Retromolar Fibrosarcoma - A Diagnostic Dilemma: Case Report

Abstract

A b s t r a c tFibrosarcoma is a malignant spindle cell tumor of the soft tissues uniformly composed of collagen-producing cells capable of exhibiting varying degrees of fibroblastic differenciation. This diagnosis was more liberally applied to many types of spindle and pleomorphic cell sarcomas that exhibited fibrosarcoma-like patterns, e.g., malignant schwannoma, synovial sarcoma, malignant fibrous histiocytoma, and some benign fibroproliferative lesions, particularly fibromatosis and reactive tumor-like lesions.The major challenge in the diagnosis lies in over and under diagnose of fibrosarcoma and underdiagnosis of reactive fibrosis. But this histologic differenciation is necessary owing to different treatment strategies.

Intraoral Soft Tissue Fibrosarcoma: A Case Report and Review

“…However, it may be of little help in differential diagnosis, from the fibrous connective tissue tumors as positive immunostaining against vimentin can be observed in all of them (Table 1). 31 The low grade FS shows low to moderate cellularity with often nuclear overlap, nuclear hyperchromasia and more prominent nucleoli as compared to the fibromatosis. Necrosis and vessel formation are rarely seen in low grade fibrosarcoma, which are absent in case of fibromatosis.…”

“…31 The grade 1 fibrosarcoma is usually discernable from fibromatosis by the presence of occasional larger nuclei with ominous chromatin clumping, greater cellularity, greater mitotic activity and thin rather than thick collagen bundles. 28,31 Immunohistochemistry can be used as an exclu sion criteria to differentiate from sarcomas arising from other mesenchymal tissues. However, it may be of little help in differential diagnosis, from the fibrous connective tissue tumors as positive immunostaining against vimentin can be observed in all of them (Table 1).…”

“…The fibromatosis constitute part of a spectrum of poorly understood proliferative lesion whose histologic features overlap to such an extent that the pathologist may be more influenced by the anatomic location of the lesion, sex and clinical behavior than by the histologic appearance in rendering his or her diagnosis. 31 The fibromatosis that occur in the head and neck including those that involve oral and paraoral structures is considered under the heading of extra-abdominal fibromatosis, infantile fibromatosis is the childhood counterpart of extra-abdominal fibromatosis. 31 The grade 1 fibrosarcoma is usually discernable from fibromatosis by the presence of occasional larger nuclei with ominous chromatin clumping, greater cellularity, greater mitotic activity and thin rather than thick collagen bundles.…”

“…31 The fibromatosis that occur in the head and neck including those that involve oral and paraoral structures is considered under the heading of extra-abdominal fibromatosis, infantile fibromatosis is the childhood counterpart of extra-abdominal fibromatosis. 31 The grade 1 fibrosarcoma is usually discernable from fibromatosis by the presence of occasional larger nuclei with ominous chromatin clumping, greater cellularity, greater mitotic activity and thin rather than thick collagen bundles. 28,31 Immunohistochemistry can be used as an exclu sion criteria to differentiate from sarcomas arising from other mesenchymal tissues.…”

“…31 The treatment of choice is surgical resection with a wide margin. The need for adjuvant radiotherapy and/or chemotherapy is still unclear and is normally indicated in highgrade tumors, because these tumors may present sub clinical or microscopic metastases at the time of diagnosis.…”