Primary Hepatic Malignant Fibrous Histiocytoma Research Articles

Primary hepatic malignant fibrous histiocytoma mimicking hepatocellular carcinoma: A report of two cases.

Malignant fibrous histiocytoma (MFH) is a tumor that occurs throughout the body as a relatively uncommon entity. The current study presents two cases of primary malignant fibrous histiocytoma of the liver. The first case was of a 67-year-old male who exhibited no symptoms or abnormal physical signs, and in whom the lesion was found by ultrasound examination during a routine physical examination. The second case was of a 35-year-old male who presented with persistent malaise, weight loss and intermittent right upper quadrant pain. The presence of liver cirrhosis due to hepatitis B virus, which was identified 10 years previously, and the clinical appearance caused MFH to appear as hepatocellular carcinoma at the time of the initial diagnosis. Abdominal magnetic resonance imaging scans were the main tools of diagnosis, but the MFH mimicked hepatocellular carcinoma due to the similar morphological characteristics, the rare occurrence of MFH and the underlying diseases of the liver. The first patient underwent a complete resection and recovered well, while the second patient underwent palliative treatment due to the large size of the tumor and the obstructive emboli in the portal vein. The diagnoses of the tumors were confirmed as MFH by histopathology and immunohistochemistry.

Clinical characteristics of the primary hepatic malignant fibrous histiocytoma in China: case report and review of the literature

BackgroundA malignant fibrous histiocytoma is a soft tissue tumor that most commonly occurs in the extremities, but rarely involves the liver. The clinical characteristics and therapeutic experiences of primary hepatic malignant fibrous histiocytoma are still limited.MethodsTwo cases of primary hepatic malignant fibrous histiocytoma were analyzed retrospectively, and all the literature concerning primary hepatic malignant fibrous histiocytoma was analyzed.ResultsIn China, a total of 76 cases had been reported, among which 50 were men, with a male to female ratio of 1.9:1. Mean age of the patients was 51.0 years old, and more than 85 percent were older than 40 years. 82.9 percent (63/76) of hepatic MFH were solitary lesions, with tumor size ranging from 2.5 to 23.5 cm (average 10.3 cm). Major clinical presentation (78.4%) was abdominal pain or discomfort, accompanied with some other non-specific symptoms such as malaise, anorexia, weight loss, jaundice and fever, and small cases (14.9%) were asymptomatic. Computed tomography and ultrasound usually revealed the location of lesions. The rate of pre-operative misdiagnosis was extremely high, and 14.9 percent of patients were even misdiagnosed as a benign liver cyst, liver abscess or hematoma. Integrated resection was performed among the most cases (49/68), among which only a few ones (12 cases) were introduced to have no recurrence or metastasis or be still alive with no detail information provided, while among the cases with palliative operation or only a biopsy, the cases that were followed-up all died.ConclusionsHepatic malignant fibrous histiocytoma is a rare malignant mesenchymal tumor. The variable features of clinical presentations and images make the diagnosis difficult. Though the prognosis of primary hepatic malignant fibrous histiocytoma was rather poor, integrated resection might provide a few cases a good opportunity for surviving, suggesting that surgery might be an effective treatment.

Primary malignant fibrous histiocytoma of the liver: CT findings in five histopathological proven patients

To describe imaging features of primary hepatic malignant fibrous histiocytoma (MFH), especially its dynamic enhancement pattern. The CT manifestations of five patients with histopathological proven primary hepatic MFH retrospectively reviewed. Six hepatic masses were detected in the five patients at CT examinations. All tumors were hypodense on plain CT scanning related to adjacent hepatic parenchyma. Five lesions were heterogeneous with predominantly cystic or necrosis areas and one lesion was homogeneous solid. After administration of contrast material, solid components of the four tumors with cystic or necrotic areas and the solid lesion showed a "fast rushing in and washing out" enhancement pattern with marked enhancement at the arterial dominated phase and fast decreasing at the portal vein dominated phase and the delay phase. The remaining one tumor showed slight enhancement of its solid components. Portal lymph node enlargement was observed in one patient and the inferior vena cava was invaded in one patient, respectively. The CT manifestations of primary hepatic MFH are various and nonspecific. A "fast rushing in and washing out" enhancement pattern of MFH in our series has not been reported before. These manifestations could help radiologists to include primary hepatic MFH in the differential diagnosis list.

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.

Characteristics of spiral computed tomography imaging of primary hepatic malignant fibrous histiocytoma.

Primary hepatic malignant fibrous histiocytoma(PHMFH)remains extremely rare with less than 60 cases reported in literature.From October 1999 to May 2008,5 patients with PHMFH had been admitted to Yantai Cancer Hospital,Yantai Yuhuangding Hospital and the First Affiliated Hospital of Wenzhou Medical College,and the results of spiral CT were analyzed.Six tumors were detected,and the maximum diameter of the tumors was more than 8.5 cm.CT plain scanning revealed that all tumors were hypodense,4 patients with tumor necrosis and cystic degeneration,and the tumor in 1 patient wag with homogen density.Enhanced CT scanning showed marked enhancement of the solid component of tumor in 4 patients,slight enhancement in 1 patient,and afast in and fast outsign in 5 patients.Hepatic bile ducts and portal vein were not involved.One patient was with portal lymph node metastasis and 1 with ioferior vena cava involvement.The characteristics of spiral CT imaging of PHMFH include tumor necrosis,cystis and invasion,as well asfast in and fast outsign,which could help to diagnose,although the ultimate diagnosis depends on histopathological examination. Key words: Liver neoplasms; Histiocytoma,malignant fibrous; Tomography,spiral computed

