Case Of Malignant Fibrous Histiocytoma Research Articles

Malignant fibrous histiocytoma in a budgerigar (Melopsittacus undulatus)

In this report, a case of malignant fibrous histiocytoma in a budgerigar (Melopsittacus undulatus) is described. At necropsy, a tumorous subcutaneous mass was noted to be located under the right wing at the level of humerus in a budgerigar. On microscopic examination, the tumor was composed of pleomorphic cells having mostly round to oval large nucleus. Presence of occasional bands composed of fibroblastoid cells were noted. Occasional giant cells and mitotic figures were also observed. Based on the microscopic findings, a diagnosis of malignant fibrous histiocytoma was made. The present case in an exotic bird was found to be interesting, since malignant fibrous histiocytomas are rare tumors of domestic animals and mostly seen in dogs.

Soft tissue sarcomas: Evaluation by immunohistochemistry

Soft tissue sarcomas represent a histologically heterogenous group of malignant tumors arising from the soft tissue compartments, i.e smooth muscles, skeletal muscles, adipose tissue, blood vessels, connective tissue mesenchyme, neural tissue and other tumors of uncertain histogenesis(1). Soft tissue sarcomas are relatively rare tumors, represent less than 1% of adult malignancies based on data report from American Cancer Society (2). The crude incidence rate in Iraq for soft tissue sarcomas was 219/ 100,000 population during 2014 with male: female ratio of 1.3:1, and highest peak age between 30-34 years (3). The histological subtype and microscopic criteria are two parameters that influence the tumor grade which is the best predictor for aggressiveness. ( 2)
 Objectives:
 A retrospective evaluation of soft tissue sarcomas, using immunohistochemical study of Myosin, Desmin, Smooth muscle Actin (SMA) and Vimentin, aiming to re-evaluate the primary diagnosis and whether IHC assessment in soft tissue sarcoma is mandatory to reach a final interpretation.
 Material and Patients: 
 A total of 50 cases soft tissue sarcomas were reviewed retrospectively from case archives of histopathology department/ Central Public Health Laboratory, for the period (2011-2018). The data for these cases were collected including the age, gender, site of the tumor and the preliminary biopsy report findings. Hematoxylin& Eosin (H&E) stain and IHC staining of unstained sections from formalin-fixed, paraffin-embedded tissue were performed using SMA, Vimentin, Desmin and Myosin.
 Methods: Age and gender distribution of the 50 cases was correlated. The IHC staining performed on 5 microns paraffin sections, applying peroxidase-Antiperoxidase technique and both positive and negative control slides were included for Smooth muscle actin (SMA), clone 1A4, Desmin (clone D33), Myosin (clone 2F12.A9) and Vimentin (Clone V9). The monoclonal antibodies used were from DAKO manufacturer as ready to use monoclonal antibodies while freeze-dried antibodies used for myosin with 1:20 dilution. Negative and positive control slides were used simultaneously. The staining intensity was assessed based on the percentage of positive cells expression of the four IHC monoclonal antibodies. Negative staining reported when no stain seen. Positive (+) means up to 30% of tumor cells with antigen expression. Positive (++) interpretation given when 31-60% of tumor cells show staining reaction, while Positive (+++) interpretation reported when over 60% of tumor cells showing staining reaction.
 Results:
 The staining interpretation of the four monoclonal antibodies were confirmatory for the original diagnosis in 40% of cases, while 60% of the final diagnoses were against the original interpretation. SMA was positive in 38/50 cases (76%). Desmin was positive in 8/50 cases (20%) Vimentin was positive in 42/50 of cases (84%), Myosin was positive in 30/50 of cases (71.4%).
 The current study focus on histological re-evaluation of different types of soft tissue sarcomas (including RMS-with its subtypes), MFH-storiform, pleomorphic and myxoid subtypes), fibrosarcoma, leiomyosarcoma, alveolar soft part sarcoma and synovial sarcoma depending on immunohistochemical study. The original diagnosis have been changed after the immunohistochemistry stain from fibrosarcoma to rhabdomyosarcoma and leiomyosarcoma , Malignant fibrous histiocytoma to rhabdomyosarcoma, alveolar rhabdomyosarcoma to Malignant fibrous histiocytoma, soft tissue sarcoma to rhabdomyosarcoma , pleomorphic MFH to pleomorphic rhabdomyosarcoma. Embryonal and alveolar rhabdomyosarcoma were confirmed by IHC as so. Leiomyosarcoma was confirmed as the same in one case. Embryonal Rhabdomyosarcoma changed to leiomyosarcoma by IHC positivity for desmin. Six cases of MFH were confirmed as malignant fibrous histiocytoma after IHC. Two cases of synovial sarcoma were re-evaluated as rhabdomyosarcoma. Vimentin revealed 100% positivity in 10 cases and regarded as a sensitive marker for mesenchymal tissue but it is not specific for certain types of sarcomas. The presence of desmin diffusely throughout a tumor is an indication of myoid differentiation and the presence of either SMA or desmin focally should not necessarily be equated with myoid lineage but rather with myofibroblastic lineage, which go in the same direction with Hirofumi N. et al. (1998).(4)
 Conclusions: The co-expression of SMA and Desmin helped in the diagnosis of leiomyosarcoma (LMS). Myosin expression was helpful in the diagnosis of rhabdomyosarcoma (RMS) and alveolar soft part sarcoma (ASPS). Smooth muscle actin (SMA) and vimentin were not specific for the diagnosis of malignant fibrous histiocytoma (MFH). High grade spindle cell sarcoma express SMA only without myosin or desmin can be categorized as pleomorphic myogenic sarcoma. By applying immunohistochemical markers, 60% of soft tissue sarcomas were different from the preliminary diagnosis while 40% of cases were supportive of the original H&E diagnosis.

