A case of primary malignant fibrous histiocytoma of the pancreas: CT and MRI findings

Primary malignant fibrous histiocytoma (MFH) of the pancreas is rare and a distinct clinical entity. We report a case of recurrence of pancreatic MFH with computed tomography (CT) and magnetic resonance imaging (MRI) findings. A 67-year-old man presented with a history of decreased body weight over the past 6 mo. Abdominal CT revealed a large, multilocular cystic mass in the head of the pancreas with obvious atrophy in the body and tail of the pancreas. After 6 mo postoperatively, MRI demonstrated a recurrent large mass in the primary area of the head of the pancreas. The lesion was heterogeneous, hypointense to the liver on T1-weighted imaging, and heterogeneously hyperintense to the liver with a hypointense area in the central part of the tumor on fat-saturated T2-weighted imaging. Contrast- enhanced T1-weighted imaging demonstrated a large multilocular cystic mass with a cystic wall, fibrous septa and enhancement of solid components. To the best of our knowledge, this is the first report on recurrence of primary MFH of the pancreas, and the first with MRI findings.

Primary intestinal malignant fibrous histiocytoma:two case reports

Malignant fibrous histiocytoma (MFH) occurs most commonly in the extremities and trunk, but rarely in the intestine. Here we report two cases of primary intestinal MFH. The first case was a 70-year old man admitted for recurrent right lower quadrant abdominal pain. At laparotomy, a tumor was found originating from the cecum, with a suspicious metastatic nodule on the surface of the right lobe of the liver. A right hemicolectomy was performed followed by an ileotransverse end-to-end anastomotic reconstruction. The second case was a 43-year old man with intussusceptions of the small intestine. An emergent laparotomy revealed 4 pedunculated masses in the small bowel and a partial resection of the small intestine was performed. Though the symptoms were not typical, based on histological and immunohistochemical studies, the patients were diagnosed as MFH of the intestine. They were not treated with chemotherapy or radiotherapy and both died within 3 mo. MFH of the intestine is an extremely rare neoplasm with an aggressive biological behavior. The pathogenesis of this disease has not been clarified to date. Complete surgical excision is preferred, adjuvant chemotherapy or radiotherapy may be advisable.

Malignant fibrous histiocytoma presenting as hemoperitoneum mimicking hepatocellular carcinoma rupture

Malignant fibrous histiocytoma (MFH) is a pleomorphic mesenchynal sarcoma. It is uncommonly arises primarily from the intra-peritoneal cavity. Primary peritoneal MFH with tumor bleeding and rupture is rare. We describe the imaging features of a 70-year-old patient presenting with ruptured hemorrhagic peritoneal MFH at subhepatic area,accompanied by massive hemoperitoneum,mimicking a ruptured pedunculated hepatocellular carcinoma. Computed tomography (CT) revealed a large heterogeneous enhanced subhepatic mass with adjacent liver,gallbladder and colon invasion. Tumor hemorrhage and rupture complicated with peritoneal seeding and massive bloody ascites were also detected. Angiography showed a hypervascular tumor fed by enlarged right hepatic arteries,cystic artery and omental branches of gastroepiploic artery. The patient underwent laparotomy for tumor resection,but the tumor recurred one month after operation. To our knowledge,the CT appearance of ruptured intraperitoneal MFH complicated by hemoperitoneum has not been previously described.

Malignant fibrous histiocytoma of the bone in a traumatic amputation stump: A case report and review of the literature

BACKGROUND Malignant fibrous histiocytoma(MFH)is one of the most common soft tissue sarcomas among adults.It is characterized by large size,high grade,and biological aggressiveness.There are many reports of MFH after local stimulation,such as bone fracture,implants,and chronic osteomyelitis.In this paper,we report a patient who developed MFH 6 years after amputation,suggesting that wound healing and mechanical force play a role in the local stimulation of this disease.CASE SUMMARY A 66-year-old man complained of persistent pain in his residual mid-thigh.He had undergone amputation surgery due to a traffic accident 6 years prior.Physical examination showed tenderness but no abnormalities in appearance.Xray radiographs and magnetic resonance imaging supported the diagnosis of a tumor,and a biopsy confirmed that the lesion was MFH.The patient received neoadjuvant chemotherapy and left hip disarticulation.During the 6-mo followup,there were no symptoms of recurrence.CONCLUSION Postsurgery MFH has been reported before,and many studies have attributed it to the biological effects of implants.Our case report shows that this disease can develop without an implant and thus highlights the importance of local stimulation.The wound-healing process and mechanical force can both promote this tumor,but whether they directly cause MFH needs further investigation.

