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Zhang B, Bai M, Tian R, Hao S. Idiopathic and radiation-induced myxofibrosarcoma in the head and neck-case report and literature review. Chin Neurosurg J 2021; 7:48. [PMID: 34823603 PMCID: PMC8620227 DOI: 10.1186/s41016-021-00267-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 11/08/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Myxofibrosarcoma (MFS), especially radiation-Induced MFS (RIMFS) in the head and neck, is an extremely rare malignant fibroblastic tumor. The diagnosis and treatment of MFS remain great challenges. In the present study, we presented one case of RIMFS. Combined with previous literature, the clinical features, essentials of diagnosis, and treatment modalities of MFS in the head and neck were reviewed to better understand this rare entity. CASE PRESENTATION We reported a case of RIMFS under the left occipital scalp in a 20-year-old girl with a history of medulloblastoma surgery and radiotherapy in 2006. A total tumor resection was performed with preservation of the overlying scalp the underlying bone, and no adjuvant therapy was administered after the first operation. The postoperative pathological diagnosis was high-grade MFS. The tumor relapsed 6 months later, and then, a planned extensive resection with negative surgical margins was carried out, followed by radiotherapy. No relapse occurred in a 12-month postoperative follow-up. CONCLUSIONS Planned gross total resection (GTR) with negative margins is the reasonable choice and footstone of other treatments for MFS. Ill-defined infiltrated borders and the complicated structures make it a great trouble to achieve total resection of MFS in the head and neck, so adjuvant radiotherapy and chemotherapy seem more necessary for these lesions.
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Affiliation(s)
- Bin Zhang
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, People's Republic of China
| | - Miao Bai
- Department of Neurology, Tang Du Hospital, Air Force Medical University, Xi'an, China
| | - Runfa Tian
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, People's Republic of China
| | - Shuyu Hao
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, People's Republic of China.
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Pagnoni C, Improta L, Alloni R, Mallozzi Santa Maria F, Aprile I, Brunetti B, Greco C, Vincenzi B, Gronchi A, Valeri S. Recurrent neck myxofibrosarcoma: a case report. J Med Case Rep 2021; 15:484. [PMID: 34593019 PMCID: PMC8485472 DOI: 10.1186/s13256-021-03053-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 08/10/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Myxofibrosarcoma (MFS) is a rare soft tissue sarcoma with a high recurrence rate and a low risk of distant metastasis. It occurs mainly in the extremities of elderly men. Head and neck MFS is extremely rare. Surgery is the cornerstone of treatment. The role of radiotherapy (RT) and chemotherapy (CHT) on MFS is still debated. CASE PRESENTATION A 67-year-old Caucasian man presented to our sarcoma referral center (SRC) with a history of MFS of the neck excised with microscopic positive surgical margins in a non-referral center. Staging imaging exams did not reveal distant metastasis. After a multidisciplinary discussion, preoperative RT was administered with a total dose of 50 Gy followed by wide surgical excision. Histological examination was negative for viable tumor cells. No relapse occurred during the 24-month postoperative follow-up. CONCLUSIONS The case described suggests the importance of planned combined treatments with both RT and surgery for high-grade soft tissue sarcoma. RT seems to be promising within this specific histotype. Close follow-up is advisable in all cases. Further studies are needed to confirm if the observed efficacy of combined treatments results in a prolonged time of disease-free survival and overall survival.
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Affiliation(s)
- Chiara Pagnoni
- Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 200 - 00128, Roma, RM, Italy
| | - Luca Improta
- Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 200 - 00128, Roma, RM, Italy.
| | - Rossana Alloni
- Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 200 - 00128, Roma, RM, Italy
| | | | - Irene Aprile
- IRCCS Fondazione Don Carlo Gnocchi-Onlus, Florence, Italy
| | - Beniamino Brunetti
- Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 200 - 00128, Roma, RM, Italy
| | - Carlo Greco
- Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 200 - 00128, Roma, RM, Italy
| | - Bruno Vincenzi
- Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 200 - 00128, Roma, RM, Italy
| | - Alessandro Gronchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian, 1, 20133, Milan, MI, Italy
| | - Sergio Valeri
- Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 200 - 00128, Roma, RM, Italy
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Dermawan JK, Whaley RD, Gjeorgjievski SG, Habeeb O, Billings SD. Primary sinonasal myxofibrosarcoma: a clinicopathological study of five cases and review of the literature. Pathology 2021; 54:63-70. [PMID: 34303554 DOI: 10.1016/j.pathol.2021.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/05/2021] [Accepted: 04/25/2021] [Indexed: 10/20/2022]
Abstract
Myxofibrosarcoma is a malignant pleomorphic fibroblastic sarcoma with variably myxoid stroma, and is characterised by a distinctive curvilinear vascular pattern. In the head and neck area, myxofibrosarcoma is extremely rare, with only a handful of case reports in the literature to date. We report the first case series of primary sinonasal myxofibrosarcoma across two institutions. Among the five cases (2 female, 3 males, aged 52-82 years old), four arose from the maxillary sinus and one from the sphenoid sinus. Four patients received surgical resection and three with adjuvant radiotherapy. The tumours ranged from 2.9 to 5.6 cm in greatest dimensions. All tumours demonstrated extensive myxoid stroma (>50% myxoid component) with a characteristic curvilinear, elongated, thin-walled vasculature with perivascular condensation of tumour cells. All but one were classified as intermediate to high grade myxofibrosarcoma. Among the four patients with follow-up information, three reported no local recurrence or distal metastasis, and one had local recurrence. Myxofibrosarcoma should be included in the differential diagnosis of sinonasal tumours with a pleomorphic spindle cell morphology and a 'null' immunophenotype.
