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Atypical fibroxanthoma. Multiple immunohistologic profiles

T A Longacre1, B R Smoller, R V Rouse

  • 1Department of Pathology, Stanford University Medical Center, CA 94305-5324.

The American Journal of Surgical Pathology
|December 1, 1993
PubMed
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This study analyzed 37 atypical fibroxanthoma (AFX) cases, revealing diverse immunohistochemical profiles. Findings suggest heterogeneous fibrohistiocytic and myofibroblastic phenotypes, necessitating an integrated diagnostic approach for cutaneous spindle cell lesions.

Area of Science:

  • Dermatopathology
  • Oncology
  • Immunohistochemistry

Background:

  • Atypical fibroxanthoma (AFX) is a rare cutaneous neoplasm.
  • Understanding its diverse cellular and immunohistochemical features is crucial for accurate diagnosis.

Purpose of the Study:

  • To present the clinical, histologic, and immunohistochemical features of 37 AFX cases.
  • To explore the spectrum of cellular morphology and immunophenotypes in AFX.
  • To propose a revised understanding of AFX classification.

Main Methods:

  • Retrospective analysis of 37 AFX cases.
  • Histologic examination and immunohistochemical staining for S-100, factor XIIIa, muscle-specific actin, smooth muscle actin, and CD68.
  • Correlation of immunophenotypes with clinical and morphologic features.

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Main Results:

  • AFX cases showed varied morphology, from predominantly spindle cells to bizarre epithelioid cells with giant cells.
  • Immunohistochemistry revealed reactivity for CD68 (57%) and actin (41%), with S-100 and factor XIIIa present in fewer cases.
  • Four distinct immunologic profiles were identified: CD68 only, actin only, double positives, and double negatives.
  • No significant differences were noted between head and neck lesions versus trunk and extremity lesions.

Conclusions:

  • The immunohistochemical spectrum of AFX is broader than previously recognized.
  • AFX may represent a heterogeneous group with bimodal fibrohistiocytic and myofibroblastic phenotypes.
  • An integrative, nonalgorithmic diagnostic approach is essential for analyzing AFX and other cutaneous spindle cell lesions.