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Low-grade fibromyxoid sarcoma is difficult to diagnose by fine needle aspiration cytology: a cytomorphological study of eight cases.

Domanski, Henryk LU ; Mertens, Fredrik LU ; Panagopoulos, Ioannis LU and Åkerman, Måns LU (2009) In Cytopathology 20. p.304-314
Abstract
Background: Low-grade fibromyxoid sarcoma (LGFMS) is an uncommon neoplasm with bland morphology and an indolent clinical course, although metastases may develop in approximately 5-10% of the cases. The diagnosis of LGFMS can be difficult to render from fine needle aspiration cytology (FNAC) alone because of morphological overlap with other spindle cell and myxoid lesions. Objective: To determine cytological criteria for LGFMS by reviewing FNAC aspirates in eight cases and to compare the findings with those in subsequent histological sections. Methods: FNAC slides were reviewed from eight patients with subsequently excised tumours diagnosed as LGFMS. Of these patients, six also had core needle biopsies (CNB). Cytogenetic and/or molecular... (More)
Background: Low-grade fibromyxoid sarcoma (LGFMS) is an uncommon neoplasm with bland morphology and an indolent clinical course, although metastases may develop in approximately 5-10% of the cases. The diagnosis of LGFMS can be difficult to render from fine needle aspiration cytology (FNAC) alone because of morphological overlap with other spindle cell and myxoid lesions. Objective: To determine cytological criteria for LGFMS by reviewing FNAC aspirates in eight cases and to compare the findings with those in subsequent histological sections. Methods: FNAC slides were reviewed from eight patients with subsequently excised tumours diagnosed as LGFMS. Of these patients, six also had core needle biopsies (CNB). Cytogenetic and/or molecular analysis was carried on all tumours. Results: The patients were six men and two women ranging in age from 26 to 78 years. Tumours arose in the deep soft tissues of the thigh (n = 5), shoulder girdle (n = 1) or upper arm (n = 1) and one in the subcutaneous tissue of the abdominal wall. Cytological features included clusters of bland spindle and round/polygonal cells embedded in a collagenous and myxoid matrix along with dissociated, uniform or slightly/moderately pleomorphic spindle cells, bare nuclei and fragments of collagen and myxoid tissue in varying proportions. Unequivocal sarcoma was diagnosed in two aspirates, but mitoses were absent in all cases. In three cases, the diagnosis was inconclusive with regard to benignity or malignancy, while three were erroneously diagnosed as benign spindle cell lesions. Although the diagnosis was suggested on three of six CNB, these presented similar diagnostic problems. Conclusions: There were no cytomorphological findings in FNAC to allow for a clear cut separation of LGFMS from other spindle cell or myxoid lesions, but high-grade sarcoma could be excluded. Surgical (incisional or excisional) biopsy or, alternatively, examination of RT-PCR for the FUS/CREB3L or FUS/CREB3L1 fusion transcripts may be necessary to obtain a correct diagnosis. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Cytopathology
volume
20
pages
304 - 314
publisher
Wiley-Blackwell
external identifiers
  • wos:000269728900005
  • pmid:18637810
  • scopus:70349083773
ISSN
1365-2303
DOI
10.1111/j.1365-2303.2008.00587.x
language
English
LU publication?
yes
id
1fa90618-14ee-4027-bbe8-d078e6c6df2f (old id 1181014)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/18637810?dopt=Abstract
date added to LUP
2008-08-11 11:41:25
date last changed
2017-08-13 04:32:45
@article{1fa90618-14ee-4027-bbe8-d078e6c6df2f,
  abstract     = {Background: Low-grade fibromyxoid sarcoma (LGFMS) is an uncommon neoplasm with bland morphology and an indolent clinical course, although metastases may develop in approximately 5-10% of the cases. The diagnosis of LGFMS can be difficult to render from fine needle aspiration cytology (FNAC) alone because of morphological overlap with other spindle cell and myxoid lesions. Objective: To determine cytological criteria for LGFMS by reviewing FNAC aspirates in eight cases and to compare the findings with those in subsequent histological sections. Methods: FNAC slides were reviewed from eight patients with subsequently excised tumours diagnosed as LGFMS. Of these patients, six also had core needle biopsies (CNB). Cytogenetic and/or molecular analysis was carried on all tumours. Results: The patients were six men and two women ranging in age from 26 to 78 years. Tumours arose in the deep soft tissues of the thigh (n = 5), shoulder girdle (n = 1) or upper arm (n = 1) and one in the subcutaneous tissue of the abdominal wall. Cytological features included clusters of bland spindle and round/polygonal cells embedded in a collagenous and myxoid matrix along with dissociated, uniform or slightly/moderately pleomorphic spindle cells, bare nuclei and fragments of collagen and myxoid tissue in varying proportions. Unequivocal sarcoma was diagnosed in two aspirates, but mitoses were absent in all cases. In three cases, the diagnosis was inconclusive with regard to benignity or malignancy, while three were erroneously diagnosed as benign spindle cell lesions. Although the diagnosis was suggested on three of six CNB, these presented similar diagnostic problems. Conclusions: There were no cytomorphological findings in FNAC to allow for a clear cut separation of LGFMS from other spindle cell or myxoid lesions, but high-grade sarcoma could be excluded. Surgical (incisional or excisional) biopsy or, alternatively, examination of RT-PCR for the FUS/CREB3L or FUS/CREB3L1 fusion transcripts may be necessary to obtain a correct diagnosis.},
  author       = {Domanski, Henryk and Mertens, Fredrik and Panagopoulos, Ioannis and Åkerman, Måns},
  issn         = {1365-2303},
  language     = {eng},
  pages        = {304--314},
  publisher    = {Wiley-Blackwell},
  series       = {Cytopathology},
  title        = {Low-grade fibromyxoid sarcoma is difficult to diagnose by fine needle aspiration cytology: a cytomorphological study of eight cases.},
  url          = {http://dx.doi.org/10.1111/j.1365-2303.2008.00587.x},
  volume       = {20},
  year         = {2009},
}