Chemotherapy of malignant fibrous histiocytoma: a Southwest Oncology Group report

Pleomorphic type undifferentiated gastric sarcoma, report of a case

Reports on pleomorphic type of undifferentiated sarcoma (PUS) originating from the gastrointestinal tract, especially the stomach, are extremely rare. We herein report a case of pleomorphic type undifferentiated gastric sarcoma. The patient was a 67-year-old woman. The chief complaint was upper abdominal pain. Upper gastrointestinal endoscopy, ultrasonography, and contrast-enhanced computed tomography showed two submucosal tumors at the greater curvature of the fundus and the lesser curvature of the gastric angle. Endoscopic ultrasound-guided fine-needle aspiration revealed a c-kit-negative spindle cell tumor at the greater curvature of the fundus. Total gastrectomy, splenectomy, and partial resection of the diaphragm and liver were performed. One lesion had invaded the lateral segment of the liver, left diaphragm and spleen. The postoperative course was uneventful. Histopathological and immunohistochemical examinations of the resected specimen revealed PUS. Peritoneal dissemination was detected at 8 months after surgery. However, no effective therapeutic agents were adopted for chemotherapy. The patient had poor performance status due to disease progression and underwent best supportive care. The patient died 10 months after surgery. This case highlights the imaging, histological diagnosis, and treatment strategy for PUS originating from the stomach. Surgeons should be aware of PUS as a differential diagnosis in cases with submucosal tumor of the stomach.

Primary pulmonary undifferentiated pleomorphic sarcoma: A rare malignant lung tumor

ABSTRACT

Undifferentiated Pleomorphic Sarcoma (UPS) is a common soft tissue sarcoma that can develop in various organs, but lung involvement is usually due to metastasis. UPS originating primarily in the lungs is called primary pulmonary undifferentiated pleomorphic Sarcoma (PPUPS) and is exceptionally rare. It is a high-grade pleomorphic neoplasm with no identifiable lines of differentiation. Thus, it is essentially a diagnosis of exclusion that requires extensive clinical, radiographic and histopathological evaluation. Herein we report the case of a 49-year-old gentleman who presented with anemia and weight loss and was found to have a large right lung mass. The lesion was diagnosed as PPUPS after detailed histopathological, immunohistochemical and molecular analysis and exclusion of a possible extrapulmonary origin.

Comparison of Features and Outcomes of Undifferentiated Pleomorphic Sarcoma of Bone and Soft Tissue

BACKGROUND

This investigation compared outcomes of patients with undifferentiated pleomorphic sarcoma of soft tissue (UPS-S) to UPS of bone (UPS-B).

METHODS

The Surveillance, Epidemiology, and End Results database was reviewed from 1975-2016. Disease-specific survival (DSS) was estimated using Kaplan-Meier, and a multivariable Cox regression model identified factors prognostic of DSS. The UPS-S cohort consisted of 4529 patients and the UPS-B cohort consisted of 200 patients. The smaller UPS-B cohort was bootstrapped to create a size-matched cohort of 4500 patients.

RESULTS

The median age of patients with UPS-S was 67 (54;78) y compared to 55 (40;69) y for UPS-B patients (P < 0.001). For UPS-S, the median DSS was 317 mo compared to 70 for UPS-B (P = 0.020). On multivariable analysis for UPS-S, age (HR, 1.018; 95% CI, 1.01-1.03; P < 0.001), non-extremity tumors (HR, 1.490; 95% CI 1.14-1.95; P = 0.004), and AJCC Stage III (HR, 2.238; 95% CI 1.2-4.17; P = 0.011), and Stage IV (HR, 9.388; 95% CI 4.69-18.79; P < 0.001) disease were negative prognostic factors, while surgery (HR 0.234; 95% CI, 0.16-0.34; P < 0.001) was a positive prognostic factor. For UPS-B, tumor size > 8 cm (HR, 3.101; 95% CI, 1.09-8.75; P = 0.033) was the only prognostic factor identified.

CONCLUSIONS

The current study found a strong association between surgery and survival for UPS-B patients on a univariable analysis, but no treatment type was associated with survival in a multivariable model. Further research is needed to reliably inform the optimal treatment of these patients.

