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Atypical fibroxanthoma with prominent sclerosis
Andrea K Bruecks1, Shaun A Medlicott, Martin J Trotter
1Calgary Laboratory Services, University of Calgary, Calgary, AB, Canada. andrea.bruecks@cls.ab.ca
Journal of Cutaneous Pathology
|May 20, 2003
Summary
A rare case of atypical fibroxanthoma (AFX) presented with significant sclerosis and hyalinization on the scalp. This presentation can mimic other conditions, highlighting the importance of thorough histopathologic examination for accurate diagnosis.
Area of Science:
- Dermatopathology
- Surgical Pathology
- Oncology
Background:
- Malignant cutaneous spindle cell lesions with marked sclerosis are rare.
- Published cases of sclerotic cutaneous leiomyosarcoma and dermatofibrosarcoma protuberans are few.
- Atypical fibroxanthoma (AFX) is an uncommon skin neoplasm.
Observation:
- A case of AFX with prominent sclerosis and hyalinization on the scalp of an 81-year-old male is presented.
- The tumor was exophytic, well-delineated, and focally ulcerated in sun-damaged skin.
- Histopathology revealed atypical spindle cells with fascicled and vaguely storiform patterns, multinucleated giant cells, and striking sclerosis.
Findings:
- Tumor cells were positive for CD99 (O13), vimentin, and smooth muscle actin, with focal CD68 positivity.
- Marked sclerosis and hyalinization were observed throughout the lesion.
- Areas of complete tumor replacement by hyalinized collagen were noted.
Implications:
- AFX can rarely present with marked sclerosis and hyalinization, potentially obscuring the diagnosis.
- Significant hyalinization in small biopsies may lead to misdiagnosis of other sclerotic spindle cell tumors.
- Awareness of this sclerotic variant of AFX is crucial for accurate histopathologic interpretation.