• Weijie Liu, Yumei Yan, Xiaohang Wu, Xiukun Hou, and Xiaomeng Qu.
• Department of Ultrasound, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China.
• Medicine (Baltimore). 2023 Dec 15; 102 (50): e36626e36626.

RationaleMyxofibrosarcoma most commonly arises as a slowly enlarging, painless mass. We describe an unusual case of low-grade myxofibrosarcoma in the axillary fossa, which infiltrated the brachial plexus, axillary artery, and axillary vein, causing severe pain. The low incidence and complex anatomical structure make imaging examination and surgery face great challenges. To the best of our knowledge, such presentation of a low-grade myxofibrosarcoma that showed an extreme infiltrative growth pattern and presented severe pain has not been reported before.Patient ConcernsWe reported a case of low-grade myxofibrosarcoma developed around the axillary neurovascular bundle, with multiple peripheral metastases in an 87-year-old male. Physical examination revealed a mass on the right axillary fossa measuring 5 × 4 cm. The patient underwent computed tomography but no definite diagnosis was obtained. Because he had claustrophobia and could not perform MRI examination. Thus, he underwent conventional ultrasound and contrast-enhanced ultrasound. Ultrasonic examination not only accurately determines the invasion scope of the tumor, but also clearly shows that the nerve has suffered from the invasion of the exogenous tumor and multiple metastatic foci around it. The contrast enhancement mode of the tumor showed centripetal high-enhancement, uneven internal enhancement, visible enhanced bridge, and non-enhancing central area.DiagnosesCombined with the results of conventional ultrasound and contrast-enhanced ultrasound, we highly suspected it to be soft tissue sarcoma, giving strong clinical assistance.InterventionsGiven the risk of sarcoma implantation along the needle track and the underestimation of tumor malignancy, an excisional biopsy was considered the most practical choice to avoid unnecessary pain and potential implantation.OutcomesThe patient underwent surgery and a histopathological examination of the lesion confirmed it as low-grade myxofibrosarcoma.Lessons SubsectionsThis report describes a rare case of myxofibrosarcoma of the axillary fossa. High-resolution ultrasound is increasingly used for the initial assessment of soft-tissue masses. However, there are few reports about the ultrasound and contrast-enhanced ultrasound examinations of myxofibrosarcoma. Accurate preoperative diagnosis and proper treatment strategies are critical in managing patients with myxofibrosarcoma. Our case may provide diagnosis experiences and will help better understand and treat this disease.Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

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