Malignant fibrous histiocytoma of the mandible – A case report and review of published case reports

The natural history of malignant fibrous histiocytoma (MFH) is still heavily debated. It's anonymous natural history is precisely denoted by its new adapted terminology ‘undifferentiated pleomorphic sarcoma (UPS)’. Thus to diagnose a lesion as UPS, it is vital to correlate its histopathological features along with its immunohistochemical (IHC) expressions to confirm the tumor cell lineage. MFH is extremely rare in mandible with the literature search in PubMed database revealing only 13 case reports of MFH involving the mandible. Among these, only 7 case reports provide IHC details of the case. Without IHC data it is not possible to determine the accuracy of the diagnosis in the remaining 6 cases. Here we report an additional 8th case of MFH involving the ramus and angle of the mandible. Histopathology revealed proliferating malignant spindle cells interspersed with histiocyte-like cells. The tumor cells were strongly positive for vimentin and CD68 and were negative for S-100, epithelial membrane antigen (EMA) and cytokeratin (CK). The diagnosis was made by correlating the histopathological findings with the IHC profile. The report also provides the data (clinical, radiographic, histopathological, immunohistochemical features and treatment details) extracted from the 7 confirmed MFH case reports involving the mandible.

Giant malignant fibrous histiocytoma of the testis.

We present a case of malignant fibrous histiocytoma of the testis in a 59 year- old male who admitted to our hospital with left testicular painless mass presenting for two months. A scrotal ultrasound examination and magnetic resonance imaging revealed a 9 cm left testicular solid mass. Serum tumor markers were unremarkable. The patient underwent left radical orchiectomy. Histopathologic diagnosis was giant cell variant of malignant fibrous histiocytoma which composed of varying amounts of a mixture of spindled, rounded and osteoclastic type giant cells. Hemorrhagic and necrotic areas were seen between tumor nodules. In immunohystochemical staining, vimentin, CD68 were positive and SMA was focally positive. The patient then received adjuvant chemoterapy and currently, he has no sign of recurrence.

Primary Pulmonary Malignant Fibrous Histiocytoma.

Malignant fibrous histiocytoma (MFH) cases are classified within the group of nonclassified sarcomas. The etiopathogenesis is unclear; however, MFH commonly develops in scar tissue and in areas exposed to radiation. MFH is the most common soft tissue sarcoma in adults and may be borne in the lungs, chest wall, mediastinum, or other tissues. Primary MFH of the lung constitutes less than 0.2% of all pulmonary neoplasms; thus, an optimal treatment strategy has not yet been elucidated. We aimed to report a case of MFH of the lung with subsequent treatment administration.