Successful Multidisciplinary Treatment for Aggressive Primary Pulmonary Undifferentiated Pleomorphic Sarcoma

Undifferentiated pleomorphic sarcoma (UPS) was previously known as malignant fibrous histiocytoma (MFH). This sarcoma occurs preferentially in the extremities and retroperitoneal space; primary pulmonary UPS/MFH is rare. We report a 52-year-old woman referred to our hospital with dyspnea and severe cough. Chest computed tomography (CT) revealed a pulmonary mass in the left upper lobe and pleural effusion. Cytology of the effusion showed no malignancy; however, the tumor increased rapidly in size, and the patient's respiratory symptoms worsened. The tumor occupied almost all of the left upper lobe and involved the adjacent pericardium. She underwent left upper lobectomy with pericardial resection and reconstruction. Postoperative pathology of the resected specimen showed undifferentiated pulmonary sarcoma, pT4N0M1a stage IV A, and genetic analyses revealed the v-Ki-ras2 Kirsten rat sarcoma viral oncogene homolog (KRAS) mutation. The patient's dyspnea recurred 1 month postoperatively, and CT showed marked pleural effusion. An 18F-fluorodeoxyglucose positron emission tomography demonstrated abnormal diffuse accumulation of 18F-fluorodeoxyglucose in the left pleural cavity. We initiated five cycles of chemotherapy with doxorubicin and ifosfamide, and the patient has been well without recurrence for 24 months after multidisciplinary treatment with surgery followed by systemic combination chemotherapy. We successfully treated our patient with primary pulmonary UPS/MFH using a multidisciplinary approach, even though this sarcoma carries a poor prognosis and is insensitive to both chemotherapy and radiotherapy.

PET in the Diagnostic Management of Soft Tissue Sarcomas of Musculoskeletal Origin

Soft tissue sarcomas (STSs) account for less than 1% of adult solid tumors and about 7% of pediatric malignancies, causing 2% of cancer-related deaths. With the advent of PET-computed tomography (CT), the value of (18) fluorine-2-fluoro-2-deoxy-d-glucose (FDG) PET imaging to improve the management of STSs has been explored. FDG PET imaging has been found useful in restaging and treatment response assessment. This article reviews current knowledge and application of FDG PET-CT in initial diagnosis, staging, restaging, treatment response monitoring, and prognosis, with a brief overview of the most common histologic subtypes of STS.

Primary Chemotherapy and Delayed Surgery for Malignant Fibrous Histiocytoma of Bone in the Extremity

Between March 1983 and September 1988, 22 patients with non-metastatic malignant fibrous histiocytoma MFH of bone of the extremities were treated with two regimens of neoadjuvant chemotherapy successively activated. Preoperatively, the patients received moderate doses of methotrexate and cisplatinum-Regimen 1- or high dose methotrexate, cisplatinum and adriamycin-Regimen 2. Cisplatinum was delivered intra-arteriously, the other drugs intravenously. Limb salvage surgery was performed in 20 patients, and 2 patients were amputated. The surgical margins were adequate (radical or wide) in 18 cases and inadequate (marginal) in 4. The histologic response to chemotherapy was good (90% or more tumor necrosis) in 8 patients. In both regimens postoperative chemotherapy was tailored according to the grade of necrosis determined by preoperative treatment on the primary tumor. At an average follow-up of 40 months (15-70), 15 patients (68%) remained continuously disease-free and 7 relapsed with metastases. No local recurrences were observed. Regimen 2 was slightly more effective than Regimen 1 in terms of good histologic response (5/10 vs 1/12) and continuous disease-free survival (8/10 vs 7/127). The results demonstrate that, as in osteosarcoma, in non-metastatic malignant fibrous histiocytoma of bone in the extremities a high percentage of patients can be cured with neoadjuvant chemotherapy and that in most of them limb sparing surgery is possible and safe.

