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Congenital-infantile fibrosarcoma presenting as a hemangioma: a case report
Melissa Kanack1, Jessica Collins, Timothy J Fairbanks
1From the *Division of Plastic Surgery, Department of Surgery, University of California San Diego; †Oasis MD; ‡Department of Surgery, University of California San Diego; §Rady Children's Hospital-San Diego; and ∥Division of Pediatric Surgery, Department of Surgery, University of California San Diego, San Diego, CA.
Insights
Congenital-infantile fibrosarcoma (CIFS) can mimic hemangiomas in infants. Prompt diagnosis and treatment, including surgery and chemotherapy, are crucial for better outcomes in this rare pediatric soft tissue tumor.
Area of Science:
- Pediatric Oncology
- Surgical Pathology
- Dermatology
Background:
- Congenital-infantile fibrosarcoma (CIFS) is a rare pediatric soft tissue tumor.
- CIFS can clinically mimic infantile hemangioma, leading to diagnostic delays.
- Timely diagnosis and management are critical for patient prognosis.
Observation:
- A 6-month-old infant presented with a rapidly growing buttock mass initially suspected as a hemangioma.
- The lesion showed rapid growth, ulceration, and bleeding, unresponsive to antibiotics.
- Imaging suggested an atypical hemangioma, prompting surgical consultation.
Findings:
- Excisional biopsy revealed congenital-infantile fibrosarcoma (CIFS).
- The patient underwent re-excision with clear margins and adjuvant chemotherapy due to recurrent disease and pulmonary metastasis.
- Pathologic confirmation is essential for differentiating CIFS from hemangioma.
Implications:
- This case highlights the importance of considering CIFS in atypical or complicated infantile hemangiomas.
- Prompt and accurate diagnosis of CIFS is vital for appropriate treatment planning.
- Multidisciplinary management involving surgery, pathology, and oncology optimizes outcomes for pediatric soft tissue tumors.
Introduction:
Congenital-infantile fibrosarcoma (CIFS) is a rare pediatric soft tissue tumor that on initial clinical presentation can mimic an infantile hemangioma. Management of these conditions differs drastically, and delay in diagnosis and treatment may affect prognosis.
Methods:
A 6-month-old male infant originally presented to dermatology for evaluation of a suspected right buttock hemangioma, present at birth as a small red mass just lateral to the gluteal cleft. The lesion rapidly grew over 2 weeks to a size of 4×4.5×4.5 cm, with violaceous color change and central ulceration. The patient received a course of cephalexin; however, the mass became painful with several episodes of bleeding and did not show clinical improvement. Magnetic resonance imaging and ultrasound supported the diagnosis of atypical hemangioma.
Results:
Plastic Surgery was consulted for excision due to recurrent bleeding. An excisional biopsy was undertaken and pathologic finding showed CIFS. The case was discussed with Hematology/Oncology and Pediatric Surgery, and the patient underwent re-excision and obtained clear margins. Initial metastatic workup was negative; however, patient had evidence of recurrent disease as well as pulmonary metastasis on his most recent surveillance imaging. He underwent re-excision of the gluteal mass and is currently receiving adjuvant chemotherapy.
Conclusions:
This case demonstrates a rare malignancy initially misdiagnosed as a hemangioma. Consideration of CIFS is crucial in cases of complicated hemangiomas not responding to standard treatment. Treatment calls for excision with wide margins and/or adjuvant chemotherapy if excision is not possible. Classic pathologic findings, immunohistochemistry, and/or reverse transcription-polymerase chain reaction can confirm the diagnosis. A correct and rapid diagnosis of CIFS is critical to optimizing treatment and subsequent prognosis.
