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Weiler EJ, Murickan T, Drayer CN, Samat SH, Kia MA. A rare case report of pancreatic low-grade fibromyxoid sarcoma (LGFMS). Surg Case Rep 2023; 9:123. [PMID: 37395833 DOI: 10.1186/s40792-023-01662-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 05/08/2023] [Indexed: 07/04/2023] Open
Abstract
BACKGROUND Low-grade fibromyxoid sarcoma (LGFMS) is an uncommon neoplasm generally affecting muscle tissue. It presents rarely in abdominal viscera and even more rarely occurs in the pancreas. All types of pancreatic sarcomas are uncommon, and LGFMS is a rarer still. We present the case of an LGFMS in the pancreas. Because of its rarity, there are no guidelines for appropriate treatment or summations of the natural course of this illness. CASE PRESENTATION We present the case of a 49-year-old female who presented with epigastric pain. She had a prior history of three episodes of acute pancreatitis many years earlier. A CT revealed a pancreatic body mass, which was biopsied. Pathology returned LGFMS. The patient underwent a distal pancreatectomy and splenectomy. She did well after the case and did not require further intervention. CONCLUSION Though it is exceedingly rare, cases of pancreatic LGFMS should be reported in order to guide clinical decisions. LGFMS has been shown to have high malignant potential in other tissues, and there is no reason to think pancreatic masses will be different. By building a body of evidence about these rare tumors, patient care will benefit.
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Affiliation(s)
- Eric J Weiler
- Sparrow Hospital, 1200 E, Michigan Ave, #255, Lansing, MI, 48912, USA.
| | - Thomas Murickan
- University of Nebraska Medical Center, 983285 Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Crystal N Drayer
- UnityPoint Clinic General Surgery, 2730 Pierce St. Suite 402, Sioux City, IA, 51104, USA
| | - Sajjaad H Samat
- Sparrow Hospital, 1200 E, Michigan Ave, #255, Lansing, MI, 48912, USA
| | - Michael A Kia
- McLaren Hospital, 3500 Calkins Rd, Flint, MI, 48532, USA
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Souza VGD, Carvalho ADL, Miranda CSS. Sarcoma fibromixoide de baixo grau em região paratesticular. Sci Med 2022; 32:e43540. [DOI: 10.15448/1980-6108.2022.1.43540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Objetivos: relatar um caso raro de sarcoma fibromixoide de baixo grau (SFMBG) em uma localização incomum de modo a reforçar aspectos histopatológicos e imunoistoquímicos relevantes para o reconhecimento desta entidade e o adequado diagnóstico diferencial de massas paratesticulares. Relato de caso: homem de 20 anos, com massa escrotal à direita, cuja análise histopatológica demonstrou a presença de tecido fibroso com áreas mixoides e predominância de células fusiformes. A imunoistoquímica foi positiva para vimentina, com índice de Ki67 de 2%, e negativa para S100, CD-34, beta-catenina, desmina e miogenina. Conclusões: caso raro de SFMBG na região paratesticular que reforça a importância da histopatologia e da imunoistoquímica no diagnóstico desse tumor. Apesar da característica histológica benigna, o SFMBG apresenta altas taxas de recorrência e metástases, sendo essencial o seguimento do paciente.
