Multiplidisciplinary Actions in the Treatiment of Atypical Fibroxatoma a rare but severe neoplasm: a real-life case report

Abstract

SUMMARY Atypical Fibroxanthoma (AFX) is a rare tumor of spindle cells, described by Helwig (1963). This is related to sun exposure in whites, elderly men (mean age 60 years). AFX is a variant of malignant fibrous histiocytoma (MFH) and presents as an erythematous, papule and ulcered lesion. The size varies from 2 to 20 cm, and difficult to differentiate from epidermoid carcinoma (SCC). We report the case of patient with lower lip AFX reinforcing adjuvant surgery and radiotherapy (RT). A 60-year-old patient, male, mason, white, from São Paulo. It refers to wound lip for 12 months, with no improvement to treatments. To clinical examination: Ulcer and vegetation lesion of the lower lip compromising the right labial commissure and distant 1.5 cm from the left commissure and infiltrating 0.5 cm to the skin. Lymph node level IB right measuring 1.5 X 1.5 cm hardened, mobile, smooth, without contiguity with the submandibular gland. We performed resection and reconstruction with emptying of levels IA and IB. It evolved with local infections and dehiscence due to lack of local care. The anatomopathological showed low differentiated and ulcerated AFX measuring 6.2 x 3.5 cm with high mitotic index and lymph node level IB right with metastasis, confirmed by immunohistochemical examination. We indicated radiotherapy (RT) in the in the total dose of 60 Gy and was asymptomatic for 24 months. The diagnosis is based on clinical, histopathological and IHQ, and extensive excision with free margins, cervical emptying for suspected LN and associated reconstruction. Radiotherapy has been indicated in this case by prognostics factors. Keywords: Atypical fibroxanthoma; Neoplasm of the lower lip; Diagnosis; Treatment.