A case of malignant fibrous histiocytoma of the head after trauma and radiation therapy

Malignant fibrous histiocytoma(MFH) firstly described as"malignant fibrous xanthoma"by O' Brien and Stout in 1964, is the most common soft tissue sarcoma of late adult life.Uncertain histogenesis and numerous subtypes make MFH a rather controversial entity.MFH only rare arises from structures of the head and neck.When it does, it most often originates in facial structures, particularly the maxilla.This report details a case of a patient with malignant fibrous histiocytoma presenting clinically as a right-sided large indurated frontoparietal mass, three months after head trauma and eight years after radiation therapy for brain lymphoma located in the right frontal and parietal lobes.Radical excision was a surgical challenge because of the extensiveness of the lesion.

Transanal excision of a malignant fibrous histiocytoma of anal canal:A case report and literature review

Malignant fibrous histiocytoma, which is composed of spindle-shaped cells arranged in a pleomorphic and storiform pattern, is rarely found in the colorectum. Although complete surgical excision remains the main stem of therapy, an optimal treatment strategy according to the stage has not been elucidated. We report a case of a 63-year-old woman with an ulcerative lesion in the anorectal junction and a final diagnosis of malignant fibrous histiocytoma. We introduced an access for transanal local excision and adjuvant radiotherapy because the patient refused abdominoperineal resection. No local recurrences or distant metastases were observed 15 mo after the operation. To our knowledge, this is the first case reported in the English literature of a malignant fibrous histiocytoma treated with the transana local excision and adjuvant radiotherapy. This report showed that this approach is selectively reserved for early-stage malignant fibrous histiocytoma and for those patients who refuse radical surgery because of the risk in a permanent colostomy.

Malignant fibrous histiocytoma of the axilla with breast cancer:A case report

BACKGROUND Multiple primary malignant neoplasms refer to multiple tumors with different origins.They may be synchronous or metachronous.The incidence is 0.73%–11.7%.Synchronous cases of breast cancer with sarcoma are rare.CASE SUMMARY Here,we report a 78-year-old female patient admitted to hospital after accidental discovery of a left axillary mass.Preoperative examination revealed a breast mass.Pathology showed left breast cancer and left axillary sarcoma.The patient underwent surgery,endocrine therapy and radiotherapy.She has been followed up for 1 year,and no local recurrence or distant metastasis was observed.CONCLUSION Attention should be paid to multiple primary malignant neoplasms,not limited to the current diagnosis and analysis,avoiding missed diagnosis and misdiagnosis.

Primary malignant fibrous histiocytoma of the esophagus: Report of three cases and review of the literatures

We reported three cases of polypoid tumor of the esophagus, among them one case of sarcomatous tumor partly covered with superficial squamous cell carcinoma. The sarcoma was consisted of anaplastic spindle and pleomorphic tumor cells, which was similar to malignant fibrous histiocytoma (MFH) of the soft tissue. Diagnosis of the surgery resected speci-men was confirmed by histological, immunohistochemical and electron microscopic methods. Both diagnostic and differential diagnostic problems of primary MFH of the esophagus and world medical literatures were discussed.

A case of primary malignant fibrous histiocytoma of the pancreas with liver metastasis

Malignant fibrous histiocytoma(MFH) is one of most common types of soft-tissue sarcoma. However, it accounts for less than 1% of all human cancer types. In addition, primary MFH of the pancreas is very rare. Herein, we report of a 37-year-old man who presented with a pancreatic mass and did not show any specific symptoms. Pre-contrast computed tomography(CT) showed a heterogeneous, liquid-filled necrotic mass in the uncinate lobe of the pancreas. Contrast-enhanced CT showed a mild enhancement of solid components and the pancreaticoduodenal artery across the mass. The patient underwent a pancreaticoduodenectomy, ethanol ablation of the liver lesions, and chemotherapy with 4 cycles of ifosfamide and doxorubicin. The tumor recurred in the liver, but not in the pancreas, after 8 months.