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Dahl M, Aurit SJ, Silberstein PT, Gootee J. Primary Site and Other Prognostic Factors for Fibrosarcoma: An Analysis of the National Cancer Database. Cureus 2021; 13:e19163. [PMID: 34873506 PMCID: PMC8631251 DOI: 10.7759/cureus.19163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2021] [Indexed: 11/12/2022] Open
Abstract
Purpose: Fibrosarcoma (FS) is a rare and malignant tumor that can occur in a variety of anatomic sites. The goal of this study is to use the National Cancer Database (NCDB) to analyze various factors affecting overall survival in FS and to be one of the rare studies to characterize the significance of the primary anatomic sites. Methods: The study cohort included 2,278 patients diagnosed with fibrosarcoma who received surgery from the NCDB. Kaplan-Meier curves, log-rank tests, and a multivariable Cox proportional hazard model were used to analyze the significance of factors affecting overall survival. Results: The head, face, and neck (HR = 1.44; 95% CI: 1.01-2.05; P = 0.046) and thorax anatomical sites (HR = 1.33; 95% CI: 1.02-1.73; P = 0.035) had a higher increased risk of death in comparison to the lower limb and hip. Compared to patients with private insurance, patients without insurance (HR = 1.99; 95% CI: 1.22 to 3.25; P = 0.006) and patients with Medicaid (HR = 1.99; 95% CI: 1.37 to 2.90; P < 0.001) had decreased overall survival. Patients associated with a zip code-level median household income ≥ $63,000 had a decreased risk of mortality when compared to lower income groups. Conclusion: In general, older patients with comorbidities, advanced-stage disease, and larger tumors who did not have private insurance and were from areas associated with lower income levels had poorer overall survival. No significant difference in overall survival was associated with receipt of neoadjuvant chemotherapy or neoadjuvant radiation.
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Affiliation(s)
- Mary Dahl
- Department of Internal Medicine, Division of Hematology/Oncology, Creighton University School of Medicine, Omaha, USA
| | - Sarah J Aurit
- Division of Clinical Research and Evaluative Sciences, Creighton University School of Medicine, Omaha, USA
| | - Peter T Silberstein
- Department of Internal Medicine, Division of Hematology/Oncology, Creighton University School of Medicine, Omaha, USA
| | - Jonathan Gootee
- Department of Surgery, West Virginia University School of Medicine, Morgantown, USA
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Kramer SP, Bowman CJ, Wang ZJ, Sheahon KM, Nakakura EK, Cho SJ, Umetsu SE, Behr SC. Hybrid Low-Grade Fibromyxoid Sarcoma and Sclerosing Epithelioid Fibrosarcoma of the Pancreas. J Gastrointest Cancer 2021; 51:1025-1029. [PMID: 32034641 DOI: 10.1007/s12029-020-00369-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Sage P Kramer
- Department of Radiology and Biomedical Imaging, UCSF Medical Center, 505 Parnassus Ave, San Francisco, CA, 94143, USA
| | | | - Zhen J Wang
- Department of Radiology and Biomedical Imaging, UCSF Medical Center, 505 Parnassus Ave, San Francisco, CA, 94143, USA
| | | | - Eric K Nakakura
- Division of General Surgery, UCSF Medical Center, CA, San Francisco, USA
| | - Soo-Jin Cho
- Department of Pathology, UCSF Medical Center, San Francisco, CA, USA
| | - Sarah E Umetsu
- Department of Pathology, UCSF Medical Center, San Francisco, CA, USA
| | - Spencer C Behr
- Department of Radiology and Biomedical Imaging, UCSF Medical Center, 505 Parnassus Ave, San Francisco, CA, 94143, USA.
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Huang J, Cohen S, Jour G. Primary small intestine mesenteric low-grade fibromyxoid sarcoma with foci of atypical epithelioid whorls and diffuse DOG1 expression: a case report. Diagn Pathol 2020; 15:23. [PMID: 32164724 PMCID: PMC7069053 DOI: 10.1186/s13000-019-0905-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 11/06/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low-grade fibromyxoid sarcoma (LGFMS) is a rare fibroblastic tumor often involving deep tissue of trunk and lower extremities in young to middle-aged patients. Rarely, LGFMS can occur in other sites including head and neck, chest, abdomen and female reproductive system. Three cases of LGFMS in mesentery of small intestine have been reported and all have conventional histologic features. Herein we reported a unique case of LGFMS in mesentery of small intestine. CASE PRESENTATION A 43 year-old male with chief complaint of lower back pain for 4 years presented to our hospital. Physical exam reveal a firm, non-tender, non-distended, mobile large abdominal mass, which was shown on abdominal CT as a 10 cm retroperitoneal tumor. Biopsy revealed a spindle cell neoplasm in a myxoid background with a delicate vascular network. Tumor resection was performed. Gross examination of the resected specimen showed a 10.8 cm, tan-white, smooth, firm, lobulated mesenteric mass with bulging and gelatinous cut surface and confined within small bowel serosa. Microscopic examination demonstrated foci epithelioid cords and whorls with prominent atypia, in additional of regular, bland-appearing spindle cells in a fibrous and myxoid stroma and osseous metaplasia. The tumor cells stained diffusely positive for DOG1 with moderate staining density, and diffusely and strongly positive for MUC4. Rearrangement involving FUS (16p11.2) gene was identified with break-apart probe and confirmed by Anchored Multiplex PCR. A final diagnosis of low-grade fibromyxoid sarcoma was rendered. CONCLUSION Our case highlights the importance of including LGFMS in the differential diagnosis of mesenteric tumors and the DOG1 positivity which could represent a potential diagnostic pitfall.
