Short-term comparative results of segmental resection versus radical resection in two patients with myxofibrosarcoma of the limbs - case series

Sergiu-Andrei Iordache 1 , Bogdan Şerban 1 , 2 , Andreea Vlad 3 , and Adrian Cursaru 1 , 2
  • 1 Orthopedics Department, University Emergency Hospital Bucharest, Romania
  • 2 “Carol Davila” University of Medicine and Pharmacy, , Bucharest, Romania
  • 3 “Grigore Alexandrescu” Children’s Clinical Emergency Hospital Bucharest, , Romania

Abstract

Introduction: Myxofibrosarcoma is a rare subtype of soft tissue sarcoma with a locally infiltrative behavior and ability to determine distant metastases.

Materials and methods: We presented two myxofibrosarcoma cases who benefited from segmental or radical resection.

Management and outcome: In the case of the 80-year-old woman, with grade 3 myxofibrosarcoma, we practiced radical surgery with scapulohumeral disarticulation followed by adjuvant radiotherapy.

The therapeutic option for the 77-year-old man with grade 2 myxofibrosarcoma was segmental resection followed by adjuvant radiotherapy. After three months, the patient was in a good clinical condition with no sign of local recurrence, but with the presence of pulmonary metastases for the patient who benefited of segmental resection.

Discussion: The radical resection had better short-term results, with no local or distant metastases at three months after surgery, although the tumor had a higher grade (G3), compared to segmental resection practiced for a lower grade tumor (G2), in which case the patient developed pulmonary metastasis at three months follow up.

Conclusion: Myxofibrosarcoma represents a challenging situation regarding the management due to its unpredictive clinical course. Our cases raised the following question: should we consider treating it more aggressively in order to obtain good local control and reduce the risk of metastasis?

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  • 1. Levy AD, Manning MA, Miettinen MM. Soft-tissue sarcomas of the abdomen and pelvis: Radiologic-Pathologic features, Part 2 - uncommon Sarcomas. Radiographics. 2017 May-Jun; 37(3):797-812.

  • 2. Casali PG, Abecassis N, Bauer S et al. ESMO Guidelines Committee and EURACAN. Soft tissue and visceral sarcomas: ESMO-EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2018 Oct 1; 29 (Supplement_4):iv51-iv67.

  • 3. Mizuno T, Susa M, Horiuchi K, Shimazaki H, Nakanishi K, Chiba K. Spontaneous Regression of Myxofibrosarcoma of the Thigh after Open Biopsy. Case Rep Oncol. 2019 May 16; 12(2):364-369. doi: 10.1159/000500504. PMID: 31182952. PMCID: PMC6547297.

  • 4. Odei B, Rwigema JC, Eilber FR et al. Predictors of Local Recurrence in Patients with Myxofibrosarcoma. Am J Clin Oncol. 2018; 41(9):827-831. doi:10.1097/COC.0000000000000382.

  • 5. Look Hong NJ, Hornicek FJ, Raskin KA et al. Prognostic factors and outcomes of patients with myxofibrosarcoma. Ann Surg Oncol. 2013; 20(1):80-86. doi:10.1245/s10434-012-2572-3.

  • 6. Kikuta K, Nakayama R, Yoshida A et al. A histological positive margin after surgery is correlated with high local re-recurrence rate in patients with recurrent myxofibrosarcoma. Jpn J Clin Oncol. 2017; 47(4):334-341. doi:10.1093/jjco/hyw199.

  • 7. Mühlhofer HML, Lenze U, Gersing A et al. Prognostic Factors and Outcomes for Patients with Myxofibrosarcoma: A 13-Year Retrospective Evaluation. Anticancer Res. 2019; 39(6):2985-2992. doi:10.21873/anticanres.13430.

  • 8. Mentzel T, Calonje E, Wadden C et al. Myxofibrosarcoma. Clinicopathologic analysis of 75 cases with emphasis on the low-grade variant. Am J Surg Pathol. 1996; 20(4):391-405. doi: 10.1097/00000478-199604000-00001.

  • 9. Teurneau H, Engellau J, Ghanei I, Vult von Steyern F, Styring E. High Recurrence Rate of Myxofibrosarcoma: The Effect of Radiotherapy Is Not Clear. Sarcoma. 2019; 2019:8517371. doi:10.1155/2019/8517371.

  • 10. Haglund KE, Raut CP, Nascimento AF, Wang Q, George S, Baldini EH. Recurrence patterns and survival for patients with intermediate- and high-grade myxofibrosarcoma. Int J Radiat Oncol Biol Phys. 2012; 82(1):361-367. doi:10.1016/j.ijrobp.2010.08.042.

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