Inflammatory myxohyaline tumor of distal extremities: cytologic findings in a lesion simulating a high-grade myxoid sarcoma.

Fine-needle aspiration cytology has been shown to be useful in the diagnosis of lesions of the distal extremities with an accuracy of ∼70% for the specific diagnosis of tumors of the hand. Despite this accuracy, some cases may be misinterpreted as to the type of lesion present. A 34-year-old male presented with a 1.5 cm mass in the soft tissue of his right middle finger. Fine-needle aspiration (FNA) was performed and produced cellular smears with a myxoid background. The majority of cells were of a short "spindle" or polygonal shape but a number of large pleomorphic cells were also present. A diagnosis of pleomorphic myxoid sarcoma was given. Subsequent incisional biopsy revealed an inflammatory myxohyaline tumor of the distal extremities (IMTDE). FNA, core needle biopsy, and even small incisional biopsies may result in misdiagnosis of IMTDE as pleomorphic sarcoma, an inflammatory condition or even Hodgkin's disease. Careful attention to the myxoid background, prominence of inflammatory cells, nature of the pleomorphic cells, and location of the lesion should favor the diagnosis of IMTDE.