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Affiliation(s)
- Jialing Huang
- Department of Pathology, Langone Medical Center, New York University, 550 1st Avenue, New York, NY, 10016, USA.
| | - Steven Cohen
- Department of Surgery, Langone Medical Center, New York University, 550 1st Avenue, New York, NY, 10016, USA
| | - Gerorge Jour
- Department of Pathology, Langone Medical Center, New York University, 550 1st Avenue, New York, NY, 10016, USA
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Mccarthy AJ, Pal P, Szentgyorgyi E, De Perrot M, Howarth DJ, Dickson BC, Chetty R. Primary low-grade fibromyxoid sarcoma of the large intestine with lung metastases: A case report and review of the literature. Human Pathology: Case Reports 2019; 15:20-28. [DOI: 10.1016/j.ehpc.2018.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Saab‐Chalhoub MW, Al‐Rohil RN. Low‐grade fibromyxoid sarcoma of acral sites: Case report and literature review. J Cutan Pathol 2019; 46:271-276. [DOI: 10.1111/cup.13413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 12/21/2018] [Accepted: 12/30/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Mario W. Saab‐Chalhoub
- Department of Pathology, Microbiology and ImmunologyVanderbilt University Medical Center Nashville Tennessee
| | - Rami N. Al‐Rohil
- Department of Pathology, Microbiology and ImmunologyVanderbilt University Medical Center Nashville Tennessee
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8
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Geramizadeh B, Zare Z, Dehghanian AR, Bolandparvaz S, Marzban M. Huge mesenteric low-grade fibromyxoid sarcoma: A case report and review of the literature. Rare Tumors 2018; 10:2036361318777031. [PMID: 29854356 PMCID: PMC5971385 DOI: 10.1177/2036361318777031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 04/25/2018] [Indexed: 11/17/2022] Open
Abstract
Low-grade fibromyxoid sarcoma is a rare soft tissue tumor which has been mostly reported in lower extremities; however, it can also occur in other parts of the body such as head and neck and abdominal wall, but its occurrence in the abdominal cavity and mesentery of bowel is an extremely rare event and has very rarely been reported. Herein, we report our experience with a 24-year-old lady with a huge mesenteric mass, turned out to be low-grade fibromyxoid sarcoma. This case is the largest one reported in the English literature. We will also discuss about the previously reported cases of low-grade fibromyxoid sarcoma in the English literature.
