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Shaker N, Phelps R, Niedt G, Patel A, Wu D, Aung PP, Prieto V, Church A, Pradhan D. Cutaneous Atypical Fibroxanthoma With Osteoclast-Like Giant Cell: A Rare but Diagnostic Pitfall. Am J Dermatopathol 2023; 45:704-707. [PMID: 37708369 DOI: 10.1097/dad.0000000000002508] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
BACKGROUND Atypical fibroxanthoma (AFX) is a dermal-based, low-grade neoplasm with no specific lineage of differentiation. The occurrence of AFX with osteoclast-like giant cells is exceptionally rare. Less than 20 cases have been reported in the literature. CASE PRESENTATION A 77-year-old man with a medical history of multiple basal and squamous cell carcinomas of the skin, presented with a progressively growing erythematous nodule on the sun-damaged right central parietal scalp. A shave biopsy showed a dermal spindle cell proliferation accompanied by numerous osteoclast-like multinucleated giant cells and predominant atypical mitotic figures. The immunohistochemical staining showed a diffuse positive staining for CD68 and SMA, patchy staining for CD10, and negative staining for SOX-10, pan-cytokeratin, CK5/6, S100, CD34, and desmin. The tumor was completely excised with negative margins. A subsequent follow-up over a period of 13 months showed no recurrence. CONCLUSION Distinguishing AFX with osteoclast-like giant cells from both malignant and benign skin lesions with osteoclast-like giant cells is crucial. Although AFX tumors display worrisome malignant histologic features, most cases have a favorable prognosis with a local recurrence rate below 5% and exceedingly rare metastasis.
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Affiliation(s)
- Nada Shaker
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Robert Phelps
- Departments of Dermatology and Dermatopathology, Mount Sinai Medical Center, New York, NY
| | - George Niedt
- Departments of Dermatology and Dermatopathology, Mount Sinai Medical Center, New York, NY
| | - Ankush Patel
- Department of Pathology, Mayo Clinic, Rochester, MN
| | - Douglas Wu
- The Ohio State University Wexner Medical Center, Columbus, OH
| | - Phyu P Aung
- Department of Dermatopathology and Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Victor Prieto
- Department Chair, Department of Dermatopathology, The University of Texas MD Anderson Cancer Center, Houston, TX; and
| | - Ann Church
- Department of Dermatopathology, The University of Nebraska Medical Center, Omaha, NE
| | - Dinesh Pradhan
- Department of Dermatopathology, The University of Nebraska Medical Center, Omaha, NE
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Tongdee E, Touloei K, Shitabata PK, Shareef S, Maranda EL. Keloidal Atypical Fibroxanthoma: Case and Review of the Literature. Case Rep Dermatol 2016; 8:156-63. [PMID: 27462224 PMCID: PMC4943314 DOI: 10.1159/000446343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 04/20/2016] [Indexed: 11/19/2022] Open
Abstract
Keloidal atypical fibroxanthoma (KAF) has recently been categorized as a variant of atypical fibroxanthoma. This paper will emphasize the importance of including KAF in both clinical and histological differential diagnosis of benign and malignant lesions which exhibit keloidal collagen and will also review the current literature on epidemiology, pathogenesis, histology, immunochemistry and treatments.
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Affiliation(s)
- Emily Tongdee
- Florida International University Herbert Wertheim College of Medicine, Miami, Fla., USA
| | - Khasha Touloei
- Broward Health Medical Center, Fort Lauderdale, Fla., USA
| | - Paul K Shitabata
- Department of Pathology, Western University, Pomona, Calif., USA; Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, Calif., USA; Dermatopathology Institute, Torrance, Calif., USA
| | | | - Eric L Maranda
- University of Miami Miller School of Medicine, Miami, Fla., USA
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Ardakani NM, Pearce R, Wood BA. Pleomorphic dermal sarcoma with osteosarcoma-like and chondrosarcoma-like elements. Pathology 2015; 48:86-9. [PMID: 27020218 DOI: 10.1016/j.pathol.2015.11.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Robert Pearce
- School of Surgery, The University of Western Australia, Perth, Australia
| | - Benjamin A Wood
- PathWest Laboratory Medicine, QEII Medical Centre, Perth, Australia; School of Pathology and Laboratory Medicine, The University of Western Australia, Perth, WA, Australia.
