Ischemic fasciitis conversion to myxofibrosarcoma: A case report

INTRODUCTION: Ischemic fasciitis is a rare pseudosarcomatous fibroblastic lesion. It is considered benign and generally occurs in the elderly. Long-term follow-up is rare therefore; the natural history is largely unknown. It is excised without specific attention to margins. CASE PRESENTATION: We present a case of a 94-year-old female with ischemic fasciitis on the shoulder for which we have three years of follow-up. During this time, multiple re- excisions for recurrence were required. This lesion eventually progressed to myxofibrosarcoma. CLINICAL DISCUSSION: We suggest ischemic fasciitis may be a precursor to malignancy. Ischemic fasciitis itself is noted to have features similar to sarcoma on histopathology. Simple excision of ischemic fasciitis without margins may be inadequate therapy. CONCLUSION: Ischemic fasciitis or pseudosarcomatous fibroblastic lesion and myxofibrosarcoma have many histological similarities. A pseudosarcomatous fibroblastic lesion may be a precursor to myxofibrosarcoma and we recommend complete excision with negative margins at the initial treatment to prevent a recurrence.