Myxoid atypical fibroxanthoma: a previously undescribed variant

Graduate School of Medicine, Knoxville, Tennessee, USA.
Journal of Cutaneous Pathology (Impact Factor: 1.58). 04/2009; 36(11):1177-84. DOI: 10.1111/j.1600-0560.2009.01255.x
Source: PubMed


Atypical fibroxanthomas (AFX) are dermal-based cutaneous tumors typically found in sun-damaged skin of the elderly. Histologic variants include spindle cell, clear cell, osteoid, osteoclastic, chondroid, pigmented, and granular cell. To date, myxoid change in AFX, has not been described.
Four cases were retrieved from the consultation and surgical pathology files of Knoxville Dermatopathology Laboratory, Knoxville, Tennessee during a 4-year period. The clinical and histologic findings were reviewed and Alcian blue/periodic acid-Schiff (PAS) stain and panel of immunohistochemical stains was obtained.
All 4 lesions occurred as solitary lesions in elderly males on the head and neck (2 cases) and upper extremity (2 cases). Histologically all tumors demonstrated a well-circumscribed, cellular lesion centered in the dermis and composed of a mix of atypical pleomorphic and spindle cells in a prominent myxomatous background. A junctional component was absent and the tumors did not arise from the epidermis or adnexal structures. Subcutaneous involvement was absent in all cases. Tumor cells were negative for melanocytic and epithelial markers. Positive staining was noted with CD10 (3/4 cases) and vimentin (4/4 cases).
Myxoid change in AFX is rare and previously undescribed in the English literature. Myxoid change may be a prominent finding in benign and malignant cutaneous tumors and awareness of this variant of AFX will avoid misdiagnosis.

13 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: Failure mechanism in interconnect systems employed in semiconductor devices have been reviewed and analyzed in some detail1 from the early purple plague producing aluminum-gold system to the latest platinum-titanium-gold beam lead process. It is shown that intermetallic compound formation occurs in all the systems studied. In the aluminum-gold system, the formation of the purple plague compound and other intermetallics is catalyzed by the presence of silicon, causing rapid degradation of bond strength. The compound formation up over the oxide is accompanied by void formation as a result of Kirkendall effect, leading to mechanically open bonds. Compound formation is found or may be expected in all the interconnect systems analyzed. The only interconnect system free of these problems is the all aluminum system.
    Reliability Physics Symposium, 1967. Sixth Annual; 12/1967
  • [Show abstract] [Hide abstract]
    ABSTRACT: Atypical fibroxanthoma (AFX) with prominent fibrosis, sclerosis and hyalinization, and near-total tumor regression is rare. Eight cases of AFX presenting with fibrosis were reviewed as to their tumor architecture, the degree and pattern of fibrosis and the associated inflammatory cell infiltrate. Seven of eight cases had an exophytic architecture, with ulceration in one case. The degree of fibrosis ranged from 10% to 90%. Early fibrosis (2/8 cases) occurred as thickened sclerotic collagen bundles, either dispersed between the neoplastic cells or as septa imparting a multilobular appearance. Advanced fibrosis (6/8 cases) was associated with lamellar sclerosis, keloidal features, hyalinization and with near-total tumor replacement. Prominent fibrosis rimming the periphery was present in all tumors. An associated lymphoid cell infiltrate with plasma cells and occasionally eosinophils was observed. Fibrosis with prominent sclerosis and hyalinization replacing the tumor is rare in AFX. Advanced fibrosis, in the absence of a history of prior trauma or surgery, may indicate spontaneous regression. These cases emphasize the importance of recognizing this subset of AFX in order to avoid misinterpretation, particularly in cases with few residual atypical cells.
    Journal of Cutaneous Pathology 09/2009; 37(3):310-5. DOI:10.1111/j.1600-0560.2009.01421.x · 1.58 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The present manuscript gives emphasis on recognizing different morphological variants of atypical fibroxanthoma (AFX), on validation of immunohistochemical markers and on discussing potential diagnostic pitfalls. Histological features analyzed in 66 AFXs were: ulceration, morphological variants, growth pattern, location in the skin and vascular/perineural invasion. The antibodies used were CK-MNF116, CK-AE1/AE3, S100, smooth muscle actin, desmin, CD31 and EMA. The study included 59 males, 7 females, aged 55-95 years, mean 77 years. All developed on sun damaged skin. Ulceration was present in 50%. Morphological patterns were pleomorphic spindle and epithelioid cells (60.6%), predominantly spindle cells (19.7%), purely spindle-cells (13.6%), and predominantly epithelioid cells (6.1%). Most were localized in the dermis (57.6%). An expansile (36.4%) rather than infiltrative (6.1%) growth into superficial subcutis was also noted. No vascular/perineural invasion was seen. Additional changes were hemorrhagic and pseudoangiomatous areas (24.2%), granular cell change (22.7%), keloid-like areas (9.1%), myxoid change (7.6%), osteoclast-like giant cells (6.1%) and clear cell change (4.6%). AFXs were consistently negative for S100, CK-MNF116, CK-AE1/AE3 and desmin. Focal positivity for SMA (45.2%), EMA (24.4%) and CD 31 (9.5%) was seen. A diagnosis of AFX is still made by exclusion of other malignant neoplasms with similar morphology. Immunohistochemistry plays a crucial role in this distinction, but can also be misleading. This study expands the spectrum of non-vascular CD31 positive tumors.
    Journal of Cutaneous Pathology 10/2009; 37(3):301-9. DOI:10.1111/j.1600-0560.2009.01425.x · 1.58 Impact Factor
Show more