Atypical fibroxanthoma with regional lymph node metastasis: report of a case and review of the literature.
BACKGROUND
Atypical fibroxanthoma (AFX) is a low-grade sarcoma usually occurring on sun-damaged skin of the head and neck in elderly patients. Metastatic disease has been reported very rarely. The potential aggressiveness of AFX is controversial.


METHODS
We describe herein a patient who developed metastatic disease in cervical lymph nodes. Our patient was an 87-year-old man with a 7-week history of a rapidly growing AFX presenting as a 1.5-cm sessile nodule on his right mandible. Two months following excision, the patient developed cervical lymphadenopathy. Histopathologic analysis of the cervical lymph nodes revealed spindle-cell tumors with histologic characteristics identical to those of the primary AFX, and the tumors were immunonegative for cytokeratin MNF-116 and S-100. In addition, we review and analyze cases from the literature and articles related to immunohistochemical stains used to diagnose AFX.


CONCLUSIONS
Atypical fibroxanthoma is a diagnosis of exclusion, and only a small number of metastatic AFX cases have been reported. A review of the literature pertaining to immunohistochemical stains suggests the potential benefit of use of CD10, procollagen I, CD99, CD117, p63, and LN-2 in differentiating AFX from other spindle-cell tumors. The metastatic potential of AFX may not be fully appreciated, and clinicians should be reminded of its potential aggressive behavior.
New
Douglas
D
Division of Dermatology, University of Louisville, Louisville, Kentucky, USA.
Bahrami
Soon
S
Malone
Janine
J
Callen
Jeffrey P
JP
D000369:Aged, 80 and over; D001706:Biopsy; D003937:Diagnosis, Differential; D018219:Histiocytoma, Benign Fibrous / Q000175:diagnosis / Q000556:secondary* / Q000601:surgery; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D009333:Neck; D012878:Skin Neoplasms / Q000473:pathology* / Q000601:surgery