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Sclerosing Epithelioid Fibrosarcoma: Case Presentation and a Systematic Review

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Clinical Orthopaedics and Related Research

Abstract

In sclerosing epithelioid fibrosarcoma (SEF), a rare variant of low-grade fibrosarcoma, treatment results and therapeutic options are poorly characterized. We systematically analyzed the data of all 89 patients (43 female, 46 male; mean age, 47 years [range, 14–87 years]) reported in the literature concerning clinical presentation, histopathology, differential diagnosis, treatment, survival rates, and prognosis, and we present an additional case. Information detailing treatment, disease control, and followup was available in 60 (67%), 75 (84%), and 68 patients (76%), respectively. Case history was variable with one-third of patients reporting a painful, enlarging mass. Ten patients (13%) presented with metastases, 23 (31%) had metastases develop after diagnosis, and 28 (37%) had local recurrence. Low cellularity, mild pleomorphy, and sclerotic hyaline matrix of SEF suggest a benign clinical behavior, and cell morphology allows for the wide differential diagnosis of benign, pseudosarcomatous, and malignant proliferations. In addition to surgery, 11 patients (15%) had chemotherapy, 22 (29%) had postoperative radiation therapy, and three (4%) had a combination of both. Twenty-three patients (34%) died from their disease after a mean of 46 months, 24 (35%) were alive with disease, and 20 (31%) were alive without evidence of disease. Patients with SEF of the head and neck had the worst prognosis.

Level of Evidence: Level III, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Felix Regenfelder, MD, for advice and assistance in performing statistics.

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Authors and Affiliations

  1. Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstr 340, 8008, Zurich, Switzerland

    Christian Ossendorf MD & Bruno Fuchs MD, PhD

  2. Department of Radiation Oncology, University of Zurich, Zurich, Switzerland

    Gabriela M. Studer MD

  3. Institute of Surgical Pathology, University of Zurich, Zurich, Switzerland

    Beata Bode MD

Authors
  1. Christian Ossendorf MD
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  2. Gabriela M. Studer MD
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  3. Beata Bode MD
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  4. Bruno Fuchs MD, PhD
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Correspondence to Bruno Fuchs MD, PhD.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved or waived approval for the reporting of this case and that all investigations were conducted in conformity with ethical principles of research.

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Ossendorf, C., Studer, G.M., Bode, B. et al. Sclerosing Epithelioid Fibrosarcoma: Case Presentation and a Systematic Review. Clin Orthop Relat Res 466, 1485–1491 (2008). https://doi.org/10.1007/s11999-008-0205-8

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