Pleomorphic Malignant Fibrous Histiocytoma Research Articles

External validation of machine learning models for prediction of survival in undifferentiated pleomorphic sarcoma.

e13551 Background: Machine learning (ML) algorithms to predict cancer survival have recently been reported for a number of sarcoma subtypes, but none have investigated undifferentiated pleomorphic sarcoma (UPS). ML is a powerful tool that has the potential to better prognosticate UPS. Methods: The Surveillance, Epidemiology, and End Results (SEER) database was queried from 2004 to 2015 for cases of histologically confirmed undifferentiated pleomorphic sarcoma (UPS) and malignant fibrous histiocytoma (MFH). Patient, tumor, and treatment characteristics were recorded, and various machine learning (ML) models were built to predict 1-, 3-, and 5-year survival. The best performing ML models were externally validated using an institutional cohort of UPS patients. Results: All ML models performed best at the 1-year time point and worst at the 5-year time point. On internal validation within the SEER cohort, the best models had c-statistics of 0.71 to 0.73 at the 5-year time point. Similarly, all ML models performed best at 1-year and worst at 5-year on external validation. The best performing models had c-statistics of 0.81 at the 5-year time point on external validation, demonstrating good performance in survival prediction. Conclusions: Machine learning models perform well for survival prediction in UPS, though this sarcoma subtype may be more difficult to prognosticate than other subtypes. Future studies are needed to further validate the machine learning approach for UPS prognostication. [Table: see text]

S1‐Guideline Cutaneous Angiosarcomas – Update 2021

S1‐Guideline Cutaneous Angiosarcomas – Update 2021

A unique case of classic pleomorphic sarcoma restricted to the toes

Over 50% of soft tissue sarcomas occurring in older adults are histologically pleomorphic and high grade. Most have traditionally been classified as malignant fibrous histiocytoma (MFH). MFH was originally defined as a malignant pleomorphic spindle cell neoplasm showing fibroblastic and histiocytic differentiation. More recently, pathologists have accepted that this morphology may be shared by a wide range of malignant neoplasms. Many sarcomas that were previously classified as pleomorphic MFH, on careful immunohistochemical and histopathologic analyses, revealed a specific line of differentiation and could be reclassified as myxofibrosarcoma (30%), myogenic sarcoma (30%), liposarcoma (4%), malignant peripheral nerve sheath tumor (2%), or soft tissue osteosarcoma (3%), whereas about 30% had no specific line of differentiation or were myofibroblastic. The term undifferentiated pleomorphic sarcoma (UPS) is now reserved for pleomorphic sarcomas that show no definable line of differentiation by current technology. The majority of extremity sarcomas occur in the lower extremity (74 vs. 26% in the upper limb). According to one of the studies conducted on 315 patients, non-metastatic soft tissue sarcoma of the lower extremity who were treated at one institution over a ten-year period. Sixty-six percent of the lesions were above the knee, and 60% were high grade. This case had a 3x3 cm ulcer at the 3rd toe in a 30-year-old male patient who subsequently underwent midfoot ampuatation.

S3057 Upper Gastrointestinal Bleeding Secondary to Gastric Metastasis of Pleomorphic Dermal Sarcoma

