Department of Dermatology and Allergology, Hospital Dresden-Friedrichstadt, Academic Teaching Hospital of the Technical University of Dresden, Dresden, Germany.
J Eur Acad Dermatol Venereol. 2010 Aug;24(8):943-6. doi: 10.1111/j.1468-3083.2010.03578.x. Epub 2010 Feb 1.
Atypical fibroxanthoma is a rare mesenchymal tumour of skin that develops on skin of elderly patients. We analysed our patients with atypical fibroxanthoma over the last 8 years.
We analysed the pathology files of our hospital for the period 2001-2009. In all cases, histology and immunohistology were performed. Data on co-morbidities, treatment and outcome were obtained.
We identified 25 patients (except two female patients, the rest were men) aged 52-95 years (mean: 79.5 years; standard deviation +/- 9.06 years). All tumours were localized in the head and neck region, except a single tumour on the shoulder. Fourteen patients had a cancer history, six had actinic keratoses or Bowen's disease (n = 1). Five patients had cardiac surgery or pacemaker, one each had a renal transplant, systemic sarcoidosis or non-Hodgkin's lymphoma. Medical history was positive for radiotherapy or chemotherapy in four patients. Histology showed a spindle-shaped dermal and subcutaneous tumour growth intermingled with multinucleated giant cells. The phenotype of tumour cells was vimentin-positive, but S100- and keratin-negative. Some tumours showed a focal expression of CD68. Complete microhistographic controlled surgery ('Mohs like') was possible in all cases followed by mesh-graft transplantation in three patients. Eighteen patients showed a complete remission. Four patients had a relapse within 2 years of follow-up treated by surgery. One patient is still under radiotherapy. All patients with a safety margin of 2 cm had no recurrence or relapse during follow-up.
Micrographic controlled surgery with wide 2 cm safety margins is the treatment of choice. A regular follow-up for the next 5 years is recommended.
非典型纤维黄色瘤是一种罕见的皮肤间叶性肿瘤，发生于老年患者的皮肤。我们分析了过去 8 年来患有非典型纤维黄色瘤的患者。
我们分析了 2001 年至 2009 年期间我院的病理档案。所有病例均行组织学和免疫组织化学检查。获得合并症、治疗和转归的数据。
我们共确定了 25 名患者（除了两名女性患者，其余均为男性），年龄 52-95 岁（平均年龄 79.5 岁；标准差 +/- 9.06 岁）。所有肿瘤均位于头颈部，除 1 例位于肩部。14 例患者有癌症病史，6 例有光化性角化病或 Bowen 病（n = 1）。5 例患者接受过心脏手术或起搏器治疗，1 例患者接受过肾移植、系统性结节病或非霍奇金淋巴瘤治疗。4 例患者有放疗或化疗病史。组织学表现为梭形真皮和皮下肿瘤生长，伴有多核巨细胞。肿瘤细胞的表型为波形蛋白阳性，但 S100 和角蛋白阴性。部分肿瘤表现为 CD68 局灶性表达。所有病例均可行完整的组织学控制手术（类似“Mohs 手术”），随后 3 例患者行网片移植。18 例患者完全缓解。4 例患者在随访 2 年内复发，均经手术治疗。1 例患者仍在接受放疗。所有安全切缘为 2 cm 的患者在随访期间均无复发或转移。
广泛 2 cm 安全切缘的显微镜控制手术是治疗的首选。建议在接下来的 5 年内定期随访。
