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Current Medical Imaging

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ISSN (Print): 1573-4056
ISSN (Online): 1875-6603

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Review Article

Myxofibrosarcoma: Clinical and Prognostic Value of MRI Features

Author(s): Paolo Spinnato*, Andrea Sambri, Tomohiro Fujiwara, Luca Ceccarelli, Roberta Clinca, Manuel R. Medellin, Massimiliano De Paolis, Davide M. Donati and Giuseppe Bianchi

Volume 17, Issue 2, 2021

Published on: 29 July, 2020

Page: [217 - 224] Pages: 8

DOI: 10.2174/1573405616999200729152135

Price: $65

Abstract

Myxofibrosarcoma is one of the most common soft tissue sarcomas in the elderly. It is characterized by an extremely high rate of local recurrence, higher than other soft tissue tumors, and a relatively low risk of distant metastases.Magnetic resonance imaging (MRI) is the imaging modality of choice for the assessment of myxofibrosarcoma, which plays a key role in the preoperative setting of these patients. MRI features associated with the high risk of local recurrence are: high myxoid matrix content (water-like appearance of the lesions), high grade of contrast enhancement and presence of an infiltrative pattern (“tail sign”). On the other hand, MRI features associated with worse sarcoma specific survival are: large size of the lesion, deep location, high grade of contrast enhancement. Recognizing the above-mentioned imaging features of myxofibrosarcoma may be helpful in stratifying the risk for local recurrence and disease-specific survival. Moreover, the surgical planning should be adjusted according to the MRI features.

Keywords: Magnetic resonance imaging, sarcoma, soft tissue neoplasm, neoplasm invasivenes, prognosis, local neoplasm recurrence.