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Abstract
Pleomorphic neoplasms are typically associated with high-grade malignant behavior, but this does not readily apply to primary cutaneous tumors. Despite morphologic features suggestive of malignancy, atypical fibroxanthoma, the classic example of a pleomorphic dermal neoplasm, is characterized by indolent clinical behavior. Atypical fibroxanthoma is a distinctive clinicopathologic disease affecting sun-damaged skin of elderly males. Histologically, it is often ulcerated and dermal based with pushing growth, characterized by a sheet-like and fascicular growth of pleomorphic epithelioid, spindled, and multinucleated tumor cells with brisk and atypical mitotic activity. However, no positive discriminatory histologic or immunohistochemical features exist. Its diagnosis is one exclusion with a wide differential diagnosis, mainly including other mesenchymal, melanocytic, and epithelial neoplasms. Particular considerations are pleomorphic dermal sarcoma, invasive melanoma, squamous cell carcinoma, metaplastic carcinoma, poorly differentiated cutaneous angiosarcoma, cutaneous leiomyosarcoma, myxofibrosarcoma, variants of fibrous histiocytoma (FH), pleomorphic fibroma, and non-neural granular cell tumor. The behavior of these tumors is varied and ranges from outright malignant to entirely benign, requiring confident diagnosis to reliably predict behavior and guide treatment. Although challenging, because of significant clinical and pathologic overlap, it is usually possible to establish a definitive diagnosis when attention is paid to the often subtle differentiating features. This requires careful tumor sampling, recognition of the subtle distinguishing morphologic features, judicious use and analysis of immunohistochemistry, and interpretation of the findings in the appropriate clinical setting.
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Abstract
Recognition of the different types of multinucleated giant cells in neoplastic and pseudotumoral lesions of the skin may be helpful in the differential diagnosis of these tumors. In this review, we will analyze the different types of multinucleated giant cells that can be found in nonepithelial cutaneous tumors and, more importantly, the clinicopathological context in which they are found. Touton giant cells are typically present in juvenile xanthogranuloma, necrobiotic xanthogranuloma, and some subtypes of xanthomas. Giant cells with a ground glass appearance are typically present in the solitary reticulohistiocytoma and multicentric reticulohistiocytosis. Osteoclast-like cells are found in giant cell tumors (GCT) of soft parts, plexiform fibrohistiocytic tumor, and atypical fibroxanthoma. Floret-like cells are present in giant cell fibroblastoma, pleomorphic lipoma, multinucleate cell angiohistiocytoma, and giant cell collagenoma.
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Zheng R, Ma L, Bichakjian CK, Lowe L, Fullen DR. Atypical fibroxanthoma with lymphomatoid reaction. J Cutan Pathol 2010; 38:8-13. [DOI: 10.1111/j.1600-0560.2010.01622.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Atypical Fibroxanthoma: A Histological and Immunohistochemical Review of 171 Cases. Am J Dermatopathol 2010; 32:533-40. [DOI: 10.1097/dad.0b013e3181c80b97] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Offman S, Pasternak S, Walsh N. Keloidal and Other Collagen Patterns in Atypical Fibroxanthomas. Am J Dermatopathol 2010; 32:326-32. [DOI: 10.1097/dad.0b013e3181c183f9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
The term 'fibrohistiocytic' tumour is a descriptive designation without histogenetic connotation for a group of heterogeneous lesions that share morphological features of histiocytes and fibroblasts on light microscopy. However, over the years it has become apparent that many so-called 'fibrohistiocytic' tumours are largely composed of relatively undifferentiated mesenchymal cells, but can also show areas of myofibroblastic differentiation. This review focuses on the clinical and histological features as well as differential diagnosis of so-called fibrohistiocytic tumours. Special emphasis is given to more recently described histological variants of fibrous histiocytoma, e.g. cellular, epithelioid, aneurysmal and atypical fibrous histiocytoma, to angiomatous and plexiform fibrous histocytoma (plexiform fibrohistiocytic tumour), lesions that are not true variants of fibrous histiocytomas but have erroneously been designated such, and to atypical fibroxanthoma. The literature on metastasizing fibrous histiocytoma is also reviewed.
