Alhumaidan Mohammed I, Bin Makhashen Maraei, Bassas Abdulelah F, Mater Mohammed E, Alsufayan Faris A, Alfaqeeh Faisal A
Plastic and Reconstructive Surgery Department, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia.
Histopathology Department, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia.
Plast Reconstr Surg Glob Open. 2023 Apr 14;11(4):e4934. doi: 10.1097/GOX.0000000000004934. eCollection 2023 Apr.
Myxoinflammatory fibroblastic sarcoma is an ultra-rare tumor type with a prevalence of fewer than two per 100,000 people. The tumor poses a challenge because it can be misdiagnosed as a benign lesion in clinical and radiological investigations, causing serious morbidity in patients. We present the case of a 33-year-old patient who presented with painless hand swelling that was misdiagnosed as lymphaticovenous malformation based on magnetic resonance imaging. The patient underwent surgical excision, and myxoinflammatory fibroblastic sarcoma was diagnosed postoperatively. All surgical interventions failed to achieve negative margin. A decision to start radiotherapy was made, and tissue convergence was done temporally using acellular dermal matrix and split-thickness skin graft. On patient follow-up, the graft had taken well, and the patient was undergoing radiotherapy sessions with a plan for permanent hand reconstruction after negative margins are achieved. Based on this case report, we identified that magnetic resonance imaging is not yet a reliable method to diagnose myxoinflammatory fibroblastic sarcoma. Therefore, implementing a multidisciplinary team approach, a preoperative core needle biopsy, planned surgical intervention, and early involvement of radiotherapy is recommended to minimize morbidity. We strongly urge establishing a sarcoma specialized treatment center in the region to limit patient morbidity.
黏液炎性纤维母细胞肉瘤是一种极为罕见的肿瘤类型，发病率低于十万分之二。该肿瘤构成了一项挑战，因为在临床和影像学检查中它可能被误诊为良性病变，从而给患者带来严重的发病风险。我们报告一例33岁患者，其手部出现无痛性肿胀，基于磁共振成像被误诊为淋巴管静脉畸形。患者接受了手术切除，术后诊断为黏液炎性纤维母细胞肉瘤。所有手术干预均未能实现切缘阴性。于是决定开始放疗，并临时使用脱细胞真皮基质和断层皮片进行组织对合。在对患者的随访中，移植组织生长良好，患者正在接受放疗疗程，计划在实现切缘阴性后进行永久性手部重建。基于本病例报告，我们发现磁共振成像尚不是诊断黏液炎性纤维母细胞肉瘤的可靠方法。因此，建议采用多学科团队方法、术前粗针活检、计划性手术干预以及放疗的早期介入，以将发病风险降至最低。我们强烈敦促在该地区建立一个肉瘤专科治疗中心，以降低患者的发病风险。
