Simultaneous occurrence of malignant fibrous histiocytoma and hepatocellular carcinoma in cirrhotic liver: A case report

Primary hepatic malignant fibrous histiocytoma (MFH) is rarely encountered. There have been no reports to date of hepatic MFH associated with liver cirrhosis. The presence of liver cirrhosis is considered an adjunctive feature favoring sarcomatoid hepatocellular carcinoma (HCC) in the diagnosis of spindle cell tumors in liver. We describe here a 59-year-old man with liver cirrhosis due to hepatitis B virus infection 20 years ago. On abdominal computed tomography scanning, two distinct hepatic masses were identified in the background of cirrhosis, which had different radiological features from conventional HCC. He underwent segmentectomy for removal of the tumors. The pathological examination of surgically resected specimen revealed the large malignant spindle cell tumor and small conventional HCC. Additional tissue sampling and immunohistochemical stainings demonstrated that the spindle cell tumor was consistent with MFH. On the post-operative follow-up for 21 mo, a round mass showing similar radiological findings for the previous MFH was appeared on the surface of resection margin, suggesting the recurrence. Despite its rarity, hepatic MFH should be considered during differential diagnosis, even in cirrhotic patients, and extensive tissue sampling and immunohistochemical analyses are necessary in the diagnosis of hepatic spindle cell tumors.

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.

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.

Pancreaticoduodenectomy for Pancreatic Metastases of Malignant Fibrous Histiocytoma

Unlike primary pancreatic carcinoma, metastases to the pancreas are rare and their resection may be performed as a palliative treatment due to poorly defined outcome. We herein present an extremely rare case of pancreatic metastases of malignant fibrous histiocytoma (MFH) undergoing pancreaticoduodenectomy with tumor-free survival within postoperative 35-month follow-up. Pancreatic resection for metastatic MFH to the pancreas should be considered in selected patients. Long-term survival or good palliation may be achieved.

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.

腹的洞的主要恶意的含纤维的 histiocytoma : CT 调查结果和病理学的关联

AIM:To study computed tomography(CT)features of abdominal malignant fibrous histiocytoma(MFH)in various rare locations.METHODS:We retroprospectively identified cases of MFH involving the abdominal cavity.Particular attention was paid to details regarding imaging features and histological types.RESULTS:The study population consisted of seven men and one woman,with a mean age of 52.5 years.Seven patients had some physical symptoms,while one was incidentally detected.The sites of origin were liver(n=3),greater omentum(n=1),superior mesentery(n=1),ileum(n=1),right psoas muscle(n=1)and right kidney(n=1).With the exception of the ileum lesion,all were of huge size.The contour of the lesions was more or less clear.Foci of necrosis were present in six lesions(n=6).On plain CT scan,all lesions were hypo to iso dense.The lesion in the greater omentum was cystic.One lesion(n=1)showed significant enhancement and the cystic lesion showed mild peripheral enhancement.An abundance of blood vessels surrounding the mass was seen in two lesions(n=2)and both were of the inflammatory variety.Pathological examination revealed storiform-pleomorphic variety(n=4),inflammatory variety(n=3)and myxoid variety(n=1).Two of the patients with inflammatory MFH had a clinical presentation of fever and one was afebrile,however,blood investigations in all three showed leukocytosis.CONCLUSION:Primary MFHs of the abdominal viscera and gastrointestinal tract are generally huge soft tissue masses containing areas of low attenuation and mild to moderate contrast enhancement.

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.

头颈部恶性纤维组织细胞瘤临床和预后分析

目的 探讨头颈部恶性纤维组织细胞瘤 (MFH )的临床病理特点、治疗方法 ,分析影响预后的相关因素。方法 回顾性分析 40例头颈部恶性纤维组织细胞瘤的临床资料 ,用Kaplan Meier法进行生存分析 ,对可能影响预后的 12项因素进行单因素和多因素分析 ,组间比较用Log rank检验 ,多因素分析采用Cox模型 ,不同因素间相关关系分析用 χ2 检验。结果 头颈部MFH 5年累积生存率为 42 .0 % ;局部复发率约 3 7.1% ;影响预后的因素主要为 :肿瘤发生部位、治疗方式、颈淋巴结转移、病理分级、肿瘤局部复发 (P <0 .0 1) ;病理分级与肿瘤发生部位相关 ;以手术为主的综合治疗者较单纯手术、放疗和化疗者预后佳 (P <0 .0 5 )。结论 头颈部MFH患者预后差、复发率高 ,颈淋巴结转移、病理分化差、局部复发患者预后差 。