Primary malignant fibrous histiocytoma of the colon: A case report and review of the literature.

A 68-year-old woman was admitted to the Peking Union Medical College Hospital with a 6-week history of fever of undetermined origin. The computed tomography scan revealed a space-occupying lesion in the ascending colon and colonic endoscopy revealed a protrusive lesion in the initial segment of the ascending colon, occupying 3/5 of the lumen. Pathological examination of a biopsy specimen revealed malignant fibrous histiocytoma (MFH). The patient then underwent a laparotomy for right hemicolectomy and en bloc lymph node dissection. The histopathological examination confirmed the diagnosis of MFH and administration of adjuvant radiotherapy was decided. MFH is a high-grade sarcoma that rarely arises in the alimentary tract. To the best of our knowledge, there has only been one case of primary colorectal MFH treated by radiotherapy recorded to date, which makes our case the second trial. We herein present a case of MFH in the ascending colon and a review of previous case reports of patients presenting with this unusual type of MFH.

Computed tomography and magnetic resonance imaging findings of malignant fibrous histiocytoma of the head and neck.

The aim of this study was to analyze the imaging findings of 15 cases of malignant fibrous histiocytoma (MFH) of the head and neck, in order to better understand the tumor characteristics based on computed tomography (CT) and magnetic resonance imaging (MRI). CT (n=11) and MRI (n=4) images from 15 patients with histologically diagnosed MFH of the head and neck were retrospectively analyzed. The imaging characteristics were analyzed and compared among different histological subtypes. The lesions were primarily located in the maxillary sinus in 5 patients, the ethmoid sinus in 1 patient, the infratemporal fossa in 2 patients, the neck in 4 patients, the left mandible in 1 patient, the gingiva in 1 patient and the epiglottis in 1 patient. A total of 4 cases were associated with radiotherapy. All the lesions were ill-defined, ranging in size from 2.1 to 5.1 cm in the largest diameter. Bone fractures were evident in 9 cases. The attenuation, signal and enhancement patterns varied, although inflammatory MFH exhibited prolonged enhancement in dual-phase enhanced CT scans. MFH of the head and neck is rare but may be associated with radiotherapy. Although the imaging manifestations of MFH are various and non-specific, inflammatory MFH exhibits prolonged enhancement on dual-phase enhanced CT scans.

A rare case report of malignant fibrous histiocytoma of male breast

Malignant fibrous histiocytoma (MFH) is an extremely rare tumor of the breast that arises from the connective tissue of glands. Its complex and various histological patterns, adds difficulty to the diagnosis. We report a case of MFH of left breast in a 70-year-old male who presented with gradually increasing painless mass over a period of 1–2 years. Fine-needle aspiration cytology revealed malignant spindle cell lesion and wide local excision was performed without axillary lymph node dissection. Histopathological examination along with immunohistochemistry confirmed the diagnosis of MFH of left breast. To the best of our knowledge, this is the 6 th case of MFH of left breast in an elderly male reported in the literature.

Laparoscopic-Assisted Surgery for Malignant Fibrous Histiocytoma Originating from the Descending Colon: A Case Report and Literature Review

Primary malignant fibrous histiocytoma (MFH) localized in the large intestine is extremely rare. We report a first case of MFH in colon that underwent a laparoscopy-assisted colectomy. A 74-year-old female had a 3-month history of blood stool. Barium enema study showed protrusion in the descending colon. Colonoscopy revealed submucosal tumor-like lesion with central ulceration.

Salivary gland adenoid cystic carcinoma.

Malignant fibrous histiocytoma, also known as pleomorphic undifferentiated sarcoma not otherwise specified, arises in numerous organs. The first-line treatment is complete excision of the mass, but in some cases postoperative chemo- and/or radiotherapy is recommended. Only a few cases of malignant fibrous histiocytoma of the vocal fold have been previously reported in the literature. We report a new case, which originated in the true vocal fold of a 65-year-old man. The mass was removed via CO2 laser excision with preservation of the vocal fold and without the need for further treatment. At 3 years of follow-up, the patient remained recurrence-free.