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Affiliation(s)
- Josephine K Dermawan
- Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, OH, USA
| | - Rumeal D Whaley
- Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, OH, USA
| | | | - Omar Habeeb
- Department of Anatomic Pathology, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand
| | - Steven D Billings
- Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, OH, USA.
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Maxillary Sinus Myxofibrosarcoma Mimicking Nodular Fasciitis: A Rare Case Report. Head Neck Pathol 2021; 15:1372-1376. [PMID: 33544385 PMCID: PMC8633264 DOI: 10.1007/s12105-021-01298-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 01/20/2021] [Indexed: 10/22/2022]
Abstract
Myxofibrosarcoma (MFS) is a fibroblastic soft tissue sarcoma that is extremely rare in the maxillofacial region. Due to its non-specific clinicoradiographic findings and challenging histopathological features, the diagnosis is difficult. Here, we present a case of MFS which was first diagnosed as nodular fasciitis. The initial examination of the incisional biopsy showed a benign-appearing proliferation of fibroblasts without features of malignancy. The patient returned with recurrence four months after surgical excision of the primary lesion. The second histologic study revealed a high-grade spindle cell sarcoma with myxoid features most compatible with MFS. Definitive diagnosis of MFS was confirmed by these histopathologic features and supportive immunohistochemical stains. Unfortunately, the patient died of disease 3 months later.
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Deeb H, Ahmad A, AlAssaf A. Myxofibrosarcoma metastasis to the pterygopalatine fossa: A case report. Ann Med Surg (Lond) 2020; 60:102-105. [PMID: 33145016 PMCID: PMC7593232 DOI: 10.1016/j.amsu.2020.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/10/2020] [Accepted: 10/11/2020] [Indexed: 10/25/2022] Open
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Du B, He X, Wang Y, He W. Multiple recurrent myxofibrosarcoma of the orbit: case report and review of the literature. BMC Ophthalmol 2020; 20:264. [PMID: 32631312 PMCID: PMC7336468 DOI: 10.1186/s12886-020-01458-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 04/30/2020] [Indexed: 02/08/2023] Open
Abstract
Background Although myxofibrosarcoma (MFS) is the most common mesenchymal tumor, occurrence in the orbit is extremely rare. A characteristic clinical feature of MFS is its propensity for local recurrence (LR). Still, none of published literature has described the entire clinical course of multiple recurrences of MFS in the orbit. Here we present an unusual case in which a patient with multiple recurrences of MFS in the orbit followed-up for 5 years. We describe its clinical-pathological correlation, treatment, and prognosis. Case presentation A 70-year-old woman sought treatment for a year history of right upper eyelid swelling in May 2014. Since then, she underwent three surgical procedures in the right orbit in the same region (in 2014, 2016, and 2017). The pathology analysis of the three surgical tissue samples was consistent with myxofibrosarcoma, characterized by spindle-shaped cells and variably myxoid stroma. In the 2 years follow-up after the third surgery, there was no evidence of tumor recurrence. Conclusion Myxofibrosarcoma of the orbit is extremely rare. Since few reports are available in the literature, the diagnosis and management of the orbit myxofibrosarcoma is still a challenge to ophthalmologists. Histopathology is highly valuable in the diagnosis. As a clinical characteristic, the lesions have a high risk of local recurrence; therefore, aggressive resection and careful postoperative follow-up are paramount.
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Affiliation(s)
- Baixue Du
- Department of Ophthalmology, West China Hospital of Sichuan University, No. 37 Guoxue Xiang, Wuhou District, Chengdu, 610041, Sichuan Province, China
| | - Xin He
- Department of pathology, West China Hospital of Sichuan University, No. 37 Guoxue Xiang, Wuhou District, Chengdu, 610041, Sichuan Province, China
| | - Yujiao Wang
- Department of Ophthalmology, West China Hospital of Sichuan University, No. 37 Guoxue Xiang, Wuhou District, Chengdu, 610041, Sichuan Province, China
| | - Weimin He
- Department of Ophthalmology, West China Hospital of Sichuan University, No. 37 Guoxue Xiang, Wuhou District, Chengdu, 610041, Sichuan Province, China.
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