Graphical Abstract

[1]
Manoso MW, Pratt J, Healey JH, Boland PJ, Athanasian EA. Infiltrative MRI pattern and incomplete initial surgery compromise local control of myxofibrosarcoma. Clin Orthop Relat Res 2006; 450(450): 89-94.
[http://dx.doi.org/10.1097/01.blo.0000229292.98850.14] [PMID: 16801862]
[2]
Teurneau H, Engellau J, Ghanei I, Vult von Steyern F, Styring E. High recurrence rate of myxofibrosarcoma: The effect of radiotherapy is not clear. Sarcoma 2019; 2019: 8517371.
[http://dx.doi.org/10.1155/2019/8517371] [PMID: 31662702]
[3]
Angervall L, Kindblom LG, Merck C. Myxofibrosarcoma. A study of 30 cases. Acta Pathol Microbiol Scand [A] 1977; 85A(2): 127-40.
[http://dx.doi.org/10.1111/j.1699-0463.1977.tb00410.x] [PMID: 15396]
[4]
Weiss SW, Enzinger FM. Myxoid variant of malignant fibrous histiocytoma. Cancer 1977; 39(4): 1672-85.
[http://dx.doi.org/10.1002/1097-0142(197704)39:4<1672::AID-CNCR2820390442>3.0.CO;2-C] [PMID: 192434]
[5]
Kindblom LG, Merck C, Angervall L. The ultrastructure of myxofibrosarcoma. A study of 11 cases. Virchows Arch A Pathol Anat Histol 1979; 381(2): 121-39.
[http://dx.doi.org/10.1007/BF01257879] [PMID: 154761]
[6]
Kindblom LG, Merck C, Svendsen P. Myxofibrosarcoma: a pathologico-anatomical, microangiographic and angiographic correlative study of eight cases. Br J Radiol 1977; 50(600): 876-87.
[http://dx.doi.org/10.1259/0007-1285-50-600-876] [PMID: 588917]
[7]
Lewis JJ, Leung D, Espat J, Woodruff JM, Brennan MF. Effect of reresection in extremity soft tissue sarcoma. Ann Surg 2000; 231(5): 655-63.
[http://dx.doi.org/10.1097/00000658-200005000-00005] [PMID: 10767786]
[8]
Mentzel T, Brown LF, Dvorak HF, et al. The association between tumour progression and vascularity in myxofibrosarcoma and myxoid/round cell liposarcoma. Virchows Arch 2001; 438(1): 13-22.
[http://dx.doi.org/10.1007/s004280000327] [PMID: 11213831]
[9]
Mentzel T, Calonje E, Wadden C, et al. Myxofibrosarcoma. Clinicopathologic analysis of 75 cases with emphasis on the low-grade variant. Am J Surg Pathol 1996; 20(4): 391-405.
[http://dx.doi.org/10.1097/00000478-199604000-00001] [PMID: 8604805]
[10]
Merck C, Angervall L, Kindblom LG, Odén A. Myxofibrosarcoma. A malignant soft tissue tumor of fibroblastic-histiocytic origin. A clinicopathologic and prognostic study of 110 cases using multivariate analysis. Acta Pathol Microbiol Immunol Scand Suppl 1983; 282( Suppl.): 1-40.
[PMID: 6444190]
[11]
Merck C, Hagmar B. Myxofibrosarcoma: a correlative cytologic and histologic study of 13 cases examined by fine needle aspiration cytology. Acta Cytol 1980; 24(2): 137-44.
[PMID: 6154396]
[12]
Noria S, Davis A, Kandel R, et al. Residual disease following unplanned excision of soft-tissue sarcoma of an extremity. J Bone Joint Surg Am 1996; 78(5): 650-5.
[http://dx.doi.org/10.2106/00004623-199605000-00003] [PMID: 8642020]
[13]
Oda Y, Takahira T, Kawaguchi K, et al. Altered expression of cell cycle regulators in myxofibrosarcoma, with special emphasis on their prognostic implications. Hum Pathol 2003; 34(10): 1035-42.
[http://dx.doi.org/10.1053/S0046-8177(03)00404-0] [PMID: 14608538]
[14]
Ford HL, Sclafani RA, Degregori J. Cell cycle regulatory cascades.Cell cycle and growth control: biomolecular regulation and cancer. 2nd ed. Hoboken, NJ: Wiley-Liss 2004; pp. 42-67.
[http://dx.doi.org/10.1002/0471656437.ch3]
[15]
Fletcher CD. The evolving classification of soft tissue tumours: an update based on the new WHO classification. Histopathology 2006; 48(1): 3-12.
[http://dx.doi.org/10.1111/j.1365-2559.2005.02284.x] [PMID: 16359532]
[16]