INTRODUCTION: Pleomorphic dermal sarcoma (PDS) is a rare cutaneous malignancy, seen primarily in sun exposed areas of elderly individuals. Along with atypical fibroxanthoma (AFX), it is believed to belong to a spectrum of malignant disorders arising from a similar fibrohistiocytic mesenchymal origin. Compared to AFX, PDS represents a more aggressive phenotype of disease with higher rates of recurrence and metastasis. CASE DESCRIPTION/METHODS: An 87-year-old male with a history PDS of the scalp with metastasis to the right humerus presented to the hospital with one week of melena. Pertinent past medical history included non-small cell lung cancer, chronic lymphocytic leukemia, melanoma, squamous and basal cell carcinoma of the skin. On presentation he was noted to be anemic with a hemoglobin of 6.8 g/dL and hematocrit of 22%. He was started on intravenous (IV) proton pump inhibitor (PPI) and underwent an esophagogastroduodenoscopy (EGD). Upon visualization of the stomach, four masses were identified along the greater curvature ranging between 1cm and 2.5cm in size, three of which were actively bleeding. Biopsies of these masses were obtained with cold biopsy forceps. No alternative source of bleeding was identified on exam. Following EGD, supportive measures were continued with IV PPI and packed RBC transfusions. Tissue histology of the gastric masses were consistent with a malignant spindle cell neoplasm, identical to that of the patient's known PDS. Additional imaging revealed new soft tissue lesions in the left hepatic lobe, right kidney, bladder and peritoneum. Given his diffusely metastatic disease, co-morbidities and frailty, therapeutic options were limited. He was deemed not an appropriate chemotherapy candidate and ultimately pursued hospice care. DISCUSSION: We present a case of upper gastrointestinal bleeding secondary to gastric metastasis of PDS. Metastasis occurs in approximately 10-20% of patients with PDS, most commonly involving the lungs and skin1. PDS had previously been classified as undifferentiated pleomorphic sarcoma or malignant fibrous histiocytoma. Under this nomenclature it has rarely been described to metastasize to the stomach and few cases have presented with gastrointestinal bleeding. This case contributes to the general understanding that the stomach can be a metastatic site for a wide variety of non-gastrointestinal cancers.Figure 1.: Proximal gastric body mass along the greater curvature.Figure 2.: Distal gastric body mass along the greater curvature.

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.

Undifferentiated pleomorphic sarcoma of the left parotid gland: a case report

Undifferentiated pleomorphic sarcoma, formerly known as malignant fibrous histiocytoma, was previously the most common type of soft-tissue sarcoma in adults (40 %). Undifferentiated pleomorphic sarcomas or malignant fibrous histiocytomas comprise a group of high-grade pleomorphic sarcomas that cannot be otherwise classified. After a re-classification, the term malignant fibrous histiocytoma became a diagnosis of exclusion. It was first recognized as a distinct clinicopathologic entity in the early 1960s as pleomorphic sarcoma. In the head and neck, malignant fibrous histiocytoma is extremely rare and accounts for only 3 % of all undifferentiated pleomorphic sarcomas. We report an unusual case of undifferentiated pleomorphic sarcoma involving the left parotid gland in a 19-year-old male patient.

Myxofibrosarcoma Following Chemotherapy and Radiotherapy for Hodgkin's Lymphoma: Case Study and Review

Introduction: Although radiation-induced sarcomas are widely documented, most reports focus on pleomorphic malignant fibrous histiocytomas (high-grade undifferentiated pleomorphic sarcomas); few case studies involve myxofibrosarcomas. This paper reports on a grade II myxofibrosarcoma of the neck arising secondary to earlier chemotherapy and radiotherapy. Material and methods: A 61-year-old male received chemotherapy plus radiotherapy in 1983 for nodular sclerosing Hodgkin's lymphoma. Twenty-six years after completing treatment, the patient developed a grade II myxofibrosarcoma involving radiated soft tissue on the left side of the neck. Results: The tumor was removed. The tumor mass weighed 90 g and measured 6 × 5 × 4.5 cm and the histological examination revealed a grade-II superficial malignant myxoid spindle-cell tumor displaying a multinodular growth pattern. Immunohistochemical staining was positive for CD34 and negative for smooth muscle actin and desmin. Conclusions: Given the increasing use of adjuvant therapies, particularly in the early stages of cancer, patients should be closely monitored to ensure detection of radiation/chemotherapy-induced sarcomas.

НЕДИФФЕРЕНЦИРОВАННАЯ ПЛЕОМОРФНАЯ САРКОМА СЕРДЦА: ВОЗМОЖНОСТИ СОВМЕЩЕННОЙ ПОЗИТРОННОЙ ЭМИССИОННОЙ И РЕНТГЕНОВСКОЙ КОМПЬЮТЕРНОЙ ТОМОГРАФИИ ДЛЯ ДИАГНОСТИКИ МЕСТНОГО РЕЦИДИВА ОПУХОЛИ И ОТДАЛЕННЫХ МЕТАСТАЗОВ (КЛИНИЧЕСКОЕ НАБЛЮДЕНИЕ)

