Atypical fibroxanthoma (AFX)

Case 277   July 2011 (P. McKee)  M 72 facial tumour 

Nodular expansile tumour.  Typical cytology.  CD10 would confirm 

DD: spindle cell SCC; MM; leiomyosarcoma etc. 

Case 324   Sept 2011 (P. McKee)  F  82 ulcerated forehead tumour 

Case 472   Mar 2012 (P.McKee)  M 74 tumour, face 

Exophytic domed rather vascular looking nodule is suggestive of diagnosis.  Spindle cells not as pleomorphic as is usual in AFX 

Ref: Spindle cell non pleomorphic AFX. Calonje E et al. Histopathology 1993;22:247-54. 

Case 501   May 2012 (R. Carr)  F 92 cheek lesion 

Fairly typical, highly pleomorphic spindle cell neoplasm.  Lesion should be circumscript with only a superficial pushing sub-cutaneous involvement.  CD10+ve;  S100/pan-keratin/p63 –ve (usually) 

Case 529  June 2012 (P. Mckee)  F 82 ulcerated tumour, forehead  (Probably different views of 324 above.) 

Case 534  June 2012 (P. McKee)  M  76 nodule forehead 

This one mimicks spindle cell angiosarcoma.  Large telangiectatic vessels 

Case 752   3.5.13  (R. Carr)  F 76 arm nodule 

Collision tumour with nodular MM. 

Case 857  30.9.13  (M. Hurt)  F 50 thigh 

Unusual site.  Melanocytic lesion R/O by –ve S100 and Sox10 

DD: Dermatofibroma with monster cells. 

Case 1431  17.12.15  (H. Diwan)  M 93 face 

Quite deep prompting suggestion of PDS.  Keratins, CD31/34, melanoma markers all –ve. 

Case 1751  13.2.17 (L Yu) (incorrect clinical details) 

CD10 strong +ve. 

Case 2651  3.9.20 (S. Taibjee) M 81 scalp nodule – balloon cell variant 

Wild cytology as expected, but balloon cell morphology.  CD10++; CD68++; S100 -ve. 

Case 2947  22.10.21 (R. Carr) ?BCC ?melanoma (site not stated) 

AFX with osteoclast type giant cells.  Severe solar elastosis suggests head/neck site. 

RC prefers the description AFX-like cutaneous sarcoma to pleomorphic dermal sarcoma. 

Reactive, osteoclastic giant cells can arise in any tumour accompanied by interstitial haemorrhage. 

Case 3052  18.3.22 (R. Carr) M 75 vertex scalp 

Xanthomaouts variant with lots of foam cells.  Not v cellular or mitotic.  IH: p53 strongly +ve; p16 null (<90% AFX are null); epithelial, melanocytic and vascular all-ve 

RC: standard IH for suspected AFX p53, p16, Ki67.