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Low-grade myxofibrosarcoma following a metal implantation in femur: a case report.

Li W, Li D, Zhu X, Lu S, He C, Yang Q - Diagn Pathol (2014)

Bottom Line: Immunohistochemical studies revealed that the tumor cells was positive for VIM and MDM2, and was negative for CK, MSA, SMA, DES, S-100 and CD34.Labeling index of Ki-67 was 25%.The clinical and imaging examinations did not reveal the evidence of a primary cancer elsewhere, and the patient had no personal or family history of malignancy.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Pathology, Gannan Medical University, No, 1, Yixueyuan Road, Ganzhou, Jiangxi 341000, China. dan.li.liu@hotmail.com.

ABSTRACT

Unlabelled: Myxofibrosarcoma is a myxoid variant of malignant fibrous histiocytoma that most commonly involves the extremities of elderly people. However, a primary myxofibrosarcoma with bone invasion in young adults is extremely rare. Herein, we report the case of a 31-year-old male with a gradually enlarging left thigh mass, who had a history of left femur fracture and received an open reduction and internal fixation with titanium alloy plates and screws 33 months previously. Imaging investigations revealed an irregularly shaped soft tissue mass around the left femur shaft and a partial bone defect in the middle one-third of the left femur. Pathological examination of the resected specimen showed a multi-nodular appearance, abundant myxoid matrix and elongated curvilinear capillaries. Immunohistochemical studies revealed that the tumor cells was positive for VIM and MDM2, and was negative for CK, MSA, SMA, DES, S-100 and CD34. Labeling index of Ki-67 was 25%. Based on the morphological finding and immunostaining, it was diagnosed as a low-grade myxofibrosarcoma. The clinical and imaging examinations did not reveal the evidence of a primary cancer elsewhere, and the patient had no personal or family history of malignancy. To our knowledge, this is the first case of a primary myxofibrosarcoma developed following a fracture and metal implantation in young adults.

Virtual slides: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1745984882113605.

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MRI images of the thigh. (a) Transverse T2-weighted image. (b) Coronal T1-weighted image. MRI images showed an irregular soft tissue mass with ill-defined margin in the anteromedial left thigh (yellow arrow), accompanied by surrounding soft tissue swelling and normal muscle structure disappearance. Bone destruction in the left femur shaft was observed (light blue arrow).
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Figure 4: MRI images of the thigh. (a) Transverse T2-weighted image. (b) Coronal T1-weighted image. MRI images showed an irregular soft tissue mass with ill-defined margin in the anteromedial left thigh (yellow arrow), accompanied by surrounding soft tissue swelling and normal muscle structure disappearance. Bone destruction in the left femur shaft was observed (light blue arrow).

Mentions: However, in June 2013, only 22 months after tumor resection, a firm and painless mass approximately 5 cm in diameter was palpated in the medial left thigh. Magnetic resonance imaging (MRI) showed an irregular soft tissue mass with ill-defined margin in the anteromedial left thigh, accompanied by surrounding soft tissue swelling and normal muscle structure disappearance. Additionally, bone destruction in the left femur shaft was also observed (Figure 4). Tissue biopsy was performed and histopathological examination showed that the tumor exhibited the classical histological features of myxofibrosarcoma, including a nodular appearance, prominent myxoid matrix and elongated curvilinear capillaries. The morphology of the tumor cells varied from small and bland to enlarged, bizarre, pleomorphic and multinucleated, suggesting increased atypia and pleomorphism compared with those in the primary tumor (Figure 5). The combination of clinical and pathological features revealed a recurrent myxofibrosarcoma with higher malignancy. There was no evidence of distant metastasis. The patient eventually underwent left hip disarticulation due to the inability to control the tumor progression.


Low-grade myxofibrosarcoma following a metal implantation in femur: a case report.

Li W, Li D, Zhu X, Lu S, He C, Yang Q - Diagn Pathol (2014)

MRI images of the thigh. (a) Transverse T2-weighted image. (b) Coronal T1-weighted image. MRI images showed an irregular soft tissue mass with ill-defined margin in the anteromedial left thigh (yellow arrow), accompanied by surrounding soft tissue swelling and normal muscle structure disappearance. Bone destruction in the left femur shaft was observed (light blue arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3926977&req=5

Figure 4: MRI images of the thigh. (a) Transverse T2-weighted image. (b) Coronal T1-weighted image. MRI images showed an irregular soft tissue mass with ill-defined margin in the anteromedial left thigh (yellow arrow), accompanied by surrounding soft tissue swelling and normal muscle structure disappearance. Bone destruction in the left femur shaft was observed (light blue arrow).
Mentions: However, in June 2013, only 22 months after tumor resection, a firm and painless mass approximately 5 cm in diameter was palpated in the medial left thigh. Magnetic resonance imaging (MRI) showed an irregular soft tissue mass with ill-defined margin in the anteromedial left thigh, accompanied by surrounding soft tissue swelling and normal muscle structure disappearance. Additionally, bone destruction in the left femur shaft was also observed (Figure 4). Tissue biopsy was performed and histopathological examination showed that the tumor exhibited the classical histological features of myxofibrosarcoma, including a nodular appearance, prominent myxoid matrix and elongated curvilinear capillaries. The morphology of the tumor cells varied from small and bland to enlarged, bizarre, pleomorphic and multinucleated, suggesting increased atypia and pleomorphism compared with those in the primary tumor (Figure 5). The combination of clinical and pathological features revealed a recurrent myxofibrosarcoma with higher malignancy. There was no evidence of distant metastasis. The patient eventually underwent left hip disarticulation due to the inability to control the tumor progression.

Bottom Line: Immunohistochemical studies revealed that the tumor cells was positive for VIM and MDM2, and was negative for CK, MSA, SMA, DES, S-100 and CD34.Labeling index of Ki-67 was 25%.The clinical and imaging examinations did not reveal the evidence of a primary cancer elsewhere, and the patient had no personal or family history of malignancy.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Pathology, Gannan Medical University, No, 1, Yixueyuan Road, Ganzhou, Jiangxi 341000, China. dan.li.liu@hotmail.com.

ABSTRACT

Unlabelled: Myxofibrosarcoma is a myxoid variant of malignant fibrous histiocytoma that most commonly involves the extremities of elderly people. However, a primary myxofibrosarcoma with bone invasion in young adults is extremely rare. Herein, we report the case of a 31-year-old male with a gradually enlarging left thigh mass, who had a history of left femur fracture and received an open reduction and internal fixation with titanium alloy plates and screws 33 months previously. Imaging investigations revealed an irregularly shaped soft tissue mass around the left femur shaft and a partial bone defect in the middle one-third of the left femur. Pathological examination of the resected specimen showed a multi-nodular appearance, abundant myxoid matrix and elongated curvilinear capillaries. Immunohistochemical studies revealed that the tumor cells was positive for VIM and MDM2, and was negative for CK, MSA, SMA, DES, S-100 and CD34. Labeling index of Ki-67 was 25%. Based on the morphological finding and immunostaining, it was diagnosed as a low-grade myxofibrosarcoma. The clinical and imaging examinations did not reveal the evidence of a primary cancer elsewhere, and the patient had no personal or family history of malignancy. To our knowledge, this is the first case of a primary myxofibrosarcoma developed following a fracture and metal implantation in young adults.

Virtual slides: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1745984882113605.

Show MeSH
Related in: MedlinePlus