The paper presents a case of a 52-year-old female patient with pleomorphic malignant fibrous histiocytoma/ undifferentiated pleomorphic sarcoma of the left atrium. One year after surgical resection of the primary tumor, microsurgical removal of the right parietal lobe metastatic tumor was performed. PET/CT with 11C-methionine and 18F-FDG performed 2 months after surgical resection of brain metastasis revealed local recurrence of sarcoma in the left atrium and left lateral ventricle metastases. This clinical case demonstrates high diagnostic accuracy of PET/CT with 18F-FDG and 11C-methionine in detecting local recurrence of cardiac undifferentiated sarcoma, however, PET/CT with 11C-methionine appears to be superior to PET/CT with18F-FDG in detecting brain metastasis.

Primary high-grade myxofibrosarcoma/pleomorphic malignant fibrous histiocytoma: Percent myxoid component to improve outcome prediction.

10556 Background: Myxofibrosarcoma and pleomorphic malignant fibrous histiocytoma (PMFH) are aggressive genetically complex sarcomas. We investigated the association of percent myxoid component (MC...

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.

Undifferentiated pleomorphic sarcoma presenting as a gingival mass: A rare case

Malignant fibrous histiocytoma which was once considered as a tumor of adults, is now being re-classified and subtyped either as a pleomorphic undifferentiated sarcoma or pleomorphic variant of other spindle cell tumors. Only less than 5% of these cases are reported in the head and neck, and its presentation intra-orally is still rarer. Herein, we report a case of gingival swelling in relation to the 16 region, which on microscopic examination showed a histomorphometric pattern of storiform pleomorphic-malignant fibrous histiocytoma. Immunohistochemical studies were done to exclude similar appearing spindle cell neoplasms. The tumor showed focal positivity for pan histiocytic marker, CD68. Based on the histopathological and immunohistochemical profiles, the tumor was diagnosed as undifferentiated pleomorphic sarcoma.

Long-Term Results of Radical Surgery and Adjuvant Radiotherapy in a Case of Primary Malignant Fibrous Histiocytoma of the Kidney

Malignant fibrous histiocytoma of the kidney is an extremely rare tumor that isthought to arise from the renal capsule. Radical nephrectomy is the standard treatment for localized disease but 25% of patients die of metastatic disease despite radical surgical resection. In the absence of clear pathogenetic information, adjuvant treatment remains empiric. Herein, we describe the case of a previously healthy 58-year-old woman who underwent radical nephrectomy because of 8-cm solid lesion of the right kidney; pathology revealed a pleomorphic malignant fibrous histiocytoma invading the perinephric fat, stage pT3aN0. She received adjuvant radiotherapy. To date, five years after surgery, she is alive and there is no evidence of disease. To our knowledge, this is the first report of favorable long-term results of surgery and adjuvant radiotherapy in a locally-advanced malignant fibrous histiocytoma of the kidney.

Metastatic Sarcoma of the Tongue: Pleomorphic Malignant Fibrous Histiocytoma and Literature Review

Metastatic tumors of the tongue are rare, most commonly arising from carcinomas of the lung, kidney, breast, and melanomas. They usually appear in end-stage disease, especially in the tongue base, probably because of the rich blood supply. Metastatic sarcomas of the tongue are even rarer. We report the seventh case of metastatic tongue sarcoma and the first one in the literature, arising from a pleomorphic malignant fibrous histiocytoma (MFH) of the lower extremity. ENT surgeons, Maxillofacial surgeons, and Oncologists should be aware of the possibility of metastatic sarcomas of the tongue, even though these lesions are extremely rare. Furthermore, metastatic sarcomas of the tongue represent a late manifestation of a previously identified primary tumor, although if the primary site has not been identified, a thorough investigation to locate an occult tumor should be conducted.

A Case of Dedifferentiated Liposarcoma Showing a Biphasic Pattern on 2-Deoxy-2-F18-Fluoro-D-Glucose Positron Emission Tomography/Computed Tomography

Integrated 2-deoxy-2-F18-fluoro-D-glucose positron emission tomography combined with computed tomography (FDG-PET/CT) has been used in the field of soft tissue sarcoma. We report an 81-year-old man with dedifferentiated liposarcoma in the left thigh, which was composed of well-differentiated liposarcoma and pleomorphic malignant fibrous histiocytoma. As well as other radiological modalities, FDG-PET was able to demonstrate a biphasic signal pattern composed of well-differentiated liposarcoma and dedifferentiated area, being consistent with the histological grade of malignancy.

