Primary intra-abdominal malignant fibrous histiocytoma presenting as pyrexia of unknown origin--report of a case with review of literature

Undifferentiated Pleomorphic Sarcoma Presenting as Abdominal Pain with a Pulsatile Mass

Malignant fibrous histiocytoma (MFH) is a rare tumor that mostly involves adults aged 50 to 70. The most common anatomic location is the lower extremities. MFH of the retroperitoneum usually manifests late in its course and may be initially mistaken with other more common diagnosis. Here, the authors describe a 60-year-old man that was brought to the emergency department with a chief complaint of periumbilical abdominal pain. Our patient presented with symptoms consistent with a symptomatic aortic aneurysm, but a mass was encountered during surgery. In such circumstances the diagnosis of malignant sarcoma must be kept in mind and attempts at full resection with tumor-free margins are necessary.

A new complication of retained surgical gauze: development of malignant fibrous histiocytoma--report of a case with a literature review

Background

Primary visceral malignant fibrous histiocytoma (MFH) is a rare disease, and few cases have been reported in the English literature. However, retained foreign bodies in the abdomen after surgical procedures are important causes of intra-abdominal infections. For legal and ethical reasons, there are few publications in the literature. In this article, we describe for the first time a case of malign abdominal fibrous histiocytoma associated with a surgical sponge forgotten in the abdominal cavity a long time ago.

Case presentation

A 64-year-old male presented to our surgical department with cachexia, abdominal pain, distention and pyrexia of unknown origin. He had a medical history of abdominal surgery for peptic ulcer perforation 32 years ago. Clinical examination revealed fever with a distended and painful abdominal wall. Radiological imaging of the abdomen showed multiple heterogeneous masses in one large cystic cavityalmost completely filling the abdomen. The patient underwent a laparotomy, and interestingly, opening the cyst revealed retained surgical gauze (RSG). The origin of the tumor was the visceral peritoneum, and it was excised totally.

Conclusions

Primary intra-abdominal MFH can present as a complication of long-lasting RSG. Therefore, clinicians must remember this while establishing the differential diagnosis for patients with a history of previous abdominal surgery and presenting with symptoms associated with both the tumor and systemic inflammatory response.

Conservative treatment of malignant fibrous histiocytoma of the kidney: a case report

Primary renal malignant fibrous histiocytoma is an extremely rare disease. There are neither clinical nor radiological signs to distinguish it from the most common renal cell carcinoma. Its prognosis is poor because of its tendency to locally recur and metastasize. Therefore, early diagnosis and proper treatment are very important. We present the case of a 66-year-old woman diagnosed with primary renal malignant fibrous histiocytoma who underwent partial nephrectomy. After 41 months' follow-up, there was no evidence of any recurrence. To our knowledge, this is the first reported case of conservative surgery for this kind of tumor.

Primary malignant fibrous histiocytoma of the abdominal cavity: CT findings and pathological correlation

AIM: To study computed tomography (CT) features of abdominal malignant fibrous histiocytoma (MFH) in various rare locations.

METHODS: We retroprospectively identified cases of MFH involving the abdominal cavity. Particular attention was paid to details regarding imaging features and histological types.

RESULTS: The study population consisted of seven men and one woman, with a mean age of 52.5 years. Seven patients had some physical symptoms, while one was incidentally detected. The sites of origin were liver (n = 3), greater omentum (n = 1), superior mesentery (n = 1), ileum (n = 1), right psoas muscle (n = 1) and right kidney (n = 1). With the exception of the ileum lesion, all were of huge size. The contour of the lesions was more or less clear. Foci of necrosis were present in six lesions (n = 6). On plain CT scan, all lesions were hypo to iso dense. The lesion in the greater omentum was cystic. One lesion (n = 1) showed significant enhancement and the cystic lesion showed mild peripheral enhancement. An abundance of blood vessels surrounding the mass was seen in two lesions (n = 2) and both were of the inflammatory variety. Pathological examination revealed storiform-pleomorphic variety (n = 4), inflammatory variety (n = 3) and myxoid variety (n = 1). Two of the patients with inflammatory MFH had a clinical presentation of fever and one was afebrile, however, blood investigations in all three showed leukocytosis.

CONCLUSION: Primary MFHs of the abdominal viscera and gastrointestinal tract are generally huge soft tissue masses containing areas of low attenuation and mild to moderate contrast enhancement.

Primary intra-abdominal malignant fibrous histiocytoma: a highly aggressive tumor

BACKGROUND AND PURPOSE

Malignant fibrous histiocytoma (MFH) is the most common soft-tissue sarcoma of late adult life occurring predominantly in the extremities. Primary intra-abdominal MFH is a very rare occurrence. The aim of this study is to describe a very rare case of an intra-abdominal MFH with a highly aggressive clinical course.

METHODS

A 67-year-old male was referred to our department with a 2-week history of dull lower abdominal pain and a gradually enlarging right lower abdominal mass, which he first noticed 2 months prior to admission. Computed tomography (CT) scan demonstrated a mass in the right iliac fossa.

RESULTS

On exploratory laparotomy, a tumor was found in the right iliac fossa attached to the parietal lateral peritoneum without any evidence of invasion into the adjacent structures. Complete excision of the tumor with clear margins was performed. Histological and immunohistochemical examinations showed a MFH. One month after surgery, while on adjuvant chemotherapy, the patient was readmitted with dyspnea and a slightly palpable mass in the area of the previous radical resection. CT scan revealed local tumor recurrence along with multiple pulmonary metastatic deposits. Unfortunately, despite treatment, the patient died of progressive disease 5 weeks later.

CONCLUSIONS

Primary intra-abdominal MFH is a very rare but aggressive malignancy with a high tendency of local recurrence and metastatic spread. Early detection and complete surgical excision with clear margins is the treatment of choice. In some cases, however, the tumor can exhibit a highly aggressive clinical course despite radical surgery and adjuvant therapy.