DOI: http://dx.doi.org/10.18203/2349-2902.isj20213153

A unique case of classic pleomorphic sarcoma restricted to the toes

Abdul Rehman Siddiqui, Suha Mohammed Akbar

Abstract


Over 50% of soft tissue sarcomas occurring in older adults are histologically pleomorphic and high grade. Most have traditionally been classified as malignant fibrous histiocytoma (MFH). MFH was originally defined as a malignant pleomorphic spindle cell neoplasm showing fibroblastic and histiocytic differentiation. More recently, pathologists have accepted that this morphology may be shared by a wide range of malignant neoplasms. Many sarcomas that were previously classified as pleomorphic MFH, on careful immunohistochemical and histopathologic analyses, revealed a specific line of differentiation and could be reclassified as myxofibrosarcoma (30%), myogenic sarcoma (30%), liposarcoma (4%), malignant peripheral nerve sheath tumor (2%), or soft tissue osteosarcoma (3%), whereas about 30% had no specific line of differentiation or were myofibroblastic. The term undifferentiated pleomorphic sarcoma (UPS) is now reserved for pleomorphic sarcomas that show no definable line of differentiation by current technology. The majority of extremity sarcomas occur in the lower extremity (74 vs. 26% in the upper limb). According to one of the studies conducted on 315 patients, non-metastatic soft tissue sarcoma of the lower extremity who were treated at one institution over a ten-year period. Sixty-six percent of the lesions were above the knee, and 60% were high grade. This case had a 3x3 cm ulcer at the 3rd toe in a 30-year-old male patient who subsequently underwent midfoot ampuatation.


Keywords


Undifferentiated pleomorphic sarcoma, Malignant fibrous histiocytoma, Myofibroblastic

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References


Doyle LA. Sarcoma classification: an update based on the 2013 World Health Organization Classification of Tumors of Soft Tissue and Bone Cancer. 2014;120(12):1763-74.

Demetri GD, Antonia S, Benjamin R. Soft tissue sarcoma. 2010;8(6):630-74.

Lim Z, Strike SA, Puhaindran ME. Sarcoma of the Lower Limb: Reconstructive Surgeon's Perspective. Indian J Plast Surg. 2019;52(1):55-61.

Vodanovich DA, Choong PMF. Soft-tissue Sarcomas. Indian J Orthop. 2018;52(1):35-44.

Collin C, Hadju SI, Godbold J, Shiu MH, Hilaris BI, Brennan MF. Localized, Operable Soft Tissue Sarcoma of the Lower Extremity. 1986;121(12):1425-33.

Cancer principles and practice of oncology-devita 10th edition, Wolters Kluwer Health Adis (ESP). 2015;1-2280.

Knighta J, Singhamb J. Metastasizing pleomorphic adenoma: Systematic review. Int J surgery. 2015;19:137-40.

Pruijna IM, Van Herpenb CM, Peggec SAJ, Van Engen van Grunsvend A, Ligtenberge MJ, Van den Hoogena FMA. Myotonic dystrophy and recurrent pleomorphic adenomas: Case report and association hypothesis. 2020;925-9.