Primary pleomorphic malignant fibrous histiocytoma of the heart

Primary pleomorphic malignant fibrous histiocytoma of the heart is rare. The present study was performed to study the clinical and pathological features of the disease. We describe two rare cases of primary cardiac malignant fibrous histiocytoma and review the published individual data of the patients. Both patients complained of dyspnea, and underwent palliative tumor resection. However, they died several months after surgery. A thorough literature review with clinical presentations, diagnostic features, treatment, and outcomes was done. We have for the first time analyzed the factors related to the survival of malignant fibrous histiocytoma. It is usually difficult to make an appropriate preoperative diagnosis. Despite complete surgical resection and aggressive chemotherapy and radiotherapy, the prognosis is still poor.

Pulmonary artery sarcoma with angiosarcoma phenotype mimicking pleomorphic malignant fibrous histiocytoma: a case report

Primary sarcomas of the major blood vessels can be classified based on location in relationship to the wall or by histologic type. Angiosarcomas are malignant neoplasms that arise from the endothelial lining of the blood vessels; those arising in the intimal compartment of pulmonary artery are rare. We report a case of pulmonary artery angiosarcoma in a 36-year old female with pulmonary masses. The patient had no other primary malignant neoplasm, thus excluding a metastatic lesion. Gross examination revealed a thickened right pulmonary artery and a necrotic and hemorrhagic tumor, filling and occluding the vascular lumen. The mass extended distally, within the pulmonary vasculature of the right lung. Microscopically, an intravascular undifferentiated tumor was identified. The tumor cells showed expression for vascular markers VEGFR, VEGFR3, PDGFRa, FGF, Ulex europaeus, FVIII, FLI-1, CD31 and CD34; p53 was overexpressed and Ki67 proliferative rate was increased. Intravascular angiosarcomas are aggressive neoplasms, often associated with poor outcome.Virtual slideThe virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/2315906377648045.

Atypical fibroxanthoma in a woman and literature review

Atypical fibroxanthoma (AFX) is a superficial variant of pleomorphic malignant fibrous histiocytoma. AFX an rare tumor of skin seen mainly in the head and neck region of elderly patients. Clinically, it can be difficult to differentiate from other tumors without histopathological examination. It may clinically resemble squamous cell carcinoma, malignant melanoma, or pyogenic granuloma. The histologic differential diagnosis primarily includes peripheral giant cell granuloma, spindle cell squamous carcinoma, and spindle cell melanoma. Clinical findings and immunohistochemical studies are often needed to establish the diagnosis. The prognosis is generally excellent, although there are rare cases of metastatic disease. The case was 77-year-old female patient. She had a 1.5 cm red-brown bulging lesion on her left cheek that sometimes can bleed for 4 years. As clinically piyogenic granuloma was considered. Excisional biopsi was performed. There was not any lymphadenopathy in her head neck region. Microscopically, the case was interpreted as AFX. The histologic appearance of this lesion was reminiscent of the peripheral giant cell granuloma and giant cell variant of malignant fibrous histiocytoma, also termed malignant giant cell tumor of soft parts. Particularly skin lesions, clinicopathologic correlation is important. Appropriately as can be much easier to diagnose.

Variation in myxoid liposarcoma: Clinicopathological examination of four cases with detectable TLS-CHOP or EWS-CHOP fusion transcripts whose histopathological diagnosis was other than myxoid liposarcoma

