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Subcutaneous angiomatoid fibrous histiocytoma mimicking metastatic melanoma.

Sparreboom E, Wetzels C, Verdijk M, Mulder S, Blokx W - Case Rep Pathol (2012)

Bottom Line: We present a case of angiomatoid fibrous histiocytoma on the upper arm of a 40-year-old female, which was initially misdiagnosed as metastatic melanoma in a lymph node.Revision of the pathology revealed an angiomatoid fibrous histiocytoma, which was later confirmed by a EWSR1-CREB1 translocation with molecular diagnostics.Furthermore, we review the relevant literature and provide an overview of all available case reports in the past ten years.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Radboud University Nijmegen Medical Centre, P.O. Box 9100, 6500 HB Nijmegen, The Netherlands.

ABSTRACT
Angiomatoid fibrous histiocytoma is an uncommon soft-tissue tumor of intermediate malignancy that is often misdiagnosed initially. As there is not one immunohistochemical marker that consequently stains positive or negative for angiomatoid fibrous histiocytoma, molecular diagnostics are becoming more widely used. So far three translocations have been reported to arise in angiomatoid fibrous histiocytoma: FUS-ATF1, EWSR1-CREB1, or EWSR1-ATF1. We present a case of angiomatoid fibrous histiocytoma on the upper arm of a 40-year-old female, which was initially misdiagnosed as metastatic melanoma in a lymph node. Revision of the pathology revealed an angiomatoid fibrous histiocytoma, which was later confirmed by a EWSR1-CREB1 translocation with molecular diagnostics. Furthermore, we review the relevant literature and provide an overview of all available case reports in the past ten years. This case report illustrates the importance for pathologists of knowing the typical pathology features of AFH and integrating immunohistochemical and molecular findings in order to prevent overdiagnosis of lymph node metastasis of a malignancy.

No MeSH data available.


Related in: MedlinePlus

(a) Pathologic review of the tumor showed fibrous septa and nodular texture surrounded by lymphocytic infiltrate. Hematoxylin and eosin stain (12, 5x). (b) Detail image showing the absence of a capsular sinus. Hematoxylin and eosin stain (25x). (c) Image of excised tumor showing fibrous septa and nodular texture surrounded by lymphocytic infiltrate. Hematoxylin and eosin stain (12, 5x). (d) Detail image showing reticular appearance and atypical cytomorphology. Hematoxylin and eosin stain (100x).
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fig1: (a) Pathologic review of the tumor showed fibrous septa and nodular texture surrounded by lymphocytic infiltrate. Hematoxylin and eosin stain (12, 5x). (b) Detail image showing the absence of a capsular sinus. Hematoxylin and eosin stain (25x). (c) Image of excised tumor showing fibrous septa and nodular texture surrounded by lymphocytic infiltrate. Hematoxylin and eosin stain (12, 5x). (d) Detail image showing reticular appearance and atypical cytomorphology. Hematoxylin and eosin stain (100x).

Mentions: A gray tan nodule measuring 1.2 cm was excised from the subcutaneous fat of the patients' left upper arm. Pathology revealed a radically excised structure resembling a lymph node in which a tumoral process was seen, consisting of a diffuse proliferation of atypical spindle cells. The atypia was specified by undefined cell borders, an amphophilic cytoplasm, large polygonal nuclei and several in part atypical mitoses (Figure 1(d)). Complementary immunohistochemical stains were negative for HMB-45, KL1, cytokeratin AE1/3, and SMa. There was focal positivity for S100 and Melan A (Figure 2(a)) leading to a presumptive diagnosis elsewhere of a melanoma metastasis.


Subcutaneous angiomatoid fibrous histiocytoma mimicking metastatic melanoma.

Sparreboom E, Wetzels C, Verdijk M, Mulder S, Blokx W - Case Rep Pathol (2012)

(a) Pathologic review of the tumor showed fibrous septa and nodular texture surrounded by lymphocytic infiltrate. Hematoxylin and eosin stain (12, 5x). (b) Detail image showing the absence of a capsular sinus. Hematoxylin and eosin stain (25x). (c) Image of excised tumor showing fibrous septa and nodular texture surrounded by lymphocytic infiltrate. Hematoxylin and eosin stain (12, 5x). (d) Detail image showing reticular appearance and atypical cytomorphology. Hematoxylin and eosin stain (100x).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3539338&req=5

fig1: (a) Pathologic review of the tumor showed fibrous septa and nodular texture surrounded by lymphocytic infiltrate. Hematoxylin and eosin stain (12, 5x). (b) Detail image showing the absence of a capsular sinus. Hematoxylin and eosin stain (25x). (c) Image of excised tumor showing fibrous septa and nodular texture surrounded by lymphocytic infiltrate. Hematoxylin and eosin stain (12, 5x). (d) Detail image showing reticular appearance and atypical cytomorphology. Hematoxylin and eosin stain (100x).
Mentions: A gray tan nodule measuring 1.2 cm was excised from the subcutaneous fat of the patients' left upper arm. Pathology revealed a radically excised structure resembling a lymph node in which a tumoral process was seen, consisting of a diffuse proliferation of atypical spindle cells. The atypia was specified by undefined cell borders, an amphophilic cytoplasm, large polygonal nuclei and several in part atypical mitoses (Figure 1(d)). Complementary immunohistochemical stains were negative for HMB-45, KL1, cytokeratin AE1/3, and SMa. There was focal positivity for S100 and Melan A (Figure 2(a)) leading to a presumptive diagnosis elsewhere of a melanoma metastasis.

Bottom Line: We present a case of angiomatoid fibrous histiocytoma on the upper arm of a 40-year-old female, which was initially misdiagnosed as metastatic melanoma in a lymph node.Revision of the pathology revealed an angiomatoid fibrous histiocytoma, which was later confirmed by a EWSR1-CREB1 translocation with molecular diagnostics.Furthermore, we review the relevant literature and provide an overview of all available case reports in the past ten years.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Radboud University Nijmegen Medical Centre, P.O. Box 9100, 6500 HB Nijmegen, The Netherlands.

ABSTRACT
Angiomatoid fibrous histiocytoma is an uncommon soft-tissue tumor of intermediate malignancy that is often misdiagnosed initially. As there is not one immunohistochemical marker that consequently stains positive or negative for angiomatoid fibrous histiocytoma, molecular diagnostics are becoming more widely used. So far three translocations have been reported to arise in angiomatoid fibrous histiocytoma: FUS-ATF1, EWSR1-CREB1, or EWSR1-ATF1. We present a case of angiomatoid fibrous histiocytoma on the upper arm of a 40-year-old female, which was initially misdiagnosed as metastatic melanoma in a lymph node. Revision of the pathology revealed an angiomatoid fibrous histiocytoma, which was later confirmed by a EWSR1-CREB1 translocation with molecular diagnostics. Furthermore, we review the relevant literature and provide an overview of all available case reports in the past ten years. This case report illustrates the importance for pathologists of knowing the typical pathology features of AFH and integrating immunohistochemical and molecular findings in order to prevent overdiagnosis of lymph node metastasis of a malignancy.

No MeSH data available.


Related in: MedlinePlus