Abstract

Sciresol

https://jmsh.ac.in/

Journal of Medical Sciences and Health

10.46347/jmsh.v9i1.22.492

REVIEW ARTICLE

Report of an Unusual Case of Hemosiderotic Fibrohistiocytic Lipomatous Tumor with Systematic Review of Clinicopathological Characteristics and Differential Diagnosis

Unusual case of hemosiderotic fibrohistiocytic lipomatous tumor

Soumya

B M

1 Sharma

Lalita

lalitasharma88@gmail.com 2 Kulkarni

Vardendra

3 Preethi

C R

4 Associate Professor of Pathology, Department of Pathology, JJM Medical College

Davangere, Karnataka

India Postgraduate of Pathology, Department of Pathology, JJM Medical College

Davangere, Karnataka

India Professor and Head, Department of Pathology, JJM Medical College

Davangere, Karnataka

India Professor of Pathology, Department of Pathology, JJM Medical College

Davangere, Karnataka

India

9 1 110

2023

Abstract

The spectrum of lipomatous lesions ranges from benign to highly malignant disease. Differentiation between these mesenchymal lesions is important for pathologist as well as clinician to indicate prognosis and choose the most appropriate treatment. Hemosiderotic firohistiocytic lipomatous tumor (HFLT) is a rare subtype of lipomatous tumor. The diagnosis is usually based on clinical, histological, and immunohistochemical (IHC) information. We reported a case of 56 years old man with a painful mass in the dorsal aspect of the thigh showing an unusal clinical presentation but a characteristic histological and IHC features. In this article we have retrospectively reviewed the 67 cases of HFLT reported in literature so far along with one case reported at our institution. The review focuses on clinicopathological and histomorphological characteristics of HFLT and the related entities. The hallmark of HFLT and its related lesions is complex admixture of mature adipose tissue, spindle tumor cells with striking deposition of hemosiderin pigment. Even though HFLT shows marked predeliction for the distal extremeties especially the foot/ ankle with a female preponderance, they can occur at uncommon site such as thigh and also in males as seen in our case.

Keywords Pleomorphic hyalinizing angiectatic tumor Hemosiderotic fibrolipomatous tumor Myxoinflammatory Fibroblastic Sarcoma Hemosiderin Lipoma

Introduction

Hemosiderotic Fibrohistiocytic Lipomatous Tumor (HFLT), Pleomorphic Hyalinizing Angiectatic Tumor (PHAT), and Myxoinflammatory Fibroblastic Sarcoma (MIFS) are rare mesenchymal neoplasms with a tendency for the distal lower extremities. Although each of these entities have been described independently in literature, various histological and genetic observations over the past two decades have led to speculation that these tumors may be interrelated. This hypothesis is based on both histomorphological and genetic features, but the exact relationship between these three entities remains a topic of controversy and debate for the scholars. In this article, we have analyzed the key histomorphologic and immunohistochemical (IHC) features of a case of HFLT which showed an unusual clinical presentation and a discussion about the closest differentials which easily confuses the pathologist and lead to chances of misdiagnosis. Since the available literature over these entities are limited, we hereby will evaluate the relationship between these tumors.

The spectrum of lipomatous lesions ranges from

<bold id="strong-340d538d088445eea36409237216c179">Case presentation</bold>

A 63-year-old male presented to surgery department of our institution with a painless swelling over upper one third of right thigh. The patient had noticed the lesion one and a half year before, which has gradually progressed to the present size (24×12 cm). There was no significant medical history or history of trauma. Family history was noncontributory. On physical examination, swelling was 24x12 cm with ill-defined margins, which was non tender, with no local rise of temperature. On further examination, patient had difficulty in flexion and external rotation of thigh and a resistance involving half the anterior medial side of the thigh was present. MR imaging revealed lipomatous lesion of the right thigh measuring 28× 13 × 10 cm with irregular boundaries. The lesion showed multiple far-reaching intramuscular and subfascial extensions. The assessment of internal structures showed a homogeneous, lobulated lesion suspicious of liposarcoma.

