Cesinaro Anna Maria, Gallo Graziana, Tramontozzi Sabrina, Migaldi Mario
Department of Anatomic Pathology, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy.
Visiting fellow from the Department of Anatomic Pathology, University "Alma Mater" of Bologna, Bologna, Italy.
J Cutan Pathol. 2021 Feb;48(2):207-210. doi: 10.1111/cup.13787. Epub 2020 Jul 28.
Atypical fibroxanthoma (AFX) and pleomorphic dermal sarcoma (PDS) share clinical, pathological, immunohistochemical and molecular features, though PDS is associated with a more aggressive behavior.
We reviewed 71 tumors fulfilling criteria for AFX and PDS to further stratify their biological potential.
Lesions were mainly located on the scalps of elderly men, and were often ulcerated. One case was necrotic, one showed vascular invasion, and one showed perineural invasion. Fifty-one tumors were limited to reticular dermis (71.8%), 20 invaded subcutaneous tissue, focally in 13 cases (18.3%), and diffusely in seven (9.9%). Subcutaneous invasion was present significantly more often in tumors showing predominantly spindle compared to pleomorphic/mixed cell morphology (P = 0.02). At a follow-up of 17-125 months, 4 cases recurred locally, 4, 6, 10 and 13 months after surgery; no metastases were observed. Three tumors were composed of spindle cells, and one of clear cells. Three cases had margins focally involved, while the fourth case had clear margins.
Depth of invasion and state of margins are criteria predicting prognosis in AFX/PDS; in addition, spindle cell morphology seems to be related to a more infiltrative pattern of growth and to aggressiveness. Grouping these tumors on a morphologic base could help to clarify their different biological behavior.
非典型纤维黄色瘤（AFX）和多形性皮肤肉瘤（PDS）具有共同的临床、病理、免疫组化及分子特征，尽管PDS具有更强的侵袭性。
我们回顾了71例符合AFX和PDS标准的肿瘤，以进一步分层其生物学潜能。
病变主要位于老年男性头皮，常发生溃疡。1例坏死，1例显示血管侵犯，1例显示神经周围侵犯。51例肿瘤局限于网状真皮层（71.8%），20例侵犯皮下组织，其中13例为局灶性侵犯（18.3%），7例为弥漫性侵犯（9.9%）。与多形性/混合细胞形态的肿瘤相比，以梭形细胞为主的肿瘤皮下侵犯更为常见（P = 0.02）。随访17 - 125个月，4例局部复发，分别在术后4、6、10和13个月复发；未观察到转移。3例肿瘤由梭形细胞组成，1例由透明细胞组成。3例手术切缘局灶受累，第4例切缘清晰。
浸润深度和切缘状态是预测AFX/PDS预后的标准；此外，梭形细胞形态似乎与更浸润性的生长方式及侵袭性有关。基于形态学对这些肿瘤进行分组有助于阐明它们不同的生物学行为。