Primary cardiac malignant fibrous histiocytoma with abdominal wall metastasis

We present a rare case of cardiac malignant fibrous histiocytoma (MFH; undifferentiated pleomorphic sarcoma); to date, fewer than 100 cases of cardiac MFH have been reported. In this case, transthoracic echocardiography revealed cardiac tumors in the left atrium (LA) of a 53-year-old woman with a 3-month history of worsening dyspnea; the largest tumor was found to protrude through the mitral valve in diastole, causing stenosis. Three of the four tumors were resected during emergency surgery; however, the residual tumor extension into the left pulmonary vein could not be removed. Histological findings of the resected tumors, such as organized thrombus and myxomatous tissue changes, indicated that the tumors were benign. After 3 months, the patient underwent total resection for a small mass that developed on her right abdominal wall, which was revealed histologically to be MFH; additionally, the residual mass in the LA had enlarged progressively. After undergoing radiation therapy without further surgery, she died of cerebral bleeding 6 months after cardiac surgery. Postmortem examination revealed that the tumor in the LA was an MFH. Thus, cardiac MFH should be considered as a differential diagnosis for tumors on the posterior wall of the LA.<Learning objective: Primary cardiac malignant fibrous histiocytoma (MFH), which is easily mistaken for atrial myxoma, is a rare type of cardiac sarcoma. MFH occurs most commonly on the posterior wall of the left atrium (LA), and total resection is currently the only effective therapy; however, the prognosis is poor. Therefore, a high level of suspicion is required to facilitate early diagnosis. Cardiac MFH should be considered as a differential diagnosis for tumors on the posterior wall of the LA.>

The preliminary report of intercalary diaphyseal endoprosthetic reconstruction for the proximal femur malignant bone tumor

Objective To evaluate the clinical effectiveness of the treatment for the proximal femur malignant bone tumor by conducting intercalary diaphyseal endoprosthetic reconstruction. Methods Form June 2011 to July 2014, 7 patients who had proximal femur malignant bone tumor were treated with intercalary diaphyseal endoprosthetic reconstruction. There were 3 males and 4 females, 61.8 years old on the average (ranging from 28 to 76 years). The tumors involved: 4 case of the limbs primary malignant tumor, 1 case of osteosarcoma, 1 case of juxtacortical osteosarcoma, 1 case of malignant lymphoma with pathological fracture, and 1 case of malignant fibrous histiocytoma with pathological fracture, as well as 3 cases of the Metastatic breast cancer of the proximal femur. All patients were evaluated by plain radiography, CT and MRI before operation. After these 7 patients were examined with MRI and the level of osteotomy was determined, prosthesis fitting is ready. The exposures of all the tumors were via the femur lateralis surgical approach. According to the general principles of tumor surgery, expose the tumor segment and soft tissue tumors. The segment of involved bone was then removed, with a surrounding cuff of normal tissue overlying the tumor. The level of osteotomy was determined as the result of preoperative imaging measurement. The proximal and distal femur intramedullary canals are reamed. The prosthesis is assembled and installed after the cement used. Results The duration of surgery was from 45 min to 120 min (90 min on average). The blood loss was from 200 ml to 800 ml (400 ml on average). All patients were followed-up for 6 months to 2 years (14 months on average). 1 case with osteosarcoma died due to pulmonary metastases 18 months after surgery. The remaining 3 cases with the primary malignant bone tumors did not recur or transfer during the follow-up period. 1 case with the metastases was comprehensive treated in another hospital, and survival with tumors. The remaining 2 cases with the metastases did not recur or transfer during the follow-up period. Conclusion The clinical results demonstrated that the intercalary diaphyseal endoprosthetic reconstruction was an ideal treatment for the proximal femur malignant bone tumor. Key words: Femur; Neoplasms; Prostheses and implants

