Case Number : Case 272 Posted By: Guest

Phillip McKee - Overseas consultations (Cave Creek, Arizona, USA) Wrote:

Yes Richard, these connective tissue tumors do leave one battered and bruised. They are very difficult. The diagnosis in this case is acral myxoinflammatory fibroblastic sarcoma. Mona's comments are excellent. Unfortunately I do not have the results of ALK1 but I assume that it was positive. Have a wonderful weekend and see you on Monday

Submitted on 24/06/2011 13:31
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Juan Carlos Garcés - Hospital Oncológico / Hospital Luis Vernaza (Guayaquil Ecuador) Wrote:

Good morning, difficult case. I think that a good possiblility is myxoinflammatory fibroblastic sarcoma

Submitted on 24/06/2011 12:02
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MSMD - () Wrote:

acral myxoinflammatory fibroblastic sarcoma

Submitted on 24/06/2011 08:49
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Mona Abdel Halim - Dermatology Department, Faculty of medicine, Cairo University (Egypt) Wrote:

I have just read that giant histiocyte like cells and RS like cells were described one case report of inflammatory myofibroblastic tumor, So with the abundant plasma cells and the lack of pseudolipoblasts, I will finalize my diagnosis here as inflammatory myofibroblastic tumor..

Submitted on 24/06/2011 08:27
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Mona Abdel Halim - Dermatology Department, Faculty of medicine, Cairo University (Egypt) Wrote:

This is extremely difficult for me. The presence of pleomorphism in the last image with many large bizzare cells, one with 2 nuclei, together with the presence of plump spindle cells, histiocytes and ? foam cells, all in collagenous and myxoid background (with some focal chondroid appearance) made me think of malignant fibrous histiocytoma (pleomorphic undiff. sarcoma), however, the striking presence of plasma cells and lymphocytes was annoying to me but I read that chronic inflammatory cells are seen throughtout this tumor particularly at the periphery of it...When I read other colleagues' comments I liked the idea of inflammatory myofibroblastic tumor which predominantely shows lymphocytes and plasma cells among its inflammatory component but could it explain the large bizarre cells in the last image??? The idea suggested by Dr Carr is superb, myxoinflammatory fibrosarcoma, again it explains the inflammatory cell component and may be the large bizzare cells in the last image with the binucleated large cell would be the ganglion cells (virocyte like or RS like cells) characteristic of this tumor, but I think there are no pseudolipoblasts here as much as I can percieve. Very nice case because I am sure it will be very educational, looking forward to know the correct diagnosis....

Submitted on 24/06/2011 07:00
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Marcela Saeb Lima - Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (Mexico City) Wrote:

Infalammatory myofibroblastic tumor

Submitted on 24/06/2011 06:01
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Eman El-Nabarawy - Cairo University (Egypt) Wrote:

Agree with Dr Carr, So i will add myxoinflammatory fibroblastic sarcoma to my dd.

Submitted on 24/06/2011 05:54
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Richard Carr - SWH (Warwick, UK) Wrote:

I will add a (acral) myxoinflammatory fibroblastic sarcoma but with little confidence. Feel battered and bruised by these spindle cell lesions!!

Submitted on 24/06/2011 05:40
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ANDREW DANCKWERTS - NHLS, WITS UNIVERSITY (JOHANNESBURG, RSA) Wrote:

AGREE - IMT. DDx: IgG4 SCLEROSING DISEASE. WOULD LIKE TO DO ALK1 IMMUNOHISTOCHEMICAL STAIN TO DIFFERENTIATE. NICE CASE!

Submitted on 24/06/2011 05:34
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Eman El-Nabarawy - Cairo University (Egypt) Wrote:

Inflammatory myofibroblastic tumor.

Submitted on 24/06/2011 04:31
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