Background Myxoinflammatory fibroblastic sarcoma (MFS) is a distinct neoplasm that usually arises in the acral zones of distal extremities. We report, for the first time, the preoperative fine needle aspiration cytology (FNAC) findings of an MFS case that was confirmed after surgical excision. Case An 81-year-old woman presented with a multinodular tumor in the distal right extremity that had been present for 1 year. FNAC of the lesion was performed and followed by local excision. The fine needle aspiration smears contained 2 of the 3 types of neoplastic cells that have been observed in MFS: spindled and ganglionlike cells. The background was myxoid, with a prominent inflammatory infliltrate. Histopathologic examination of the surgical specimen confirmed the diagnosis of MFS. Conclusion Although the cytologic diagnosis was "pleomorphic sarcoma, " MFS was considered and local excision recommended, given the reported low grade nature of this entity. However, the need for extreme caution in the diagnosis of soft tissue lesions On cytologic grounds alone cannot be overemphasized.