-
European Journal of Surgical Oncology :... Jul 2019Despite the overall diagnostic utility of core needle biopsy (CNB) comparable to incisional biopsy, increased diagnostic errors have been suggested of CNB for myxoid... (Comparative Study)
Comparative Study
BACKGROUND
Despite the overall diagnostic utility of core needle biopsy (CNB) comparable to incisional biopsy, increased diagnostic errors have been suggested of CNB for myxoid soft tissue tumors. This study compared the diagnostic performance of CNB between myxoid and non-myxoid soft tissue tumors.
METHODS
369 patients who underwent ultrasound-guided CNB prior to resection for soft tissue tumors were classified into two groups according to resection pathology; myxoid group (n = 75) and non-myxoid group (n = 294). One-hundred and ninety-three patients were male and the median age of the patients was 40 years. Two-hundred and sixty-three tumors were malignant.
RESULTS
CNB correctly diagnosed malignancy in 84% (58 of 69) for the myxoid group and 95% (184 of 194) for the non-myxoid group. For diagnosing histologic grade of soft tissue sarcoma, CNB correctly identified high grade in 78% (18 of 23) for the myxoid group and 74% (94 of 128) for the non-myxoid group. Correct diagnosis rate of histological type was significantly lower in the myxoid group (63% [47 of 75] in the myxoid group and 83% [242 of 294] in the non-myxoid group, p = 0.013).
CONCLUSION
Our study suggests that CNB is useful for myxoid soft tissue tumors of the extremity, with regard to diagnosing malignancy and histologic grade. However, CNB was less useful for identifying histologic subtype in myxoid tumors than in non-myxoid tumors.
Topics: Adult; Aged; Biopsy, Large-Core Needle; Chondrosarcoma; Diagnostic Errors; Female; Fibroma; Fibrosarcoma; Humans; Leiomyosarcoma; Liposarcoma, Myxoid; Male; Middle Aged; Myxoma; Myxosarcoma; Neoplasm Grading; Neoplasms, Connective and Soft Tissue; Neurilemmoma; Neurofibrosarcoma; Sarcoma; Sarcoma, Ewing; Sarcoma, Synovial; Sensitivity and Specificity; Soft Tissue Neoplasms; Tumor Burden
PubMed: 31085026
DOI: 10.1016/j.ejso.2019.05.001 -
Journal of Medical Case Reports Mar 2017Myxofibrosarcoma is an aggressive soft tissue neoplasm, classified as a variant of malignant fibrous histiocytoma. Most often, it occurs in middle to late adult life...
BACKGROUND
Myxofibrosarcoma is an aggressive soft tissue neoplasm, classified as a variant of malignant fibrous histiocytoma. Most often, it occurs in middle to late adult life peaking in the seventh decade and involving the lower extremities (77%), trunk (12%), and retroperitoneum or mediastinum (8%). We report the first case of thoracic myxofibrosarcoma presenting as a Pancoast tumor.
CASE PRESENTATION
A 48-year-old non-tobacco smoking African-American man presented with a slow-growing mass in his neck along with 11 kg weight loss over 9 months. A review of his systems was positive for hoarseness and lowgrade intermittent fever without any shortness of breath or cough. A physical examination revealed a mass on the left side of his neck superior to his sternoclavicular joint measuring 3 × 3 × 1 cm. He had ptosis and miosis of his left eye. His breath sounds were decreased and coarse at the left apex. A neurological examination revealed 3/5 strength in his left upper arm. The remainder of the physical examination was unremarkable. Ultrasound of his neck showed an ill-defined heterogeneous mass lateral to his left thyroid lobe. A computed tomography scan of his chest showed a large multiloculated pleural-based mass in his left lung surrounding the adjacent neurovascular structures. A percutaneous biopsy was non-diagnostic. Subsequently, he underwent a left thoracotomy with biopsy. The mass extended from his anterior mediastinum medially at the level of the pulmonary trunk, superiorly into the superior sulcus and posteriorly into his chest wall. Surgical pathology confirmed the diagnosis of myxofibrosarcoma.