Complete tumor resection was performed with free margins. After resection the specimen was subjected to histopathological evaluation.

The specimen was fixed in 10% neutral formalin, then conventional paraffin sectioning and hematoxylin and eosin (H&E) staining were performed. The morphology of tumor tissue was observed under a light microscope.

On gross examination, lipomatous lesion measured 28×13×10cm. It was darker yellow than the normal surrounding fat. External surface was well circumscribed, congested and showed blood vessels. Cut surface showed collated appearance. Cystic areas were filled with necrotic debris and hemorrhagic areas were made out (Figure 1).

Figure 1 <bold id="s-076c14693a13">Cut section of the tumor showing solid and cystic areas. Areas of necrosis noted</bold>

Microscopically, ten representative samples throughout the whole tumor were reviewed. Histopathological examination revealed a neoplastic lesion composed of spindle cells infiltrating into adipocytic component in a honey comb pattern . These spindle cells had elongated, vesicular nuclei, inconspicuous nucleoli and scanty cytoplasm. The adipocytic component was mature without atypia and no lipoblasts were seen. There were numerous small to large ectatic blood vessels with a number of them showing organising thrombi, aggregates of histiocytes containing hemosiderin pigment (Figure 2). No evidence of increased mitotic activity was noted. On IHC staining of CD34, a notable diffuse staining primarily of the spindle cells, fibrocytes and vascular endothelium was seen (Figure 3). On staining with CD68 we found out positive staining for macrophage lineage such as tissue histiocytes. (Figure 4)

Figure 2 <bold id="s-f27de6d6359f">Photomicrograph showing varying proportions of bland spindle cells, mature adipose tissue, ectatic blood vessels and hemosiderin pigment. The spindle cells are seen in the fascicular and whorled arrangement dissecting the adipocyte component in honey comb pattern (H&E, 10x)</bold> Figure 3 <bold id="s-02785a0a9249">Photomicrograph showing CD34 immunostaining showing diffuse positivity of capillary endothelium and spindle cell component (40x)</bold> Figure 4 <bold id="s-37c277b94fbb">Photomicrograph showing CD68immunostaining showing diffuse positivity for macrophages (40x)</bold>

By combining histology and IHC features of resected specimen with clinical information, the diagnosis of HFLT was established. There were no operative or post-operative complications noted. Eighteen months after the excision, the patient continued to show no signs of recurrence.

Methods

We reviewed 67 cases of HFLT from the literature, published in English and Portuguese language which were available at Pubmed data base (Table 1).

Case reports, articles that diagnosed HFLT with adequate evidence supported by gross examination, histology, biopsy and previous recurrrences were included. Demographic data such as age at diagnosis, gender, location and size were recorded. An attempt to look for clinico-pathologic features of HFLT along with IHC features was done. All the 67 cases were studied using descriptive statistics.

Table 1 <bold id="s-bb5427ff5ad9">Data collection</bold>

Data base

Results

Pubmed

8 Original articles

3 Letter to editor

1 Updating article

3 Case series

7 Case reports

4 Review articles

1 Research article

1 Short communication 1 Scientific article

Results

The demographic characteristics of all HFLT included were studied and tabulated (Table 2). Our review of the literature suggests that HFLT predominately presents in middle-aged women (median age being 50 years and mean age being 51 years). Age group ranged from 7 months to 78 years, the ratio of male to female was 1: 2.6 with close to half (46%) the cases having a history of trauma or vascular disease.

HFLT occurs within the soft tissue of limb extremities, with foot/ankle accounts for 77%, but also involves the hands,1, 2, 3 forearm,4, 5 wrist6 and one case involving cheek and finger.7

It has been reported that majority cases of HFLT are characterized by CD34 expression in spindle cells and vascular endothelium.

It was noted that HFLT needs to be pathologically distinguished from related adipocytic lesions such as PHAT and MIFS which share similar location and morphologic characteristics. Summary of key morphological and genetic features of adipocytic lesions are tabulated in Table 3.

