Abstract
Malignant fibrous histiocytoma (MFH) is rare in the chest wall, particularly in patients who have undergone radiotherapy for primary nasopharyngeal cancer. In the present study, a case of MFH of the upper chest wall that appeared four years after initial radiotherapy for squamous cell carcinoma of the nasopharynx is reported. Furthermore, two-step surgical management was successfully performed consisting of i) tumor-reductive excision and ii) limb salvage surgery, including wide resection of the tumor mass, defect reconstruction of the chest wall using left latissimus dorsi myocutaneous flap and dermatoplasty of the flap-supplied region. The progress of the clinical characteristics, the reasons for radiation-induced carcinogenesis, the treatment options and the prognostic factors of MFH are also reviewed. Finally, the importance of prevention and follow-up of this malignancy are highlighted and specific advice is offered.
Highlights
Malignant fibrous histiocytoma (MFH) is one of the most common soft‐tissue sarcomas in adults [1] and has the aggressive clinical feature of a high rate of local recurrence, and a short survival time
MFH originating from the thoracic wall is the fifth most uncommon sarcoma [7], and post‐irradiation MFH, which is mainly followed by radiotherapy for breast cancer, is even more infrequent than primary MFH
A case of MFH of the upper chest wall that appeared more than four years after initial radiotherapy for squamous cell carcinoma of the nasopharynx is described
Summary
A case of MFH of the upper chest wall that appeared four years after initial radiotherapy for squamous cell carcinoma of the nasopharynx is described. A 28‐year‐old female was admitted to the Department of Thoracic Surgery of Tangdu Hospital (Xi'an, China) complaining of a fast‐growing mass in the upper chest wall, which had been diagnosed as MFH by biopsy in another hospital. A mushroom‐shaped mass (20x20x6 cm) that had the odor of necrotic tissue was found in the left anterior‐superior chest wall (Fig. 1A). The secondary limb‐sparing surgery was performed that included resection of the whole tumor mass, the left clavicle, part of the first rib, the affected sternum and the sternoclavicular joint, with a wide margin beyond 2 cm from the tumor (Fig. 1B).
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