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Atypical fibroxanthoma (view source)
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'''Atypical fibroxanthoma''', abbreviated '''AFX''', is poorly differentiated [[skin tumour]] with likeness to [[undifferentiated pleomorphic sarcoma]]. | |||
==General== | |||
*Typically head & neck region.<ref>URL: [http://emedicine.medscape.com/article/1056204-overview http://emedicine.medscape.com/article/1056204-overview]. Accessed on 2 September 2011.</ref> | |||
*Thought to be related to [[pleomorphic undifferentiated sarcoma]];<ref name=pmid21664889>{{Cite journal | last1 = Withers | first1 = AH. | last2 = Brougham | first2 = ND. | last3 = Barber | first3 = RM. | last4 = Tan | first4 = ST. | title = Atypical fibroxanthoma and malignant fibrous histiocytoma. | journal = J Plast Reconstr Aesthet Surg | volume = | issue = | pages = | month = Jun | year = 2011 | doi = 10.1016/j.bjps.2011.05.004 | PMID = 21664889 }}</ref><ref name=pmid23319144>{{Cite journal | last1 = Tchernev | first1 = G. | last2 = Tronnier | first2 = M. | last3 = Ananiev | first3 = J. | last4 = Taneva | first4 = T. | last5 = Patterson | first5 = JW. | last6 = Gulubova | first6 = M. | last7 = Trafeli | first7 = JP. | last8 = Gegova | first8 = A. | last9 = Harrell | first9 = M. | title = Atypical fibroxanthoma-a diagnosis of exclusion! | journal = Wien Med Wochenschr | volume = 163 | issue = 15-16 | pages = 380-386 | month = Aug | year = 2013 | doi = 10.1007/s10354-012-0173-1 | PMID = 23319144 }}</ref> some say it is the same thing.<ref name=danny>Ghazarian, Danny; 16 September 2011.</ref> | |||
*Usually benign. | |||
**May metastasize - case report-type of occurrence.<ref>{{Cite journal | last1 = New | first1 = D. | last2 = Bahrami | first2 = S. | last3 = Malone | first3 = J. | last4 = Callen | first4 = JP. | title = Atypical fibroxanthoma with regional lymph node metastasis: report of a case and review of the literature. | journal = Arch Dermatol | volume = 146 | issue = 12 | pages = 1399-404 | month = Dec | year = 2010 | doi = 10.1001/archdermatol.2010.206 | PMID = 20713774 | URL = http://archderm.jamanetwork.com/article.aspx?articleid=422416 }}</ref> | |||
Clinical: | |||
*Rapid growth. | |||
*Elderly. | |||
*Good prognosis.<ref name=pmid20526171>{{Cite journal | last1 = Beer | first1 = TW. | last2 = Drury | first2 = P. | last3 = Heenan | first3 = PJ. | title = Atypical fibroxanthoma: a histological and immunohistochemical review of 171 cases. | journal = Am J Dermatopathol | volume = 32 | issue = 6 | pages = 533-40 | month = Aug | year = 2010 | doi = 10.1097/DAD.0b013e3181c80b97 | PMID = 20526171 }}</ref> | |||
==Microscopic== | |||
Features:<ref name=Ref_Derm521>{{Ref Derm|521}}</ref> | |||
*Dermal lesion - '''key point'''. | |||
*Marked nuclear atypia. | |||
*Mitoses. | |||
*Mulitnucleated cells. | |||
*Foamy cytoplasm - '''key feature'''. | |||
DDx: | |||
*[[Melanoma]]. | |||
*[[Pleomorphic undifferentiated sarcoma]] (MFH) - deeper than the dermis. | |||
*[[Leiomyosarcoma]]. | |||
*Sarcomatoid [[squamous carcinoma]]. | |||
Notes: | |||
*No Grenz zone. (???) | |||
Image: | |||
*[http://dermatology.cdlib.org/141/case_reports/afx/1.jpg AFX (cdlib.org)].<ref name=pmid18319023>{{Cite journal | last1 = Vandergriff | first1 = TW. | last2 = Reed | first2 = JA. | last3 = Orengo | first3 = IF. | title = An unusual presentation of atypical fibroxanthoma. | journal = Dermatol Online J | volume = 14 | issue = 1 | pages = 6 | month = | year = 2008 | doi = | PMID = 18319023 }}</ref> | |||
==IHC== | |||
Features:<ref name=Ref_Derm521>{{Ref Derm|521}}</ref> | |||
*S100 -ve (done to r/o melanoma). | |||
*34betaE12 -ve. | |||
*p63 -ve (done to exclude SCC) | |||
**Scant staining not considered +ve. | |||
*Desmin -ve (done to r/o leiomyosarcoma). | |||
==Sign out== | |||
===Incompletely excised=== | |||
<pre> | |||
SKIN LESION, MID BACK, SHAVE BIOPSY: | |||
- ATYPICAL SPINDLE CELL NEOPLASM, SEE MICRO AND COMMENT. | |||
COMMENT: | |||
The diagnosis of atypical fibroxanthoma (AFX) is favoured. The main differential | |||
diagnosis is pleomorphic undifferentiated sarcoma. | |||
The extent of the lesion cannot be determined, as it is present at the deep margin. | |||
This lesion should be re-excised, as it could represent an aggressive malignancy. | |||
</pre> | |||
==See also== | |||
*[[Dermatologic neoplasms]]. | |||
*[[Undifferentiated pleomorphic sarcoma]]. | |||
==References== | |||
{{Reflist|2}} | |||
[[Category:Diagnosis]] | [[Category:Diagnosis]] | ||
[[Category:Dermatologic neoplasms]] | |||