Difference between revisions of "Atypical fibroxanthoma"
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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]] | |||
Revision as of 02:51, 22 December 2013
Atypical fibroxanthoma, abbreviated AFX, is poorly differentiated skin tumour with likeness to undifferentiated pleomorphic sarcoma.
General
- Typically head & neck region.[1]
- Thought to be related to pleomorphic undifferentiated sarcoma;[2][3] some say it is the same thing.[4]
- Usually benign.
- May metastasize - case report-type of occurrence.[5]
Clinical:
- Rapid growth.
- Elderly.
- Good prognosis.[6]
Microscopic
Features:[7]
- 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:
IHC
Features:[7]
- 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
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.
See also
References
- ↑ URL: http://emedicine.medscape.com/article/1056204-overview. Accessed on 2 September 2011.
- ↑ Withers, AH.; Brougham, ND.; Barber, RM.; Tan, ST. (Jun 2011). "Atypical fibroxanthoma and malignant fibrous histiocytoma.". J Plast Reconstr Aesthet Surg. doi:10.1016/j.bjps.2011.05.004. PMID 21664889.
- ↑ Tchernev, G.; Tronnier, M.; Ananiev, J.; Taneva, T.; Patterson, JW.; Gulubova, M.; Trafeli, JP.; Gegova, A. et al. (Aug 2013). "Atypical fibroxanthoma-a diagnosis of exclusion!". Wien Med Wochenschr 163 (15-16): 380-386. doi:10.1007/s10354-012-0173-1. PMID 23319144.
- ↑ Ghazarian, Danny; 16 September 2011.
- ↑ New, D.; Bahrami, S.; Malone, J.; Callen, JP. (Dec 2010). "Atypical fibroxanthoma with regional lymph node metastasis: report of a case and review of the literature.". Arch Dermatol 146 (12): 1399-404. doi:10.1001/archdermatol.2010.206. PMID 20713774.
- ↑ Beer, TW.; Drury, P.; Heenan, PJ. (Aug 2010). "Atypical fibroxanthoma: a histological and immunohistochemical review of 171 cases.". Am J Dermatopathol 32 (6): 533-40. doi:10.1097/DAD.0b013e3181c80b97. PMID 20526171.
- ↑ 7.0 7.1 Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 521. ISBN 978-0443066542.
- ↑ Vandergriff, TW.; Reed, JA.; Orengo, IF. (2008). "An unusual presentation of atypical fibroxanthoma.". Dermatol Online J 14 (1): 6. PMID 18319023.