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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Atypical fibroxanthoma &#40;AFX&#41; and pleomorphic dermal sarcoma are rare mesenchymal tumors&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#8211;4</span></a> Historically&#44; the classification of these tumors was based on a changing and imprecise terminology&#44; which has made them difficult to study&#44; and until recently&#44; little data was available regarding their potential aggressiveness&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2&#44;5</span></a> In 2012&#44; the term pleomorphic dermal sarcoma &#40;PDS&#41; was coined to describe dermal tumors without clear cell differentiation and with histologic characteristics similar to those of AFX&#44; but with clinical and&#47;or histologic characteristic of aggressiveness&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;2&#44;4</span></a> The presence of necrosis&#44; lymphovascular or perineural invasion&#44; and&#47;or evident invasion of the subcutaneous cell tissue are the defining histopathology criteria for PDS&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;2&#44;4</span></a> Currently&#44; AFX and PDS tend to be considered as part of the same spectrum&#44; with very similar general epidemiologic and histologic characteristics&#44; but with different clinical behavior and aggressiveness&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#44;6</span></a> In this study&#44; we review 43 cases of AFX and 31 cases of PDS diagnosed and treated between 2005 and 2020 at Instituto Valenciano de Oncolog&#237;a and Hospital Cl&#237;nico Universitario&#44; Valencia&#44; Spain&#44; with the objective of identifying the differences in the clinical and pathologic characteristics and the behavior of the 2 tumors&#46; The clinical and histologic characteristics assessed are shown in the supplemental material &#40;<a class="elsevierStyleCrossRef" href="#sec0010">supplemental Tables 1&#8211;4</a>&#41;&#44; together with the statistical analyses performed&#46; In all cases&#44; the absence of a defined line of cellular differentiation was confirmed&#44; requiring an absence of staining with S100&#44; desmin&#44; pan-cytokeratin &#40;CKAE1-AE3&#41;&#44; and CD34&#46; In some cases&#44; additional staining was also performed&#44; including CD10&#44; CD31&#44; and smooth-muscle actin &#40;SMA&#41;&#46; Seventy &#40;94&#46;6&#37;&#41; of the cases were men&#44; with a mean age of 79&#46;5 years&#46; A total of 97&#46;3&#37; of the patients had a past history of chronic exposure to sunlight and the most common location of the tumor was the scalp &#40;58&#46;1&#37;&#41;&#46; The median size of the lesions was 15<span class="elsevierStyleHsp" style=""></span>mm in diameter &#40;range&#44; 5&#8211;60<span class="elsevierStyleHsp" style=""></span>mm&#41;&#46; Median time between appearance of the lesion until diagnosis was 3 months &#40;range&#44; 1&#8211;48 mo&#41;&#46; In terms of the general clinical and epidemiologic characteristics&#44; we found no significant differences between the 2 tumors with regard to distribution by sex&#44; age&#44; location of the tumor&#44; or by time until diagnosis&#46; The median size of the AFX was 13&#46;5<span class="elsevierStyleHsp" style=""></span>mm&#44; whereas that of the PDS was 23<span class="elsevierStyleHsp" style=""></span>mm &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; No significant differences were observed between AFX and PDS with regard to tumor growth pattern&#44; degree of cell pleomorphism&#44; predominant cell type&#44; number of mitoses&#44; ulceration&#44; degree of inflammation&#44; predominant location of the inflammatory infiltrate&#44; and predominant inflammatory cell type&#46; The median tumor thickness of the PDS &#40;7&#46;2<span class="elsevierStyleHsp" style=""></span>mm&#41; was significantly greater than that of the AFX &#40;4&#46;1<span class="elsevierStyleHsp" style=""></span>mm&#41;&#46; Furthermore&#44; we found significant differences in the maximum invasion area and presence of necrosis&#44; lymphovascular invasion&#44; perineural invasion&#44; and invasion of the subcutaneous cell tissue &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; In total&#44; 18 cases &#40;24&#46;3&#37;&#41; recurred after the initial treatment&#44; of which 4 &#40;22&#46;2&#37;&#41; were AFX and 14 &#40;77&#46;8&#37;&#41; were PDS&#46; Eight cases &#40;10&#46;8&#37;&#41; were locally advanced at some point in the course of the tumor &#8211; all of these were PDS &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The median follow-up time was 16 months &#40;range&#44; 1&#8211;228 mo&#41;&#46; Four cases &#40;5&#46;4&#37;&#41; presented metastasis &#40;1 lymph node&#44; 2 lung&#44; and 1 lung and brain&#41; and 3 patients &#40;4&#46;1&#37;&#41; died as a result of the disease&#44; all of whom had PDS&#46; Finally&#44; we performed a survival analysis using the Kaplan-Meier estimator and found significant differences between the 2 tumors&#58; disease-free survival after 2 years was 88&#46;2&#37; for AFX&#44; compared to 46&#46;7&#37; for PDS &#40;hazard ratio&#44; 6&#46;1&#59; HR 95&#37; CI&#44; 2&#46;017&#8211;18&#46;753&#59; logrank <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Due to the historical confusion that has surrounded the classification of these tumors&#44; the behavior and true potential aggressiveness of AFX and PDS were relatively unknown until recently&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2&#8211;4&#44;7</span></a> Some years ago&#44; the term AFX was used to denote cutaneous tumors&#44; including those with subdermal extension&#44; and several cases of AFX with locoregional and systemic metastasis were described&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#8211;3&#44;7</span></a> More recent reviews&#44; however&#44; have clarified the fact that&#44; today&#44; those tumors would be diagnosed as PDS or even as mesenchymal tumors of nondermal origin&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> Since the introduction of the term PDS&#44; the publication of well-defined series of AFX and PDS has allowed for better characterization of the behavior of these tumors&#46; Using strict diagnostic criteria&#44; AFX has eminently benign clinical behavior&#44; whereas PDS may present local aggressiveness in a not insignificant proportion of cases&#44; and may even present distant metastasis&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#8211;3&#44;5&#44;8&#44;9</span></a> Nevertheless&#44; the risk factors that make it possible to predict a worse outcome have not been identified and no broad consensus exists to date regarding treatment and follow-up of these tumors&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#44;7</span></a> In the treatment of AFX&#44; Mohs surgery is superior to conventional surgery&#44;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> but sufficient data are not yet available in PDS &#40;although recent studies suggest that Mohs surgery may be more useful&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> In our series&#44; in line with the available literature&#44; we found no differences between the general clinical and pathologic characteristics of the 2 tumors but we did find differences in those characteristics linked to aggressiveness &#40;tumor size&#44; tumor thickness&#44; percentage of recurrences&#41;&#46; A considerable percentage of PDS cases recurred after treatment with conventional surgery &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41; and disease-free survival after 2 years was significantly higher for AFX&#46; In conclusion&#44; we present a broad and well-characterized series of AFX and PDS&#44; which highlight the general clinical and pathologic similarities between the 2 tumors and their different behavior and potential aggressiveness&#46;</p></span>"
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Characteristic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">AFX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">PDS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tumor size&#44; mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mean&#44; 14&#46;5Median&#44; 13&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mean&#44; 25&#46;2Median&#44; 23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tumor thickness&#44; mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mean&#44; 4&#46;04Median&#44; 4&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mean&#44; 7&#46;7Median&#44; 7&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Maximum invasion area&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dermis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 dermis17 SCT9 galea aponeurotica3 cartilage1 muscle&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Necrosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">None&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#47;31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vascular invasion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">None&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#47;31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Perineural infiltration&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">None&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#47;31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Infiltration of SCT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">None&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#47;31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Recurrence&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">None 391 relapse 3More than 1 relapse 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">None 171 relapse 5More than 1 relapse 9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">DFS after 2 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">88&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Clinical and Pathologic Characteristics That Showed Differences Between Atypical Fibroxanthoma and Pleomorphic Dermal Sarcoma&#46;</p>"
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Case and Research Letter
Atypical Fibroxanthoma and Pleomorphic Dermal Sarcoma: A Two-Center Retrospective Study of 74 Cases
Fibroxantoma atípico y sarcoma pleomórfico dérmico: estudio bicéntrico retrospectivo de 74 casos
E. Ríos-Viñuelaa,
Corresponding author
elisariosvi@hotmail.com

Corresponding author.
