Fax +41 61 306 12 34 E-Mail karger@karger.ch www.karger.com Fine Needle Aspiration Acta Cytologica 2012;56:15–24 DOI: 10.1159/000333134 Myxofibrosarcoma: Cytomorphologic Findings and Differential Diagnosis on Fine Needle Aspiration Matthew T. Olson a Syed Z. Ali a, b Departments of a Pathology and b Radiology, The Johns Hopkins Hospital, Baltimore, Md., USA cells (71%), and curvilinear vessels (65%). Myxoid matrix, spindle cells, and nuclear pleomorphism were very often concomitant observations. Conclusion: MFS demonstrates characteristic albeit nonspecific morphological findings and can overlap morphologically with other clinically significant entities based on FNA material. Copyright © 2012 S. Karger AG, Basel Introduction Myxofibrosarcoma (MFS) [1] is a soft tissue sarcoma that typically presents on the extremities of adults in their 6th–8th decades. It has previously been called myxoid malignant fibrous histiocytoma (MFH) [2]. The MFS no- menclature now has broad consensus because of the re- producible morphologic appearance and ultrastructure [3]. MFS also portends a better prognosis than the vari- ants of MFH [4–7]. MFS classically presents superficially in the lower extremities, followed by the trunk, upper ex- tremities, neck, and head [1, 8–10], but it has also been reported superficially in the breast [11, 12], perineum [13], and orbit [14, 15]. Reports also exist of MFS in deep sites, including the esophagus [16], hypopharynx [17], vocal fold [18], parotid [19], heart [20–22], aorta [23], pulmo- nary artery [24], lung [25] and brain [26, 27]. Key Words Cytomorphologic findings  Fine needle aspiration  Histiocytoma  Malignant fibrous histiocytoma  Myxofibrosarcoma  Myxoid liposarcoma  Myxoid neoplasm  Soft tissue tumor Abstract Objective: To analyze the cytomorphologic findings of myxofibrosarcoma (MFS) on fine needle aspiration (FNA) and examine the differential diagnoses. Study Design: A ret- rospective review was undertaken of material from 22 pa- tients with an FNA procedure of their tumor prior to resec- tion. A tally was performed of all the features known in the literature, including myxoid matrix, spindle cells, nuclear pleomorphism, curvilinear vessels, and multinucleated cells. A review of the literature was also performed to elucidate any advances in the use of morphology and other modalities to deconvolute the challenging differential diagnosis. Clini- coradiologic characteristics and immunostaining were also analyzed and correlated. Results: FNA diagnoses included high-grade sarcoma (32%), recurrent MFS (23%), spindle cell neoplasm (18%), indeterminate-grade sarcoma (14%), low- grade sarcoma (9%), and pleomorphic adenoma (4%). Of the cases available for morphologic review, myxoid matrix was the most frequent observation (88%), followed by spindle cells (82%), nuclear pleomorphism (76%), multinucleated Received: August 17, 2011 Accepted: September 15, 2011 Published online: January 4, 2012 Correspondence to: Dr. Syed Z. Ali Departments of Pathology and Radiology, The Johns Hopkins Hospital 600 North Wolfe Street, Room Path 406 Baltimore, MD 21287 (USA) Tel. +1 410 955 1180, E-Mail sali  @  jhmi.edu © 2012 S. Karger AG, Basel 0001–5547/12/0561–0015$38.00/0 Accessible online at: www.karger.com/acy