A rare presentation of myxofibrosarcoma as a Pancoast tumor: a case report

Abstract

BackgroundMyxofibrosarcoma is an aggressive soft tissue neoplasm, classified as a variant of malignant fibrous histiocytoma. Most often, it occurs in middle to late adult life peaking in the seventh decade and involving the lower extremities (77%), trunk (12%), and retroperitoneum or mediastinum (8%). We report the first case of thoracic myxofibrosarcoma presenting as a Pancoast tumor.Case presentationA 48-year-old non-tobacco smoking African-American man presented with a slow-growing mass in his neck along with 11 kg weight loss over 9 months. A review of his systems was positive for hoarseness and lowgrade intermittent fever without any shortness of breath or cough. A physical examination revealed a mass on the left side of his neck superior to his sternoclavicular joint measuring 3 × 3 × 1 cm. He had ptosis and miosis of his left eye. His breath sounds were decreased and coarse at the left apex. A neurological examination revealed 3/5 strength in his left upper arm. The remainder of the physical examination was unremarkable.Ultrasound of his neck showed an ill-defined heterogeneous mass lateral to his left thyroid lobe. A computed tomography scan of his chest showed a large multiloculated pleural-based mass in his left lung surrounding the adjacent neurovascular structures. A percutaneous biopsy was non-diagnostic. Subsequently, he underwent a left thoracotomy with biopsy. The mass extended from his anterior mediastinum medially at the level of the pulmonary trunk, superiorly into the superior sulcus and posteriorly into his chest wall. Surgical pathology confirmed the diagnosis of myxofibrosarcoma.ConclusionsHere we present a case of Pancoast tumor with myxofibrosarcoma as the underlying etiology. Pancoast syndrome generally entails an infiltrating lesion in the superior sulcus presenting with upper extremity pain, atrophy of the hand muscles, and Horner’s syndrome. The differential diagnosis of Pancoast syndrome includes inflammatory and infectious etiologies, as well as neoplasms of benign and malignant nature. Of the neoplasms implicated, the most common are non-small cell lung carcinomas; myxofibrosarcoma presenting as a Pancoast tumor has not been reported in the literature.

Description and management of non-metastatic thoracic myxofibrosarcoma: a case report

“…In this paper, despite other studies (1,3,8) for the first time, immunohistochemical staining was negative for CD34 in this type of cancer after twice repeated.…”

“…Myxofibrosarcoma is a kind of soft tissue sarcoma (STS) that one of the most common neoplasms of the limbs of elderly patients reported in the 1970 th (1). Although both genders are involved, the prevalence of myxofibrosarcoma among males is higher than females.…”

“…Although both genders are involved, the prevalence of myxofibrosarcoma among males is higher than females. Myxofibrosarcoma is considered as a common neoplasm of dermal and subcutaneous tissues (1). The signs of myxofibrosarcoma depend on painless mass, slow-growing, skin-colored, or erythematous nodules or tumors (1).…”

“…Myxofibrosarcoma is considered as a common neoplasm of dermal and subcutaneous tissues (1). The signs of myxofibrosarcoma depend on painless mass, slow-growing, skin-colored, or erythematous nodules or tumors (1). Prognostic determinants for this cancer and metastasis-free survival depend on the tumor mass at surgery, histological grade, positive surgical resection margins, percentage of necrosis, and mitotic rate (2).…”

Giant Myxofibrosarcoma in the Lower Limb: An Overview of Diagnostic and Clinical Management

“…Bethel et al reported the case of a giant myxofibrosarcoma involving the brachial plexus and causing compression of the airway structures [ 36 ]. An interesting case of MFS presented a Pancoast tumor-like manifestation with upper extremity pain, hand muscle atrophy, and Horner`s syndrome [ 37 ]. It can also present as pain in the knee joint [ 38 ].…”