Article

Acral myxoinflammatory fibroblastic sarcoma fine needle aspiration: A case report

Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA.
Diagnostic Cytopathology (Impact Factor: 1.52). 08/2012; 40 Suppl 2(S2):E144-8. DOI: 10.1002/dc.21721
Source: PubMed

ABSTRACT Cytological diagnosis of low grade sarcomas can be a daunting task, owing to the varied cytomorphological appearances possible. We report a case of acral myxoinflammatory fibroblastic sarcoma (AMIFS) in a woman who presented with a longstanding mass on the dorsum of her left foot. The diagnosis was suggested by fine needle aspiration cytology and established by wide excision. Microscopic examination showed that fine needle aspirate smears of this lesion contained the characteristic features seen in the surgical excision of this AMIFS: myxoid material, spindled to epithelioid cells with variably prominent nucleoli, nuclear pseudoinclusions, bipolar cytoplasmic extensions, globules of extracellular material, and bizarre virocyte or ganglion-like giant cells.

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    • "1/9 0/9 1-60 Sakaki et al., 2003 [16] 5 15-75 5/5 Excision 2.7 2/4 1/4 8-58 Kusumi et al., 2005 [17] 1 58 1/1 Excision 4.9 0/1 0/1 12 Lang et al., 2006 [18] 5 22-66 4/5 Excision NA 0/5 0/5 14-22 Narvaez et al., 2007 [8] 4 22-66 3/4 Excision NA 0/4 0/4 NA Yasuda et al., 2007 [19] 1 68 1/1 Excision NA 0/1 0/1 48 Hassanein et al., 2008 [20] 5 39-65 5/5 3 excision, 1 amputation, 1 loss to follow-up 1.4.0 2/4 1/4 0.5-95 Kovarik et al., 2008 [12] 18 21-66 10/18 Excision 1.0-10.0 0/13 0/13 1-23 Chahdi et al., 2010 [21] 1 51 1/1 Excision 3 0/1 0/1 10 Fukasawa et al., 2012 [22] 1 48 1/1 Excision 2 0/1 0/1 24 Wickham et al., 2012 [23] 1 40 1/1 Excision 3.5 0/1 0/1 NA Ertener et al., 2013 [10] 1 53 1/1 Excision 2 0/1 0/1 7 Silver et al., 2013 [24] 1 33 1/1 Excision 2 1/1 0/1 60 Toll et al., 2013 [25] 3 40-70 3/3 2 excision, 1 amputation NA 1/3 0/3 24-84 Raghavan et al., 2012 [26] 1 50 1/1 Excision 6 0/1 0/1 24 "
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    ABSTRACT: Myxoinflammatory fibroblastic sarcoma (MIFS) is a rare low-grade, malignant soft tissue tumor that is usually observed in the extremities of adult patients. Magnetic resonance imaging (MRI) findings for this tumor type have rarely been reported. We report a case involving the distal left femur of a middle-aged man and tumoral invasion of the bone, which, to our knowledge, has been previously described only once. He was treated by distal femoral tumor resection and reconstruction with a modular prosthesis. Histopathologic diagnosis confirmed MIFS. We reviewed literature of the diagnostic imaging and bone invasion findings associated with this tumor type.
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    ABSTRACT: Background: Acral myxoinflammatory fibroblastic sarcoma (AMFS) is a rare low-grade sarcoma with somewhat unique morphologic characteristics. While recurrences are relatively common, distant metastases are infrequent. Cytopathologic descriptions of AMFS are limited, prompting the current study. Methods: A retrospective review was performed at two tertiary-care hospitals, and 3 patients with this diagnosis were identified. The cytopathologic and clinical features were reviewed. The following clinical data was collected for each case: age, gender, site of lesion, treatment, and follow-up information. Results: Pertinent cytologic features included large atypical epithelioid cells with occasional macronucleoli and lipoblast-like features in a background of bland spindle cells, myxoid stroma, and inflammation. All patients presented with acral mass lesions. Metastatic disease to an inguinal lymph node was found in 1 patient. Conclusions: AMFS is a low-grade sarcoma which shows some characteristic cytologic features. However, due to the presence of occasional bizarre and pleomorphic giant cells, there can be overlap with higher-grade sarcomas, and correlation with histology, immunohistochemistry, and imaging are required to make this diagnosis.
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