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Infantile fibrosarcoma of the left upper limb mimicking a hemangioma: A case report
Hafedh Daly1, Faiez Boughanmi2, Mohamed Zayati2
1Department of Cardiovascular Surgery, Monastir University Hospital, Tunisia.
Insights
Infantile fibrosarcoma (IFS) can mimic infantile hemangioma, posing diagnostic challenges. Early histopathological diagnosis and multidisciplinary management are crucial for favorable outcomes in this rare pediatric soft tissue malignancy.
Area of Science:
- Pediatric Oncology
- Surgical Pathology
- Diagnostic Imaging
Background:
- Infantile fibrosarcoma (IFS) is a rare pediatric soft tissue malignancy.
- IFS often presents with clinical and radiologic features similar to benign vascular tumors, such as infantile hemangiomas.
- Accurate and early diagnosis of IFS is critical for effective management.
Observation:
- A case of a 3-year-old child with a rapidly growing left upper limb mass is presented.
- Initial imaging (Doppler ultrasound and MRI) suggested infantile hemangioma.
- Surgical excision revealed a vascularized tumor involving the brachial artery and median nerve.
Findings:
- Histopathological analysis confirmed infantile fibrosarcoma, noting spindle cells, high mitotic activity, hemosiderin, and vascular proliferation.
- Immunohistochemistry was negative for several markers, aiding in differential diagnosis.
- The definitive diagnosis of IFS relies on histopathology and immunohistochemistry.
Implications:
- This case highlights the diagnostic difficulty in differentiating IFS from infantile hemangioma based on imaging alone.
- Multidisciplinary management, including surgical resection and potentially chemotherapy, is essential for optimal outcomes.
- IFS should be included in the differential diagnosis of congenital soft tissue masses, especially with atypical features.
Introduction And Importance:
Infantile fibrosarcoma (IFS) is a rare soft tissue malignancy that primarily affects children under one year of age. Its clinical and radiologic features often resemble benign vascular tumors like hemangiomas, making diagnosis challenging. Early and accurate identification is essential for effective management.
Case Presentation:
We report a case of a 3-year-old child with a progressively enlarging mass in the left upper limb. Clinical examination revealed a firm, non-pulsatile mass with prominent venous collateral circulation. Doppler ultrasound and MRI findings suggested an infantile hemangioma. Surgical excision revealed a highly vascularized tumor closely associated with the brachial artery and median nerve. Histopathological analysis confirmed infantile fibrosarcoma, characterized by spindle-shaped cells with mild atypia, high mitotic activity, hemosiderin deposits, and significant vascular proliferation. Immunohistochemistry was negative for myogenin, cytokeratin, desmin, CD68, and TLE1.
Clinical Discussion:
This case underscores the diagnostic challenge posed by IFS, which can closely mimic infantile hemangioma on imaging. MRI findings suggested but did not confirm the diagnosis. Histopathology remains the definitive method for diagnosis. Multidisciplinary management-including surgical resection and, when indicated, chemotherapy-is essential for optimal outcomes.
Conclusion:
IFS should be considered in the differential diagnosis of congenital soft tissue masses, particularly when atypical features are present. Definitive diagnosis relies on histopathological and immunohistochemical evaluation. Multidisciplinary management plays a critical role in ensuring favorable clinical outcomes.
