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Atypical Fibroxanthoma in a 115-Year-Old Patient.

Goktas FB, Akdeniz H, Ozer K, Unverdi H, Kocer U - Arch Plast Surg (2015)

View Article: PubMed Central - PubMed

Affiliation: Plastic, Reconstructive and Aesthetics Surgery Clinic, Ankara Research and Training Hospital, Ankara, Turkey.

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Atypical fibroxanthoma (AFX) is a rare, low-grade malignant mesenchymal neoplasm of the dermis... On immunohistochemical staining (Fig. 3), the tumor cells were positive for CD 68, vimentin, focal epithelial membrane antigen (EMA), and negative for S100 protein, desmin, pan-cytokeratin (CK), smooth muscle actin (SMA), myogenin, CK5/6, melan-A, human melanoma black (HMB) 45, and CD34... Spindle cell squamous cell carcinoma was excluded because of the negative results for pan-CK, p63, and CK 5/6; malignant melanoma was excluded by the negative results for S100, melan-A, and HMB 45; smooth muscle-origin tumors were excluded by the negative results for SMA and desmin; skeletal muscle tumors were excluded by the negative results for myogenin; and neuronal tumors were excluded by the negative results for S100... AFX is a pleomorphic spindle cell neoplasm of the dermis... AFX arises on sun-damaged skin of the head and neck, and it predominantly affects elderly (>70-year-old) male patients... A diagnosis of AFX also requires the absence of positive immunohistochemical staining for cytokeratins, S100, desmin, or CD34 in order to differentiate this tumor from other cancer types, including malignant melanoma, squamous cell carcinoma, and other non-melanocytic spindle cell tumors, such as leiomyosarcoma, rhabdomyosarcoma, angiosarcoma, liposarcoma, and dermatofibrosarcoma protuberans... Historically, AFX was considered to be a superficial variant of malignant fibrous histiocytoma (MFH)... If these criteria are followed, AFX shows an entirely benign clinical course after complete excision... As mentioned, complete excision is generally curative, as in our case... AFX generally has a good prognosis, with a low rate of recurrence, even so local recurrence has been described for lesions larger than 1.5-2.0 cm, as well as a low rate of lymph node metastasis... Surgery is the only treatment option... Complete excision with safety margins is recommended as a treatment strategy.

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The tumor cells showed strong positive immunostaining with CD68, as shown by the red arrow (×200).
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Figure 3: The tumor cells showed strong positive immunostaining with CD68, as shown by the red arrow (×200).

Mentions: A 115-year-old man presented to our outpatient clinic with an elevated, ulcerated, reddish, and shiny nodule on the right lateral side of the nose. The nodule was 3 cm×3 cm in diameter (Fig. 1). The lesion was asymptomatic and had grown within one year, with no history of local trauma. No other special findings were detected, and total excision was performed. A full-thickness skin graft harvested from the supraclavicular area was used to repair the skin defect. A histopathological examination of the biopsy indicated partial ulceration in the epidermis, invasion of the tumoral cells into the adipose tissue, and lymphocytic infiltration in the tumor base. Additionally, the tumor was made up of atypical spindle cells, mixed with pleomorphic cells that had lobulated hyperchromatic nuclei. Numerous mitotic figures and spotty necrosis were detected (Fig. 2). On immunohistochemical staining (Fig. 3), the tumor cells were positive for CD 68, vimentin, focal epithelial membrane antigen (EMA), and negative for S100 protein, desmin, pan-cytokeratin (CK), smooth muscle actin (SMA), myogenin, CK5/6, melan-A, human melanoma black (HMB) 45, and CD34. Spindle cell squamous cell carcinoma was excluded because of the negative results for pan-CK, p63, and CK 5/6; malignant melanoma was excluded by the negative results for S100, melan-A, and HMB 45; smooth muscle-origin tumors were excluded by the negative results for SMA and desmin; skeletal muscle tumors were excluded by the negative results for myogenin; and neuronal tumors were excluded by the negative results for S100. The patient was diagnosed with AFX. Local recurrence was not observed in a six-month follow-up examination.