Table 2 <bold id="s-cd7850c49f36">Demographicand morphological characteristics of cases from reviewed studies</bold>

Study	Year	Number of patients	Gender	Average age in years	Localisation	Size
Marshall et al. ⁷	2000	10	2 - Male 8- Female	50.6	8 - Foot 1 - Cheek, 1- Finger	Range 2.5 -17cm
Kazakov et al.8	2005	2	2 - Female	54	1- Foot 1- Foot	6x5x4 cm
Browne et al.1	2005	13	6 - Male 7 - Female	49	12- Ankle/foot 1 - Hand	Range 1- 13cm
Luzar et al.9	2006	1	Female	47	Ankle	1.9x1.2 cm
West et al.10	2007	1	Female	38	Foot	NA
de Vreeze et al.11	2008	1	Male	66	Thigh	19x8x4 cm
Wettach et al. ¹²	2008	1	Female	35	Foot	NA
Hallor et al.13	2008	1	Female	40	Ankle	NA
Ramalho et al.14	2009	1	Female	33	Knee	10x8x6 cm
Moretti et al. ¹⁵	2010	1	Female	56	Foot	7x5x2 cm
Antonescu et al. ²	2011	14	2 - Male 12 - Female	45	13 - Foot 1 - Hand	NA
Sawalha Setal. ³	2011	1	Female	55	Hand	3x1 cm
Carter et al.4	2014	7	3 - Male 4 - Female	53	4 - Foot 3 - Forearm	NA
O’Driscoll et al.5	2014	5	3 - Male 2 - Female	60	4 - Foot 1 - Forearm	18 cm
Marusic Z et al.16	2014	1	Female	57	Ankle	15x5 cm
Zreik et al.17	2016	1	Female	77	Foot	NA
Morency et al. ¹⁸	2016	1	Female	55	Foot	3x1 cm
Wilk et al.19	2016	1	Female	45	Foot	14x6 cm
Etchebehere et al.20	2016	1	Female	38	Thigh	22x18x11cm
Hou et al.21	2018	1	Male	50	Knee joint	4x2.5x1.9cm
Bourhroum N et al.22	2019	1	Female	50	Ankle	7 cm
Pang CY et al. ⁶	2021	1	Female	45	Wrist	NA
Current study	2022	1	Male	63	Thigh	28x13x10cm

NA - Not available

Discussion

HFLT is a rare benign fibrolipomatous lesion first described as an entity in 2000 by Marshall - Taylor and Fanburg - Smith. It accounts for 0.2% of benign lipomatous lesion.7

HFLT generally affects the ankle and the dorsum of the foot, although it may appear in other locations such as cheeks and hands. It typically affects adults, more commonly females, in the 5th and 6th decades of life. The distinct feature about our case is its huge size, site and occurrence in male. Thigh is not the usual site of presentation. Our case and only two other cases in literature (de Vreeze et al.11 and Etchebehere et al.20)have reportedthigh as the location.

Histologically, it is characterized by a lipomatous lesion composed of three elements occurring in varying proportions. These elements include mature adipocytes, spindle cells and hemosiderin pigment, which is present predominantly in macrophages within the spindle cell areas, whose original deposit is unclear. The mature adipose tissue is infiltrated by strands of fibrous tissue featuring fibroblastic spindle cells and hemosiderin deposits.

Scattered areas with atypical pleomorphic cells may be present. Focal clusters of ectatic blood vessels as seen in PHAT are not uncommon. Chronic inflammatory cells are usually seen in the background. Mitosis or necrosis are usually not seen. CD34 positivity clearly differentiates the fibroblastic differentiation while CD68 positivity shows diffuse staining for the macrophages. ¹

<bold id="strong-8b4aef8138bf4878b85273034f102785">Adipocytic lesions with overlapping clinical and histopathological features </bold>

There is an ongoing debate about the resemblance of early PHAT and HFLT; some consider HFLT a precursor lesion of PHAT, implicating HFLT to be a neoplastic lesion,8, 23others consider HFLT an individual more reactive lesion.1, 9

The hypothesis that PHATis related to HFLT was first suggested by Folpe and Weiss24 in their 2004 study on 41 PHAT cases. These investigators noted that in nearly 50% of their cases, there was the presence of areas which were morphologically indistinguishable from HFLT at the periphery.

