PMC9893065_01
Left chest wall mass extending to axilla (orange arrow).
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Chest X-ray showed large left chest wall soft tissue mass with axillary extension involving the inferior angle of the scapula (Figure 1).
CT-chest shows left axillary soft tissue mass measuring 9.6 x 8.5 x 10.9 cm3 in size infiltrating the pectoralis muscle (orange arrow).. Left axillary lymph nodes enlargement, the largest measuring 1.1 x 1.05 cm2 in size.
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Left axillary lymph nodes enlargement, the largest measuring 1.1 x 1.05 cm2 in size (Figure 2).
(a) Diffuse proliferation of mononuclear spindle cells admixed with occasional multinucleated giant cells; with variably myxoid to chondroid stroma, representing various stages of cartilaginous development (H&E stained 40x original magnification). (b) Photomicrograph of the tumor displaying myofibroblastic-like spindle cell proliferation with loosely arranged myxoid stroma, minimal cellular atypia, and rare mitoses together with storiform or fascicular pattern (H&E stained 200x original magnification).
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The excised tumor was taken for histopathology which concluded it to be CMF (Figure 3) with differential diagnosis of inflammatory myofibroblastic tumor.
Photograph showing recurrent left axillary mass with previous surgery scars.
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The child presented again after 7 months with recurrence for the second time at the same site (Figure 4).
Post-operative clinical photograph showing no recurrence and healed hypertrophic scar.
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He was reviewed after 1 month, whereby the wound has healed with a hypertrophic scar, has no upper limb edema, and has a full range of motion of his shoulder joint (Figure 5).
(a) CMF demonstrating diffuse population of mononuclear spindle cells and admixed multinucleated giant cells (H&E 40x original magnification). (b) CMF highlighting the presence of lobules of stellate cells with variably myxoid to chondroid stroma, representing various stages of cartilaginous development (H&E 100x original magnification). (c) Photomicrograph of CMF showing cells having variable pink cytoplasm, bipolar to multipolar cytoplasmic extensions and oval to spindled nuclei with myxoid stroma (H&E 200x original magnification). (d) Infiltration of skeletal muscle by the tumor cells with moderate nuclear pleomorphism (H&E 200x original magnification).
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The presence of infiltrative pattern and necrosis gave the differential diagnosis of low-grade myxofibrosarcoma, myxoid dermatofibrosarcoma, proliferative fasciitis, and solitary fibrous tumor (Figure 6).