Evaluation of prognostic factors in localized high-grade undifferentiated pleomorphic sarcoma: report of a multi-institutional experience of Anatolian Society of Medical Oncology

Most data on prognostic factors for patients with high-grade undifferentiated pleomorphic sarcoma (HGUPS) is obtained from analyses of soft tissue sarcomas. The purpose of this study was to evaluate the clinicopathologic features and their impact on outcomes specifically in patients diagnosed with HGUPS. In this multicenter trial, we retrospectively analyzed 112 patients who were diagnosed and treated at 12 different institutions in Turkey. We collected data concerning the patients, tumor characteristics, and treatment modalities. There were 69 males (61.6 %) and 43 females (38.4 %). Median age was 56 years (19-90). The most common anatomic site of tumor origin was the upper extremity. Pleomorphic variant was the predominant histological subtype. Median tumor size was 8.2 cm (0.6-30 cm). Tumors were mainly deeply seated (57.1 %). Fifty-seven patients (50.9 %) were stage II and the remainder were stage III at the time of diagnosis. Median follow-up was 30 months (2-160). The primary site of distant metastasis was the lung (73.5 %) and the second most common site was the liver (11.7 %). The 5-year overall survival, distant metastasis-free survival, and local recurrence-free survival rates were 56.3, 53.4, and 67.2 %, respectively. Multivariate analysis showed that Eastern Cooperative Oncology Group (ECOG) performance score of II (p = 0.033), deep tumor location (p = 0.000), and development of distant metastasis (p = 0.004) were negatively correlated with overall survival, and perioperative radiotherapy and negative microscopic margins were significant factors for local control rates (p = 0.000 for each). Deep tumor location (p = 0.003) was the only adverse factor related to distant metastasis-free survival. Deep tumor location, ECOG performance score of II, and development of distant metastasis carry a poor prognostic implication on overall survival. These will aid clinicians in predicting survival and treatment decision.

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

We report a 44-year-old woman with a malignant fibrous histiocytoma (MFH) of the kidney. Primary renal MFH is an extremely rare tumor with a poor prognosis. Renal MFH is differentiated from renal cell carcinoma, renal sarcoma, and sarcomatoid renal tumors only by histological and immunohistochemical studies. Because the therapeutic options for MFH are different, its early diagnosis is imperative.

Primary Malignant Fibrous Histiocytoma in Mediastinum: Imaging with (18)F-FDG PET/CT

Malignant fibrous histiocytoma (MFH) is the most common soft tissue tumor which often occurs in the extremities and the retroperitoneum. Primary mediastinal MFH is rare; thus, findings on (18)F-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) of mediastinal MFH have not been reported yet. We report herein the case of a 64-year-old man who was presented with a superior mediastinal mass. The mass showed intense (18)F-FDG uptake with central metabolic defect on PET/CT. The maximum standardized uptake value was 17.4. After tumor removal via median sternotomy, an MFH of the storiform-pleomorphic type was diagnosed on histopathologic examination. We present the first report of (18)F-FDG PET/CT imaging of MFH in the superior mediastinum.

A case of primary malignant fibrous histiocytoma of the duodenum

BACKGROUND

Primary malignant fibrous histiocytoma (MFH) of the duodenum is rare and a distinct clinical entity.

CASE REPORT

A 55-year-old man presented with a history of upper gastrointestinal bleeding, vomiting and decreased body weight over the past 2 months. Abdominal exam showed an epigastric mass of 10 cm. An upper gastrointestinal endoscopy documented a tumor in the third part of duodenum. The histopathological examination of biopsy has concluded a MFH. Abdominal CT revealed a large and heterogeneous mass of 10 cm in the third part of the duodenum. The intervention was conducted by way of a bi-subcostal laparotomy. Exploration of the tumor revealed involvement of the third part of duodenum. This lesion adhered and invaded the inferior vena cava. A palliative procedure using a gastro-entero-anastomosis was carried out with uneventful postoperative course. Neither adjuvant chemotherapy nor radiotherapy were conducted. The patient died four months following his operation.

CONCLUSION

The biological behavior of malignat fibrous histiocytomas is extremely aggressive and mainly conditioned by size and histological grading. The treatment of choice, whenever possible, is based on early and complete surgical excision of the tumor.

Benign fibrous histiocytoma of larynx: A rare cause of acute airway obstruction

Fibrous histiocytoma of larynx is a rare entity. We herein present a 35-year-old femaleof benign fibrous histiocytoma oflarynx with severe airway obstruction that requiring urgent endotracheal intubation followed by tracheostomy. We also report the good long-term survival of this case after such a critical condition.