, M. Pons Benaventb, C. Monteagudoc, E. Nagorea, O. Sanmartína
a Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, Spain
b Servicio de Dermatología, Hospital Clínico Universitario, Valencia, Spain
c Servicio de Anatomía Patológica, Hospital Clínico Universitario, Valencia, Spain
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lymphovascular or perineural invasion&#44; and&#47;or evident invasion of the subcutaneous cell tissue are the defining histopathology criteria for PDS&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;2&#44;4</span></a> Currently&#44; AFX and PDS tend to be considered as part of the same spectrum&#44; with very similar general epidemiologic and histologic characteristics&#44; but with different clinical behavior and aggressiveness&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#44;6</span></a> In this study&#44; we review 43 cases of AFX and 31 cases of PDS diagnosed and treated between 2005 and 2020 at Instituto Valenciano de Oncolog&#237;a and Hospital Cl&#237;nico Universitario&#44; Valencia&#44; Spain&#44; with the objective of identifying the differences in the clinical and pathologic characteristics and the behavior of the 2 tumors&#46; The clinical and histologic characteristics assessed are shown in the supplemental material &#40;<a class="elsevierStyleCrossRef" href="#sec0010">supplemental Tables 1&#8211;4</a>&#41;&#44; together with the statistical analyses performed&#46; In all cases&#44; the absence of a defined line of cellular differentiation was confirmed&#44; requiring an absence of staining with S100&#44; desmin&#44; pan-cytokeratin &#40;CKAE1-AE3&#41;&#44; and CD34&#46; In some cases&#44; additional staining was also performed&#44; including CD10&#44; CD31&#44; and smooth-muscle actin &#40;SMA&#41;&#46; Seventy &#40;94&#46;6&#37;&#41; of the cases were men&#44; with a mean age of 79&#46;5 years&#46; A total of 97&#46;3&#37; of the patients had a past history of chronic exposure to sunlight and the most common location of the tumor was the scalp &#40;58&#46;1&#37;&#41;&#46; The median size of the lesions was 15<span class="elsevierStyleHsp" style=""></span>mm in diameter &#40;range&#44; 5&#8211;60<span class="elsevierStyleHsp" style=""></span>mm&#41;&#46; Median time between appearance of the lesion until diagnosis was 3 months &#40;range&#44; 1&#8211;48 mo&#41;&#46; In terms of the general clinical and epidemiologic characteristics&#44; we found no significant differences between the 2 tumors with regard to distribution by sex&#44; age&#44; location of the tumor&#44; or by time until diagnosis&#46; The median size of the AFX was 13&#46;5<span class="elsevierStyleHsp" style=""></span>mm&#44; whereas that of the PDS was 23<span class="elsevierStyleHsp" style=""></span>mm &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; No significant differences were observed between AFX and PDS with regard to tumor growth pattern&#44; degree of cell pleomorphism&#44; predominant cell type&#44; number of mitoses&#44; ulceration&#44; degree of inflammation&#44; predominant location of the inflammatory infiltrate&#44; and predominant inflammatory cell type&#46; The median tumor thickness of the PDS &#40;7&#46;2<span class="elsevierStyleHsp" style=""></span>mm&#41; was significantly greater than that of the AFX &#40;4&#46;1<span class="elsevierStyleHsp" style=""></span>mm&#41;&#46; Furthermore&#44; we found significant differences in the maximum invasion area and presence of necrosis&#44; lymphovascular invasion&#44; perineural invasion&#44; and invasion of the subcutaneous cell tissue &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; In total&#44; 18 cases &#40;24&#46;3&#37;&#41; recurred after the initial treatment&#44; of which 4 &#40;22&#46;2&#37;&#41; were AFX and 14 &#40;77&#46;8&#37;&#41; were PDS&#46; Eight cases &#40;10&#46;8&#37;&#41; were locally advanced at some point in the course of the tumor &#8211; all of these were PDS &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The median follow-up time was 16 months &#40;range&#44; 1&#8211;228 mo&#41;&#46; Four cases &#40;5&#46;4&#37;&#41; presented metastasis &#40;1 lymph node&#44; 2 lung&#44; and 1 lung and brain&#41; and 3 patients &#40;4&#46;1&#37;&#41; died as a result of the disease&#44; all of whom had PDS&#46; Finally&#44; we performed a survival analysis using the Kaplan-Meier estimator and found significant differences between the 2 tumors&#58; disease-free survival after 2 years was 88&#46;2&#37; for AFX&#44; compared to 46&#46;7&#37; for PDS &#40;hazard ratio&#44; 6&#46;1&#59; HR 95&#37; CI&#44; 2&#46;017&#8211;18&#46;753&#59; logrank <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Due to the historical confusion that has surrounded the classification of these tumors&#44; the behavior and true potential aggressiveness of AFX and PDS were relatively unknown until recently&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2&#8211;4&#44;7</span></a> Some years ago&#44; the term AFX was used to denote cutaneous tumors&#44; including those with subdermal extension&#44; and several cases of AFX with locoregional and systemic metastasis were described&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#8211;3&#44;7</span></a> More recent reviews&#44; however&#44; have clarified the fact that&#44; today&#44; those tumors would be diagnosed as PDS or even as mesenchymal tumors of nondermal origin&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> Since the introduction of the term PDS&#44; the publication of well-defined series of AFX and PDS has allowed for better characterization of the behavior of these tumors&#46; Using strict diagnostic criteria&#44; AFX has eminently benign clinical behavior&#44; whereas PDS may present local aggressiveness in a not insignificant proportion of cases&#44; and may even present distant metastasis&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#8211;3&#44;5&#44;8&#44;9</span></a> Nevertheless&#44; the risk factors that make it possible to predict a worse