Yoo HJ, Hong SH, Kang Y, et al. MR imaging of myxofibrosarcoma and undifferentiated sarcoma with emphasis on tail sign; diagnostic and prognostic value. Eur Radiol 2014; 24(8): 1749-57.
[http://dx.doi.org/10.1007/s00330-014-3181-2] [PMID: 24889995]
[17]
Sambri A, Spinnato P, Bazzocchi A, Tuzzato GM, Donati D, Bianchi G. Does pre-operative MRI predict the risk of local recurrence in primary myxofibrosarcoma of the extremities? Asia Pac J Clin Oncol 2019; 15(5): e181-6.
[http://dx.doi.org/10.1111/ajco.13161] [PMID: 31111597]
[18]
Willems SM, Debiec-Rychter M, Szuhai K, Hogendoorn PC, Sciot R. Local recurrence of myxofibrosarcoma is associated with increase in tumour grade and cytogenetic aberrations, suggesting a multistep tumour progression model. Mod Pathol 2006; 19(3): 407-16.
[http://dx.doi.org/10.1038/modpathol.3800550] [PMID: 16415793]
[19]
Roland CL, Wang WL, Lazar AJ, Torres KE. Myxofibrosarcoma. Surg Oncol Clin N Am 2016; 25(4): 775-88.
[http://dx.doi.org/10.1016/j.soc.2016.05.008] [PMID: 27591498]
[20]
Kaya M, Wada T, Nagoya S, et al. MRI and histological evaluation of the infiltrative growth pattern of myxofibrosarcoma. Skeletal Radiol 2008; 37(12): 1085-90.
[http://dx.doi.org/10.1007/s00256-008-0542-4] [PMID: 18629459]
[21]
Fujiwara T, Stevenson J, Parry M, Tsuda Y, Tsoi K, Jeys L. What is an adequate margin for infiltrative soft-tissue sarcomas? Eur J Surg Oncol 2020; 46(2): 277-81.
[PMID: 31627932]
[22]
Lefkowitz RA, Landa J, Hwang S, et al. Myxofibrosarcoma: prevalence and diagnostic value of the “tail sign” on magnetic resonance imaging. Skeletal Radiol 2013; 42(6): 809-18.
[http://dx.doi.org/10.1007/s00256-012-1563-6] [PMID: 23318907]
[23]
Jo VY, Fletcher CD. WHO classification of soft tissue tumours: an update based on the 2013 (4th) edition. Pathology 2014; 46(2): 95-104.
[http://dx.doi.org/10.1097/PAT.0000000000000050] [PMID: 24378391]
[24]
Sambri A, Bianchi G, Righi A, Ferrari C, Donati D. Surgical margins do not affect prognosis in high grade myxofibrosarcoma. Eur J Surg Oncol 2016; 42(7): 1042-8.
[http://dx.doi.org/10.1016/j.ejso.2016.05.015] [PMID: 27260849]
[25]
Sanfilippo R, Miceli R, Grosso F, et al. Myxofibrosarcoma: prognostic factors and survival in a series of patients treated at a single institution. Ann Surg Oncol 2011; 18(3): 720-5.
[http://dx.doi.org/10.1245/s10434-010-1341-4] [PMID: 20878245]
[26]
Look Hong NJ, Hornicek FJ, Raskin KA, et al. Prognostic factors and outcomes of patients with myxofibrosarcoma. Ann Surg Oncol 2013; 20(1): 80-6.
[http://dx.doi.org/10.1245/s10434-012-2572-3] [PMID: 22890594]
[27]
Mühlhofer HML, Lenze U, Gersing A, et al. Prognostic factors and outcomes for patients with Myxofibrosarcoma: A 13-Year retrospective evaluation. Anticancer Res 2019; 39(6): 2985-92.
[http://dx.doi.org/10.21873/anticanres.13430] [PMID: 31177139]
[28]
Haglund KE, Raut CP, Nascimento AF, Wang Q, George S, Baldini EH. Recurrence patterns and survival for patients with intermediate- and high-grade myxofibrosarcoma. Int J Radiat Oncol Biol Phys 2012; 82(1): 361-7.
[http://dx.doi.org/10.1016/j.ijrobp.2010.08.042] [PMID: 20951504]
[29]
Wittekind C, Compton CC, Greene FL, Sobin LH. TNM residual tumor classification revisited. Cancer 2002; 94(9): 2511-6.
[http://dx.doi.org/10.1002/cncr.10492] [PMID: 12015777]
[30]
Gundle KR, Kafchinski L, Gupta S, et al. Analysis of margin classification systems for assessing the risk of local recurrence after soft tissue sarcoma resection. J Clin Oncol 2018; 36(7): 704-9.
[http://dx.doi.org/10.1200/JCO.2017.74.6941] [PMID: 29346043]
[31]
Colia V, Fiore M, Provenzano S, et al. Activity of anthracycline- and ifosfamide-based chemotherapy in a series of patients affected by advanced myxofibrosarcoma. Clin Sarcoma Res 2017; 7: 16.