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Affiliation(s)
- Bostjan Luzar
- Medical Faculty, Institute of Pathology, University of Ljubljana, Ljubljana, Slovenia
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Stefanato CM, Robson A, Calonje JE. The histopathologic spectrum of regression in atypical fibroxanthoma. J Cutan Pathol 2010; 37:310-5. [DOI: 10.1111/j.1600-0560.2009.01421.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Patton A, Page R, Googe PB, King R. Myxoid atypical fibroxanthoma: a previously undescribed variant. J Cutan Pathol 2009; 36:1177-84. [DOI: 10.1111/j.1600-0560.2009.01255.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Luzar B, Calonje E. Morphological and immunohistochemical characteristics of atypical fibroxanthoma with a special emphasis on potential diagnostic pitfalls: a review. J Cutan Pathol 2009; 37:301-9. [PMID: 19807823 DOI: 10.1111/j.1600-0560.2009.01425.x] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
UNLABELLED The present manuscript gives emphasis on recognizing different morphological variants of atypical fibroxanthoma (AFX), on validation of immunohistochemical markers and on discussing potential diagnostic pitfalls. MATERIAL AND METHODS Histological features analyzed in 66 AFXs were: ulceration, morphological variants, growth pattern, location in the skin and vascular/perineural invasion. The antibodies used were CK-MNF116, CK-AE1/AE3, S100, smooth muscle actin, desmin, CD31 and EMA. RESULTS The study included 59 males, 7 females, aged 55-95 years, mean 77 years. All developed on sun damaged skin. Ulceration was present in 50%. Morphological patterns were pleomorphic spindle and epithelioid cells (60.6%), predominantly spindle cells (19.7%), purely spindle-cells (13.6%), and predominantly epithelioid cells (6.1%). Most were localized in the dermis (57.6%). An expansile (36.4%) rather than infiltrative (6.1%) growth into superficial subcutis was also noted. No vascular/perineural invasion was seen. Additional changes were hemorrhagic and pseudoangiomatous areas (24.2%), granular cell change (22.7%), keloid-like areas (9.1%), myxoid change (7.6%), osteoclast-like giant cells (6.1%) and clear cell change (4.6%). AFXs were consistently negative for S100, CK-MNF116, CK-AE1/AE3 and desmin. Focal positivity for SMA (45.2%), EMA (24.4%) and CD 31 (9.5%) was seen. CONCLUSIONS A diagnosis of AFX is still made by exclusion of other malignant neoplasms with similar morphology. Immunohistochemistry plays a crucial role in this distinction, but can also be misleading. This study expands the spectrum of non-vascular CD31 positive tumors.
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Affiliation(s)
- Bostjan Luzar
- Institute of Pathology, Medical Faculty University of Ljubljana, Korytkova 2,1000 Ljubljana, Slovenia
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Abstract
BACKGROUND Keloidal atypical fibroxanthoma (AFX) is a rare variant of AFX with thick bands of hyalinized collagen. The identification of keloidal collagen associated with fibrohistiocytic cells may erroneously lead to the diagnosis of keloidal dermatofibroma. Although AFX is a pleomorphic cutaneous tumor typically associated with a good prognosis, occasional reports of metastatic AFX highlight the importance of accurate identification. METHODS A total of nine cases of an unusual variant of AFX with keloidal tumoral sclerosis were collected and examined. The cases were stained with antibodies directed against S100, cytokeratin, CD68 and CD31. RESULTS Histopathological examination revealed pleomorphic cells trapped within hyalinized keloidal collagen bands. In several cases, the keloidal collagen also formed ring-shaped structures surrounding CD31-positive vascular structures. Pleomorphic cells were negative for S100 protein and keratin, but consistently labeled with antibodies directed against CD68. CONCLUSIONS The diagnosis of keloidal AFX requires the exclusion of other malignant and benign lesions with keloidal or sclerotic collagen. Awareness of the rare variant of keloidal AFX may avoid a diagnostic pitfall leading to an erroneous diagnosis, particularly in small biopsies. The finding of sclerotic collagen preferentially deposited around vessels is an interesting and poorly understood phenomenon.
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Affiliation(s)
- Jinah Kim
- Department of Dermatology, Yale University School of Medicine, New Haven, CT 06520-8059, USA
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Abstract
A 90-year-old Caucasian man with a history of basal cell carcinoma and squamous cell carcinoma presented with a friable erythematous nodule on his scalp that had been present for several months. The lesion measured 1.4 x 1.8 cm. What is your diagnosis? How would you proceed?