Early Recurrence of a Cardiac Malignant Fibrous Histiocytoma

Malignant fibrous histiocytoma (MFH) is a rare tumor of the heart and the patients with these tumors usually have a poor prognosis. We report a case of MFH with an origin from the left superior pulmonary vein, involving the left atrium and protruding through the mitral valve, which needed urgent surgery. Complete resection was performed but local recurrence was detected one month later.

A comparison of malignant fibrous histiocytoma of head, neck and extremities

Objective To compare the epidemiology, local and regional invasion and prognosis of head and neck malignant fibrous histiocytoma (MFH) and extremity MFH Methods Between January 1, 1972 and December 31, 1993, 173 patients with MFH (71 head and neck, 102 extremities and trunk) were referred to the Cancer Hospital for surgical treatment They were 101 men and 72 women, with age ranging from 13 to 83 years (median: 45 years) The extent of surgery was classified into radical, wide and local resection Results For head and neck, local recurrence of MFH after wide resection was 80 4% (37/46), compared with 36.4% (8/22) after radical surgery ( P =0 000) The five year survival was 50 79% in all the head and neck patients (74 75% in patients free of local recurrence, 37 74% in patients with local recurrence; P =0 0181), compared with 70 71% in extremity patients ( P =0 0005) Repeated surgery after recurrence of MFH could cure 40 9% of the head and neck patients and 80 7% of the extremity patients Conclusion Inadequate resection of head and neck MFH in initial surgery is associated with a high incidence of local recurrence, which is always correlated with worse prognosis Repeated surgery for recurrent head and neck MFH is not as effective as for recurrent extremity MFH Therefore, we suggest that the initial surgery for head and neck MFH should be as radical as allowed to avoid a possible local recurrence

Malignant fibrous histiocytoma of right atrium

Afifty-year-old male patient was admitted with dyspnoea and cough. Four days before admission, he wasepisode of dyspnoea, could not prostrate with non- productive cough when he was offered with a gastroscopy examination in a local hospital due to anepithymia. The patient had no history of medication or allergies. However, he had smoked for more than thirty years-sixty cigarettes per day. Chest distress without haemoptysis, pink frothy sputum, apsychia, amaurosis, and fever was developed. The symptoms worsened gradually. On examination at the Department of Emergency, Shenzhen People＇s Hospital, dyspnoea with jugular vein distension and oedema in his head, neck and thoracic region were discovered. The breathing sounds on both lower lungs were low. His heart rate was 100 beats/min without arrhythmia or murmur. His abdomen was soft without rebound tenderness. His liver and spleen were not palpable. Pitting oedema occurred in both low limbs. Furosemide was given, but the symptoms were not relieved.

Clinical features and prognostic factors of primary intracranial malignant fibrous histiocytoma:A report of 8 cases and a literature review

Objective: Primary intracranial malignant fibrous histiocytoma(MFH) is rare. We describe the detailed clinical features of 8 cases and fully review the literature to evaluate several prognostic factors. Methods: Eight patients with pathologically confirmed primary intracranial MFH were retrospectively reviewed. We searched Pub Med for relevant articles with the term "intracranial malignant fibrous histiocytoma". Results: Of the 8 patients, 4 were men and 4 were women. Three patients had received previous radiotherapy. The age of the patients ranged from 19 to 69 years, with a median age of 48 years. Most tumors could be totally resected; and only 1 tumor was subtotally resected. Six patients received postoperative radiotherapy and 3 patients received postoperative chemotherapy. Most patients died within the first year after surgery; and only 1 patient was still alive on the date of the last follow-up. We reviewed the literature and included a total of 46 patients in the Kaplan-Meier survival analysis. Young patients(less than 30 years old) seemed to have a better prognosis and survival rate than older patients(more than 30 years old)(log-rank test, P = 0.008).However, sex(P = 0.675), extent of resection(P = 0.934), postoperative radiotherapy(P = 0.592), and postoperative chemotherapy(P = 0.424) did not affect patient prognosis.Conclusions: The prognosis of MFH is usually poor, and most patients die within the first year after surgery. Younger MFH patients(less than 30 years old) seem to have a better prognosis and improved survival compared to older patients.