CONCLUSIONS
Here we present a case of Pancoast tumor with myxofibrosarcoma as the underlying etiology. Pancoast syndrome generally entails an infiltrating lesion in the superior sulcus presenting with upper extremity pain, atrophy of the hand muscles, and Horner's syndrome. The differential diagnosis of Pancoast syndrome includes inflammatory and infectious etiologies, as well as neoplasms of benign and malignant nature. Of the neoplasms implicated, the most common are non-small cell lung carcinomas; myxofibrosarcoma presenting as a Pancoast tumor has not been reported in the literature.
Topics: Antineoplastic Agents, Alkylating; Biopsy, Large-Core Needle; Blepharoptosis; Fibrosarcoma; Head and Neck Neoplasms; Humans; Ifosfamide; Male; Middle Aged; Miosis; Myxosarcoma; Pancoast Syndrome; Soft Tissue Neoplasms; Tomography, X-Ray Computed; Treatment Outcome; Weight Loss
PubMed: 28264709
DOI: 10.1186/s13256-017-1223-5 -
Journal of Surgical Oncology Feb 2021Myxofibrosarcoma (MFS) is an aggressive soft tissue tumor with an unpredictable recurrence pattern. We sought to (a) determine whether margin status in MFS is correlated...
BACKGROUND AND OBJECTIVES
Myxofibrosarcoma (MFS) is an aggressive soft tissue tumor with an unpredictable recurrence pattern. We sought to (a) determine whether margin status in MFS is correlated to rates of local recurrence (LR) and (b) identify demographic and treatment variables associated with disease-related outcomes in this population.
METHODS
This retrospective study identified 42 surgically treated patients with MFS over 10 years at a single institution. Patient demographics, tumor characteristics, intraoperative variables, and disease-related outcomes were recorded.
RESULTS
Thirty-three (83%) patients had negative surgical margins and seven (18%) had positive margins. Four of 32 patients (13%) with negative margins developed subsequent LR compared to six of seven (86%) patients with positive margins (p < .001). Three patients (75%) with metastatic disease were deceased at the end of the study, while five (15%) without metastasis were deceased (p = .024).
CONCLUSIONS
Positive margin procedures for MFS were associated with LR. However, negative surgical margins demonstrated a relatively high rate of LR compared to other soft tissue sarcoma subtypes. Furthermore, though MFS tends to locally recur and have a propensity for distant metastasis, patients are observed to have a higher probability of death from other causes.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Female; Fibrosarcoma; Follow-Up Studies; Humans; Male; Margins of Excision; Middle Aged; Myxosarcoma; Neoplasm Recurrence, Local; Prognosis; Prospective Studies; Retrospective Studies; Survival Rate; Young Adult
PubMed: 33125727
DOI: 10.1002/jso.26277 -
Skeletal Radiology Oct 2019Myxofibrosarcoma is a malignant fibroblastic soft tissue neoplasm containing a variable amount of myxoid stroma that commonly presents as a slow-growing mass in elderly...
Myxofibrosarcoma is a malignant fibroblastic soft tissue neoplasm containing a variable amount of myxoid stroma that commonly presents as a slow-growing mass in elderly patients. The neoplasm may be superficial or deep to the muscle fascia and characteristically has an infiltrative growth pattern with a dominant or multinodular mass. We describe an unusual case of high-grade myxofibrosarcoma of the wrist and forearm that infiltrated the muscles, tendons, and wrist joint, causing bone erosions. The tumor was mistakenly diagnosed as synovitis and a chronic, erosive, inflammatory process. The diffuse nature, absence of a dominant mass, and radiographic appearance complicated the diagnosis. Although neoplasms of the synovial spaces are rare, this case demonstrates that tumors with a highly infiltrative growth pattern can mimic inflammatory synovitis and that neoplasms should be considered in the differential diagnosis when clinical and laboratory features are discordant with the imaging appearance.