Malignant Fibrous Histiocytoma Accompanying Hemorrhage in the Pleural Cavity

Malignant fibrous histiocytoma is a type of soft tissue tumor that frequently occurs in the limbs, trunk, retroperitoneum, etc. We herein report a case of MFH occurring in the thoracic wall, which was accompanied by hemorrhage in the pleural cavity. A 79-year-old male transferred to our hospital for a detailed examination of a chest wall tumor in his right back. The tumor was diagnosed as pleomorphic malignant fibrous histiocytoma (MFH) by an incisional biopsy. Before the scheduled operation, the patient developed right upper abdominal pain. A CT, blood test and pleural puncture revealed that the patient had a massive hemothorax, which required emergency surgery. The eighth, ninth and tenth ribs and intercostal muscles, along with the seventh intercostal muscle, were resected, which enabled the tumor to be completely removed. MFH originating in the thoracic wall is rare; but it is important to be aware of the risk of hemothorax when MFH is exposed directly to the pleural cavity.

Management of extremity malignant fibrous histiocytoma: A 10-year experience

Summary Background Malignant fibrous histiocytoma (MFH) is a common soft-tissue sarcoma in adults, which commonly affects the extremities, trunk, head, and neck. Of these regions, the extremities are more often affected. However, only a few studies have specifically investigated the clinical behavior and prognosis of this malignancy, especially in East Asian populations. Aims and objectives We collected data on MFH cases for a period of 10 years and present our experience here in treating patients with extremity MFH. Materials and methods This study was a retrospective analysis of patients with extremity MFH treated in the Department of Plastic Surgery at National Cheng Kung University Hospital between January 2004 and December 2013. Data on patient profiles, surgical resection, radiotherapy, and chemotherapy were all reviewed. The patients were followed up regarding their local recurrences and survivals. Results Thirteen patients (6 men and 7 women) were enrolled in this study. The mean age of the patients was 57.9 years (range, 33–82 years). The sizes of the clinical tumors ranged from 1.7 to 15 cm in a maximal linear dimension (mean, 7.3 cm), and 76.9% of the tumors developed in the lower extremities. The average follow-up time was 63.5 months. One patient received limb amputation, and 12 patients were treated with limb salvage including marginal or wide excisions. Adjuvant radiotherapy was performed in 10 patients whose tumor sizes exceeded 5 cm or who exhibited inadequate excision or recurrence. Chemotherapy was performed in six patients who exhibited a distant metastasis or vessel invasion. The local and distant recurrence rates were 53.8% and 30.8%, respectively. A total of 42.9% of patients with local recurrence developed distant metastases. The surgical margin was the only significant factor of local disease control, and distant metastasis was the only factor relevant to the overall survival (OS). Conclusion An adequate resection margin during treatment for the primary MFH tumor achieves optimal results for local disease control. It influences the OS rate, because local-recurrence-related distant metastasis is significantly associated with high mortality.

Histopathological study of soft tissue tumors: A three year experience in tertiary care centre

Background: Soft tissue sarcomas compared with carcinomas and other neoplasms are relatively rare and constitute less than 1% of all the cancer. Soft tissue sarcomas may occur anywhere in the body but most arise from large muscle of extremeties, the chest wall, the mediastinum and the retroperitoneum. Aims and objectives: To study the macroscopic and microscopic pathology of benign and malignant soft tissue tumour and there clinicopathological correlation. Materials and methods: The study was conducted in Dr .D .Y Patil School of Medicine, Navi Mumbai, from 1st of January 2008 to December 2010. A Cross sectional study of 150 cases of soft tissue tumors were carried out in details. A pretested proforma was used to classify each tumor and details like age, sex, clinical features, gross and microscopic findings were noted. Results: The most common soft tissue tumor in the study were benign tumors (140 cases), followed by malignant (9 cases) and one case was reported as borderline. Lipomas were the most common benign tumors accounting for 49 out of 140 cases. Benign smooth muscle tumors were the next most common tumor accounting for 44 cases.Benign vascular and benign peripheral nerve sheath tumor accounted for 19 cases in each category. Of 19 cases of benign vascular tumor, 16 cases were of haemangioma, 3 cases were of angiofibroma. Of 19 benign peripheral nerve sheethtumor, 12 cases were reported as neurofibroma and 7 schwannomas. Of 5 cases of fibrohistiocytictumor, 3 cases were benign, 1 case of borderline (Dermatofibrosarcoma protuberance) and 1 case of malignant fibrous histiocytoma (MFH). Of 7 cases of Fibrous tumor, 6 cases were of Benign and 1 cases of malignant variant (Fibrosarcoma). Out of 6 cases which were reported as benign, comprised of 2 cases each of fibroma, fibromxyoma, and palmar fibromatosis. 9 out of 150 cases were malignant tumors,3 cases were malignant peripheral nerve sheath tumor(MPNST) ,whearas Gastrointestinal stromal tumor(GIST),leiomyos