Undifferentiated pleomorphic sarcoma of the liver presenting as a unilocular cyst

BACKGROUND:A malignant fibrous histiocytoma,recently referred to as an undifferentiated pleomorphic sarcoma (UPS),is very rare in the liver,and only 34 cases of primary hepatic malignant fibrous histiocytoma have been reported in the English literature. METHODS:We report a rare case of a hepatic UPS presenting as a unilocular cystic lesion with respect to histopathologic features,the newly revised diagnostic criteria,and the differential diagnosis. RESULTS:A 60-year-old man presented for evaluation of epigastric pain of 7 months duration.Abdominal computed tomography revealed a hypodense,unilocular cystic mass in the right lobe of the liver,measuring 14.0×11.1 cm.A right lobectomy was performed.Grossly,the cut surface showed a single,well-circumscribed unilocular cystic tumor mass containing dark red-brown necrotic debris and blood clots, which occupied most of the mass.Microscopically,the tumor consisted of haphazardly arranged mononuclear pleomorphic tumor cells,admixed with abundant osteoclast- like multinucleated giant cells.Immunohistochemically,the tumor cells expressed vimentin only.The histopathologic and immunohistochemical findings were compatible with a UPS.The patient is alive and well 41 months after surgery without recurrence. CONCLUSIONS:Clinically,most of the hepatic UPSs are solid masses.Only two cases have presented as multilocular cystic masses.A primary hepatic UPS presenting as a unilocular cyst has never been reported.A UPS should be included in the differential diagnosis of unilocular cystic lesions in the liver.

Myxofibrosarcoma of the scalp with difficult preoperative diagnosis:A case report and review of the literature

BACKGROUND A myxofibrosarcoma(MFS)is a malignant fibroblastic tumor that tends to occur in the lower and upper extremities.The reported incidence of head and neck MFSs is extremely rare.We report a 46-year-old male with“a neoplasm in the scalp”who was hospitalized and diagnosed with an MFS(highly malignant with massive necrotic lesions)based on histologic and immunohistochemistry evaluations.The magnetic resonance imaging manifestations did not demonstrate the“tail sign”mentioned in several studies,which resulted in a great challenge to establish an imaging diagnosis.The treatment plan is closely associated with the anatomic location and histologic grade,and more importantly,aggressive surgery and adjuvant radiotherapy may be helpful.Hence,we report the case and share some valuable information about the disease.CASE SUMMARY A 46-year-old male with“a neoplasm in the scalp for 6 mo”was hospitalized.Initially,the tumor was about the size of a soybean,without algesia or ulceration.The patient ignored the growth,did not seek treatment,and thus,did not receive treatment.Recently,the tumor increased to the size of an egg;there was no bleeding or algesia.His family history was unremarkable.No abnormalities were found upon laboratory testing,including routine hematologic,biochemistry,and tumor markers.Computed tomography showed an ovoid mass(6.25 cm×3.29 cm×3.09 cm in size)in the left frontal scalp with low density intermingled with equidense strips in adjacent areas of the scalp.Magnetic resonance imaging revealed a lesion with an irregular surface and an approximate size of 3.55 cm×6.34 cm in the left frontal region,with clear boundaries and visible separation.Adjacent areas of the skull were damaged and the dura mater was involved.Contrast enhancement showed an uneven enhancement pattern.Surgery was performed and postoperative adjuvant radiotherapy was administered to avoid recurrence or metastasis.The post-operative pathologic diagnosis confirmed an MFS.A repeat computed tomography scan showed no local recurrence or distant metastasis 19 mo post-operatively.CONCLUSION The case reported herein of MFS was demonstrated in an extremely rare location on the scalp and had atypical magnetic resonance imaging findings,which serves as a reminder to radiologists of the possibility of this diagnosis to assist in clinical treatment.Given the special anatomic location and the high malignant potential of this rare tumor,combined surgical and adjuvant radiotherapy should be considered to avoid local recurrence and distant metastasis.The significance of regular follow-up is strongly recommended to improve the long-term survival rate.

Malignant transformation of aneurysmal bone cysts： a case report

An aneurysmal bone cyst is a non-neoplastic, .destructive and expansile lesion consisting of a＂blood-filled sponge＂ that is defined to represent a benign reactive vascularity. Szendroi et al suggested that the aneurysmal bone cyst corresponds to a haemodynamic disturbance that is primary or secondary venous malformation of the bones. The association with trauma including fracture has also been noted and 25%-71% of such patients have a history of trauma. Conventionally, malignant transformation of aneurysmal bone cysts is perceived as a rare occurrence except those induced by irradiation. Both malignant fibrous histiocytoma and osteosarcoma have been reported in the malignant transformation cases.