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Affiliation(s)
- Bita Geramizadeh
- Shiraz Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Zare
- Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Shahram Bolandparvaz
- Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran.,Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahsa Marzban
- The University of British Columbia, Vancouver, BC, Canada
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Tsukamoto Y, Takahata H, Teramoto N, Nishimura R, Hato S, Nozaki I, Matsuo S, Hirota S. Primary gastric low-grade fibromyxoid sarcoma with FUS-CREB3L1 fusion – A hitherto undescribed origin of Evans tumor. Human Pathology: Case Reports 2018. [DOI: 10.1016/j.ehpc.2017.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Ud Din N, Ahmad Z, Zreik R, Horvai A, Folpe AL, Fritchie K. Abdominopelvic and Retroperitoneal Low-Grade Fibromyxoid Sarcoma: A Clinicopathologic Study of 13 Cases. Am J Clin Pathol 2018; 149:128-134. [PMID: 29385413 DOI: 10.1093/ajcp/aqx137] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Low-grade fibromyxoid sarcoma (LGFMS) is a rare tumor often arising in the lower extremities. Only rare examples in the abdominal cavity, pelvis, and retroperitoneum have been reported. METHODS cases of abdominopelvic and retroperitoneal LGFMS were retrieved. MUC4, Actin, ALK, β-catenin, desmin, DOG1, KIT, S100 protein, and STAT6 testing was performed, and a subset was tested for FUS rearrangement. RESULTS Sites included intra-abdominal/abdominal wall (four cases), retroperitoneum (three cases), pelvis (three cases), small bowel (two cases), and kidney (one case) (median size, 15 cm; age range, 5-61 years). Tumors harbored spindled cells with mild to moderate atypia, displaying alternating myxoid nodules and hyalinized areas. All cases were positive for MUC4, and five (of five) cases tested harbored FUS rearrangement. Variable positivity for DOG1 (four of 10) and actin (two of 10) was identified. Six tumors recurred, and one patient developed metastasis. CONCLUSION LGFMS arising in these central locations exhibits similar clinicopathologic features to its counterpart in the extremities. LGFMS at these sites may show limited immunoreactivity for DOG1 and actin.
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Affiliation(s)
- Nasir Ud Din
- Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Zubair Ahmad
- Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Riyam Zreik
- Department of Pathology, Scott & White Medical Center, Temple, TX
| | - Andrew Horvai
- Department of Pathology, University of California, San Francisco
| | - Andrew L Folpe
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Karen Fritchie
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
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12
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Ban LK, Tseng AH, Huang SH, Lee HHC. Low-grade fibromyxoid sarcoma of the external anal sphincter: a case report. World J Surg Oncol 2017; 15:109. [PMID: 28558780 PMCID: PMC5450221 DOI: 10.1186/s12957-017-1174-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 05/17/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low-grade fibromyxoid sarcoma (LGFMS) is a rare soft tissue tumor that has a tendency to grow in the deep soft tissue of the trunk and extremities. Despite its benign appearance, the tumor has a high recurrence rate and metastatic potential. LGFMS in the perineal space is rare, and only a few cases have been reported. We present the first case of LGFMS to be located at the external anal sphincter. CASE PRESENTATION A 27-year-old male patient admitted to our Surgical Department with perianal pain and swollen for a year. The digital rectal examination revealed a perianal mass. Oral metronidazole and analgesia were prescribed on suspicion of perianal abscess failed to alleviate the symptom; hence, the patient was scheduled for surgery. Intraoperative diagnosis revealed an encapsulated tumor in the external anal sphincter that extended from the perianal region orally to the pararectal space. The results of immunohistochemistry (MUC4 staining) and FUS gene rearrangement by fluorescence in situ hybridization confirmed the diagnosis of LGFMS. CONCLUSIONS This case is unique in terms of the location of the rare soft tissue tumor. Although LGFMS is considered low grade, its unpredictable behavior necessitates a long-term follow-up.
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Affiliation(s)
- Lee-Kiat Ban
- Department of Surgery, Hsinchu Cathay General Hospital, Jhonghua Rd, Hsinchu, Taiwan.,College of Medical Technology, Nursing and Wellbeing, Yuanpei University of Medical Technology, Yuanpei Street, Hsinchu, Taiwan
| | - Ailun Heather Tseng
- Department of Surgery, Hsinchu Cathay General Hospital, Jhonghua Rd, Hsinchu, Taiwan
| | - Shih-Hung Huang
- Department of Pathology, Cathay General Hospital, Jen-Ai Road, Taipei, Taiwan
| | - Henry Hsin-Chung Lee
- Department of Surgery, Hsinchu Cathay General Hospital, Jhonghua Rd, Hsinchu, Taiwan. .,Graduate Institute of Translational and Interdisciplinary Medicine, College of Health Sciences and Technology, National Central University, Jung-Da Rd, Taoyuan, Taiwan. .,School of Medicine, Fu Jen Catholic University, Zhongzheng Rd, New Taipei, Taiwan.
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