Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 6, 2020; 8(11): 2350-2358
Published online Jun 6, 2020. doi: 10.12998/wjcc.v8.i11.2350
Myxofibrosarcoma of the scalp with difficult preoperative diagnosis: A case report and review of the literature
Xiao-Ting Ke, Xiong-Feng Yu, Ji-Yang Liu, Fang Huang, Mei-Gui Chen, Qing-Quan Lai
Xiao-Ting Ke, Xiong-Feng Yu, Ji-Yang Liu, Fang Huang, Mei-Gui Chen, Qing-Quan Lai, Department of CT/MRI, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian Province, China
Author contributions: Ke XT participated in the design of the report, analyzed the data, and wrote the paper; Yu XF, Liu JY and Huang F collected the medical imaging materials; Chen MG and Lai QQ designed the report and performed the preliminary revision of the article.
Informed consent statement: Consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Qing-Quan Lai, MA, Associate Professor, Chief Physician, Department of CT/MRI, The Second Affiliated Hospital of Fujian Medical University, No. 34 Zhongshanbei Road, Licheng District, Quanzhou 362000, Fujian Province, China. laiqingquan888@163.com
Received: January 21, 2020
Peer-review started: January 21, 2020
First decision: April 14, 2020
Revised: April 17, 2020
Accepted: April 29, 2020
Article in press: April 29, 2020
Published online: June 6, 2020
Processing time: 138 Days and 19.7 Hours
Abstract
BACKGROUND

A myxofibrosarcoma (MFS) is a malignant fibroblastic tumor that tends to occur in the lower and upper extremities. The reported incidence of head and neck MFSs is extremely rare. We report a 46-year-old male with “a neoplasm in the scalp” who was hospitalized and diagnosed with an MFS (highly malignant with massive necrotic lesions) based on histologic and immunohistochemistry evaluations. The magnetic resonance imaging manifestations did not demonstrate the “tail sign” mentioned in several studies, which resulted in a great challenge to establish an imaging diagnosis. The treatment plan is closely associated with the anatomic location and histologic grade, and more importantly, aggressive surgery and adjuvant radiotherapy may be helpful. Hence, we report the case and share some valuable information about the disease.

CASE SUMMARY

A 46-year-old male with “a neoplasm in the scalp for 6 mo” was hospitalized. Initially, the tumor was about the size of a soybean, without algesia or ulceration. The patient ignored the growth, did not seek treatment, and thus, did not receive treatment. Recently, the tumor increased to the size of an egg; there was no bleeding or algesia. His family history was unremarkable. No abnormalities were found upon laboratory testing, including routine hematologic, biochemistry, and tumor markers. Computed tomography showed an ovoid mass (6.25 cm × 3.29 cm × 3.09 cm in size) in the left frontal scalp with low density intermingled with equidense strips in adjacent areas of the scalp. Magnetic resonance imaging revealed a lesion with an irregular surface and an approximate size of 3.55 cm × 6.34 cm in the left frontal region, with clear boundaries and visible separation. Adjacent areas of the skull were damaged and the dura mater was involved. Contrast enhancement showed an uneven enhancement pattern. Surgery was performed and postoperative adjuvant radiotherapy was administered to avoid recurrence or metastasis. The post-operative pathologic diagnosis confirmed an MFS. A repeat computed tomography scan showed no local recurrence or distant metastasis 19 mo post-operatively.

CONCLUSION

The case reported herein of MFS was demonstrated in an extremely rare location on the scalp and had atypical magnetic resonance imaging findings, which serves as a reminder to radiologists of the possibility of this diagnosis to assist in clinical treatment. Given the special anatomic location and the high malignant potential of this rare tumor, combined surgical and adjuvant radiotherapy should be considered to avoid local recurrence and distant metastasis. The significance of regular follow-up is strongly recommended to improve the long-term survival rate.

Keywords: Malignant fibrous histiocytoma; Myxofibrosarcoma; Scalp; Magnetic resonance imaging; Treatment; Case report

Core tip: Myxofibrosarcoma (MFS) is a malignant fibroblastic tumor that has a predilection for lower and upper extremities. Rare occurrences have been reported in the scalp. We describe a 46-year-old male diagnosed with a MFS of the scalp (highly malignant with massive necrotic lesions) by histologic examination and immunohistochemistry testing. The magnetic resonance imaging findings did not conform to the reported typical “tail sign”, which may be confused with other tumors and lead to the correct diagnosis being missed. The definitive diagnosis of MFS is based on immunohistologic features. Considering the location and non-specific imaging manifestations of this case, the treatment is also worthy of discussion. Surgical excision combined with postoperative adjuvant radiotherapy was effective in our case.