Topics: Aged; Amputation, Surgical; Arthritis; Diagnosis, Differential; Female; Fibrosarcoma; Humans; Magnetic Resonance Imaging; Muscle Neoplasms; Myxosarcoma; Radiography; Upper Extremity
PubMed: 30989248
DOI: 10.1007/s00256-019-03217-w -
Brachytherapy 2016Prior studies illustrated a reduction in wound complications with the use of staged reconstruction (SR) and negative pressure wound therapy when treating soft tissue...
PURPOSE
Prior studies illustrated a reduction in wound complications with the use of staged reconstruction (SR) and negative pressure wound therapy when treating soft tissue sarcoma (STS) with surgical resection followed by high-dose-rate adjuvant brachytherapy. The purpose of this study is to compare the outcomes of SR and immediate reconstruction (IR) brachytherapy in recurrent STS.
METHODS AND MATERIALS
A retrospective review of 40 patients with recurrent STS of the local extremity and trunk treated with resection followed by adjuvant brachytherapy alone. Margin status was defined as positive (SM(+)) if there was microscopic involvement (R1) or ≤1 mm margin and negative (SM(-)) if >1 mm margin was obtained. SR and IR were compared regarding toxicity, local control, and limb preservation.
RESULTS
Median followup was 27 months. When comparing the SR (n = 22) and IR (n = 18) cohorts, there was a significantly lower final SM(+) rate in SR (32% vs. 83%, p < 0.01). A 2-year local control benefit seen with SR (80% vs. 34%; p = 0.012) and a final SM(-) (81% vs. 39%; p = 0.023). SR was associated with less toxicity on multivariate analysis, including a 90% decrease in persistent edema, an 80% decrease in wound dehiscence, and a 94% decrease in nonhealing wounds, when compared to IR. Ten of 31 (32%) extremity cases required eventual amputation from either chronic wound complications (n = 4) or local recurrence (n = 6). SR predicted for a benefit in 2-year limb preservation (88% vs. 50%; p = 0.008).
CONCLUSION
In our series, the treatment with SR brachytherapy resulted in less morbidity and an improved final SM(-) rate. This technique translated to an improvement in both local control and limb preservation of recurrent STS.
Topics: Adult; Aged; Aged, 80 and over; Brachytherapy; Extremities; Female; Fibrosarcoma; Follow-Up Studies; Humans; Liposarcoma; Male; Margins of Excision; Middle Aged; Multivariate Analysis; Myxosarcoma; Negative-Pressure Wound Therapy; Neoplasm Recurrence, Local; Radiotherapy Dosage; Radiotherapy, Adjuvant; Plastic Surgery Procedures; Retrospective Studies; Sarcoma; Soft Tissue Neoplasms; Surgical Flaps; Time Factors; Wound Healing; Young Adult
PubMed: 27180128
DOI: 10.1016/j.brachy.2016.03.013 -
Oncology Research and Treatment 2020The aim of this retrospective study is to verify whether preoperative systemic inflammatory markers (serum C-reactive protein [CRP] and neutrophil-lymphocyte ratio...
BACKGROUND
The aim of this retrospective study is to verify whether preoperative systemic inflammatory markers (serum C-reactive protein [CRP] and neutrophil-lymphocyte ratio [NLR]) can help in predicting the disease-specific survival (DSS) and local recurrence (LR) rate in adult patients affected by localized myxofibrosarcoma (MFS) of the extremities.
METHODS
We reviewed 126 adult patients with primary, localized MFS of the limbs. We analyzed DSS and LR.