放疗导致上颌窦恶性纤维组织细胞瘤1例

1临床资料 患者,女,65岁。1991年于外院行右鼻侧切开术,术后病理报告为霍奇金淋巴瘤,术后放疗1.5个月（剂量未知）。于2001年因左眼眶肿痛,于外院行左眶上部切开肿瘤切除术，术后病理为霍奇金淋巴瘤，术后放疗1个月。于2005年9月复查发现“右上颌窦占位”于外院行右鼻侧切开术，术后病理为恶性纤维组织细胞瘤，术后放疗15次（剂量未知）。此后接受中药治疗。2006年2月起患者出现右面颊部肿痛伴鼻内臭味。查体：鼻外形塌陷，鼻尖、鼻背向右侧偏斜。右侧鼻颊沟、右鼻翼至唇间沟见切口瘢痕。右下眼睑有一个弧形瘢痕，右眶下部塌陷。左眶上缘有切口瘢痕。

超声在原发性肝恶性纤维组织细胞瘤诊断中的价值

目的：对超声在原发性肝恶性纤维组织细胞瘤诊断中的价值进行评价,为今后的临床诊断工作提供参考依据。方法抽取在2013年1月-2015年4月间我院收治临床手术后病理确诊原发性肝恶性纤维组织细胞瘤患者11例,对其术前超声检查结果进行回顾性分析。结果本组11例患者均表现为单发病灶,病灶位于肝左叶者6例,位于肝右叶者5例;病灶直径〉10 cm者2例,直径在5--10 cm者6例,直径〈5 cm者3例;病灶回声呈现不均匀低回声者6例,不均匀强回声者3例,囊实性混合性回声者2例。结论：经超声检查对原发性肝恶性纤维组织细胞瘤进行诊断的临床价值较高,超声表现呈现出多样性,在今后的临床诊断中应对其给予足够的重视。

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.

Spontaneous pancreatic undifferentiated pleomorphic sarcoma in a laboratory rat: A case report

We present a case of spontaneous undifferentiated/unclassified sarcoma,of a pleomorphic subtype formerly known as malignant fibrous histiocytoma(UPS/MFH),arising from the pancreas of a laboratory rat.The mass was excised after laparotomy from a 6‐month‐old female laboratory Wistar rat.It presented a giant multilobulated mass of irregular shape,which had arisen from the pancreas and occupied almost the entire peritoneal cavity.Histologically the tumor was characterized by a highly variable morphological pattern,with frequent transitions from storiform to pleomorphic areas.An extensive immunohistochemical examination revealed no specific lines of differentiation.Immunohistochemical positivity was observed only to MIB‐1(high Ki‐67 proliferation index),vimentin and CD68 antibodies.The diagnosis was compatible with UPS/MFH.To the best of our knowledge,the present case is the first report of a spontaneous primary UPS/MFH arising from the pancreas of a laboratory rat.

P^(53)蛋白和PCNA在恶性纤维组织细胞瘤中的表达与预后的关系

为探讨恶性纤维组织细胞瘤（Ｍａｌｉｇｎａｎｔｆｉｂｒｏｕｓｈｉｓｔｉｏｃｙｔｏｍａ，ＭＦＨ）中Ｐ５３蛋白和增殖细胞核抗原（Ｐｒｏｌｉｆｅｒａｔｉｎｇｃｅｌｎｕｃｌｅａｒａｎｔｉｇｅｎ，ＰＣＮＡ）的表达强度与预后的关系，应用免疫组化ＬＳＡＢ法及彩色图像分析系统定量检测了４６例ＭＦＨ细胞中Ｐ５３蛋白和ＰＣＮＡ的表达强度。结果显示ＭＦＨ的Ｐ５３蛋白与ＰＣＮＡ表达间呈正相关，Ｐ５３蛋白阳性表达组ＰＣＮＡ的表达强度高于Ｐ５３蛋白阴性表达组（Ｐ＜０．０５）。Ｐ５３蛋白表达阳性和ＰＣＮＡ表达强度值高组较Ｐ５３表达阴性和ＰＣＮＡ表达强度值低组的生存期短、肿瘤转移率高、组织学分级高（Ｐ＜０．０５）；肿瘤位置深在组Ｐ５３蛋白和ＰＣＮＡ表达强度高于肿瘤位置浅表组（Ｐ＜０．０５）。结果提示定量检测ＭＦＨ的Ｐ５３蛋白和ＰＣＮＡ对于评估ＭＦＨ患者的预后具有较可靠的应用价值。

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.

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.

恶性纤维组织细胞瘤的整形外科治疗

目的 探讨恶性纤维组织细胞瘤的手术及修复方法，以求最佳的治疗效果。方法 对7例恶性纤维组织细胞瘤患者行以手术治疗为主的综合治疗，并对病理类型、手术及修复方法进行探讨。结果 所有7例患者术后恢复良好，生活质量得到明显提高。经2～3年随访，局部复发2例，占28％。结论 恶性组织细胞瘤的治疗，根治切除是关键，术后再辅以放疗、化疗等综合治疗。术后应根据肿瘤类型、部位及患者一般状况，选择不同修复方法。