Successful treatment of malignant fibrous histiocytoma originating in the chest wall: report of a case

Malignant fibrous histiocytoma (MFH) rarely originates in the chest wall, so its clinical features are not well defined. We report a case of MFH that recurred locally 3 years after primary resection. The patient, a 59-year-old woman, underwent wide excision, and is alive without recurrence 7 months after the operation. We reviewed the clinical features and treatment strategies of the total 39 cases of MFH originating in the chest wall reported from Japan. The fact that all patients who underwent wide excision with negative margins at the primary operation were alive without recurrence at the time of each report, despite a local recurrence rate as high as 40%, shows the importance of this operative strategy. Thus, early diagnosis of MFH of the chest wall is essential for improving the outcome of these patients. Neoadjuvant chemotherapy plus radiation therapy may be worthwhile for patients with advanced disease.

Primary malignant fibrous histiocytoma of the small bowel: a report of an additional case in duodenum

AIMS

We report herein an additional case of primary malignant fibrous histiocytoma (MFH) in the duodenum and provide a review of the existing literature.

METHODS AND RESULTS

A 61-yr-old Chinese man was admitted to our hospital with symptoms of melena, anorexia, and weight loss. An abdominal computed tomography (CT) and gastrointestinal barium meal examination demonstrated a tumor of the duodenum suggestive of primary malignancy. The tumor was successfully treated by pancreaticoduodenectomy. It was histopathologically and immunohistochemically diagnosed to be a storiform-type primary MFH of the duodenum. There have been a total of 40 cases of primary malignant fibrous histiocytoma of the small bowel documented in the literature including our Chinese cases.

CONCLUSION

Primary malignant fibrous histiocytoma of the small bowel, especially in the duodenum is extremely rare. The final diagnosis is made only after pathological and immunopathological examination of the tumor. The malignant potential of such tumors is high. The prognosis may be mainly dependent on the invasion and metastasis of tumor, while tumor size is irrelevant. The treatment should be surgery if possible. Early surgical intervention may be the best form of management that may offer the patient good result.

Benign fibrous histiocytoma of the pterygopalatine fossa with intracranial extension

A very rare case of fibrous histiocytoma arising in the pterygopalatine fossa with intracranial extension is described. Despite the histologic absence of nuclear pleomorphism, the tumor rapidly recurred after complete surgical resection. The patient, a 45 year old male, died shortly thereafter. The aggressive nature of our patient's tumor confirms previous observations that an aggressive radiographic appearance has prognostic value when dealing with skeletal and soft tissue tumors. The benefit of multimodal therapy has not been established in these rare head and neck lesions. In the subset of fibrous histiocytomas that invade bone, however adjunctive treatment with radiation and or chemotherapy may be appropriate.

Malignant fibrous histiocytoma of the trachea

We experienced a rare case of malignant fibrous histiocytoma (MFH) arising in the trachea. A 24-year-old man with severe dyspnea had a well-defined mass in the cervical trachea on chest X-ray examination. Chest computed tomography showed a 2.0-cm diameter mass originating in the right-posterior wall of the trachea. The tumor occupied over 90% of the lumen. A radical excision of the tumor (tracheal resection) with tracheal plasty was performed. The microscopic diagnosis was MFH. The patient remains well, without evidence of recurrence, 3 months after surgery.

Malignant Fibrous Histiocytoma of the Hypopharynx: A Case Report in a Young Adult

This is the first case report of malignant fibrous histiocytoma of the hypopharynx in a young adult with preservation of the larynx. Although the initial histopathological diagnosis of the biopsy was benign fibrous histiocytoma, subsequent histopathological evaluation of the surgical specimen was malignant fibrous histiocytoma. Thereafter, re-excision of the histiocytoma with a wide margin was performed coupled with reconstruction of the hypopharynx while preserving the larynx. We also report the good long-term survival of this case of low-grade type of malignant fibrous histiocytoma.

Malignant fibrous histiocytoma of the parotid gland

Primary malignant fibrous histiocytoma (MFH) arising in a major salivary gland is rare. We encountered a case of MFH affecting the parotid gland. The patient was a 54-year-old man diagnosed as having pleomorphic type of MFH after extended total parotidectomy. Examination of the resected specimen revealed the tumor had not been completely removed. Accordingly treatment consisted in the resection of MFH and radiotherapy in combination with chemotherapy using carboplatin (CBDCA). This postoperative therapy was effective in controlling the growth of the remaining tumor tissue. As the patient showed no signs of local recurrence and distant metastasis for 5 years, plastic surgery was performed to improve the serious deformation of the face with a free anterolateral thigh flap. Our literature review yielded 17 cases of parotid MFH and the 2-year survival rate was 33%.