RESULTS
Median age at the time of surgery was 68 years (range 19-92). Median CRP was 0.4 mg/dL and median NLR was 2.8. A worse DSS was found in patients who had preoperative CRP >0.5 mg/dL (p = 0.002) and in those with NLR >3.5 (p < 0.001). In multivariate analysis, tumor size and grade as well as preoperative CRP values and NLR were confirmed to be prognostic factors in terms of DSS. An increased risk of LR was found in multivariate analysis in patients with a tail sign and with high gadolinium enhancement at preoperative MRI.
CONCLUSIONS
Patients with high preoperative CRP and NLR levels, as well as large and high-grade tumors, might be considered as candidates for additional, more aggressive treatment approaches or more stringent follow-up schedules.
Topics: Adult; Aged; Aged, 80 and over; Biomarkers; C-Reactive Protein; Extremities; Female; Fibrosarcoma; Humans; Inflammation; Lymphocytes; Male; Middle Aged; Multivariate Analysis; Myxosarcoma; Neoplasm Recurrence, Local; Neutrophils; Preoperative Period; Prognosis; Retrospective Studies; Soft Tissue Neoplasms; Survival Rate; Young Adult
PubMed: 32810863
DOI: 10.1159/000509429 -
Cancer Research and Treatment Oct 2018Myxofibrosarcoma is a rare tumor, refractory to cytotoxic chemotherapy and radiotherapy. Pembrolizumab is an innovative immunotherapy drug consisting of programmed death...
Myxofibrosarcoma is a rare tumor, refractory to cytotoxic chemotherapy and radiotherapy. Pembrolizumab is an innovative immunotherapy drug consisting of programmed death receptor ligand 1 antibody proven to be useful for numerous types of cancer cells. A patient had been diagnosed with metastatic myxofibrosarcoma, refractory to radiotherapy and conventional cytotoxic chemotherapy. The patient achieved a partial response during palliative chemotherapy with pembrolizumab for 14 cycles. To the best of our knowledge, this is the first case report demonstrating the efficacy of pembrolizumab for refractory myxofibrosarcoma.
Topics: Antibodies, Monoclonal, Humanized; Antineoplastic Agents, Immunological; Fibrosarcoma; Humans; Male; Middle Aged; Myxosarcoma; Neoplasm Metastasis; Palliative Care; Treatment Outcome
PubMed: 29361819
DOI: 10.4143/crt.2017.529 -
Medicine Dec 2017Fibromyxosarcoma is common in head and neck, vessel, omentum, and reproductive system, with low-grade malignant behavior. However, primary atrial fibromyxosarcoma with...
RATIONALE
Fibromyxosarcoma is common in head and neck, vessel, omentum, and reproductive system, with low-grade malignant behavior. However, primary atrial fibromyxosarcoma with highly malignant behavior is extremely rare.
PATIENT CONCERNS
A 34-year-old female presented with oppression in the chest, short breath, and onset of headache as initial symptoms. The preoperative echocardiogram showed a medium-size echogenic mass close to the posterior leaflet of the mitral valve in the left atrium.
DIAGNOSIS
Primary atrial fibromyxosarcoma with multiple-system metastases.
INTERVENTIONS
The patient underwent surgery, and the tumor was removed completely. The diagnosis of left atrium fibromyxosarcoma was confirmed through postoperative histopathological examination. Positron emission tomography/computed tomography scan was performed, which revealed multiple metastases to left adnexa, bilateral adrenal glands, left iliacus, right lateral ventricle, and skeletal system.
OUTCOMES
The patient died of cerebral hernia caused by hemorrhage from the metastatic brain tumor, 30 days after the surgery, without receiving chemotherapy or radiotherapy.
LESSONS
Cardiac fibromyxosarcoma is a rare primary malignant cardiac neoplasm, probably with systemic metastases. The possibility of malignancy should be considered as differential diagnosis for cardiac mass.