These HFLT-like areas were labeled “early PHAT,” and were felt to represent the precursor lesion to classic PHAT24.PHAT and HFLT both shares recurrent t(1;10) (p22;q24) rearrangement involving the TGFBR3 and MGEA5 genes.13, 2

Same as HFLT, PHAT also has usually middle-aged adults preponderance and a proclivity for the lower extremities, though a few cases has occurred at the sites such as the arm, thigh, buttocks, or trunk with a median size of approximately 6cm. Becauseangiectatic vessels is a prominent feature, PHAT quite a few times is clinically mistaken for a hematoma or vascular neoplasm. PHAT is a vaguely circumscribed mass composed of spindled or pleomorphic cells surrounding clusters of thin-walled, ectatic vessels with sub-endothelial and intraluminal fibrin deposits and perivascular hyalinization.

Although PHAT could appear circumscribed at low power, the margin is typically infiltrative. The lesional cells range from spindled to strikingly pleomorphic and shows frequent intranuclear inclusions. Mitotic activity in PHAT is very low (<1/50 HPF). Hemosiderin deposits can be seen in macrophages or in the cytoplasm of the lesional cells. Scattered inflammatory cells are usually present.25

Myxoid stroma is focally present and usually there is a prominent inflammatory component. Cytologically, HFLT is consists of bland fibroblasts without significant mitotic activity and may contain scattered osteoclast-type giant cells. Small ectatic vessels with mural hyalinization or fibrinous thrombi may be present. ^{1, 24}HFLT-like areas can be found at the periphery or admixed with otherwise typical examples of PHAT. This observation led to a hypothesis that HFLT may well be a precursor lesion to PHAT.24

In few rare cases it is seen that, PHAT and HFLT has progressed to a sarcoma of variable histologic grade, more often with in the setting of recurrences.13, 2, 4, 17 The sarcomas in such cases have myxoid stroma and a prominent inflammatory infiltrate and shows morphologic resemblance to MIFS. Solid, undifferentiated spindle cell sarcoma-like morphology has also been reported. ¹⁷

Most PHATs and HFLTs are both positive for CD34 and negative for S100, SMA, and desmin.7, 4, 23, 24

MIFS also referred as “inflammatory myxohyaline tumor of the distal extremities,”26 “acralMIFS,”27 and “inflammatory myxoid tumor of the soft parts with bizarre giant cells,”28 is a locally aggressive, rarely metastasizing, fibroblastic tumor of borderline malignancy that typically involves the distal extremities of middle-aged adults.

The marginal region of a PHAT, and MIFS demonstrates overlapping histomorphogy with HFLT. There is seen relatively mild spindle-cell infiltration of adipose tissue and deposition of hemosiderin. However, PHAT shows obvious plexiform expansion of thin-walled vessels with fibrin-like material deposition, and cytoplasmic pseudo inclusion bodies seen with in the nuclei of tumor cells. MIFS lesions contain high mucus-but low adipose-content, while usually little or no mucus is produced in HFLT

Literature suggests that there does not seem to be a direct morphologic link between HFLT and MIFS, and the available molecular genetic data within the literature are contradictory, likely attributable to the use of different morphologic criteria for the diagnosis of MIFS by different investigators. Although cases are described as representing “hybrid HFLT-PHAT,” the preponderance of evidence suggests that such lesions are way more closely associated with HFLT and PHAT representing a sort of morphologic progression to high grade myxoid sarcoma.

Conclusion

Ambiguity existed about reactive or neoplastic origin of HFLT. It is now well-established on the basis of histomorphology and molecular genetic evidence that HFLT and PHAT represent different manifestations of a single entity, with HFLT representing the precursor or “early” lesion of classic PHAT. The hallmark of these lesions is complex admixture of mature adipose tissue, spindle tumor cells with striking deposition of hemosiderin pigment. Even though HFLT shows marked prediliction for the distal extremeties especially the foot/ ankle and female gender, they can occur at uncommon site such as thigh and in a male patient as seen in our case.