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Affiliation(s)
- Rachel Farley
- Department of Dermatology, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
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Al-Brahim N, Salama S. Malignant Melanoma with Osteoclast-Like Giant Cells: An Unusual Host Response. Am J Dermatopathol 2005; 27:126-9. [PMID: 15798437 DOI: 10.1097/00000372-200504000-00007] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Melanomas with unusual histologic features are very rarely reported in the literature and demonstrate the diversity of melanocytic expression. Three cases of malignant melanoma with osteoclast-like giant cells are reported. Two cases showed undifferentiated malignant cells without melanin pigment and one showed spindled cell morphology. Immunohistochemistry showed that the osteoclast- like giant cells expressed CD68, but not melanocytic markers (HMB45, Melan-A, and S100). Ultrastructural analysis further supports that these cells are reactive histiocytes rather than transformed malignant cells. This suggests they represent an unusual host response, similar to those rarely observed in other neoplasms. Awareness of this entity is important to avoid misdiagnosis of melanoma as a histiocytic tumor. Since only few cases have been reported, greater recognition and documentation may help to evaluate the prognosis of such cases with unusual morphology.
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Affiliation(s)
- Nabeel Al-Brahim
- From St. Joseph's Hospital and McMaster University, Hamilton, Ontario, Canada
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Billings SD, Folpe AL. Cutaneous and Subcutaneous Fibrohistiocytic Tumors of Intermediate Malignancy. Am J Dermatopathol 2004; 26:141-55. [PMID: 15024197 DOI: 10.1097/00000372-200404000-00035] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The fibrohistiocytic tumors of intermediate malignancy are uncommon mesenchymal tumors, which typically occur in the skin and subcutis and which may pose significant problems for the dermatopathologist. This article reviews the clinical, histopathologic, and genetic features of dermatofibrosarcoma protuberans, giant cell fibroblastoma, angiomatoid (malignant) fibrous histiocytoma, plexiform fibrous histiocytoma, and soft tissue giant cell tumor (of low malignant potential). The differential diagnosis of these tumors with a variety of benign and fully malignant cutaneous soft tissue neoplasms is discussed.
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Abstract
BACKGROUND Malignant cutaneous spindle cell lesions with marked sclerosis are uncommon. Only a few cases of cutaneous leiomyosarcoma and dermatofibrosarcoma protuberans with sclerosis have been published. METHODS We report a case of atypical fibroxanthoma (AFX) with prominent sclerosis and hyalinization occurring on the scalp of an 81-year-old male. RESULTS Histopathologic examination revealed an exophytic, well-delineated, focally ulcerated tumor arising in sun-damaged skin. The lesion was composed of atypical spindle cells arranged in a fascicled and vaguely storiform pattern. Occasional multinucleated giant cells were present. The tumor cells were strongly positive for CD99 (O13), vimentin, and smooth muscle actin, and focally positive for CD68. There was striking sclerosis with hyalinization throughout the lesion. CONCLUSIONS Rarely, AFX may exhibit marked sclerosis with areas of complete replacement of tumor by hyalinized collagen. In a small biopsy, such hyalinization may be a diagnostic pitfall leading to an erroneous diagnosis.
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Affiliation(s)
- Andrea K Bruecks
- Calgary Laboratory Services, University of Calgary, Calgary, AB, Canada.
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Diaz-Cascajo C, Weyers W, Borghi S. Pigmented atypical fibroxanthoma: a tumor that may be easily mistaken for malignant melanoma. Am J Dermatopathol 2003; 25:1-5. [PMID: 12544091 DOI: 10.1097/00000372-200302000-00001] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Nine cases of an unusual presentation of atypical fibroxanthoma that we previously termed pigmented atypical fibroxanthoma are reported. Pigmented atypical fibroxanthoma can be easily mistaken for malignant melanoma both clinically and histopathologically. The resemblance of pigmented atypical fibroxanthoma to melanoma is secondary to the ability of neoplastic cells to ingest and degrade erythrocytes following intratumoral hemorrhage and to accumulate hemosiderin in their cytoplasm. The histopathologic diagnosis of pigmented atypical fibroxanthoma can be easily confirmed by immunohistochemistry and iron stain.
