sarcomas are mesenchymal neoplasms with various lines of differentiation , i.e. , fibrocytic , myogenic , neurogenic , vascular , chondro - osseus , or undefined .
it is a spindle - cell tumor composed of collagen - rich and myxoid parts .
lgfs prefers subfascial soft tissue layers on the trunk and proximal extremities in younger adults but can also develop in internal organs .
pediatric cases have also been reported.[13 ] herein , we present a 48-year - old female patient who developed a lgfs on the lower leg .
the clinical presentation , histopathology , surgical treatment , and follow - up are discussed .
a 48-year - old woman was referred to our department because she had developed a slow - growing plaque below the left knee for 2 years .
on examination we found an otherwise healthy , slim , woman with a symptomless firm subcutaneous plaque of about 2 cm size on the anterior aspect of the left lower leg figure 1.there was some bluish discoloration and circumscribed ulceration but no erythema or warmth .
( a ) overview and ( b ) the ulcerated honeycomb - like plaque routine laboratory tests were unremarkable .
thoracic dual - energy x - ray and abdominal and lymph node ultrasound excluded a metastatic spread .
histology revealed a spindle - cell tumor , with mild atypia and fibroblast - like morphology [ figure 2 ] .
cells were arranged in a whorled or plexifiorm pattern , with alternating collagenous stroma and myxoid zones .
the tumor was surgically removed with a wide safety margin ( > 3 cm ) .
the defect was covered by a mesh graft transplant covered by vacuum - assisted closure ( vac ; kci international ) [ figure 3 ] .
compression stockings were prescribed to protect the transplant and prevent leg edema . a regular follow - up for at least 5 years
( a ) overview ( h&e , 4 ) and ( b ) detail ( h&e , 40 ) surgical procedure . ( a ) wide excision of suprafascial soft tissue ;
( b ) mesh graft transplantation ; and ( c ) placement of microporous white sponge for vacuum - assisted closure above the transplant
lgfs is a very rare and distinctive type of fibrosarcoma that was first described by evans in 1987 .
there is a discrepancy between the bland histologic features with sparse mitotic figures and absent or mild nuclear and cellular pleomorphism and the anaplasia . the hyalinizing spindle - cell tumor with giant rosettes
is considered a subtype of lgfs.[13 ] the tumor is further characterized by t(7;16)(q34;p11 ) translocation and fusion of fus and creb3l1 genes .
tumor cell phenotype is positive for vimentin , ema , cd99 , and bcl-2 , but negative for cd34 , sma , s-100 , desmin , keratins , neuron - specific enolase , and cd177 .
the differential diagnosis includes other types of sarcomas , myxoma , neurofibroma , peripheral sheath tumor , histocytoma , desmoid tumor , and others .
the diagnosis often is delayed - mainly because the patients do not seek treatment early .
( 2000 ) reported that in 15% of patients a histologic diagnosis was delayed by > 5 years . in our case
although the histopathologic features suggest a low - grade malignancy , local recurrence is seen in more than 50% of patients and metastasis occurs in 6% of patients .
tumor cell dormancy is responsible for very late metastasis in some patients , with 45 years being the longest period observed between primary surgery and metastasis .
complete surgery with wide margins ( > 3 cm ) is the most important procedure .
we used a combination of mesh graft transplantation and vacuum - assisted closure to cover the large defect .
it has been demonstrated recently that such a combination , with microporous sponge for vacuum - assisted closure , results in a significantly improved take rate .
 a 48-year - old female with an atypical plaque - like lesion of the lower leg is presented in this article . 
 histologic investigation revealed a rare low - grade fibromyxoid sarcoma ( pt1a cn0 cm0 ; stage ia ) of suprafascial localization . 
 staging of the patient did not reveal metastatic spread . 
 the tumor was surgically removed with wide safety margins . 
 the defect was closed using a mesh graft transplant and vacuum - assisted closure . 
 healing was complete . 
 regular follow - up for at least 5 years is recommended . besides the rareness of this tumor 
 , this case is also remarkable because of the localization on the lower leg and the suprafascial soft tissue . 