Malignant fibrous histiocytoma in the anterior mediastinum

The origin of a malignant fibrous histiocytoma in the anterior mediastinum is rare. A 71-year-old man was referred to our department for treatment of a tumor 15 cm in diameter originating in the anterior mediastinum. Malignant fibrous histiocytoma was suspected after a percutaneous needle biopsy. Systemic screening showed no other organ involvement, and the tumor was considered to be a primary mediastinal tumor. The tumor, resected through a median sternotomy, was well encapsulated and resection was complete. The pathological diagnosis was malignant fibrous histiocytoma originating in the anterior mediastinum.

Malignant Fibrous Histiocytoma Arising in the Upper Posterior Triangle of the Neck

We describe the case of a 59-year-old man who came to us with a right neck mass of 4 to 5 months’ duration. A histologic diagnosis of malignant fibrous histiocytoma was made, and the patient underwent wide local excision and neck dissection followed by postoperative radiation therapy. We briefly discuss the characteristics and treatment of this rare entity.

Radiographic evaluation of malignant fibrous histiocytoma affecting maxillary alveolar bone: a report of 2 cases

OBJECTIVE

The purpose of this study was to evaluate the radiographic findings of malignant fibrous histiocytoma (MFH) and to discuss the contribution of these findings to a differentiation of MFH from other malignant tumors of the head and neck.

STUDY DESIGN

Two cases of MFH of the maxillary sinus affecting the alveolar bone were evaluated radiographically and scintigraphically.

RESULTS

We reported the following findings, which have only seldom been described: the presence of fairly well-demarcated bone destruction in the intraoral radiograph; the relatively smooth surface, uniform density, or no necrotic area of the tumor; in computed tomograph images showing the clear separation of the tumor from surrounding soft tissues; bone scintigraphs reflecting the periosteal reaction to tumor invasion; and lymphoscintigraphy of the metastatic lymph nodes.

CONCLUSION

We evaluated the radiographic findings from 2 cases of MFH and describe findings that may aid in the differentiation of MFH. These radiographic features may help dentists differentiate MFH from other malignant tumors in the head and neck, although MFH is a rare disease and there are no radiographic findings that would indicate a specific diagnosis of MFH.

Intracranial meningeal malignant fibrous histiocytoma mimicking parasagittal meningioma--case report

A 69-year-old female presented with a rare intracranial meningeal malignant fibrous histiocytoma (MFH). The neuroimaging appearance of this tumor was very similar to parasagittal meningioma. The tumor was grossly totally removed, and local irradiation of 50 Gy was performed. The histological diagnosis was MFH. The patient recovered from the preoperative deficits, and no recurrence was observed by 27 months after surgery.

[Malignant fibrohistiocytoma of the bladder]

We report on new case of a rare vesical tumour. We result the importance of immunohistochemistry and ultrastructural study to support the diagnosis of malignant fibrous histiocytoma of the urinary bladder. There has been described another 16 cases of this tumour in the literature, however, only four of them -five with ours- reports an extensive immunohistochemical and ultrastructural study. The rarity of vesical localization of this tumour may delay its diagnosis. It must be supported by a immunohistochemistry and/or ultrastructural study, in order to differentiate from other tumours with fibrohistiocytoma-like pattern: leiomyosarcoma and sarcomatoid carcinoma of the bladder. After radical removal of tumour, adjuvant therapy is recommended both systemic chemotherapy and local radiotherapy, although survival rates are over 5.3 months after first therapeutical actuation.

Primary malignant fibrous histiocytoma of the ascending colon: report of a case

We report herein an unusual case of primary malignant fibrous histiocytoma (MFH) of the ascending colon. A 47-year-old man was admitted to our hospital for further investigations following the discovery of a mass in the right lower quadrant of the abdomen during a medical checkup. Abdominal ultrasonography (US) and computed tomography (CT) demonstrated a mass extending to the right lateral side from the ascending colon. At laparotomy, a tumor was found originating in the ascending colon and infiltrating the right lateral peritoneum. A right hemicolectomy and partial peritoneal dissection were performed followed by an ileotransverse colostomy reconstruction. The resected specimen contained a tumor measuring 7 x 5 x 4 cm, the cut surface of which was yellowish white, and the mucosa of the colon was intact. Based on histological and immunohistochemical inspection, the tumor was diagnosed as MFH of the ascending colon. We reviewed the total 18 known cases of colorectal MFH documented in the literature including our case. After surgery, 4 of 17 patients died of local recurrence, all within 42 months, indicating that early and complete excision of tumor is essential to achieve cure.