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Gulmann C, Egan B, Cottell D, Keane FBV, Jeffers MD. Aberrant S100 expression in cutaneous malignant fibrous histiocytoma: a potential pitfall in diagnosis. Histopathology 2002; 41:363-4. [PMID: 12383220 DOI: 10.1046/j.1365-2559.2002.01452.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- C Gulmann
- Department of Cellular Pathology, The Adelaide and Meath Hospital, Dublin, Ireland
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Wilk1 M, Nilles2 M, Zelger3 B. Atypisches Fibroxanthom - eine nicht-"histiozytare" Neoplasie. . Atypical fibroxanthoma - a non-histiocytic neoplasm. ACTA ACUST UNITED AC 2002. [DOI: 10.1046/j.1439-0353.2002.02095.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Affiliation(s)
- D R Guillén
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas 75235, USA
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23
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Campanacci M. Atypical Fibroxanthoma of the Skin. BONE AND SOFT TISSUE TUMORS 1999:959-960. [DOI: 10.1007/978-3-7091-3846-5_65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Abstract
AIM The purpose of this report is to call attention to a pigmented variant of atypical fibroxanthoma that resembles malignant melanoma, both clinically and histopathologically. METHODS AND RESULTS Thirty-eight cases of atypical fibroxanthoma were examined for the presence of pigmented areas. Four such cases were found. Neoplastic cells showed erythrophagocytosis and accumulation of haemosiderin pigment in the cytoplasm. In three cases, immunohistochemical studies using a battery of antibodies were performed. Neoplastic cells were strongly positive for vimentin and weakly positive for CD68, whereas they were negative for melanocytic markers, including S100 protein, HMB45, and the monoclonal antibody NK1-C3 to melanoma-associated antigen. CONCLUSIONS Pigmented atypical fibroxanthoma represents a poorly recognized variant of the neoplasm that may be easily misinterpreted as malignant melanoma. To the best of our knowledge, this is the first report of erythrophagocytosis in atypical fibroxanthoma.
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Abstract
Atypical fibroxanthoma is a malignant fibrohistiocytic neoplasm that develops most commonly on sun-exposed skin of elderly individuals. A number of different variants have been described, ranging from a purely spindle cell type to a xanthomatous form. We recently observed an unusual variant of atypical fibroxanthoma in which there were numerous osteoclast-like multinucleated giant cells. Histologically, there was a diffuse spindle cell neoplasm in the dermis exhibiting fibrohistiocytic differentiation associated with inflammatory cells. The neoplastic spindle cells were markedly pleomorphic and many were in mitosis, some being tripolar and tetrapolar. In addition to these features, which are common in atypical fibroxanthoma, there were numerous multinucleated giant cells scattered throughout the lesion with features resembling normal osteoclasts. Epithelioid cells with features of histiocytes were seen in association with these cells. No osteoid was observed, however, that suggested monocyte-macrophage differentiation. The histologic appearance of this lesion was reminiscent of the giant cell variant of malignant fibrous histiocytoma, also termed malignant giant cell tumor of soft parts. Thus, osteoclast-like giant cells may be seen in atypical fibroxanthoma. These cells probably represent multinucleated histiocytes rather than true osteoclasts. It is important to recognize this variant to avoid confusion with other malignant soft tissue neoplasms.
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Affiliation(s)
- Z M Khan
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, USA
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Tomaszewski MM, Lupton GP. Atypical fibroxanthoma. An unusual variant with osteoclast-like giant cells. Am J Surg Pathol 1997; 21:213-8. [PMID: 9042289 DOI: 10.1097/00000478-199702000-00012] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We report three cases of an unusual variant of atypical fibroxanthoma with numerous multinucleated osteoclast-like giant cells. Histologically, the lesions were composed of uniformly dispersed multinucleated osteoclast-like giant cells within a pleomorphic cellular proliferation with microscopic and histochemical features of atypical fibroxanthoma. Multinucleated osteoclast-like giant cells, however, stained with KP-1, a macrophage-associated antigen only. These cells are not necessarily an integral part of the tumor and may represent a reactive histiocytic component.
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Affiliation(s)
- M M Tomaszewski
- Department of Dermatopathology, Armed Forces Institute of Pathology, Washington, DC 20306-6000, USA
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28
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McKee PH. Immunocytochemistry and cutaneous neoplasia ('something will turn up', Micawber 1863). Clin Exp Dermatol 1990; 15:235-44. [PMID: 2208771 DOI: 10.1111/j.1365-2230.1990.tb02082.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- P H McKee
- Department of Histopathology, St Thomas' Hospital, London, UK
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