Atypický fibroxantóm, zriedkavý a často nerozpoznaný kožný mäkko-tkanivový nádor – kazuistika a prehľad literatúry

Atypický fibroxantóm (AFX) je zriedkavý kožný mäkko-tkanivový nádor typicky sa vyskytujúci u starších ľudí na koži vystavenej slnečnému žiareniu. Histologicky je tvorený pleomorfnými atypickými bunkami s početnými mitózami vrátane atypických mitóz, čím pripomína nediferencovaný malígny nádor. AFX je považovaný za benígny nádor s takmer výlučne excelentnou prognózou po konzervatívnej liečbe, ak sú použité prísne diagnostické kritériá. Prezentujeme prípad 68-ročného muža s nádorom kože v temporo-parietálnej oblasti. Histomorfologické a imunohistochemické nálezy zodpovedali diagnóze atypického fibroxantómu. Ponúkame prehľad terminológie a kategorizácie tohto nádoru a spektrum imunohistochemických markerov nápomocných v diferenciálne-diagnostickom procese na vylúčenie iných malígnych nádorov, pretože AFX je diagnóza per exclusionem. Správnou diagnózou sa vyhneme nepotrebnej liečbe pacienta.

Klíčová slova:

Atypický fibroxantóm – nediferencovaný pleomorfný sarkóm – imunohistochémia.

Autoři: Zuzana Čierna ¹; Rastislav Trška ²
Vyšlo v časopise: Čes.-slov. Patol., 55, 2019, No. 3, p. 182-186
Kategorie: Původní práce

Souhrn

Klíčová slova:

Atypický fibroxantóm – nediferencovaný pleomorfný sarkóm – imunohistochémia.

Zdroje

1. Koch M, Freundl AJ, Agaimy A, et al. Atypical fibroxanthoma - histological diagnosis, immunohistochemical markers and concepts of therapy. Anticancer research 2015; 35(11): 5717-5735.

2. Helwig EB. Atypical fibroxanthoma. In: Tumor Seminar Proceedings of 18th Annual Tumor Seminar of San Antonio Society of Pathologists. Tex State J Med 1963; 59: 664-667.

3. Calonje JE, Brenn T, Komminoth P. Atypical fibroxanthoma. In: Fletcher CDM, Bridge JA, Hogendoorn PCW, Mertens F, eds. WHO Classification of Tumours of Soft Tissue and Bone (4th ed). Lyon: International Agency for Research on Cancer (IARC); 2013: 202-203.

4. Lopez L, Velez R. Atypical fibroxanthoma. Arch Pathol Lab Med 2016; 140(4): 376-379.

5. Luzar B, Calonje E. Morphological and immunohistochemical characteristics of atypical fibroxanthoma with a special emphasis on potential diagnostic pitfalls: a review. J Cutan Pathol 2010; 37(3): 301-309.

6. Wright NA, Thomas CG, Calame A, Cockerell CJ. Granular cell atypical fibroxanthoma: case report and review of the literature. J Cutan Pathol 2010; 37(3): 380-385.

7. Patton A, Page R, Googe PB, King R. Myxoid atypical fibroxanthoma: a previously undescribed variant. J Cutan Pathol 2009; 36(11): 1177-1184.

8. Rudisaile SN, Hurt MA, Santa Cruz DJ. Granular cell atypical fibroxanthoma. J Cutan Pathol 2005; 32(4): 314-317.

9. Pastor-Nieto MA, Kilmurray LG, Requena L. Pigmented or hemosiderotic atypical fibroxanthoma. Actas Dermosifiliogr 2009; 100(4): 321-324.

10. Requena L, Sangueza OP, Sanchez Yus E, Furio V. Clear-cell atypical fibroxanthoma: an uncommon histopathologic variant of atypical fibroxanthoma. J Cutan Pathol 1997; 24(3): 176-182.

11. Kim J, McNiff JM. Keloidal atypical fibroxanthoma: a case series. J Cutan Pathol 2009; 36(5): 535-539.

12. Zheng R, Ma L, Bichakjian CK, Lowe L, Fullen DR. Atypical fibroxanthoma with lymphomatoid reaction. J Cutan Pathol 2011; 38(1): 8-13.

13. Tongdee E, Touloei K, Shitabata PK, Shareef S, Maranda EL. Keloidal atypical fibroxanthoma: case and review of the literature. Case Rep Dermatol 2016; 8(2): 156-163.

14. Němejcová K, Dundr P. Granular cell variant of atypical fibroxanthoma. A case report. Cesk Patol 2014; 50(1): 34-37.

15. Ito A, Yamada N, Yoshida Y, Morino S, Yamamoto O. Myofibroblastic differentiation in atypical fibroxanthomas occurring on sun-exposed skin and in a burn scar: an ultrastructural and immunohistochemical study. J Cutan Pathol 2011; 38(8): 670-676.

16. Weiss SW, Goldblum JR. Malignant fibrohistiocytic tumors. In: Strauss M, ed. Enzinger and Weiss´s Soft Tissue Tumors (4th ed). USA: Mosby; 2001: 535-569.

17. Fernandez-Flores A. Cutaneous squamous cell carcinoma of different grades: variation of the expression of CD10. Cesk Patol 2008; 44(4): 100-102.

18. Weiss SW, Goldblum JR. Malignant fibrous histiocytoma (pleomorphic undifferentiated sarcoma). In: Schmitt W, ed. Enzinger and Weiss’s Soft Tissue Tumors (5th ed). Philadelphia, PA: Mosby Elsevier; 2008: 403-428.