Table 3 <bold id="s-f4faa2613590">Summary of key morphologic and genetic features of adipocytic lesions</bold>

Diagnosis	Morphologic Features	Association with HFLT	Molecular alteration
HFLT	Mature adipose tissue, myxoid stroma CD34-positive spindled cells with intracytoplasmic hemosiderin deposition CD68 -positive macrophagesseen Small aggregates of variable sized blood vessels Areas resembling “miniature” PHATs	Not applicable	Frequent
PHAT	Clusters of thin-walled, ectatic blood vessels, containing organizing thrombi and surrounded by amorphous eosinophilic material Pleomorphism seen, CD34-positive tumor cells with intranuclear pseudoinclusions and intracytoplasmic hemosiderin deposition Low-mitotic activity Chronic inflammatory cell infiltrate Peripheral areas identical to HFLT	Yes	Frequent
MIFS	Multinodular and poorly circumscribed hyalinized zones, typically containing bizarreappearing cells with prominent macronucleoli Areas of dense chronic inflammation myxoid nodules, often containing multivacuolated (“lipoblast-like”) fibroblastic cells Mitotic activity is low Necrosis not seen Arborizing, thick-walled vessels as seen in myxofifibrosarcoma is usually absent here CD34 positive	No	Infrequent
HFLT with progression to myxoid srcoma (“hybrid HFLT-MIFS)	Areas of typical HFLT Myxoid sarcoma showing a well-developed, thick-walled vasculature Pseudolipoblasts may be seen Absence of hyalinized zones Absence of “Reed-Sternberg-like” or “virocytelike” cells	Yes	Frequent

Adapted from: Boland & Folpe 25

<bold id="strong-c21546160bb14dde8e2b4b8c592b7f36">Abbreviations</bold>

HFLT: Hemosiderotic Fibrohistiocytic Lipomatous Tumor; PHAT: Pleomorphic Hyalinizing Angiectatic Tumor, MIFS: Myxoinflammatory Fibroblastic Sarcoma; TGFBR3: Transforming Growth Factor Beta Receptor 3; MGEA5: Meningioma Expressed Antigen 5; IHC: Immunohistochemical

