Malignant Fibrous Histiocytoma of the Scalp with Skull Invasion: A Rare and Aggressive Presentation.

David A Hill,Peter Andrawes,Ami Raval,Marilyn Ng,Alfred Culliford

doi:10.7759/cureus.7801

David A Hill, Peter Andrawes + Show 3 more

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https://doi.org/10.7759/cureus.7801

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Journal: Cureus	Publication Date: Apr 23, 2020
Citations: 1	License type: cc-by

Affiliation: Staten Island University Hospital, Northwell Health

Abstract

Malignant fibrous histiocytoma (MFH) is an undifferentiated high-grade pleomorphic sarcoma and is considered the most common primary soft tissue sarcoma in adults. MFH is known to arise in the trunk, extremities and retroperitoneum although it can arise anywhere in the body.MFH of the skin is uncommon and even less frequent is the involvement of the scalp, especially with skull invasion. Most of the MFH cases present as a gradually growing lesion over a period of one to two years and is associated with ulceration and hemorrhage in most of the cases. Treatment of MFH is usually surgical resection.We present a case of MFH in an 85-year-old gentleman that was invading the skull which required a multidisciplinary surgical treatment for resection and microvascular free flap reconstruction.

Highlights

Malignant fibrous histiocytoma (MFH) is a pleomorphic sarcoma, which is considered the most common primary soft tissue sarcoma in adults [1,2,3,4,5]
We present a case of MFH in an 85-year-old gentleman that was invading the skull which required a multidisciplinary surgical treatment for resection and microvascular free flap reconstruction
MFH is known to develop in the trunk, extremities and retroperitoneum it can occur anywhere in the body [5]

Summary

Introduction

Malignant fibrous histiocytoma (MFH) is a pleomorphic sarcoma, which is considered the most common primary soft tissue sarcoma in adults [1,2,3,4,5]. We report a case of MFH of the scalp with invasion through the skull, which required a multidisciplinary surgical treatment for resection and microvascular free flap reconstruction. After obtaining preoperative medical clearance, the patient was taken to the operating room for a combined procedure with neurosurgery and plastic surgery for en bloc resection and reconstruction. The plastic surgery team performed a microvascular free flap tissue reconstruction of the 7.5-cm-diameter circular scalp defect. Malignant fibrous histiocytoma or atypical fibroxanthoma is composed of pleomorphic spindle cells (yellow arrow). All the images were taken from glass slides stained with H&E (hematoxylin and eosin). (A) 40X image taken from underneath the skin showing pleomorphic nuclei and mitosis and lymphocytic infltration (yellow arrow). (B) 4X image demonstrating involvement of the skull bone (yellow arrow)

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Sakamoto A