[http://dx.doi.org/10.1186/s13569-017-0082-6] [PMID: 28852467]
[32]
Mutter RW, Singer S, Zhang Z, Brennan MF, Alektiar KM. The enigma of myxofibrosarcoma of the extremity. Cancer 2012; 118(2): 518-27.
[http://dx.doi.org/10.1002/cncr.26296] [PMID: 21717447]
[33]
Imanishi J, Slavin J, Pianta M, et al. Tail of superficial Myxofibrosarcoma and undifferentiated pleomorphic sarcoma after preoperative radiotherapy. Anticancer Res 2016; 36(5): 2339-44.
[PMID: 27127141]
[34]
Kransdorf MJ, Murphey MD. Radiologic evaluation of soft-tissue masses: a current perspective. AJR Am J Roentgenol 2000; 175(3): 575-87.
[http://dx.doi.org/10.2214/ajr.175.3.1750575] [PMID: 10954433]
[35]
Zoga AC, Weissman BN, Kransdorf MJ, et al. Soft tissue masses. https://acsearch.acr.org/docs/69435/Narrative/ [February 7, 2016.]; 2012 Published 2012.
[36]
Kransdorf MJ, Murphey MD. Imaging of soft-tissue musculoskeletal masses: Fundamental concepts. Radiographics 2016; 36(6): 1931-48.
[http://dx.doi.org/10.1148/rg.2016160084] [PMID: 27726739]
[37]
Gartner L, Pearce CJ, Saifuddin A. The role of the plain radiograph in the characterisation of soft tissue tumours. Skeletal Radiol 2009; 38(6): 549-58.
[http://dx.doi.org/10.1007/s00256-008-0513-9] [PMID: 18566812]
[38]
Lakkaraju A, Sinha R, Garikipati R, Edward S, Robinson P. Ultrasound for initial evaluation and triage of clinically suspicious soft-tissue masses. Clin Radiol 2009; 64(6): 615-21.
[http://dx.doi.org/10.1016/j.crad.2009.01.012] [PMID: 19414084]
[39]
Ritchie DA. Commentary on ultrasound for initial evaluation and triage of clinically suspicious soft-tissue masses. Clin Radiol 2009; 64(6): 622-3.
[http://dx.doi.org/10.1016/j.crad.2009.02.008] [PMID: 19414085]
[40]
Carra BJ, Bui-Mansfield LT, O’Brien SD, Chen DC. Sonography of musculoskeletal soft-tissue masses: techniques, pearls, and pitfalls. AJR Am J Roentgenol 2014; 202(6): 1281-90.
[http://dx.doi.org/10.2214/AJR.13.11564] [PMID: 24848826]
[41]
Subhawong TK, Fishman EK, Swart JE, Carrino JA, Attar S, Fayad LM. Soft-tissue masses and masslike conditions: what does CT add to diagnosis and management? AJR Am J Roentgenol 2010; 194(6): 1559-67.
[http://dx.doi.org/10.2214/AJR.09.3736] [PMID: 20489097]
[42]
Mavrogenis AF, Rimondi E, Rossi G, Calabrò T, Ruggieri P. CT-guided biopsy for musculoskeletal lesions. Orthopedics 2013; 36(6): 416-8.
[http://dx.doi.org/10.3928/01477447-20130523-02] [PMID: 23746005]
[43]
Spinnato P, Bazzocchi A, Facchini G, et al. Vertebral fractures of unknown origin: Role of computed tomography-guided biopsy. Int J Spine Surg 2018 21 Dec; 12(6): 673-9. eCollection 2018 Dec.
[http://dx.doi.org/10.14444/5084.]
[44]
Heyer CM, Al-Hadari A, Mueller KM, Stachon A, Nicolas V. Effectiveness of CT-guided percutaneous biopsies of the spine: an analysis of 202 examinations. Acad Radiol 2008; 15(7): 901-11.
[http://dx.doi.org/10.1016/j.acra.2008.01.020] [PMID: 18572127]
[45]
Lim HJ, Johnny Ong CA, Tan JW, Ching Teo MC. Utility of positron emission tomography/computed tomography (PET/CT) imaging in the evaluation of sarcomas: A systematic review. Crit Rev Oncol Hematol 2019; 143: 1-13.
[http://dx.doi.org/10.1016/j.critrevonc.2019.07.002] [PMID: 31449981]
[46]
Sambri A, Bianchi G, Longhi A, et al. The role of 18F-FDG PET/CT in soft tissue sarcoma. Nucl Med Commun 2019; 40(6): 626-31.
[http://dx.doi.org/10.1097/MNM.0000000000001002] [PMID: 30908341]
[47]
Ito K, Masuda-Miyata Y, Wada S, et al. F-18 FDG PET/CT imaging of bulky myxofibrosarcoma in chest wall. Clin Nucl Med 2011; 36(3): 212-3.
[http://dx.doi.org/10.1097/RLU.0b013e318208f2e0] [PMID: 21285680]