Malignant fibrous histiocytoma: a method to control intraoperative hemorrhage by clamping the feeding arteries

Malignant fibrous histiocytoma (MFH), also referred to in the past as malignant fibrous xanthoma and fibroxanthosarcoma, is a tumor of mesenchymal tissue origin. A case of retroperitoneal MFH was reported. In this paper, we describe a method of hemostasis and intraoperative control of hemorrhage during resection of retroperitoneal MFH by snaring the feeding arteries. The patient was successfully operated on using this technique.

Fibrous histiocytoma of the larynx

We present a case of fibrous histiocytoma of the larynx in a young female who presented eight years ago and is still alive and well with no evidence of any regional invasion or distant metastasis. This rare lesion has been described in 30 cases previously of which 26 were malignant and four benign. Our case is unusual in a sense that histologically it has not been possible to determine its exact biological behaviour and growth potential. However, clinically it behaved as a low-grade malignant tumour.

Resection of malignant fibrous histiocytoma invading the thoracic aorta

We report a case of surgically resected malignant fibrous histiocytoma which arose in the posterior mediastinum. Tumor removal with the required sufficient-margin and the resection of the affected thoracic aorta, led to flaccid paraplegia below the tenth thoracic level. This patient is now surviving with no evidence of recurrence at 42 months after the operation. Although malignant fibrous histiocytoma in the thorax generally shows a poor prognosis, this patient with complete resection could have a relatively long survival.

Malignant fibrous histiocytoma originating from the chest wall: report of a case and collective review of cases

Malignant fibrous histiocytomas occur principally as a mass of the extremities, abdominal cavity, or retroperitoneum in adults. However, they only rarely occur in the chest wall. A rare case of primary malignant fibrous histiocytoma originating from the chest wall is herein presented. The 36 previously reported cases are also reviewed. Of the 32 patients who underwent a resection as the initial treatment, 10 (31.3%) had a local recurrence. Of the 37 patients with this disease, 9 (25.0%) had subsequent metastases. The majority of the deaths (36.1%) from this disease occurred within the first 12 months. The patients who undergo surgical and adjuvant therapy must therefore be monitored carefully by frequent examinations.

Primary malignant fibrous histiocytoma of the descending colon

We herein present the case of a 50-year-old woman with malignant fibrous histiocytoma arising from the descending colon and localizing in the colonic wall. Malignant fibrous histiocytoma of the large bowel is a very rare tumor. A total of 18 cases, including our case, have been reported in the world medical literature so far and we also reviewed these cases. In our case, combined adjuvant chemotherapy was administered after a complete resection had been performed. No clinical signs of local recurrence or distant metastasis were found at 7 years after the operation.

Primary malignant fibrous histiocytoma of the lung in a child: a case report and review of literature

Malignant fibrous histiocytoma (MFH), an aggressive high-grade soft tissue sarcoma, usually occurs in the elderly during the fifth to seventh decade of life. It commonly arises in the retroperitoneum, extremities, and head and neck region. Primary pulmonary MFH is extremely rare and is frequently fatal. We present the youngest known case, a 9-year-old boy with a primary left lung grade II inflammatory MFH, stage II. He underwent a left upper lobectomy for tumor resection. After completing radiation therapy, he was started on vincristine, actinomycin D, and cyclophosphamide alternating with vincristine, doxorubicin, and cyclophosphamide every 3 weeks. After five such cycles, he had a histologically proven local recurrence. He then received chemotherapy consisting of ifosfamide (2 g/m2) and etoposide (VP-16) (100 mg/m2) given daily for 3 days every 3 weeks. The patient attained complete remission (CR) after five such cycles and completed treatment without any major complications. He received a total of 16 courses and is continuing in CR 36 months off treatment. Ifosfamide and etoposide (VP-16), known for their usefulness in treatment of adult soft tissue sarcomas, can be used as salvage chemotherapy for patients with MFH who fail the front-line conventional chemotherapy.

