A case of high grade Myxofibrosarcoma of the lower leg

Myxofibrosarcoma, also known as myxoid malignant fibrous histiocytoma, is one of the most common fibroblastic sarcomas in the older patient. It
occurs mainly in the limbs and there is a tendency for predominantly subcutaneous, multinodular, diffusely infiltrative growth, which may extend
to the overlyin dermis and present as a cutaneous lesion. A 90-year-old female presented with solitary, 5cm sized, firm, fixed mass on right lower
leg with the onset of 2 months ago. The histologic examination of the lesion showed malignant spindle cell tumor with myxoid stroma. Many of
the cells were spindle or ovoid shape and elongated curvilinear capillaries were observed. Overall tumor cellularity was high and marked nuclear
atypical, more than 20 mitoses per 10 high power filed, focal necrosis and hemorrhage were present. CD 34 stain was focally positive in spindle
cells, but S100, smooth muscle actin, and pankeratin were negative. Incisional biopsy of the lesion confirmed high grade myxofibrosarcoma. On
magnetic resonance imaging and positron emission tomography-computed tomography, there was no distant metastasis. The wide excision with a
1cm margin was performed. The patient was under observation for 6 months without local recurrence. MFS always requires surgery to remove the
cancer and a margin of healthy tissue around it. The extent of surgery varies according to tumor size and other characteristics. Radiation therapy
usually supplements surgical treatment.