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LETTER TO EDITOR  
Year : 2014  |  Volume : 57  |  Issue : 3  |  Page : 503-504
Paratesticular myxofibrosarcoma


1 Department of Pathology, School of Medicine, Suleyman Demirel University, Isparta, Turkey
2 Department of Urology, School of Medicine, Suleyman Demirel University, Isparta, Turkey
3 Department of Medical Oncology, School of Medicine, Suleyman Demirel University, Isparta, Turkey

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Date of Web Publication14-Aug-2014
 

How to cite this article:
Baspinar S, Kapucuoglu N, Akdeniz R, Oksay T, Guzel A, Kocer M. Paratesticular myxofibrosarcoma. Indian J Pathol Microbiol 2014;57:503-4

How to cite this URL:
Baspinar S, Kapucuoglu N, Akdeniz R, Oksay T, Guzel A, Kocer M. Paratesticular myxofibrosarcoma. Indian J Pathol Microbiol [serial online] 2014 [cited 2020 Jun 5];57:503-4. Available from: http://www.ijpmonline.org/text.asp?2014/57/3/503/138805


Editor,

Myxofibrosarcoma (MFS), which is originally considered as myxoid variant of malignant fibrous histiocytoma is one of the most common sarcomas typically presents in the extremities of elderly people, and it is very rare in the paratesticular region. [1],[2],[3] We reported here a 50-year-old man with a painless left testicular swelling, which had increased in size over 1-month. There was no history of any recent scrotal trauma, prior urinary tract infections or genitourinary surgery. Clinical examination revealed a firm, well-circumscribed mass in the left scrotum. Serum lactate dehydrogenase, alpha-fetoprotein, beta subunit of human chorionic gonadotropin values were within the normal range. Contrast enhanced abdominal and pelvic computed tomography (CT) scan revealed a heterogeneous and unencapsulated mass measuring 10 cm 8 cm at its greatest dimension, arising from left scrotal cavity, pushing the left testis and extending to the inguinal canal. There was no evidence of any lymphadenopathy in the pelvic and inguinal regions or metastatic lesions at other solid organs. The patient underwent left radical orchiectomy with ligation of the spermatic cord at the level of internal inguinal ring through an inguinal approach. On macroscopic examination the tumor appeared as a multinodular mass, 10.5 cm 9.5 cm 6.5 cm in size with yellowish to pale gray solid gelatinous surface and expansile sharp unencapsulated peripheral margins, which is reminiscent of myxoid liposarcoma in gross differential diagnosis. The tumor did not show invasion into epididymis, and it was separated from the normal testicular tissue, which was 3 cm 3 cm 2.9 cm in dimension [Figure 1]. Examination of the microscopic section showed that the tumor was hypocellular and consisted of loose myxoid stroma with few noncohesive plump spindled or stellate cells and giant cells. The nuclei of the tumor cells were slightly hyperchromatic and irregularly shaped [Figure 2]a. There was no hemorrhage or necrosis. Mitotic figures were 1-3/10 HPF and Ki-67 labeling index [Figure 2]b] was 5% in the tumor cells. Immunohistochemically, the tumor cells were positive for vimentin [Figure 2]c, and CD34 [Figure 2]d and negative for smooth muscle actin (SMA) [Figure 2]e, desmin and S-100 [Figure 2]f. On the basis of the histopathological and immunhistochemical features, the tumor was diagnosed as low-grade MFS. Adjuvan chemotherapy and/or radiotherapy were not recommended, as there were no findings of recurrence or metastasis in abdominal and thorax CT. The postoperative clinical course was uneventful and he remained free of disease 8 months after the operation. Myxofibrosarcoma has to be differentiated from other benign or malignant myxoid soft tissue tumors. Benign lesions such as myxomas and angiomyxomas lack nuclear hyperchromasia, pleomorphism or mitotic figures. Furthermore, it has to be differentiated from myxoid liposarcoma, myxoid leiomyosarcoma and low-grade fibromyxoid sarcoma. [4] Lipoblasts seen in liposarcoma, and long and short fascicles of spindle cells with blunt ends as seen in leiomyosarcoma were not identified morphologically in our case, and in contrast to leiomyosarcoma, SMA was negative in this tumor. As low-grade paratesticular MFS has little potential for metastatic spread, our current approach will be to monitor the patient by means of clinical and radiological follow-up to rule out tumor recurrence.
Figure 1: Gross appearance of the multinodular tumor with yellowish to pale gray solid gelatinous cut surface, which is separate from the normal testicular tissue

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Figure 2: Tumor characterized by myxoid matrix containing spindle to stellate cells (H&E, ×200) (a). Immunohistochemical analysis shows positive staining for (b) Ki-67 (DAB, ×200), (c) Vimentin (DAB, ×100), and (d) CD34 (DAB, ×200) and negative for (e) Smooth muscle actin (DAB, ×100), and (f) S-100 (DAB, ×200)

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   References Top

1.
Ozkan B, Ozgüroglu M, Ozkara H, Durak H, Talat Z. Adult paratesticular myxofibrosarcoma : r0 eport of a rare entity and review of the literature. Int Urol Nephrol 2006;38:5-7.  Back to cited text no. 1
    
2.
Merck C, Angervall L, Kindblom LG, Odén A. Myxofibrosarcoma. A malignant soft tissue tumor of fibroblastic-histiocytic origin. A clinicopathologic and prognostic study of 110 cases using multivariate analysis. Acta Pathol Microbiol Immunol Scand Suppl 1983;282:1-40.  Back to cited text no. 2
    
3.
Mentzel T, Calonje E, Wadden C, Camplejohn RS, Beham A, Smith MA, et al. Myxofibrosarcoma. Clinicopathologic analysis of 75 cases with emphasis on the low-grade variant. Am J Surg Pathol 1996;20:391-405.  Back to cited text no. 3
    
4.
Khoubehi B, Mishra V, Ali M, Motiwala H, Karim O. Adult paratesticular tumours. BJU Int 2002;90:707-15.  Back to cited text no. 4
    

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Correspondence Address:
Sirin Baspinar
Suleyman Demirel University School of Medicine, Department of Pathology, Isparta
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.138805

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