outcome have not been identified and no broad consensus exists to date regarding treatment and follow-up of these tumors&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#44;7</span></a> In the treatment of AFX&#44; Mohs surgery is superior to conventional surgery&#44;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> but sufficient data are not yet available in PDS &#40;although recent studies suggest that Mohs surgery may be more useful&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> In our series&#44; in line with the available literature&#44; we found no differences between the general clinical and pathologic characteristics of the 2 tumors but we did find differences in those characteristics linked to aggressiveness &#40;tumor size&#44; tumor thickness&#44; percentage of recurrences&#41;&#46; A considerable percentage of PDS cases recurred after treatment with conventional surgery &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41; and disease-free survival after 2 years was significantly higher for AFX&#46; In conclusion&#44; we present a broad and well-characterized series of AFX and PDS&#44; which highlight the general clinical and pathologic similarities between the 2 tumors and their different behavior and potential aggressiveness&#46;</p></span>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Flow diagram illustrating the management of cases of atypical fibroxanthoma and pleomorphic dermal sarcoma in the study&#46;</p>"
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estimated disease-free survival based on tumor type &#40;atypical fibroxanthoma &#91;AFX&#93; or pleomorphic dermal sarcoma &#91;PDS&#93;&#41;&#58; disease-free survival after 2 years was 88&#46;2&#37; for AFX&#44; compared to 46&#46;7&#37; for PDS &#40;hazard ratio&#44; 6&#46;1&#59; logrank <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46;</p>"
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          "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>&#58; AFX indicates atypical fibroxanthoma&#59; DFS&#44; disease-free survival&#59; PDS&#44; pleomorphic dermal sarcoma&#59; SCT&#44; subcutaneous cell tissue&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Characteristic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">AFX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">PDS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tumor size&#44; mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mean&#44; 14&#46;5Median&#44; 13&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mean&#44; 25&#46;2Median&#44; 23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tumor thickness&#44; mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mean&#44; 4&#46;04Median&#44; 4&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mean&#44; 7&#46;7Median&#44; 7&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Maximum invasion area&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dermis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 dermis17 SCT9 galea aponeurotica3 cartilage1 muscle&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Necrosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">None&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#47;31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vascular invasion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">None&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#47;31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Perineural infiltration&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">None&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#47;31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Infiltration of SCT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">None&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#47;31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Recurrence&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">None 391 relapse 3More than 1 relapse 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">None 171 relapse 5More than 1 relapse 9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">DFS after 2 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">88&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Clinical and Pathologic Characteristics That Showed Differences Between Atypical Fibroxanthoma and Pleomorphic Dermal Sarcoma&#46;</p>"
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                    0 => array:2 [
                      "titulo" => "Pleomorphic dermal sarcoma adverse histologic features predict aggressive behavior and allow distinction from atypical fibroxanthoma"
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                          "etal" => false
                          "autores" => array:3 [
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                        "tituloSerie" => "Am J Surg Pathol"
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                        "volumen" => "36"
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                    0 => array:2 [
                      "titulo" => "Pleomorphic dermal sarcoma&#58; a more aggressive neoplasm than previously estimated"
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                          "etal" => true
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                            0 => "J&#46;C&#46; Tardio"
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                    0 => array:2 [
                      "titulo" => "Relation between atypical fibroxanthoma and pleomorphic dermal sarcoma&#58; histopathologic features and review of the literature"
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                      "titulo" => "Extended surgical safety margins and ulceration are associated with an improved prognosis in pleomorphic dermal sarcomas"
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Article information
ISSN: 00017310
Original language: English
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