<bold id="strong-f7fcabc728c143ddafd8f7536f228ce6">Conflict of interest</bold>

Nil

References Boland Jennifer M Folpe Andrew L Hemosiderotic Fibrolipomatous Tumor, Pleomorphic Hyalinizing Angiectatic Tumor, and Myxoinflammatory Fibroblastic Sarcoma: Related or Not? Advances in Anatomic Pathology 2017 24 5 268 277 1072-4109 Ovid Technologies (Wolters Kluwer Health) https://doi.org/10.1097/pap.0000000000000151 Browne T J Fletcher C D Browne TJ, Fletcher CD. Haemosiderotic fibrolipomatous tumour (so-called haemosiderotic fibrohistiocytic lipomatous tumour): analysis of 13 new cases in support of a distinct entity. Histopathology 2006 48 4 453 461 https://doi.org/10.1111/j.1365-2559.2006.02360.x Antonescu Cristina R Zhang Lei Nielsen G Petur Rosenberg Andrew E Cin Paola Dal Fletcher Christopher D M Consistent t(1;10) with rearrangements of TGFBR3 and MGEA5 in both myxoinflammatory fibroblastic sarcoma and hemosiderotic fibrolipomatous tumor Genes Chromosomes and Cancer 2011 50 10 757 764 1045-2257 Wiley https://doi.org/10.1002/gcc.20897 Sawalha S Low A Packer N Recurrent haemosiderotic fibrohistiocytic lipomatous lesion of the hand Malaysian Journal of Pathology 2011 33 1 43 45 21874751 https://pubmed.ncbi.nlm.nih.gov/21874751/ Carter Jodi M Sukov William R Montgomery Elizabeth Goldblum John R Billings Steven D Fritchie Karen J Folpe Andrew L TGFBR3 and MGEA5 Rearrangements in Pleomorphic Hyalinizing Angiectatic Tumors and the Spectrum of Related Neoplasms American Journal of Surgical Pathology 2014 38 9 1182 1992 0147-5185 Ovid Technologies (Wolters Kluwer Health) https://doi.org/10.1097/pas.0000000000000212 O’driscoll Dearbhail Athanasian Edward Hameed Meera Hwang Sinchun Radiological imaging features and clinicopathological correlation of hemosiderotic fibrolipomatous tumor: experience in a single tertiary cancer center Skeletal Radiology 2015 44 5 641 648 0364-2348 Springer Science and Business Media LLC https://doi.org/10.1007/s00256-014-2078-0 Pang C Y Wong E Liao J W Chan Jkc Cheuk W Fibrolipomatous Pauci-Hemosiderotic” Fibrolipomatous Tumor: A Mimicker of Various Lipomatous Lesions International journal of surgical pathology 2021 29 1 64 68 https://doi.org/10.1177/1066896920930799 Marshall-Taylor Cristina Fanburg-Smith Julie C Hemosiderotic Fibrohistiocytic Lipomatous Lesion: Ten Cases of a Previously Undescribed Fatty Lesion of the Foot/ankle Modern Pathology 2000 13 11 1192 1199 0893-3952 Elsevier BV https://doi.org/10.1038/modpathol.3880221 Moretti Vincent M Brooks John S J Ogilvie Christian M Case Report: Hemosiderotic Fibrohistiocytic Lipomatous Lesion Clinical Orthopaedics & Related Research 2010 468 10 2808 2813 0009-921X Ovid Technologies (Wolters Kluwer Health) https://doi.org/10.1007%2Fs11999-010-1242-7 Marusic Z Cengic T Dzombeta T Vucicm Hybrid myxoinflammatory fibroblastic sarcoma/hemosideroticfibrolipomatoustumor of the ankle following repeated trauma Pathol Int 2014 64 4 195 197 https://doi.org/10.1111/pin.12153 Zreik Riyam T Carter Jodi M Sukov William R Ahrens William A Fritchie Karen J Montgomery Elizabeth A Weiss Sharon W Folpe Andrew L TGFBR3 and MGEA5 rearrangements are much more common in “hybrid” hemosiderotic fibrolipomatous tumor-myxoinflammatory fibroblastic sarcomas than in classical myxoinflammatory fibroblastic sarcomas: a morphological and fluorescence in situ hybridization study Human Pathology 2016 53 14 24 0046-8177 Elsevier BV https://doi.org/10.1016/j.humpath.2016.02.005 Morency Elizabeth Laskin William Lin Xiaoqi Cytologic and Histologic Features of Pleomorphic Undifferentiated Sarcoma Arising in a Hybrid Hemosiderotic Fibrolipomatous Tumor and Pleomorphic Hyalinizing Angiectatic Tumor: Report of an Unusual Case with a Literature Review Acta Cytologica 2015 59 6 493 497 0001-5547 S. Karger AG https://doi.org/10.1159/000443319 Wilk M Zelger B G Zelger B Hemosiderotic Fibrolipomatous Tumor The