Two Cases of Primary Malignant Fibrous Histiocytoma of the Liver: Immunohistochemical Expression of Ezrin and Its Relationship with Prognosis

Malignant fibrous histiocytoma (MFH) as soft tissue sarcoma would not be especially noteworthy, but primary hepatic MFH reports are extremely rare. Herein, we report ezrin expression in tumor tissues from two primary hepatic MFH cases with different prognoses. Cases 1 and 2 were both women, ages 45 and 70 years, respectively. Case 1 had an 11×10 cm liver tumor in segment (S) 3, and case 2 had two liver tumors, 12×8 cm in S5 and 10×7 cm in S8. Neither had any other systemic tumors. Cases 1 and 2 survived for two year and ten months and for eight and a half months, respectively, after the initial tumor resection. Microscopically, the tumors of these two cases were similar and showed proliferation of atypical cells, including spindle, pleomorphic and multi-nucleated giant cells arranged in storiform, sheet and/or fascicle patterns, with scattered foci of inflammatory cells, indicating MFH. Ezrin expression in tumor tissue from case 1 was sparse, whereas that of case 2 showed strong ezrin expression in many tumor cells. The present results indicate ezrin immunoreactivity in primary hepatic MFH to correlate possible with prognosis, which is consistent with reports on some other types of malignancies.

Primary Hepatic Malignant Fibrous Histiocytoma

Primary hepatic malignant fibrous histiocytoma (MFH) is a rare entity with ill-defined clinicopathologic characteristics. We present the largest series to date (7 cases) of primary hepatic MFH, a systematic review of 27 cases published in the English literature, and an analysis of prognostic factors including ezrin expression. The 2 men and 5 women in our series were 34 to 80 years old (average 61 y) and presented with abdominal pain (6/7), systemic symptoms of low-grade fever, malaise, anorexia and weight loss (4/7), and spiking fever (1/7). One case was an incidental finding. Computed tomography and ultrasound revealed a well-demarcated solitary heterogeneous low-density mass ranging from 5.5 to 20 cm (average 12 cm) in largest dimension (5/7), or multiple small nodules up to 2 cm in diameter (1/7) or a 10 cm multiloculated cystic lesion owing to extensive necrosis (1/7). Histologically, a storiform-pleomorphic pattern with variable degrees of necrosis predominated (6/7). A myxoid pattern was seen in only 1 case and this case lacked necrosis. Lymphoplasmacytic infiltration was seen in 3/7 of the cases. Tumors were grade I (1/7), grade II (2/7), grade III (4/7), stage pT1 (4/7), pT2 (1/7), pT4 (1/7), and pT4, cM1 (1/7) at diagnosis. Three patients with tumor cell ezrin immunoreactivity score >or=1 died of tumor within 1 year. Two patients with tumor cell ezrin immunoreactivity score <1 survived >4 years after surgery. Combined analysis of our series and previously reported cases suggest that primary hepatic MFH possess certain characteristic clinicopathologic features that may help in making the diagnosis and in differentiating it from other more common neoplasms in the liver. The prognosis of hepatic MFH depends primarily on tumor size and stage at the time of diagnosis. Ezrin expression in tumor cells can provide additional prognostic information and may be a potential target for new adjuvant therapies.

Primary hepatic malignant fibrous histiocytoma: a case report and review of the literature.

Primary malignant fibrous histiocytoma (MFH) of the liver remains extremely rare with only several cases having been reported in literature. We report a case of hepatic MFH in a 53-year-old man who presented with upper abdominal pain, and weight loss for one month. Ultrasound and computed tomography (CT) scan showed a large mass with fine tumor vessels over the left lobe of the liver. Histopathological findings indicated a mesenchymal tumor consisting of spindle cells in storiform pattern intermingled with histiocyte-like cells and giant cells. Immunohistochemically, most tumor cells expressed vimentin, alpha-1 anti-chymotrypsin, alpha-1 antitrypsin and CD68. Morphological and immunohistochemical findings support that the tumor should be classified as a primary malignant fibrous histiocytoma. The literatures is briefly reviewed.

Primary malignant fibrous histiocytoma of the liver: imaging features of five surgically confirmed cases.

The purpose of the present study was to describe the various imaging features of primary malignant fibrous histiocytoma (MFH) of the liver, a rare tumor of mesenchymal origin. Sonography (n = 5), computed tomography (CT; n = 5), magnetic resonance (MR) imaging (n = 2), and hepatic arteriography (n = 3) in five patients who underwent partial hepatectomy for tumor resection were retrospectively reviewed and correlated with pathologic findings. All tumors were clearly demarcated from surrounding hepatic parenchyma in sectional imaging with (n = 2) or without (n = 3) a fibrous capsule, which was pathologically verified. Internal architecture of abundant fibrosis, myxoid degeneration, and/or hemorrhagic necrosis reflected the sonographic, CT and MR imaging findings. Marginal tumor staining without definite tumor vasculature was the main feature of hepatic arteriography. There was no intratumoral calcification. All three tumors involving the right lobe of the liver invaded the right hemidiaphragm. Although there were no unique findings of primary hepatic MFH, a combined interpretation of various imaging modalities may elucidate the malignant nature of the tumor.