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Clinical Problem Solving: Pathology
February 2004

Pathology Quiz Case 1—Diagnosis

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Copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2004

Arch Otolaryngol Head Neck Surg. 2004;130(2):240. doi:10.1001/archotol.130.2.240

Atypical fibroxanthoma (AFX), which was first described by Helwig1 in 1961, is a rare fibrohistiocytic tumor that is generally known as a superficially situated low-grade sarcoma with a low recurrence rate.2 It is also called pseudosarcoma, paradoxical fibrosarcoma, pseudosarcomatous dermatofibroma, and pseudosarcomatous reticulohistiocytoma.3 It typically presents as a nodular skin lesion on sun-exposed areas of the head and neck2,3 and is most commonly seen on the nose, auricles, cheeks, and scalp. Occupational or therapeutic exposure to radiation may also be an etiologic factor.3 Atypical fibroxanthoma is histologically composed of spindle-shaped or round cells with prominent pleomorphism, nuclear atypia, and a high mitotic rate.3,4 It is also characterized by cells with bizarre cytologic atypia arranged in a haphazard or vague fascicular pattern.3

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