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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 12-year-old girl with no medical history was referred to the pediatric plastic surgery department for a lesion that had appeared 3 months earlier on the back of her right hand and consisted of an indurated&#44; slightly raised brownish plaque that was painful to the touch &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">The first diagnostic test performed was a Doppler ultrasound&#44; which revealed a subcutaneous lesion compatible with an arteriovenous malformation&#46; Subsequent magnetic resonance imaging &#40;MRI&#41; supported this suspicion&#46; After presenting the case to the Vascular Anomalies Committee at our center&#44; we opted for treatment with embolization and subsequent surgery&#46; Embolization was not possible due to imaging findings compatible with thrombosis of the malformative nidus&#46; As the patient was asymptomatic at the time&#44; a wait-and-see approach with ultrasound monitoring was adopted&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">One year later&#44; the patient requested treatment for pain related to trauma and the visible lesion was surgically resected&#46; Histopathology of the lesion indicated a plexiform fibrohistiocytic tumor without tumor-free margins&#46; The neoformation affected the subcutaneous cellular tissue and superficial areas of the skeletal muscle&#44; sparing the overlying skin&#46; It presented a plexiform distribution&#44; with tumor nests composed of spindle cells or monomorphic epithelioid cells accompanied by giant multinucleated cells&#46; A fibrous stroma with dilated vessels was evident between the nests&#46; The proliferative index was less than 3&#37; and no atypical mitoses&#44; necrosis&#44; or xanthomatous cells were observed &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Immunohistochemistry was negative for CD31&#44; CD34&#44; Wilms tumor protein 1 &#40;WT1&#41;&#44; and glucose transporter-1 &#40;GLUT1&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">A thoracic computed tomography scan&#44; performed as part of the tumor extension study&#44; revealed a nodule of 3<span class="elsevierStyleHsp" style=""></span>mm in the right lower pulmonary lobe&#46; The pediatric thoracic surgery team proceeded with thoracoscopic resection of the nodule&#44; which was compatible with a carcinoid tumorlet&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The results of imaging studies of the right hand revealed a residual lesion with invasion of muscle and tendon and erosion of the cortical bone of the fourth metacarpal&#46; After discussing the case with a multidisciplinary team consisting of oncologists&#44; plastic surgeons&#44; traumatologists&#44; radiologists and pathologists&#44; 2 therapeutic options were established&#58; close clinical observation or complete resection of the lesion&#46; Ultimately&#44; the family opted for surgery&#44; and the fourth and fifth fingers of the right hand were amputated&#46; Currently&#44; the patient is asymptomatic and is undergoing follow-up and rehabilitation&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Plexiform fibrohistiocytic tumor&#44; first reported by Enzinger and Zhang in 1988&#44;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> is a rare soft-tissue tumor with intermediate potential for malignancy&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> It shows a predilection for children and young adults&#44; affecting those under 20 years of age in 60&#37;&#8211;70&#37; of cases&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">3&#44;4</span></a> It is more prevalent in females and does not predominate in any ethnic group&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a> Its etiology is unknown&#44; but congenital cases and those related to previous trauma have been reported&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">3&#8211;6</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Clinically it presents as a painless&#44; slow-growing&#44; indurated mass or plaque &#40;1&#8211;3<span class="elsevierStyleHsp" style=""></span>cm&#41; that affects the dermis and hypodermis&#46; It can sometimes cause pain&#44; ulceration&#44; or changes in the color of the overlying skin&#44; and in rare cases&#44; including the present case&#44; spreads to the skeletal muscle&#46; It usually affects the upper limbs&#44; mainly the fingers&#44; hand&#44; or wrist&#46; Cases of lower limb&#44; trunk&#44; head&#44; and neck involvement have been reported&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">3&#8211;6</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Initial clinical and radiological diagnosis is challenging&#46; MRI shows an infiltrative lesion or plaque at the level of the subcutaneous tissue&#44; with no specific signal characteristics that allow differentiation from other benign &#40;including some types of vascular anomalies&#41; or malignant entities&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a> The definitive diagnosis is based on pathological findings&#46; Histology shows nodules or fascicles of histiocytes&#44; fibroblasts&#44; and osteoclast-like cells&#44; arranged in a characteristic plexiform pattern&#46; Immunohistochemistry reveals CD68<span class="elsevierStyleSup">&#43;</span> histiocytic cells and fibroblasts positive for smooth muscle actin and vimentin&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">3&#8211;6&#44;8</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Surgical