Atypical Fibroxanthoma in a 115-Year-Old Patient.

Goktas FB, Akdeniz H, Ozer K, Unverdi H, Kocer U - Arch Plast Surg (2015)

The tumor cells showed strong positive immunostaining with CD68, as shown by the red arrow (×200).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4660002&req=5

Figure 3: The tumor cells showed strong positive immunostaining with CD68, as shown by the red arrow (×200).
Mentions: A 115-year-old man presented to our outpatient clinic with an elevated, ulcerated, reddish, and shiny nodule on the right lateral side of the nose. The nodule was 3 cm×3 cm in diameter (Fig. 1). The lesion was asymptomatic and had grown within one year, with no history of local trauma. No other special findings were detected, and total excision was performed. A full-thickness skin graft harvested from the supraclavicular area was used to repair the skin defect. A histopathological examination of the biopsy indicated partial ulceration in the epidermis, invasion of the tumoral cells into the adipose tissue, and lymphocytic infiltration in the tumor base. Additionally, the tumor was made up of atypical spindle cells, mixed with pleomorphic cells that had lobulated hyperchromatic nuclei. Numerous mitotic figures and spotty necrosis were detected (Fig. 2). On immunohistochemical staining (Fig. 3), the tumor cells were positive for CD 68, vimentin, focal epithelial membrane antigen (EMA), and negative for S100 protein, desmin, pan-cytokeratin (CK), smooth muscle actin (SMA), myogenin, CK5/6, melan-A, human melanoma black (HMB) 45, and CD34. Spindle cell squamous cell carcinoma was excluded because of the negative results for pan-CK, p63, and CK 5/6; malignant melanoma was excluded by the negative results for S100, melan-A, and HMB 45; smooth muscle-origin tumors were excluded by the negative results for SMA and desmin; skeletal muscle tumors were excluded by the negative results for myogenin; and neuronal tumors were excluded by the negative results for S100. The patient was diagnosed with AFX. Local recurrence was not observed in a six-month follow-up examination.

View Article: PubMed Central - PubMed

Affiliation: Plastic, Reconstructive and Aesthetics Surgery Clinic, Ankara Research and Training Hospital, Ankara, Turkey.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Atypical fibroxanthoma (AFX) is a rare, low-grade malignant mesenchymal neoplasm of the dermis... On immunohistochemical staining (Fig. 3), the tumor cells were positive for CD 68, vimentin, focal epithelial membrane antigen (EMA), and negative for S100 protein, desmin, pan-cytokeratin (CK), smooth muscle actin (SMA), myogenin, CK5/6, melan-A, human melanoma black (HMB) 45, and CD34... Spindle cell squamous cell carcinoma was excluded because of the negative results for pan-CK, p63, and CK 5/6; malignant melanoma was excluded by the negative results for S100, melan-A, and HMB 45; smooth muscle-origin tumors were excluded by the negative results for SMA and desmin; skeletal muscle tumors were excluded by the negative results for myogenin; and neuronal tumors were excluded by the negative results for S100... AFX is a pleomorphic spindle cell neoplasm of the dermis... AFX arises on sun-damaged skin of the head and neck, and it predominantly affects elderly (>70-year-old) male patients... A diagnosis of AFX also requires the absence of positive immunohistochemical staining for cytokeratins, S100, desmin, or CD34 in order to differentiate this tumor from other cancer types, including malignant melanoma, squamous cell carcinoma, and other non-melanocytic spindle cell tumors, such as leiomyosarcoma, rhabdomyosarcoma, angiosarcoma, liposarcoma, and dermatofibrosarcoma protuberans... Historically, AFX was considered to be a superficial variant of malignant fibrous histiocytoma (MFH)... If these criteria are followed, AFX shows an entirely benign clinical course after complete excision... As mentioned, complete excision is generally curative, as in our case... AFX generally has a good prognosis, with a low rate of recurrence, even so local recurrence has been described for lesions larger than 1.5-2.0 cm, as well as a low rate of lymph node metastasis... Surgery is the only treatment option... Complete excision with safety margins is recommended as a treatment strategy.

No MeSH data available.


Related in: MedlinePlus