Atypical Fibroxanthoma Containing Necrosis: A Case Report and Literature Review

Yıl 2013, Cilt: 4 Sayı: 16, 51 - 57, 03.03.2015

Hasan Gökçe Serhat Toprak Esin Doğan Mehmet Yenidünya Tümay Özgür

Öz

A 83-year-old female patient who had ulcerated nodular mass on her right temple was admitted Plastic and Reconstructive Surgery Clinic. Excised material was sent to the pathology laboratory. After routine tissue fixation, tissue processing and sectioning of the excised material, the slides stained with hematoxyline&eosin dye. On microscopic examination, a tumoral lesion with expansive borders was seen limited in the dermis. The tumor was consisted of spindle, oval or stellate-shaped cells containing pleomorphic nuclei. Many typical and atypical mitotic figures, multinucleated cells and tumor necrosis was present. Vimentin, CD68, pancytokeratin, S-100 protein, smooth muscle actin, desmin, HMB-45 and CD34 were stained by immunohistochemistry. Periodic acid-Schiff dye was performed by histochemically. The tumor cells were diffusely positive for vimentin and CD68, and weakly positive for pancytokeratin. Tumors containing extensive tumor necrosis, infiltrative growth pattern, perineural and vascular invasion are called as superficial malignant fibrous histiocytoma in the literature. The present case, because it contains only a limited focus of necrosis were reported as atypical fibroxanthoma and clinical follow-up was recommended

Anahtar Kelimeler

Atypical fibroxanthoma, superficial malignant fibrous histiocytoma, necrosis

NEKROZ İÇEREN ATİPİK FİBROKSANTOMA: OLGU SUNUMU VE LİTERATÜR EŞLİĞİNDE DEĞERLENDİRME

Öz

Seksen üç yaşındaki kadın hasta sağ şakağındaki ülsere nodüler kitle nedeniyle Plastik ve Rekonstrüktif Cerrahi Polikliniğine başvurdu. Eksize edilen materyal patoloji laboratuarına
gönderildi. Rutin doku tespiti, doku takibi ve kesit alma işlemlerinden sonra preparatlar hematoksilen&eosin ile boyandı. Mikroskopik incelemede dermiste lokalize, ekspansif sınırlı tümöral lezyon görüldü. Tümör iğsi, oval ya da yıldızsı şekilli, pleomorfik çekirdekli hücrelere sahipti. Çok sayıda tipik ve atipik mitoz, mültinükleer hücre formları ve tümör nekrozu mevcuttu. İmmünohistokimyasal olarak vimentin, CD68, pansitokeratin, S-100 protein, düz kas aktin, desmin, HMB-45 ve CD34 boyaları; histokimyasal olarak Periodic acid-Schiff boyası yapıldı. Tümör
hücreleri vimentin ve CD68 ile diffüz pozitif, pansitokeratin zayıf yoğunlukta pozitif boyandı. Literatürde geniş tümör nekrozu alanları içeren, infiltratif büyüme paternine sahip, perinöral ve vasküler invazyon içeren bu tür olgular yüzeyel malign fibröz histiositom adlandırılmaktadır. Mevcut olgu, sadece sınırlı nekroz odağı içermesi nedeniyle atipik fibroksantoma olarak raporlandı ve klinik takip önerildi.

Anahtar Kelimeler

Atipik fibroksantoma, yüzeyel malign fibröz histiositom, nekroz

Kaynakça

• Sakamoto A, Oda Y, Itakura E, Oshiro Y, Nikaido O, Iwamoto Y, et al. Immunoexpression of
• ultraviolet photoproducts and p53 mutation analysis in atypical fibroxanthoma and superficial
• malignant fibrous histiocytoma. Modern Pathology. 2001;14(6):581-8.
• Vandergriff TW, Reed JA, Orengo IF. An unusual presentation of atypical fibroxanthoma.
• Dermatology online journal. 2008;14(1).
• Sabhikhi A, Panicker N, Rai R. Atypical fibroxanthoma. Indian Journal of Dermatology,
• Venereology, and Leprology. 1998;64(5):238.
• Sakamoto A, Akieda S, Oda Y, Iwamoto Y, Tsuneyoshi M. Mutation analysis of the Gadd45
• gene at exon 4 in atypical fibroxanthoma. BMC dermatology. 2009;9(1):1.
• Orosz Z, Kelemen J, Szentirmay Z. Granular cell variant of atypical fibroxanthoma. Pathology
• & Oncology Research. 1996;2(4):244-7.
• Kabukçuoğlu S, Ülkü Ö, Işıksoy S, Saraçoğlu ZN. Kulak Kepçesinin Pleomorfik Malign
• Fibröz Histiyositoması: Pleomorfik Malign Fibröz Histiyositoma Ile Atipik FibroksantomunAyrımındaTümör Boyutu Kriter Olabilir Mi? Türkiye Klinikleri Tıp Bilimleri Dergisi. 2000;20(2):92-
• -
• Melendez MM, Xu X, McClain SA, Huang S-ID. Atypical fibroxanthoma in a young woman:
• An unusual case presentation. The Canadian Journal of Plastic Surgery. 2007;15(3):169.
• Lanigan S, Gilkes J. Spectrum of atypical fibroxanthoma of the skin. Journal of the Royal
• Society of Medicine. 1984;77(Suppl 4):27.
• Longacre TA, Smoller BR, Rouse RV. Atypical fibroxanthoma: multiple immunohistologic
• profiles. The American journal of surgical pathology. 1993;17(12):1199-209.
• Dei Tos A, Maestro R, Doglioni C, Gasparotto D, Boiocchi M, Laurino L, et al. Ultravioletinduced
• p53 mutations in atypical fibroxanthoma. The American journal of pathology.
• ;145(1):11.
• Mirza B, Weedon D. Atypical fibroxanthoma: a clinicopathological study of 89 cases.
• Australasian journal of dermatology. 2005;46(4):235-8.
• Helwig EB. Atypical fibroxanthoma. Tex J Med. 1963;59:664-7.
• Monteagudo C, Calduch L, Navarro S, Joan-Figueroa A, Llombart-Bosch A. CD99
• Immunoreactivity in Atypical Fibroxanthoma A Common Feature of Diagnostic Value. American
• journal of clinical pathology. 2002;117(1):126-31.
• Helwig EB, May D. Atypical fibroxanthoma of the skin with metastasis. Cancer.
• ;57(2):368-76.
• Bansal C, Sinkre P, Stewart D, Cockerell CJ. Two cases of cytokeratin positivity in atypical
• fibroxanthoma. Journal of clinical pathology. 2007;60(6):716-7.
• Suárez-Vilela D, Izquierdo-García F, Domínguez-Iglesias F, Méndez-Álvarez JR. Combined
• papillated Bowen disease and clear cell atypical fibroxanthoma. Case reports in dermatology.
• ;2(2):69-75.
• Thewes M, Engst R, Boeck K, Johannes R. Expression of cathepsins in dermal fibrous tumors:
• an immunohistochemical study. European Journal of Dermatology. 1998;8(2):86-9.