Ossifying Fibromyxoid Tumour of Soft Tissues: A Rare Case Report

A case of ossifying fibromyxoid tumour of the soft part, a rare neoplasm arising about the knee of a young man is reported. The tumour has the characteristic morphology, having a thin bony shell, vascular myxohyaline stroma with oval or slightly spindly epitheloid cells arranged in cord pattern. The important histomorphological features have been highlighted and illustrated. The histogenesis, biological behavioral variations and differential diagnosis has been briefly discussed. Figure 1: Photomicrograph showing a) Thin bony shell with extension of calcification into the septae (H & E, x100) b) Moderately cellular tumour with scattered foci of microcalcification (H&E;, x400). Citation: Panicker NK, Buch AC, Garg K, Satav VH (2014) Ossifying Fibromyxoid Tumour of Soft Tissues: A Rare Case Report. J Cancer Sci Ther 6: 322-323. doi:10.4172/1948-5956.1000288 Volume 6(9) 322-323 (2014) 323 J Cancer Sci Ther ISSN:1948-5956 JCST, an open access journal immunohistochemical and ultrastructural evidence suggest schwannian or chondroid differentiation [1,7,8]. Some have also considered myoepithelial differentiation [5,9]. Neuroepithelial differentiation has also been postulated [10]. Immunocytochemically, the tumour cells have a scrambled phenotype, the most consistent positive reactivity has been with vimentin, S-500, NSE and CD57. Here also there is much variability from tumour to tumour [1,11]. Hence there is no consistent immunological marker for this tumour. Our case also showed positive staining for S-100 and vimentin but was negative for desmin. Most workers agree that cytomorphologically and behaviorally intermediate and malignant forms of tumour exist others hold that the small numbers of intermediate and malignant examples identified are probably other tumour types [11]. Our case had innocuous histology with other classical features of OFMT. Most cases of OFMT are cured by adequate surgical excision. Recurrence has been reported in up to 22% cases and metastasis in 6% [4,10]. Though those tumours with high cellularity, high nuclear grade or increased mitotic activity (more than 2/50 HPF) are expected to behave aggressively, occasional typical benign appearing OFMT may reoccur or produce metastasis [12]. Some tumours have predominant myxoid areas [2,12]. Most others have predominant hyalinised collagenous areas, occasionally with foci of calcification and cartilaginous areas as seen in our case [13,14]. Our case had only small areas of loose myxoid tissue, but the areas of external shell of bone, hyaline cartilaginous areas with cord like pattern and microcalcification were striking. The tumour need to be distinguished from epitheloid schwanoma, condroid syringoma, myxoid chondrosarcoma and epitheloid leiomyoma. It has many morphological and immunohistochemical similarities to nerve sheath tumours. But the calcifying shell, nodularity and cytological features are helpful distinctions. Chondroid syringoma has distinct epithelial elements and markers. Myxoid chondrosarcoma is also cytologically different and display intracytoplasmic glycogen not present in OFMT. Only occasional OFMT show muscle antigen unlike smooth muscle tumours which are invariably S-100 negative. We conclude by stating that OFMT is rare tumour of the soft tissuewith sufficiently distinctive clinical and histomorpholical featuresaiding its identification. We are of the impression that the neoplasmis probably not all that rare as a fair number may not be recognizedas such and tend to be dumped with conditions having overlappingmorphology.References 1. Enzinger FM, Weiss SW, Liang CY (1989) Ossifying fibromyxoid tumor of softparts. A clinicopathological analysis of 59 cases. Am J Surg Pathol 13: 817-827. 2. Graham RP, Dry S, Li X, Binder S, Bahrami A, et al. (2011) Ossifyingfibromyxoid tumor of soft parts: a clinicopathologic, proteomic, and genomicstudy. Am J Surg Pathol 35: 1615-1625. 3. Folpe AL, Weiss SW (2003) Ossifying fibromyxoid tumor of soft parts: aclinicopathologic study of 70 cases with emphasis on atypical and malignantvariants. Am J Surg Pathol 27: 421-431. 4. Enzinger FM, Weiss SW, Liang CY (1989) Ossifying fibromyxoid tumor of softparts. A clinicopathological analysis of 59 cases. Am J Surg Pathol 13: 817-827. 5. Kilpatrick SE, Ward WG, Mozes M, Miettinen M, Fukunaga M, et al. (1995)Atypical and malignant variants of ossifying fibromyxoid tumor. Clinicopathologicanalysis of six cases. Am J Surg Pathol 19: 1039-1046. 6. Zámecník M, Michal M, Simpson RH, Lamovec J, Hlavcák P, et al. (1997)Ossifying fibromyxoid tumor of soft parts: a report of 17 cases with emphasison unusual histological features. Ann Diagn Pathol 1: 73-81. 7. 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Yoshida H, Minamizaki T, Yumoto T, Furuse K, Nakadera T (1991) Ossifyingfibromyxoid tumor of soft parts. Acta Pathol Jpn 41: 480-486. 13. Zámecník M, Michal M, Simpson RH, Lamovec J, Hlavcák P, et al. (1997)Ossifying fibromyxoid tumor of soft parts: a report of 17 cases with emphasison unusual histological features. Ann Diagn Pathol 1: 73-81. 14. Weiss SW, Goldblum JR (2008) Enzinger and Weiss’s Soft Tissue Tumour,Mosby Elsevier. Schmill W Black S Editoral’s. 5thed. Mosby Inc. Philadelphia.U.S. PP-1093-1268.Figure 2: Photomicrograph showing a) Hyalinised loose cartilaginousappearing stroma with cord like arrangement of spindle cells (H&E;, x100) b)Myxoid areas with thin walled vessels (arrow) (H&E;, x400). Citation: Panicker NK, Buch AC, Garg K, Satav VH (2014) OssifyingFibromyxoid Tumour of Soft Tissues: A Rare Case Report. J Cancer Sci Ther 6:322-323. doi:10.4172/1948-5956.1000288