Liposarcomas are separated into clinicopathological entities by a characteristic morphological spectrum and distinctive genetic changes. Myxoid liposarcoma (MLS) represents one such entity with specific chromosomal translocations leading to the generation of fusion genes, the human translocation liposarcoma (TLS)-CCAAT/enhancer binding protein (C/EBP) homologous protein (CHOP) or the Ewing sarcoma (EWS)-CHOP. In the present study, four cases of liposarcoma with detection of TLS-CHOP or EWS-CHOP, whose postoperative diagnosis was other than MLS (one well-differentiated liposarcoma, two de-differentiated liposarcomas and one unclassified) were examined for medical records, imaging data and histopathology. Clinical records demonstrated that three of the four cases were considerably difficult to diagnose definitively, and histopathological re-examination pointed out areas of myxomatous change as a minor component (<10%). Their dominant components (>90%) resembled pleomorphic sarcoma, pleomorphic malignant fibrous histiocytoma and monophasic synovial sarcoma. The current cases may represent an extreme variant of the morphological spectrum within MLS. In cases of difficulty in making definitive diagnosis of soft tissue sarcoma by standard histopathological examination and identification of myxoid stroma even as a minor component, analyzing TLS-CHOP and EWS-CHOP fusion genes may aid the diagnosis of unusual MLS.

Automated Brightfield Dual-Color In Situ Hybridization for Detection of Mouse Double Minute 2 Gene Amplification in Sarcomas

The human homolog of the mouse double minute 2 (MDM2) oncogene is amplified in about 20% of sarcomas. The measurement of the MDM2 amplification can aid in classification and may provide a predictive value for recently formulated therapies targeting MDM2. We have developed and validated an automated bright field dual-color in situ hybridization application to detect MDM2 gene amplification. A repeat-depleted MDM2 probe was constructed to target the MDM2 gene region at 12q15. A chromosome 12-specific probe (CHR12) was generated from a pα12H8 plasmid. The in situ hybridization assay was developed by using a dinitrophenyl-labeled MDM2 probe and a digoxigenin-labeled CHR12 probe on the Ventana Medical Systems' automated slide-staining platforms. The specificity of the MDM2 and CHR12 probes was shown on metaphase spreads and further validated against controls, including normal human tonsil and known MDM2-amplified samples. The assay performance was evaluated on a cohort of 100 formalin-fixed, paraffin-embedded specimens by using a conventional bright field microscope. Simultaneous hybridization and signal detection for MDM2 and CHR12 showed that both DNA targets were present in the same cells. One hundred soft tissue specimens were stained for MDM2 and CHR12. Although 26 of 29 lipomas were nonamplified and eusomic, MDM2 amplification was noted in 78% of atypical lipomatous tumors or well-differentiated liposarcomas. Five of 6 dedifferentiated liposarcoma cases were amplified for MDM2. MDM2 amplification was observed in 1 of 8 osteosarcomas; 3 showed CHR12 aneusomy. MDM2 amplification was present in 1 of 4 chondrosarcomas. Nine of 10 synovial sarcomas displayed no evidence of MDM2 amplification in most tumor cells. In pleomorphic sarcoma, not otherwise specified (pleomorphic malignant fibrous histiocytoma), MDM2 was amplified in 38% of cases, whereas 92% were aneusomic for CHR12. One alveolar rhabdomyosarcoma and 2 embryonal rhabdomyosarcomas displayed low-level aneusomy of CHR12 without net MDM2 amplifications. These results show that the use of the ISH MDM2 and CHR12 assay allows simultaneous analyses of the 2 DNA targets within the context of tissue morphology. This method combines the advantages of a fully automated protocol with bright field microscopy and has the potential for routine application in surgical pathology.

Malignant Fibrous Histiocytoma Originating in the Short-term after Excision

MFH is rare with just a few thousand cases diagnosed each year. We report a case of right flank malignant fibrous histiocytoma (MFH) in the short-term after tumor excision. A 47-year-old woman visited hospital after being diagnosed with MFH. Resection margin was positive, so we planned for wide excision. While awaiting surgery, 1.5 ㎝ sized new mass occurred adjacent to the incision site. The patient underwent wide excision. Postoperative pathologic findings observed a 1.0 ㎝ diameter mass with infiltrative borders in the subcutaneous fat. It was composed of spindle or epithelial cell showing severe polymorphism. Many mitotic cells were observed including atypia. In immunohistochemical study, tumor cells were negative for smooth muscle actin, desmin, myoglobin, S100, cytokeratin, and positive for CD68, and thus diagnosed as pleomorphic MFH. With the purpose of improving local tumor control, radiation therapy was performed after wide excision.