[48]
Erdoğan EB, Asa S, Aksoy SY, Ozhan M, Halac M. Appearance of recurrent cardiac myxofibrosarcoma on FDG PET/CT. Clin Nucl Med 2014; 39(6): 559-60.
[http://dx.doi.org/10.1097/RLU.0000000000000420] [PMID: 24662649]
[49]
Odei B, Rwigema JC, Eilber FR, et al. Predictors of local recurrence in patients with Myxofibrosarcoma. Am J Clin Oncol 2018; 41(9): 827-31.
[http://dx.doi.org/10.1097/COC.0000000000000382] [PMID: 28640064]
[50]
Nishimura H, Zhang Y, Ohkuma K, Uchida M, Hayabuchi N, Sun S. MR imaging of soft-tissue masses of the extraperitoneal spaces. Radiographics 2001; 21(5): 1141-54.
[http://dx.doi.org/10.1148/radiographics.21.5.g01se141141] [PMID: 11553822]
[51]
Fanburg-Smith JC, Spiro IJ, Katapuram SV, Mankin HJ, Rosenberg AE. Infiltrative subcutaneous malignant fibrous histiocytoma: a comparative study with deep malignant fibrous histiocytoma and an observation of biologic behavior. Ann Diagn Pathol 1999; 3(1): 1-10.
[http://dx.doi.org/10.1016/S1092-9134(99)80003-3] [PMID: 9990107]
[52]
Iwata S, Yonemoto T, Araki A, et al. Impact of infiltrative growth on the outcome of patients with undifferentiated pleomorphic sarcoma and myxofibrosarcoma. J Surg Oncol 2014; 110(6): 707-11.
[http://dx.doi.org/10.1002/jso.23708] [PMID: 24975462]
[53]
Fernebro J, Wiklund M, Jonsson K, et al. Focus on the tumour periphery in MRI evaluation of soft tissue sarcoma: infiltrative growth signifies poor prognosis. Sarcoma 2006; 2006: 21251.
[http://dx.doi.org/10.1155/SRCM/2006/21251] [PMID: 17496992]
[54]
Erlemann R, Reiser MF, Peters PE, et al. Musculoskeletal neoplasms: static and dynamic Gd-DTPA--enhanced MR imaging. Radiology 1989; 171(3): 767-73.
[http://dx.doi.org/10.1148/radiology.171.3.2717749] [PMID: 2717749]
[55]
Nakamura T, Matsumine A, Matsubara T, et al. Infiltrative tumor growth patterns on magnetic resonance imaging associated with systemic inflammation and oncological outcome in patients with high-grade soft-tissue sarcoma. PLoS One 2017; 12(7): e0181787.
[http://dx.doi.org/10.1371/journal.pone.0181787] [PMID: 28727824]
[56]
Coussens LM, Werb Z. Inflammation and cancer. Nature 2002; 420(6917): 860-7.
[http://dx.doi.org/10.1038/nature01322] [PMID: 12490959]
[57]
Fletcher C, Bridge J, Hogendoorn P, Mertens F. WHO Classification of Tumours of Soft Tissue and Bone 4. Lyon, France: IARC 2013.
[58]
Lee AY, Agaram NP, Qin LX, et al. Optimal percent myxoid component to predict outcome in high-grade Myxofibrosarcoma and Undifferentiated pleomorphic sarcoma. Ann Surg Oncol 2016; 23(3): 818-25.
[http://dx.doi.org/10.1245/s10434-015-5063-5] [PMID: 26759307]
[59]
Huang HY, Lal P, Qin J, Brennan MF, Antonescu CR. Low-grade myxofibrosarcoma: a clinicopathologic analysis of 49 cases treated at a single institution with simultaneous assessment of the efficacy of 3-tier and 4-tier grading systems. Hum Pathol 2004; 35(5): 612-21.
[http://dx.doi.org/10.1016/j.humpath.2004.01.016] [PMID: 15138937]
[60]
Baheti AD, Tirumani SH, Rosenthal MH, et al. Myxoid soft-tissue neoplasms: comprehensive update of the taxonomy and MRI features. AJR Am J Roentgenol 2015; 204(2): 374-85.
[http://dx.doi.org/10.2214/AJR.14.12888] [PMID: 25615761]
[61]
Peterson KK, Renfrew DL, Feddersen RM, Buckwalter JA, el-Khoury GY. Magnetic resonance imaging of myxoid containing tumors. Skeletal Radiol 1991; 20(4): 245-50.
[http://dx.doi.org/10.1007/BF02341657] [PMID: 1853214]
[62]
Löwenthal D, Zeile M, Niederhagen M, et al. Differentiation of myxoid liposarcoma by magnetic resonance imaging: a histopathologic correlation. Acta Radiol 2014; 55(8): 952-60.
[http://dx.doi.org/10.1177/0284185113508114] [PMID: 24123962]
