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1. METASTASIZING ATYPICAL FIBROXANTHOMA Authors: Angel F. Campos Gines, Adrian Guevara, M. Manuel Landeros, Juan Herrada(Hospital Infanta Elena, Valdemoro, Madrid) INTRODUCTION Atypical fibroxanthoma (AFX) is an uncommon mesenchymal skin neoplasm that occurs mostly on the sun-exposed skin of elderly individuals. AFX is generally considered a benign, superficial variant of malignant fibrous histiocytoma. We present a patient with metastatic atypical fibroxanthoma. 1 2 MATERIAL AFX mixoide type 4 Case Report RESULTS An eighty-eight year old male was evaluated for sudden onset of pruritus and pain in his mid back area. On physical exam, an erythematous nodule was noted, and it was surgically resected. The pathology examination revealed atypical fibroxanthoma involving dermis and with focal extension to the subcutaneous fat tissue with margins of excision and base free of tumor. The phenotype of the tumor cells was positive for CD68 and negative for AE1/AE3, CD34, CD45 and S-100. Three months later the patient noted five discreet nodules in his upper and lower back. He underwent wide local excision (2 cm safety margin) of each nodule followed by complex closure of the wound. The pathology examination revealed recurrent atypical fibroxanthoma involving dermis and subcutaneous tissue with negative resection margins. Additional evaluation with computed tomography detected an enlarged right axillary lymph node , which was completely excised. The lymph node showed features similar to the to the recurring skin tumor. The patient declined the recommended postoperative radiotherapy. Lesion AFX mixoide type 4-CD68+ AFX mixoide type 1 AFX mixoide type 2 AFX mixoide type 5-CD68+ COMMENTARY Atypical fibroxanthoma is a tumor that occurs primarily in older individuals. Clinically, lesions usually are suggestive of malignancy because they arise rapidly. Histologically, lesions show a highly atypical and pleomorphic cellular appearance. Many atypical fibroxanthoma tumors may represent a superficial form of malignant fibrous histiocytoma. Male-to-female ratio is equal, with a mean age of 69 years. The skin nodules are red, juicy, and dome shaped and may be ulcerated. Nodules primarily are located on the head and neck, trunk, and extremities. The ratio of lesions that occur on the head and neck to lesions that occur in other areas is approximately 4:1. The pathologic appearance of atypical fibroxanthoma is composed of large, fibrocytic, spindle-shaped and anaplastic cells arranged in a haphazard fashion, occasionally in fascicles, and usually with an increased number of mitotic figures. Large histiocytic cells may form bizarre multinucleated giant cells that frequently contain lipid, contributing to the tumor's name. 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