American Journal of Dermatopathology 2016 38 9 714 716 https://doi.org/10.1097/DAD.0000000000000540 Etchebehererm R M Almeida E C S Santos C D T Micheletti A M R Leitão A S Sarcomatous transformation of a hemosideroticfibrohistiocytic lipomatous tumor: a case report Rev Bras 2016 52 3 366 369 https://doi.org/10.1016/j.rboe.2016.11.002 Hou W Li C Guo C Zhang L Meng X Liu Q Primary hemosideroticfibrolipomatous tumor in bone: a case report and review of the literature Int J Clin Exp Pathol 2018 11 5 2497 2505 31938362 Bourhroum N Elouazzani H Chadi F Zouaidia F HemosideroticFibrolipomatousTumour and Similar Lesions: Case Report and Literature Review Austin Pathology 2019 2 1 1 3 https://austinpublishinggroup.com/austin-pathology/fulltext/austinpathol-v2-id1006.pdf Kazakov Dmitry V Sima Radek Michal Michal Hemosiderotic fibrohistiocytic lipomatous lesion: clinical correlation with venous stasis Virchows Archiv 2005 447 1 103 106 0945-6317 Springer Science and Business Media LLC https://doi.org/10.1007/s00428-005-1223-5 Luzar Bostjan Gasljevic Gorana Juricic Vesna Bracko Matej Hemosiderotic fibrohistiocytic lipomatous lesion: Early pleomorphic hyalinizing angiectatic tumor? Pathology International 2006 56 5 283 286 1320-5463 Wiley https://doi.org/10.1111/j.1440-1827.2006.01955.x West A T Toms A P Murphy J Sultan M 2008 37 1 71 74 https://doi.org/10.1007/s00256-007-0397-0 Vreeze Ronald S A De Koops Wim Haas Rick L Coevorden Frits Van An Unusual Case of Hemosiderotic Fibrohistiocytic Lipomatous Lesion: Correlation of MRI and Pathologic Findings Sarcoma 2008 2008 1 4 1357-714X Hindawi Limited https://doi.org/10.1155%2F2008%2F893918 Wettach George R Boyd Luke J Lawce Helen J Magenis R Ellen Mansoor Atiya Cytogenetic analysis of a hemosiderotic fibrolipomatous tumor Cancer Genetics and Cytogenetics 2008 182 2 140 143 0165-4608 Elsevier BV https://doi.org/10.1016/j.cancergencyto.2008.01.012 Hallor Karolin H Sciot Raf Staaf Johan Heidenblad Markus Rydholm Anders Bauer Henrik Cf Åström Kristina Domanski Henryk A Meis Jeanne M Kindblom Lars-Gunnar Panagopoulos Ioannis Mandahl Nils Mertens Fredrik Two genetic pathways, t(1;10) and amplification of 3p11-12, in myxoinflammatory fibroblastic sarcoma, haemosiderotic fibrolipomatous tumour, and morphologically similar lesions The Journal of Pathology 2009 217 5 716 727 0022-3417 Wiley https://doi.org/10.1002/path.2513 Ramalho Antônio Roberto Oliveira Nunes Marcella Nara Adad Sheila Jorge Leitão Sebastião Almeida Micheletti Adilha Misson Rua Hemosiderotic fibrohistiocytic lipomatous lesion: case report and review of the literature Sao Paulo Medical Journal 2009 127 3 174 176 FapUNIFESP (SciELO) https://doi.org/10.1590/s1516-31802009000300012 Smith M E Fisher C Weiss S W Pleomorphic hyalinizing angiectatic tumor of soft parts. A low-grade neoplasm resembling neurilemoma Am J Surg 1996 20 1 21 29 https://doi.org/10.1097/00000478-199601000-00002 Folpe A L Weiss S W Pleomorphic hyalinizing angiectatic tumor: analysis of 41 cases supporting evolution from a distinctive precursor lesion Am J Surg Pathol 2004 28 11 1417 1425 https://doi.org/10.1097/01.pas.0000141406.02581.fb Montgomery E A Devaney K O Giordano T J Weiss S W Inflammatory myxohyaline tumor of distal extremities with virocyte or Reed-Sternberg-like cells: a distinctive lesion with features simulating inflammatory conditions, Hodgkin's disease, and various sarcomas Modern pathology 1998 11 4 384 391 9578090 https://pubmed.ncbi.nlm.nih.gov/9578090/ Meis-Kindblom J M Kindblom L G Acral myxoinflammatory fibroblastic sarcoma: a low-grade tumor of the hands and feet Am Journal of Surgical Pathology 1998 22 8 911 924 https://doi.org/10.1097/00000478-199808000-00001 Michal M Inflammatory Myxoid Tumor of the Soft Parts with Bizarre Giant Cells Pathology - Research and Practice 1998 194 8 529 533 0344-0338 Elsevier BV https://doi.org/10.1016/s0344-0338(98)80041-1