literature

Nonaka

Pacheco

Nunes

et al. 2009

Journal of Periodontology

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“…Malignant lesions (those with > 2 MF/50 HPF) and infiltrative growth patterns are associated with a higher potential for recurrence but surprisingly necrosis, tumor size, presence of satellite nodules, and positive margins were not associated with recurrence risk.8 Fortunately, metastases are much more rare but have been reported in lungs, mediastinum, thigh, and kidney. 8,10 In the case we present, our patient was found to have an OFMT in the parapharyngeal space. The differential diagnosis of OFMT in the parapharyngeal space neoplasms includes pleomorphic adenoma (40%), paraganglioma (20%), neurogenic tumor (including schwannoma?)…”

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confidence: 64%

“…The only study which does specifically address management of OFMT is that by Suehiro et al which involved a case of mediatstinal and pulmonary metastases. 10 Surgical management is one option for treatment of this tumor and the one utilized for our patient. However, chemotherapy and radiation treatment should be evaluated as alternative options, especially given that not every patient may be a candidate for surgery.…”

Section: Resultsmentioning

confidence: 99%

“…In their study, Suehiro et al found inconclusive evidence for the use of radiotherapy or chemotherapy, again emphasizing the need to further investigate the role of this treatment. 10 Although the ossifying fibromyxoid tumor is rare, in its malignant form recurrence rates are substantial. Current literature on both features of the tumor itself and its management are limited and as such it remains a malignancy that demands further study.…”

Section: Resultsmentioning

confidence: 99%

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Malignant Ossifying Fibromyxoid Tumor of the Parapharyngeal Space

Tanna¹,

Chadha²,

Kori³

et al. 2009

The Laryngoscope

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Ossifying Fibromyxoid Tumor (OFMT) is a rare, recently described tumor. As such, there is a paucity of information in the literature regarding this neoplasm. Most reports cite that the tumor most commonly occurs subcutaneously in the soft tissues of the extremities. 1-3 Additionally, OFMT has a predilection for men and exhibits a moderate recurrence rate (27%). 2 Malignant forms of the tumor are even rarer than their benign counterparts. At the time of manuscript preparation, the authors found only 27 reported cases of the malignant OFMT (versus 82 reports of benign OFMT). Similar to benign OFMT, most of the reported malignant cases occurred subcutaneously in extremities. However, a few uncommon locations have been described such as the mandible, 4 oral cavity, 5 and scalp. 6 While rare occurrences in the head and neck have been noted, to the authors' knowledge no such tumor has been reported in the parapharyngeal space. The authors present a case of a malignant ossifying fibromyxoid tumor in the parapharyngeal space.A 33-year old Pakistani male presented for evaluation for a two-year history of progressively enlarging right-sided neck mass. The patient also complained of gradual dysphonia but denied any dysphagia, odynophagia, snoring, stridor, trismus, or otologic symptoms. His past medical and surgical history were otherwise non-contributory. He did report a history of nicotine use, having smoked _ pack per day for the past 16 years. He denied daily alcohol consumption.On physical examination, the patient had symmetric palatal elevation, but the tonsillar fossae were asymmetrical (right buldge). With palpation of the neck, a firm right neck mass was detected, located anterior and deep to the right sternocleidomastoid and spanned from the angle of the jaw to the midlevel of the neck. Flexible nasopharyngolaryngoscopy revealed a slight bulge of the right pharyngeal wall and partial obliteration of the right piriform sinus (Figure 1). Vocal cord abduction and adduction was otherwise intact and symmetric.Magnetic resonance imaging (MRI) of the lesion indicated a 5.2 x 5.0 x 7.0 right neck mass extending from the skull base to the level of the thyroid cartilage ( Figure 2). It showed areas of cystic degeneration and enhancement with gadolinium. Magnetic resonance angiogram revealed lateral displacement of the right internal jugular vein anterior displacement of the external and internal carotid arteries. There was however, no splaying of the external and internal carotid arteries. Preoperative FNA was not performed secondary to the potential risk of bleeding associated with a suspected paraganglioma.The patient underwent uncomplicated right transcervical excision of the parapharyngeal lesion. Histopathologic analysis of the mass demonstrated features consistent with malignant OFMT. It demonstrated high nuclear grade and cellularity along with >2 MF/ 50 HPF . Immunohistochemical studies showed the presence of basal lamina, immunoreactivity of the neopastic cells to S-100 protein and glial fibrillary acidic treatment...

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Mediastinal and Pulmonary Metastases of Malignant Ossifying Fibromyxoid Tumor

Cited by 13 publications

References 4 publications

Ossifying Fibromyxoid Tumor of Soft Parts—A Clinicopathologic and Immunohistochemical Study of 104 Cases With Long-term Follow-up and a Critical Review of the Literature

Ossifying Fibromyxoid Tumor of Soft Parts—A Clinicopathologic and Immunohistochemical Study of 104 Cases With Long-term Follow-up and a Critical Review of the Literature

Ossifying Fibromyxoid Tumor in the Mandibular Gingiva: Case Report and Review of the Literature

Malignant Ossifying Fibromyxoid Tumor of the Parapharyngeal Space

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