Infiltrating Myxofibrosarcoma of the Forearm: An Infrequent Entity of Difficult Diagnosis and Complex Treatment, which Requires Great Collaboration

Abstract

Introduction

Myxofibrosarcoma (MFS) is one of the most common sarcomas affecting the extremities in elderly patients. Clinically, it may present as a tumor with a benign appearance, but its aggressive features and tendency for easy local recurrence with increasing aggressiveness classify it as a malignant tumor within the subgroup of fibroblastic or myofibroblastic tumors.

We aim to highlight the need for an aggressive diagnostic and therapeutic consensus, with the goal of preserving limb integrity while minimizing the chances of recurrence. Therefore, we emphasize the importance of multidisciplinary work, utilizing Magnetic Resonance Imaging (MRI) for lesion mapping.

Materials and Methods

We present two cases of superficial and diffuse MFS of the forearm, previously intervened as supposedly benign lesions, but in which, later, the anatomopathological study demonstrated the presence of an aggressive lesion with infiltration of the edges. Control studies with MRI showed that the extension of the tumor was greater than preconceived due to the clinically visible nodule and allowed us to correctly perform surgical planning for the extended marginal excision of the lesion. Subsequently, the different stages for the reconstruction of the defect created are discussed.

Results

In both cases, resections were achieved with wide margins and optimal results in terms of functionality and quality of life.

Discussion

We evaluate the diagnostic characteristics of these lesions with clinical and imaging studies (MRI) and their differential diagnosis with other pathologies. We address the surgical options and how we should approach complete resection and subsequent reconstruction to avoid recurrence, as well as the need for adjuvant treatment and follow-up with serial radiological studies in case of recurrence or metastatic disease.

Conclusions

Among soft tissue sarcomas, we find a rare entity in the upper limb, but we must be aware of it, especially its radiological characteristics, in order to be able to treat it as safely as possible to avoid its progression.

Keywords

myxofibrosarcoma - soft tissue sarcomas - subdermal tumor - resection limits - “tail sign”

Ethical Responsibilities and Protection of People and Animals

The authors declare that the procedures followed were by the ethical standards of the committee responsible for human experimentation and by the World Medical Association and the Declaration of Helsinki.

Data Confidentiality

The authors declare that they have followed their workplace protocols on the publication of patient data.

Patient Privacy and Informed Consent

The authors have obtained informed consent from the patients and/or subjects referred to in the article. This document is in the possession of the corresponding author.

Publication History

Received: 03 July 2024

Accepted: 07 April 2025

Article published online:
21 July 2025

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