Atypical Fibroxanthoma (AFX) vs Pleomorphic Dermal Sarcoma (PDS): 5-Minute Pathology Pearls

Excerpted from my dermpath board review video ( • Dermpath Board Review:... ) for my 5-Minute Pathology Pearls video series. See also my full AFX video showing how I workup pleomorphic spindle cell tumors of the skin: kikoxp.com/posts/4238
WSI digital slide: pathpresenter.net/#/public/di...
A complete organized library of all my videos, digital slides, pics, & sample pathology reports is available here: kikoxp.com/posts/5084 (dermpath) & kikoxp.com/posts/5083 (bone/soft tissue sarcoma pathology).
You also might like my Dermatopathology survival guide textbook:bit.ly/2Te2haB ‬
This video is geared towards medical students, pathology or dermatology residents, or practicing pathologists or dermatologists. Of course, this video is for educational purposes only and is not formal medical advice or consultation.
Presented by Jerad M. Gardner, MD. Please subscribe to my channel to be notified of new pathology teaching videos.
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[@JMGardnerMD]

A complete organized library of all my videos, digital slides, pics, & sample pathology reports is available here: kikoxp.com/posts/5084 (dermpath) & kikoxp.com/posts/5083 (bone/soft tissue sarcoma pathology).

[@gurbetyokus5294]

Thank you so much for sharing your wonderful knowledge with us

[@dibyanshusekharmohapatra9929]

Nice case and love the pointers at the end

[@lithiumgaurd]

“The more stuff I see... the more paranoid I get. I’m gonna be a real problem in ten years, lol.”

[@salehamoghal1727]

Love 5 min videos.. Stay blessed dear sir

[@RaulRodriguez-sh6vb]

I love those summaries at the end!!! All we need to know!!! So in this lesion is usual to find foamy histiocytes?

[@JMGardnerMD]

Only sometimes. Despite the name, many are not xanthomatous.

[@RaulRodriguez-sh6vb]

Good to know. Thanks

[@carolinedoucet2100]

Thank you for making pathology entertaining ;) what do you do with a big lesion (for example 5 cm x 2.4 cm thick) but that is very exophytic and does not go beyond the dermis?

[@JMGardnerMD]

I would likely call that a pleomorphic dermal sarcoma. Large size is considered by some to be enough to call PDS rather than AFX.

[@carolinedoucet2100]

Thanks, very nice of you to take time to answer.

[@RaulRodriguez-sh6vb]

Awesome

[@flatebinginneh5048]

Great video, What if you have exact same tumor, but in sun protected area?

[@JMGardnerMD]

That would make me consider atypical fibrous histiocytoma. Looks like sarcoma in the middle but looks like dermatofibroma at the periphery. Or it would make me think of a undifferentiated pleomorphic sarcoma (or high grade myxofibrosarcoma). Depends on exact situation and appearance of course.

[@jplassky]

Thank you for your videos. Any tips for deciding between atypical fibrous histiocytoma and AFX/PDS? Also, how do you determine calling a tumor with this appearance PDS vs. undifferentiated pleomorphic sarcoma when the site is not head/neck but still sun exposed (for instance, a limb)?

[@JMGardnerMD]

Atypical FH is usually in young people away from head and neck. It usually has peripheral areas that look like regular FH/DF. AFX/PDS is almost always on sun damaged head and neck of elderly, But I have rarely made that diagnosis in sun damaged non head/neck site like forearm. PDS is usually centered in dermis and subcutis. UPS is usually large and deep. But for practical purposes, I think of them as essentially the same tumor. PDS is essentially like a small superficial UPS (although clearly the etiology/origin must be UV drive for PDS but not for large deep UPS).

[@JMGardnerMD]

I discuss atypical FH in this video: kikoxp.com/posts/6553

[@jplassky]

@@JMGardnerMD so helpful, thank you!