Jemds.com Case Report J Evolution Med Dent Sci / eISSN - 2278-4802, pISSN - 2278-4748 / Vol. 9 / Issue 44 / Nov. 02, 2020 Page 3348 Atypical Presentation of Recurrent High-Grade Myxofibrosarcoma – A Case Report Meenakshi Yeola 1 , Kushagra Singh 2 , Aditya Mehta 3 , Roshani S. Manekk 4 1, 2, 3, 4 Department of General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed University), Sawangi (Meghe) Wardha, Maharashtra, India. Myxofibrosarcoma (MFS) is an unusual malignancy, a type of Soft Tumour Sarcoma (STS) with a proclivity for the upper and lower extremities. The World Health Organization (WHO) in the year 2002, declared a precise classification for MFS and stated it as a specific pathologic entity. A very striking clinical feature of MFS is its predilection for recurring locally. MFS is relatively uncommon and has unique sites of presentation with no standard protocols to guide the treatment decisions making approach to every case unique. PRESENTATION OF CASE A 65-year-old female presented with complaints of swelling over the right infraclavicular fossa since 1 month. The swelling was insidious in onset and gradually progressive in nature and was not associated with any symptoms of pain over the swelling, loss of weight, loss of appetite, breathlessness and backache. Patient is a known case of hypertension. The patient also gave history of similar swelling in the past which was excised two times, once 5 months ago and another 3 months prior to current presentation. The previous histopathology report was suggestive of “High Grade Myxofibrosarcoma”. The cells were mild to moderately pleomorphic spindle cells with moderate amount of eosinophilic cytoplasm, variable mitotic activity of up to 4 per HPF (High Power Field) with less than 50 % of focal necrosis and focal myxoid areas were present. It is spindle cell tumour involving the adipose tissue and skeletal muscle. Immunohistochemistry was done, the tumour cells express SMA (Smooth Muscle Actin) and CDK 4 and are immunonegative for desmin, h-caldesmon, CD-34, S-100 protein ALK and MDM-2. [Figure 1] Figure 1. Histopathological Features of High-Grade Myxofibrosarcoma in the Present Case Study: A. Bizarre Cells, B. Involvement of Skeletal Muscle, C. Myxoid Areas, D. Involvement of Adipose Tissue.: Immunohistochemistry (IHC) Images E. SMA IHC, F. CDK4 IHC Corresponding Author: Dr. Kushagra Singh, Department of Surgery, DMIMS (DU), Sawangi (M), Wardha, Maharashtra, India. E-mail: dr.kushagrasingh@gmail.com DOI: 10.14260/jemds/2020/736 How to Cite This Article: Yeola M, Singh K, Mehta A, et al. Atypical presentation of recurrent high- grade myxofibrosarcoma – a case report. J Evolution Med Dent Sci 2020;9(44):3348- 3350, DOI: 10.14260/jemds/2020/736 Submission 18-07-2020, Peer Review 24-09-2020, Acceptance 30-09-2020, Published 02-11-2020. Copyright © 2020 Meenakshi Yeola et al. This is an open access article distributed under Creative Commons Attribution License [Attribution 4.0 International (CC BY 4.0)] INTRODUCTION