[63]
Chou SS, Hippe DS, Lee AY, et al. Gadolinium contrast enhancement improves confidence in diagnosing recurrent soft tissue sarcoma by MRI. Acad Radiol 2017; 24(5): 615-22.
[http://dx.doi.org/10.1016/j.acra.2016.12.010] [PMID: 28117119]
[64]
Cheney MD, Giraud C, Goldberg SI, et al. MRI surveillance following treatment of extremity soft tissue sarcoma. J Surg Oncol 2014; 109(6): 593-6.
[http://dx.doi.org/10.1002/jso.23541] [PMID: 24374823]
[65]
Spinnato P, Bazzocchi A, Brioli A, et al. Contrast enhanced MRI and ¹-F-FDG PET-CT in the assessment of multiple myeloma: a comparison of results in different phases of the disease. Eur J Radiol 2012; 81(12): 4013-8.
[http://dx.doi.org/10.1016/j.ejrad.2012.06.028] [PMID: 22921683]
[66]
Watts AC, Teoh K, Evans T, Beggs I, Robb J, Porter D. MRI surveillance after resection for primary musculoskeletal sarcoma. J Bone Joint Surg Br 2008; 90(4): 484-7.
[http://dx.doi.org/10.1302/0301-620X.90B4.20089] [PMID: 18378924]
[67]
Crombé A, Marcellin PJ, Buy X, et al. Soft-Tissue Sarcomas: Assessment of MRI reatures correlating with histologic grade and patient outcome. Radiology 2019; 291(3): 710-21.
[http://dx.doi.org/10.1148/radiol.2019181659] [PMID: 30964422]
[68]
Dewan V, Darbyshire A, Sumathi V, Jeys L, Grimer R. Prognostic and survival factors in myxofibrosarcomas. Sarcoma 2012; 2012: 830879.
[http://dx.doi.org/10.1155/2012/830879] [PMID: 22736953]
[69]
Gronchi A, Casali PG, Mariani L, et al. Status of surgical margins and prognosis in adult soft tissue sarcomas of the extremities: a series of patients treated at a single institution. J Clin Oncol 2005; 23(1): 96-104.
[http://dx.doi.org/10.1200/JCO.2005.04.160] [PMID: 15625364]
[70]
Willeumier J, Fiocco M, Nout R, et al. High-grade soft tissue sarcomas of the extremities: surgical margins influence only local recurrence not overall survival. Int Orthop 2015; 39(5): 935-41.
[http://dx.doi.org/10.1007/s00264-015-2694-x] [PMID: 25743028]
[71]
Lee SY, Jee WH, Jung JY, et al. Differentiation of malignant from benign soft tissue tumours: use of additive qualitative and quantitative diffusion-weighted MR imaging to standard MR imaging at 3.0 T. Eur Radiol 2016; 26(3): 743-54.
[http://dx.doi.org/10.1007/s00330-015-3878-x] [PMID: 26080796]
[72]
Nagata S, Nishimura H, Uchida M, et al. Diffusion-weighted imaging of soft tissue tumors: usefulness of the apparent diffusion coefficient for differential diagnosis. Radiat Med 2008; 26(5): 287-95.
[http://dx.doi.org/10.1007/s11604-008-0229-8] [PMID: 18661213]
[73]
Jeon JY, Chung HW, Lee MH, Lee SH, Shin MJ. Usefulness of diffusion-weighted MR imaging for differentiating between benign and malignant superficial soft tissue tumours and tumour-like lesions. Br J Radiol 2016; 89(1060): 20150929.
[http://dx.doi.org/10.1259/bjr.20150929] [PMID: 26892266]
[74]
Bruno F, Arrigoni F, Mariani S, et al. Advanced magnetic resonance imaging (MRI) of soft tissue tumors: techniques and applications. Radiol Med (Torino) 2019; 124(4): 243-52.
[http://dx.doi.org/10.1007/s11547-019-01035-7] [PMID: 30949892]
[75]
Hong JH, Jee WH, Jung CK, Jung JY, Shin SH, Chung YG. Soft tissue sarcoma: adding diffusion-weighted imaging improves MR imaging evaluation of tumor margin infiltration. Eur Radiol 2019; 29(5): 2589-97.
[http://dx.doi.org/10.1007/s00330-018-5817-0] [PMID: 30413958]
[76]
Sambri A, Tuzzato G, Spinnato P, De Paolis M, Donati DM, Bianchi G. Grading in Myxofibrosarcoma of the extremities can predict survival and local control. Oncol Res Treat 2020; 43(5): 189-95.
[http://dx.doi.org/10.1159/000506844] [PMID: 32268331]

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