19. Goldblum JR, Weiss SW, Folpe AL. Undifferentiated pleomorphic sarcoma. In: Schmitt WR, ed. Enzinger and Weiss’s Soft Tissue Tumors (6th ed). Philadelphia, PA: Elsevier Saunders; 2014: 421-442.

20. Doyle LA. Sarcoma classification: an update based on the 2013 World Health Organization classification of tumors of soft tissue and bone. Cancer 2014; 120(12): 1763-1774.

21. Jo VY, Fletcher CD. WHO classification of soft tissue tumours: an update based on the 2013 (4th) edition. Pathology 2014; 46(2): 95-104.

22. LeBoit PE, Burg G, Weedon D, Sarasin A. WHO Classification of Tumours. Pathology and Genetics of Skin Tumours (3th ed). Lyon: International Agency for Research on Cancer (IARC); 2006: 357 p.

23. Beer TW, Calonje E, Wick MR. Tumours of uncertain differentiation. Atypical fibroxanthoma and variants. In: Elder DE, Massi D, Scolyer RA, Willemze R, eds. WHO Classification of Skin Tumours (4th ed). Lyon: International Agency for Research on Cancer (IARC); 2018: 368-369.

24. Satter EK. Metastatic atypical fibroxanthoma. Dermatol Online J 2012; 18(9): 3.

25. Nergard J, Glener J, Reimer D, Greenwald JS. Atypical fibroxanthoma of the scalp with recurrent and multiple regional cutaneous metastases. JAAD Case Rep 2016; 2(6): 491-493.

26. New D, Bahrami S, Malone J, Callen JP. Atypical fibroxanthoma with regional lymph node metastasis: report of a case and review of the literature. Arch Dermatol 2010; 146(12): 1399-1404.

27. Miettinen M. Fibroblastic and myofibroblastic neoplasms with malignant potential. In: Miettinen M, ed. Modern Soft Tissue Pathology. Tumors and Non-neoplastic Conditions. New York: Cambridge University Press; 2010: 348-392.

28. Helwig EB, May D. Atypical fibroxanthoma of the skin with metastasis. Cancer 1986; 57(2): 368-376.

29. Helbig D, Ihle MA, Putz K, et al. Oncogene and therapeutic target analyses in atypical fibroxanthomas and pleomorphic dermal sarcomas. Oncotarget 2016; 7(16): 21763-21774.

30. Benoit A, Wisell J, Brown M. Cutaneous spindle cell carcinoma misdiagnosed as atypical fibroxanthoma based on immunohistochemical stains. JAAD Case Rep 2015; 1(6): 392-394.

31. Gleason BC, Calder KB, Cibull TL, et al. Utility of p63 in the differential diagnosis of atypical fibroxanthoma and spindle cell squamous cell carcinoma. J Cutan Pathol 2009; 36(5): 543-547.

32. Ha Lan TT, Chen SJ, Arps DP, et al. Expression of the p40 isoform of p63 has high specificity for cutaneous sarcomatoid squamous cell carcinoma. J Cutan Pathol 2014; 41(11): 831-838.

33. Alomari AK, Glusac EJ, McNiff JM. p40 is a more specific marker than p63 for cutaneous poorly differentiated squamous cell carcinoma. J Cutan Pathol 2014; 41(11): 839-845.

34. Henderson SA, Torres-Cabala CA, Curry JL, et al. p40 is more specific than p63 for the distinction of atypical fibroxanthoma from other cutaneous spindle cell malignancies. Am J Surg Pathol 2014; 38(8): 1102-1110.

35. Palla B, Su A, Binder S, Dry S. SOX10 expression distinguishes desmoplastic melanoma from its histologic mimics. Am J Dermatopathol 2013; 35(5): 576-581.

36. Smith-Zagone MJ, Prieto VG, Hayes RA, Timperman WW, Jr., Diwan AH. HMB-45 (gp103) and MART-1 expression within giant cells in an atypical fibroxanthoma: a case report. J Cutan Pathol 2004; 31(3): 284-286.

37. Thum C, Hollowood K, Birch J, Goodlad JR, Brenn T. Aberrant Melan-A expression in atypical fibroxanthoma and undifferentiated pleomorphic sarcoma of the skin. J Cutan Pathol 2011; 38(12): 954-960.

38. Cai JP, Randall B. HMB-45 expression in a clear cell variant of atypical fibroxanthoma. J Cutan Pathol 2006; 33(2): 186-188.

39. Gonzalez CD, Hawkes JE, Bowles TL. Recurrent cutaneous angiosarcoma of the ear masquerading as atypical fibroxanthoma. JAAD Case Rep 2016; 2(6): 445-447.

40. Crowson AN, Carlson-Sweet K, Macinnis C, et al. Clear cell atypical fibroxanthoma: a clinicopathologic study. J Cutan Pathol 2002; 29(6): 374-381.

41. Nguyen CM, Chong K, Cassarino D. Clear cell atypical fibroxanthoma: a case report and review of the literature. J Cutan Pathol 2016; 43(6): 538-542.

42. Wollina U, Schonlebe J, Ziemer M, et al. Atypical fibroxanthoma: a series of 56 tumors and an unexplained uneven distribution of cases in southeast Germany. Head Neck 2015; 37(6): 829-834.

43. Doggett S, Brazil J, Limova M, Press L, Smith S, Peck J. Electronic brachytherapy management of atypical fibroxanthoma: report of 8 lesions. J Contemp Brachytherapy 2017; 9(2): 158-160.