A case of cutaneous malignant fibrous histiocytoma

Surgical excision margins for fibrohistiocytic tumors, including atypical fibroxanthoma and undifferentiated pleomorphic sarcoma: A probability model based on a systematic review

BACKGROUND

Mohs micrographic surgery or wide local excision is the treatment of choice for fibrohistiocytic tumors with metastatic potential, including atypical fibroxanthoma (AFX) and cutaneous undifferentiated pleomorphic sarcoma (cUPS). Since margin clearance is the strongest predictor of clinical recurrence, improved recommendations for appropriate surgical margins help delineate uniform excision margins when intraoperative margin assessment is not available.

OBJECTIVE

To determine appropriate surgical wide local excision margins for AFX and cUPS.

METHODS

Literature search (Ovid MEDLINE, Embase, Web of Science, and Cochrane Library from inception to March 2020) to detect case-level data. Estimation of margins required using a mathematical model based on extracted cases without recurrences.

RESULTS

Probabilistic modeling based on 100 cases extracted from 37 studies showed peripheral clearance margin (ie, wide local excision margin) calculated to clear 95% of all tumors was 2 cm for AFX and 3 cm for cUPS. AFX tumors 1 cm or less required a margin of 1 cm.

LIMITATIONS

Data were extracted from published cases.

CONCLUSIONS

Atypical fibroxanthoma removed with at least a 2-cm peripheral excision margin is less likely to recur. Smaller tumors 1 cm or less can be treated with a more conservative margin. Margin-control surgical techniques are recommended to ensure complete removal while minimizing surgical morbidity.

Cutaneous inflammatory malignant fibrous histiocytoma presenting with a leukemoid reaction: a case report and review of the literature

Malignant fibrous histiocytoma (MFH) is the most common sarcoma found in adults. We discuss a case of inflammatory MFH of dermal/epidermal origin presenting with a severe leukemoid reaction (LR). A 60 years old white male presented to hematology/oncology clinic complaining of mild shortness of breath on exertion. Past medical history was remarkable for removal of a left upper extremity necrotic mass 4.4 × 3 × 3 cm. Microscopy of the specimen showed clear surgical margin, and tumor cells restricted to the dermis without lymphovascular invasion. Immunohistochemestry was positive for CD 68 and CD 99. Chest x-ray was negative for metastatic disease. White blood cell count was 109.4 k/mm(3) with 24 k/mm(3) band neutrophils, and absolute neutrophil count of 69 k/mm(3). CT scan of the thorax revealed numerous bilateral pulmonary nodules suspicious for metastasis. Based on these findings patient was diagnosed with metastatic cutaneous IMFH associated with a LR. Following review of medical literature, this appears to be the first reported case of inflammatory cutaneous MFH associated with LR. This histological variant is rare, and carries a poor prognosis. Thus, we would like to emphasize the need for investigating alternative therapies capable of improving the survival of these patients.

Fibro-histiocitoma maligno de extremidade: relato de caso

Fibro-histiocitoma maligno é o sarcoma de tecidos moles mais encontrado em jovens. Raramente confina-se com exclusividade à pele e ao subcutâneo. O diagnóstico, na maioria das vezes, só é feito após excisão e estudo da peça cirúrgica. É agressivo, apresentando alto grau de recorrência local e metástases. Este artigo relata o caso de um paciente jovem com fibro-histiocitoma maligno de extremidade.

Pediatric cutaneous malignant fibrous histiocytoma

Malignant fibrous histiocytoma (MFH) is an aggressive soft-tissue sarcoma that most commonly occurs in the skeletal muscle of the extremities or retroperitoneum of adults. Although the majority of MFH is located beneath the fascia, the tumor occasionally occurs in the subcutaneous tissue. MFH rarely occurs in children and the disease course, prognosis, and outcome in younger patients has not been well described. We report a case of cutaneous MFH presenting on the thigh of a 12-year-old boy.