Surgical management of giant secondary malignant fibrous histiocytoma following radiotherapy for nasopharyngeal carcinoma: A case report and literature review.

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.

A Rare Type of Secondary Cancer in a Child With Acute Lymphoblastic Leukemia

Secondary cancers which are related with treatment of childhood acute lymphoblastic leukemia (ALL) is a significant problem with longer term. For development of secondary cancer after treatment, the latency period varies between 5 and 10 years. In this case, a 13 year-old-boy diagnosed as high-risk ALL was treated with chemotherapy and prophylactic cranial radiotherapy at a dose of 1800 cGy. Six years after the end of treatment he developed a 5 × 5 × 4 cm mass at the right temporal region of the cranium. The mass was excised totally with clear surgical margin. Pathology of mass has been diagnosed as malignant fibrous histiocytoma (MFH), recently referred to as an undifferentiated pleomorphic sarcoma (UPS). After treatment of childhood ALL, reported cases of secondary MFH is extremely rare in the literature. Herein we present a case of MFH/UPS that developed as a secondary cancer 6 years after the end of ALL treatment.

胸壁原発の悪性線維性組織球腫の1例

胸壁原発の悪性線維性組織球腫の1例

前頭骨を破壊し硬膜浸潤を認めたmalignant fibrous histiocytoma（≒undifferentiated pleomorphic sarcoma）の1例

前頭骨を破壊し硬膜浸潤を認めたmalignant fibrous histiocytoma（≒undifferentiated pleomorphic sarcoma）の1例

Role of matrix metalloproteinase (MMP) 2 and MMP-9 in soft tissue sarcoma.

BackgroundWe investigated the expression of matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) in malignant fibrous histiocytoma (MFH), and determined whether these could be useful as prognostic factors.MethodsAmong patients treated from 1993 to 2007, 30 cases of MFH were evaluated. Immunohistochemical staining was performed for MMP-2, MMP-9, TIMP-1, and TIMP-2 using paraffin wax-embedded blocks of MFH tissues. Reverse transcriptase polymerase chain reaction (RT-PCR) and Western blot and zymography were performed using fresh tissues obtained from 17 of the 30 cases. The levels of MMP and TIMP expression were compared between the MFH and normal control groups, and between non-metastatic and metastatic MFH groups.ResultsExpression levels of MMP-2, MMP-9, TIMP-1, and TIMP-2 were higher in the MFH group than the control group by RT-PCR, Western blotting, and zymography. Immunohistochemical staining revealed that MMP-2 and MMP-9 protein expression was higher in the metastatic than in the non-metastatic group. The expression levels of MMP-2 and TIMP-1 were significantly higher in the metastatic than in the non-metastatic group (p < 0.05) by RT-PCR. By Western blot analysis, the expression levels of MMP-2, TIMP-1, and TIMP-2 were higher in the metastatic group (p < 0.05), but MMP-9 showed only a slight increase in the metastatic group compared with the non-metastatic group (p > 0.05). Finally, gelatin zymography analysis showed that the expression levels of the pro- and active forms of MMP-2 were significantly higher in the metastatic group (p < 0.05), but the expression of the pro- and active forms of MMP-9 showed a slight decrease in the metastatic group (p > 0.05).ConclusionsThese results suggest that MMP-2, MMP-9, TIMP-1, and TIMP-2 may have important roles in the development and progression of MFH, and that the degree of expression of these metalloproteinases and their inhibitors, especially MMP-2, could be useful as prognostic factors related to metastasis in MFH.