resection with negative margins is the treatment of choice&#46; Local recurrence has been documented in 12&#46;5&#37;&#8211;40&#37; of cases&#44; and is often detected 1&#8211;2 years after surgery&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> After complete resection the clinical course of this tumor is typically benign&#44; although regional lymph node &#40;6&#37;&#41; and lung &#40;2&#37;&#8211;19&#37;&#41; metastases have been reported&#44; necessitating long-term follow-up of affected patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">3&#8211;5</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">In summary&#44; we describe a case of plexiform fibrohistiocytic tumor in a 12-year-old girl&#46; The decision to resect the tumor&#44; despite a relatively low risk of nodal and pulmonary metastases&#44; posed a conflict for the treating physicians as it involved amputation of 2 fingers on the affected hand&#46; Ultimately the family&#44; perhaps influenced by the incidental diagnosis of a pulmonary nodule in the tumor extension study&#44; opted for surgery to avoid the potential risk of future metastasis&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">We wish to emphasize the importance of pathological anatomy in the diagnosis of soft-tissue tumors&#44; which comprise multiple entities&#44; the management and prognosis of which can vary considerably&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of Interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest&#46;</p></span></span>"
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Case and Research Letter
Plexiform Fibrohistiocytic Tumor in a 12-Year-Old Girl
Tumor fibrohistiocitario plexiforme en una niña de 12 años
A. Gómez Sáncheza,
Autor para correspondencia
alicigom@gmail.com

Corresponding author.
, M.E. Martí-Carrerab, J.V. Redondo-Sedanoc, M.D. Delgado-Muñozd
a Servicio de Cirugía Pediátrica, Hospital Universitario 12 de Octubre, Spain
b Servicio de Cirugía Plástica, Sección Cirugía Plástica Infantil, Hospital Universitario 12 de Octubre, Spain
c Servicio de Cirugía Pediátrica, Sección Cirugía Plástica Infantil, Hospital Universitario 12 de Octubre, Spain
d Servicio de Cirugía Pediátrica, Jefe de sección, Cirugía Plástica Infantil, Hospital Universitario 12 de Octubre, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 12-year-old girl with no medical history was referred to the pediatric plastic surgery department for a lesion that had appeared 3 months earlier on the back of her right hand and consisted of an indurated&#44; slightly raised brownish plaque that was painful to the touch &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">The first diagnostic test performed was a Doppler ultrasound&#44; which revealed a subcutaneous lesion compatible with an arteriovenous malformation&#46; Subsequent magnetic resonance imaging &#40;MRI&#41; supported this suspicion&#46; After presenting the case to the Vascular Anomalies Committee at our center&#44; we opted for treatment with embolization and subsequent surgery&#46; Embolization was not possible due to imaging findings compatible with thrombosis of the malformative nidus&#46; As the patient was asymptomatic at the time&#44; a wait-and-see approach with ultrasound monitoring was adopted&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">One year later&#44; the patient requested treatment for pain related to trauma and the visible lesion was surgically resected&#46; Histopathology of the lesion indicated a plexiform fibrohistiocytic tumor without tumor-free margins&#46; The neoformation affected the subcutaneous cellular tissue and superficial areas of the skeletal muscle&#44; sparing the overlying skin&#46; It presented a plexiform distribution&#44; with tumor nests composed of spindle cells or monomorphic epithelioid cells accompanied by giant multinucleated cells&#46; A fibrous stroma with dilated vessels was evident between the nests&#46; The proliferative index was less than 3&#37; and no atypical mitoses&#44; necrosis&#44; or xanthomatous cells were observed &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Immunohistochemistry was negative for CD31&#44; CD34&#44; Wilms tumor protein 1 &#40;WT1&#41;&#44; and glucose transporter-1 &#40;GLUT1&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">A thoracic computed tomography scan&#44; performed as part of the tumor extension study&#44; revealed a nodule of 3<span class="elsevierStyleHsp" style=""></span>mm in the right lower pulmonary lobe&#46; The pediatric thoracic surgery team proceeded with thoracoscopic resection of the nodule&#44; which was compatible with a carcinoid tumorlet&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The results of imaging studies of the right hand revealed a residual lesion with invasion of muscle and tendon and erosion of the cortical bone of the fourth metacarpal&#46; After discussing the case with a multidisciplinary team consisting of oncologists&#44; plastic surgeons&#44; traumatologists&#44; radiologists and pathologists&#44; 2 therapeutic options were established&#58; close clinical observation or complete resection of the lesion&#46; Ultimately&#44; the family opted for surgery&#44; and the fourth and fifth fingers of the right hand were amputated&#46; Currently&#44; the patient is asymptomatic and is undergoing follow-up and rehabilitation&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Plexiform fibrohistiocytic tumor&#44; first