Low-Grade Myofibroblastic Sarcoma on Back with Repeated Localized Recurrence and Regional Metastasis
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Low-grade myofibroblastic sarcoma (LGMS) is a rare spindle cell tumor with indolent course. Due to rarity and low-grade histologic features of LGMS, accurate diagnosis is chal- lenging. We report a 63-year-old female patient with a three-month history of a 3.1 cm×2.5 cm sized, firm, skin-colored, painless, protruding left back mass. Initial excisional biopsy was performed and the mass was diagnosed as nodular fasciitis. After 18 months after exci- sion, the mass recurred with pain and grew larger. Considering the clinical manifestations, diagnostic impression was changed as dermatofibrosarcoma protuberans not nodular fas- ciitis. Second wide excision was performed and the histopathology revealed proliferative atypical spindle cells with moderate nuclear atypia and a distinctive whorling pattern, which is suggestive of low-grade sarcoma. Additional computed tomography and positron emis- sion tomography revealed no metastasis and suspicious residual viable malignant tissue. To remove suspicious residual tumor, third wide excision were performed and the diagnosis confirmed as LGMS. A microscopically clear resection was achieved with deep and lateral safety margin 0.6 cm each. Despite of postoperative radiotherapy with 35 times, recurrence of the tumor and lung metastasis was found after 7 months later. LGMS rarely metastasizes and occurs most commonly in the head and neck region. Thus, we report a rare case of LGMS on back which repeated localized recurrence and regional lung metastasis occurred despite wide excision and adjuvant radiotherapy.
Abstract
Low-grade myofibroblastic sarcoma (LGMS) is a rare spindle cell tumor with indolent course. Due to rarity and low-grade histologic features of LGMS, accurate diagnosis is chal- lenging. We report a 63-year-old female patient with a three-month history of a 3.1 cm×2.5 cm sized, firm, skin-colored, painless, protruding left back mass. Initial excisional biopsy was performed and the mass was diagnosed as nodular fasciitis. After 18 months after exci- sion, the mass recurred with pain and grew larger. Considering the clinical manifestations, diagnostic impression was changed as dermatofibrosarcoma protuberans not nodular fas- ciitis. Second wide excision was performed and the histopathology revealed proliferative atypical spindle cells with moderate nuclear atypia and a distinctive whorling pattern, which is suggestive of low-grade sarcoma. Additional computed tomography and positron emis- sion tomography revealed no metastasis and suspicious residual viable malignant tissue. To remove suspicious residual tumor, third wide excision were performed and the diagnosis confirmed as LGMS. A microscopically clear resection was achieved with deep and lateral safety margin 0.6 cm each. Despite of postoperative radiotherapy with 35 times, recurrence of the tumor and lung metastasis was found after 7 months later. LGMS rarely metastasizes and occurs most commonly in the head and neck region. Thus, we report a rare case of LGMS on back which repeated localized recurrence and regional lung metastasis occurred despite wide excision and adjuvant radiotherapy.
참고문헌 (20)
- Mentzel T, "Low-grade myofibroblastic sarcoma : analysis of 18 cases in the spectrum of myofibroblastic tumors", Am J Surg Pathol, 22, pp.1228~1238 (1998)
- Chan JY, "Lowgrade myofibroblastic sarcoma : a population-based study", Laryngoscope, 127, pp.116~121 (2017)
- Montgomery E, "Myofibrosarcoma : a clinicopathologic study", Am J Surg Pathol, 25, pp.219~228 (2001)
- Eyden BP, "A study of spindle cell sarcomas showing myofibroblastic differentiation", Ultrastruct Pathol, 15, pp.367~378 (1991)
- Meng GZ, "Myofibroblastic sarcomas: a clinicopathological study of 20 cases", Chin Med J(Engl), 120, pp.363~369 (2007)
- Li M, "Low-grade fibromyxoid sarcoma : a clinicopathologic and molecular study of 10 genetically confirmed cases", Int J Clin Exp Pathol, 11, pp.5860~5868 (2018)
- Kuo YR, "Low-grade myofibroblastic sarcoma arising from keloid scar on the chest wall after thoracic surgery", Ann Thorac Surg, 110, pp.e469~e471 (2020)
- Kim JH, "Surgical treatment and long-term outcomes of low-grade myofibroblastic sarcoma : a single-center case series of 15 patients", World J Surg Oncol, 19, pp.339~ (2021)
- Coindre JM, "Grading of soft tissue sarcomas : review and update", Arch Pathol Lab Med, 130, pp.1448~1453 (2006)
- Kordač P, "Low-grade myofibroblastic sarcoma of the larynx: case report and review of literature", Acta Medica(Hradec Kralove), 57, pp.162~164 (2014)
- Zhang S, "Low-grade myofibroblastic sarcoma of the orbit: a case report and literature review", Medicine(Baltimore), 96, pp.e9172~ (2017)
- Thompson LD, "Spindle cell(sarcomatoid)carcinomas of the larynx : a clinicopathologic study of 187 cases", Am J Surg Pathol, 26, pp.153~170 (2002)
- 이동근, "후이개에 생긴 저악성 근섬유아세포 육종 1예", 임상이비인후과, 21(2), pp.253~256 (2010), 대한이비인후과학회 부산,울산,경남 지부회[DOI]
- Watanabe K, "h-Caldesmon in leiomyosarcoma and tumors with smooth muscle cell-like differentiation : its specific expression in the smooth muscle cell tumor", Hum Pathol, 30, pp.392~396 (1999)
- Vlad D, "Low-grade myofibroblastic sarcoma of the larynx", J Craniofac Surg, 27, pp.e270~e271 (2016)
- Demarosi F, "Low-grade myofibroblastic sarcoma of the oral cavity", Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 108, pp.248~254 (2009)
- Qiu X, "Inf lammatory myofibroblastic tumor and low-grade myofibroblastic sarcoma : a comparative study of clinicopathologic features and further observations on the immunohistochemical profile of myofibroblasts", Hum Pathol, 39, pp.846~856 (2008)
- Yamada T, "Low-grade myofibroblastic sarcoma of the palate", Int J Oral Sci, 4, pp.170~173 (2012)
- Keller C, "Low-grade myofibrosarcoma of the head and neck : importance of surgical therapy", J Pediatr Hematol Oncol, 26, pp.119~120 (2004)
- Smith DM, "Myofibrosarcoma of the head and neck in children", Pediatr Pathol Lab Med, 15, pp.403~418 (1995)