Document Detail


Myxofibrosarcoma. Clinicopathologic analysis of 75 cases with emphasis on the low-grade variant.
MedLine Citation:
PMID:  8604805     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Myxofibrosarcoma is one of the most common sarcomas in the extremities of elderly patients. We analysed the clinicopathologic features in a series of 75 patients. All patients were adults (range, 22-91 years; median, 66 years) with an approximately equal incidence in men and women. Thirty-five tumors arose in the lower and 25 in the upper extremities, nine on the trunk, two each in the retroperitoneum and the head and neck region, and one each in the pelvis and penis. Forty-eight cases (69.5%) were located in dermal or subcutaneous tissues. Distinctive histologic features included the following: a commonly nodular growth pattern; a myxoid matrix containing elongated, curvilinear capillaries; and fusiform, round or stellate tumor cells with indistinct cell margins, slightly eosinophilic cytoplasm, and hyperchromatic atypical nuclei. These lesions varied from a hypocellular, mainly myxoid, and purely spindle-cell appearance (low-grade neoplasms) to high-grade, pleomorphic (malignant fibrous histiocytoma-like) lesions with multinucleated giant cells, high mitotic activity, and areas of necrosis. Immunohistochemistry in 44 cases revealed only vimentin and occasional actin positivity. Ultrastructurally, tumor cells had a fibroblastic phenotype. DNA flow cytometry and proliferation analysis showed an association between aneuploidy and histologic grade. An average follow-up of 45 months (range, 5-300 months) in 60 cases has revealed local recurrence in 33 cases (54%). Thirteen patients developed metastases, and 13 tumor-related deaths occurred. A short interval to first local recurrence was associated with poor clinical outcome. The rate of local recurrence was independent of histologic grade, but only intermediate and high-grade neoplasms metastasized. The depth of the primary lesion did not influence the incidence of local recurrence. However, in deep-seated neoplasms, the incidence of metastases was higher and the percentage of tumor-related deaths was twice as high as in superficially located lesions, reflecting the fact that deep-seated lesions tended to be higher-grade, larger tumors. Myxofibrosarcoma tends to become progressively higher grade in recurrences, as demonstrated in five cases in our series. The poorly recognized low-grade myxofibrosarcoma is emphasized, as proper diagnosis and treatment and scrupulous follow-up are mandatory to avoid local recurrence and gradual tumor progression to a higher-grade neoplasm that may then metastasize.
Authors:
T Mentzel; E Calonje; C Wadden; R S Camplejohn; A Beham; M A Smith; C D Fletcher
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The American journal of surgical pathology     Volume:  20     ISSN:  0147-5185     ISO Abbreviation:  Am. J. Surg. Pathol.     Publication Date:  1996 Apr 
Date Detail:
Created Date:  1996-05-14     Completed Date:  1996-05-14     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  7707904     Medline TA:  Am J Surg Pathol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  391-405     Citation Subset:  IM    
Affiliation:
Soft Tissue Tumour Unit, St. Thomas's Hospital, London, England.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Cell Division
Extremities
Female
Fibrosarcoma / chemistry,  pathology*,  ultrastructure
Head and Neck Neoplasms / chemistry,  pathology,  ultrastructure
Histiocytoma, Benign Fibrous / chemistry,  pathology*,  ultrastructure
Humans
Male
Middle Aged
Myxosarcoma / chemistry,  pathology*,  ultrastructure
Pelvic Neoplasms / chemistry,  pathology,  ultrastructure
Penile Neoplasms / chemistry,  pathology,  ultrastructure
Retroperitoneal Neoplasms / chemistry,  pathology,  ultrastructure
Retrospective Studies

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