Topics: Adult; Echocardiography; Fatal Outcome; Female; Heart Atria; Heart Neoplasms; Humans; Myxosarcoma; Neoplasm Metastasis; Positron Emission Tomography Computed Tomography
PubMed: 29245258
DOI: 10.1097/MD.0000000000008930 -
Journal of Veterinary Emergency and... 2014To describe the clinical presentation, treatment, and outcome of a dog with an arterial tumor embolism.
OBJECTIVE
To describe the clinical presentation, treatment, and outcome of a dog with an arterial tumor embolism.
CASE SUMMARY
An 11-year-old, neutered male Irish Setter presented with acute right forelimb lameness. The dog was unable to bear weight on the right forelimb, which was cool to the touch with no palpable pulses. Diagnosis of thromboembolism was confirmed using angiography, revealing a lack of blood flow to the right axillary artery. Balloon angioplasty, thrombosuction, and infusion of the thromboembolism with tissue plasminogen activator were used to achieve increased, but not complete, blood flow through the vasculature. Echocardiogram revealed vegetative mitral valve lesions consistent with endocarditis, thrombus, neoplasia, or a combination thereof. At the time of discharge, there was improvement in the temperature and motor function of the proximal limb but no conscious proprioception or deep pain sensation in the distal limb. Histopathologic analysis of the sample retrieved with thrombosuction was consistent with a diagnosis of myxosarcoma. A series of 3 rechecks showed continued improvement in neuromuscular function. Treatment for suspected mitral valve myxosarcoma was declined. The patient was lost to follow up until being presented for necropsy 16 months later. Necropsy confirmed myxosarcoma of the mitral valve with tumor emboli to the coronary arteries, lungs, and the right axillary artery.
UNIQUE INFORMATION PROVIDED
To the authors' knowledge, there is no report of myxosarcoma originating on the mitral valve in dogs, although it has been reported in the human literature. To the authors' knowledge, there are also no reports of tumor embolism of the axillary artery in a dog. This case demonstrates a unique presentation of a dog that had a myxosarcoma tumor embolism. It also describes the use of angiography for diagnosis and localization of the vascular obstruction and a variety of interventional techniques for the treatment of thromboembolism.
Topics: Angioplasty, Balloon; Animals; Axillary Artery; Diagnosis, Differential; Dog Diseases; Dogs; Echocardiography; Forelimb; Heart Neoplasms; Lameness, Animal; Male; Mitral Valve; Myxosarcoma; Thromboembolism
PubMed: 25471647
DOI: 10.1111/vec.12247 -
Intracranial Low-Grade Fibromyxoid Sarcoma: Findings on Electron Microscopy and Histologic Analysis.World Neurosurgery Mar 2020Low-grade fibromyxoid sarcoma is a rare tumor that manifests as a deep soft tissue mass characterized by a benign histology, but with potentially aggressive clinical...
BACKGROUND
Low-grade fibromyxoid sarcoma is a rare tumor that manifests as a deep soft tissue mass characterized by a benign histology, but with potentially aggressive clinical behavior and a high rate of recurrence; primary intracranial sarcomas are even rarer. We present a case of primary intracranial low-grade fibromyxoid sarcoma, emphasizing its clinical, radiologic, and histologic features.
CASE DESCRIPTION
A 39-year-old woman presented with a recent history of headache and seizures. A right parietal mass was detected on computed tomography and magnetic resonance imaging, and she was subsequently operated on to remove the intracranial mass. Histologic examination of the resected tumor revealed mildly atypical fibroblastic cells embedded within a myxoid matrix. The diagnosis was confirmed by electron microscopy and cytogenetic analyses.
CONCLUSIONS
This report describes electron microscopic evaluation of intracranial low-grade fibromyxoid sarcoma, which has an extremely rare occurrence.
Topics: Adult; Brain Neoplasms; Female; Fibrosarcoma; Humans; Microscopy, Electron; Myxosarcoma; Neoplasm Grading; Sarcoma
PubMed: 31899392
DOI: 10.1016/j.wneu.2019.12.135