Malignant Fibrous Histiocytoma of the Heart: Case Report and Literature Review

A case report of a 57-year-old woman with malignant fibrous histiocytoma of the heart is presented. The clinical presentation was suggestive of a benign atrial myxoma. Careful pathologic study is necessary to differentiate the myxoid variant of malignant fibrous histiocytoma of the heart from the more common benign atrial myxoma. Usually, the evolution of malignant fibrous histiocytoma of the heart is rapidly fatal. Clinical aspects of this patient's case are discussed in conjunction with a review of the available literature.

Proliferating cell nuclear antigen staining as a prognostic indicator in soft-tissue malignant fibrous histiocytoma

To determine the value of proliferating cell nuclear antigen (PCNA) staining as a prognostic indicator in soft-tissue malignant fibrous histiocytoma (MFH), we studied 27 patients who underwent resection including an adequately wide margin but without chemotherapy. The survival rate of patients with a lesion in which less than 70% of the cells was positively stained was significantly higher (P < 0.01) than of those with more than 70% positive staining. Twenty-two patients (81.5%) evidenced disease-free survival (mean follow-up period 4.6 years), 1 patient was alive with disease, and 4 (14.8%) died of the disease with lung or lymph node metastasis. In all 4 patients who died, PCNA staining was over 70% positive. In 2 of them, an increase in the number of PCNA-positive cells was observed after repeated recurrence. We conclude that PCNA is a useful prognostic indicator which provides a quantitative measure of the grade of malignancy in MFH patients who receive operative treatment without chemotherapy.

Radiation-induced malignant fibrous histiocytoma of the transverse colon: case report and review of the literature

We report the first case, to our knowledge, of a malignant fibrous histiocytoma (MFH) of the transverse colon that seems to have been induced by radiation and we review the 12 other cases of colorectal MFH in the literature. The frequency of recurrence after radical surgery was 33% (4/12), excluding a patient with synchronous liver metastases, during the follow-up periods reported in the literature. The presence of ulceration of the tumor was a factor indicating poor prognosis (P < 0.001). Our patient had local recurrence and peritoneal metastases within only 3 months after curative resection and died 4 months after the initial operation. This case may suggest the necessity of adjuvant chemotherapy or radiotherapy in such patients, although the effectiveness of these methods has not been confirmed.

Malignant fibrous histiocytoma originating in the mediastinum: report of a case

Malignant fibrous histiocytoma (MFH) is a tumor which most often develops in the soft tissues of the extremities and retroperitoneum, but very rarely originates in the mediastinum. We report herein the case of a 63-year-old man who underwent surgical resection of a rapidly growing tumor in the right thoracic cavity which was diagnosed as an MFH of mediastinal origin on the basis of histological findings, the definitive diagnosis ultimately being made by specific immunostaining.

Malignant fibrous histiocytoma of the bladder with focal rhabdoid tumor differentiation

A case of primary malignant fibrous histiocytoma of the bladder is presented. This tumor involving the bladder is rare and the unusual histological features in the present case caused significant delay in accurate diagnosis. Since early diagnosis and aggressive surgical resection are essential to the effective treatment of this neoplasm, physicians should continually bear in mind the possibility of this malignant tumor whenever the pathological diagnosis is inconclusive.

Malignant fibrous histiocytoma of the head and neck

Malignant fibrous histiocytomas are now recognized as the most common soft tissue sarcomas in adults. These tumors involve the head and neck region in 1 to 3% of cases. In this report we describe our experience with two typical and one unusual case of malignant fibrous histiocytoma of the head and neck region. In addition we review the diagnostic and therapeutic aspects of these tumors.

Malignant fibrous histiocytoma in childhood

BACKGROUND

Malignant fibrous histiocytoma (MFH) is a neoplasm of late adult life and often is reported in the pediatric population. It is thought to behave more benignly in children than in adults.

METHOD

Clinical and pathologic features, treatment, and outcome of nine pediatric patients seen at British Columbia's Children's Hospital between 1983 and 1990 were examined. The literature regarding pediatric malignant fibrous histiocytoma was reviewed.