reported by Enzinger and Zhang in 1988&#44;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> is a rare soft-tissue tumor with intermediate potential for malignancy&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> It shows a predilection for children and young adults&#44; affecting those under 20 years of age in 60&#37;&#8211;70&#37; of cases&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">3&#44;4</span></a> It is more prevalent in females and does not predominate in any ethnic group&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a> Its etiology is unknown&#44; but congenital cases and those related to previous trauma have been reported&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">3&#8211;6</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Clinically it presents as a painless&#44; slow-growing&#44; indurated mass or plaque &#40;1&#8211;3<span class="elsevierStyleHsp" style=""></span>cm&#41; that affects the dermis and hypodermis&#46; It can sometimes cause pain&#44; ulceration&#44; or changes in the color of the overlying skin&#44; and in rare cases&#44; including the present case&#44; spreads to the skeletal muscle&#46; It usually affects the upper limbs&#44; mainly the fingers&#44; hand&#44; or wrist&#46; Cases of lower limb&#44; trunk&#44; head&#44; and neck involvement have been reported&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">3&#8211;6</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Initial clinical and radiological diagnosis is challenging&#46; MRI shows an infiltrative lesion or plaque at the level of the subcutaneous tissue&#44; with no specific signal characteristics that allow differentiation from other benign &#40;including some types of vascular anomalies&#41; or malignant entities&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a> The definitive diagnosis is based on pathological findings&#46; Histology shows nodules or fascicles of histiocytes&#44; fibroblasts&#44; and osteoclast-like cells&#44; arranged in a characteristic plexiform pattern&#46; Immunohistochemistry reveals CD68<span class="elsevierStyleSup">&#43;</span> histiocytic cells and fibroblasts positive for smooth muscle actin and vimentin&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">3&#8211;6&#44;8</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Surgical resection with negative margins is the treatment of choice&#46; Local recurrence has been documented in 12&#46;5&#37;&#8211;40&#37; of cases&#44; and is often detected 1&#8211;2 years after surgery&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> After complete resection the clinical course of this tumor is typically benign&#44; although regional lymph node &#40;6&#37;&#41; and lung &#40;2&#37;&#8211;19&#37;&#41; metastases have been reported&#44; necessitating long-term follow-up of affected patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">3&#8211;5</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">In summary&#44; we describe a case of plexiform fibrohistiocytic tumor in a 12-year-old girl&#46; The decision to resect the tumor&#44; despite a relatively low risk of nodal and pulmonary metastases&#44; posed a conflict for the treating physicians as it involved amputation of 2 fingers on the affected hand&#46; Ultimately the family&#44; perhaps influenced by the incidental diagnosis of a pulmonary nodule in the tumor extension study&#44; opted for surgery to avoid the potential risk of future metastasis&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">We wish to emphasize the importance of pathological anatomy in the diagnosis of soft-tissue tumors&#44; which comprise multiple entities&#44; the management and prognosis of which can vary considerably&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of Interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest&#46;</p></span></span>"
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                      "titulo" => "Plexiform fibrohistiocytic tumor&#58; imaging features and clinical findings"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46; Ghuman"
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                      "titulo" => "Plexiform fibrohistiocytic tumour&#58; morphological changes and challenges in assessment of recurrent and metastatic lesions"
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                            2 => "M&#46; Shingde"
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                            4 => "J&#46;R&#46; Howle"
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        "titulo" => "Acknowledgments"
        "texto" => "<p id="par0070" class="elsevierStylePara elsevierViewall">The authors thank Dr&#46; Rodriguez and Dr&#46; Espinola&#44; pathologists at Hospital 12 de Octubre&#44; Madrid&#44; for providing the histological images associated with this clinical case&#46; Thanks also to the staff in the departments of Pediatric Traumatology &#40;Dr&#46; Mart&#237;&#41;&#59; Pediatric Thoracic Surgery &#40;Dr&#46; Morante&#44; Dr&#46; Lopez&#44; and Dr&#46; Ant&#243;n-Pacheco&#41;&#59; Pediatric Hemato-Oncology &#40;Dr&#46; Perez and Dr&#46; Baro&#41;&#59; and Pediatric Radiodiagnosis &#40;Dr&#46; Gallego&#41; of the Hospital 12 de Octubre&#44; Madrid&#44; for their contributions to decision-making and patient management&#46;</p>"
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Información del artículo
ISSN: 00017310
Idioma original: Inglés
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