RESULTS

The tumors included one primary renal tumor and two occurring in the orbit after radiation therapy for retinoblastoma during the neonatal period. Histologic examination showed that six tumors had a storiform-pleomorphic pattern, one was myxoid, and two were angiomatoid in type. Six children are alive with a disease-free survival of 20 months to 8 years after surgical resection. Two of these received adjuvant chemotherapy, none had radiation therapy. Three patients have died of disease, two with pulmonary metastases that developed despite multiagent chemotherapy and radiation therapy. Poor outcome was associated with large tumors, deep and proximal location, and the storiform-pleomorphic histologic type with atypical mitoses.

CONCLUSION

Malignant fibrous histiocytoma is similar in children and adults. Surgery is the mainstay of therapy, but the risk of local recurrence and pulmonary metastases indicates the need for adjuvant therapy in selected patients.

Malignant fibrous histiocytoma of the limbs

Between June 1985 and May 1990 we treated 12 patients with malignant fibrous histiocytoma (MFH) of the limbs by a combination of wide excision and adjuvant radiotherapy. The Enneking surgical staging was II in 11 cases and III in 1. There were 6 women and 6 men, with an average age of 54 years. The leg was involved in 8 patients and the arm in 4. Limb salvage was achieved in 10 patients and amputation was performed in 2. All received adjuvant radiotherapy, with an average of 51.5 Gy. In 6 patients adjuvant CYVADIC chemotherapy was administered for an average of 4 cycles. In the other patients this treatment was not tolerated. Local recurrence occurred in 2 patients and metastases to the lung were seen in a further 2. At an average follow-up of 41.3 months, the Kaplan-Meier estimation of 5 year survival was 87.5%, with a 5 year continuous disease-free survival rate of 66.7%.

Malignant fibrous histiocytoma of the maxilla--a report of two cases

Two cases of malignant fibrous histiocytoma of the maxilla are reported. The tumours were excised via a combined temporal and intra-oral approach in order to gain adequate surgical access and minimise the aesthetic deformity. One patient required orbital exenteration.

Malignant fibrous histiocytoma of the pulmonary vein with prolapse through the mitral valve orifice

We present the case of a 33 year old white woman with malignant fibrous histiocytoma arising from the pulmonary vein and prolapsing through the mitral valve, causing acute heart failure. The patient underwent emergency cardiothoracic surgery with resection of the tumour while on cardiopulmonary bypass. The patient's heart failure improved immediately following the resection, demonstrating the benefit of palliative surgery. Adjuvant chemotherapy was recommended and the patient did well for 18 months of follow-up.

Prolonged partial remission of malignant fibrous histiocytoma in posterior mediastinum by immunotherapy

The case of a 16-year-old female patient with the giant cell type of malignant fibrous histiocytoma (MFH) in the left posterior mediastinum is reported. This is a very unusual site for MFH. Immunotherapy induced a prolonged partial remission lasting 15 months with a marked reduction in tumor size. The usefulness of immunotherapy for MFH needs to be evaluated.

Post radiation sarcoma (malignant fibrous histiocytoma) of the cervical spine following ependymoma (a case report)

A case is reported of a 36 y/o man treated with radiation therapy for cervical cord ependymoma who developed malignant fibrous histiocytoma of the cervical spine 15 years later. Pathology revealed the sarcoma adjacent to the recurrent ependymoma. Post-radiation sarcomas following treatment of central nervous system malignancies is discussed.

Malignant fibrous histiocytoma: review and case report

Malignant fibrous histiocytoma (MFH) is a rare tumour of the spermatic cord. We present the second reported case in Australia and review the literature, discussing the recommended management and prognosis of this condition.

Myxoid malignant fibrous histiocytoma of the bladder

Although the most common soft tissue sarcoma of adulthood, malignant fibrous histiocytoma (MFH) is an extremely rare tumor of the urinary bladder. Only three well-documented cases have been reported in the world literature. The patient presented in this report represents the first case of the myxoid variant to develop in the urinary bladder. Whereas all previous patients with MFH of the bladder had intermittent hematuria, this patient's chief complaint was bladder outlet obstruction due to extension of the tumor into the prostate. He was managed with radical cystoprostatectomy, postoperative radiation therapy to the tumor bed, and adjuvant chemotherapy using doxorubicin. The patient tolerated the therapy well and was disease-free at the 3-year follow-up visit. The histogenesis, clinical features, pathologic characteristics, and treatment considerations of this rare bladder tumor are discussed in detail.