Undifferentiated Pleomorphic Sarcoma in Mandible

Malignant fibrous histiocytoma of the mandible: A rare case report with diagnostic challenge and treatment approach

Malignant fibrous histiocytoma (MFH), now termed undifferentiated pleomorphic sarcoma (UPS), is a high-grade tumour, mostly affecting the extremities and retroperitoneum. It is a rare entity in the mandible. After a literature search in the PubMed database, only 15 cases have been reported, indicating how uncommon it is in the mandible. In this instance, we document an unusual occurrence of MFH, affecting the mandible in a 37-year-old male patient. Histopathology of the biopsy specimen along with the strong positivity to immunohistochemical markers such as Vimentin and CD68 confirmed the diagnosis of MFH. It is a rare entity presenting diagnostic and therapeutic challenges requiring a multidisciplinary approach for optimal management and treatment.

A Rare Entity of Undifferentiated Pleomorphic Sarcoma of the Mandible - A Case Report

The Rationale:

Undifferentiated pleomorphic sarcoma originally known as malignant fibrous histiocytoma was declassified by the World Health Organization in 2002 as a formal diagnostic entity and renamed as an undifferentiated pleomorphic sarcoma. It accounts for <1% of malignant tumours of the long bone.

Patient Concerns:

A 33-year-old male patient reported with swelling and pain in the lower left posterior jaw region for 3 months with a history of fall on the floor 3 months back.

Diagnosis:

On examination, diffuse solitary swelling was present on the left lower third of the face and was diagnosed radiographically and histopathologically as undifferentiated pleomorphic sarcoma of the mandible.

Treatment and Outcomes:

Selective neck dissection, followed by reconstruction with fibula osteomyocutaneous flap and then referred for adjuvant radiotherapy.

Take-away Lessons:

Vimentin staining plays a substantial role in the diagnosis of undifferentiated pleomorphic sarcoma. A long-term follow-up after treatment is required to increase the chances of disease-free survival for the patients.

Secondary undifferentiated pleomorphic sarcoma of the mandible in a HIV patient who underwent radiotherapy for oral carcinoma

Undifferentiated pleomorphic sarcoma (UPS), also defined malignant fibrous histiocytoma (MFH), is one of the most common sarcomas affecting soft tissues in adults, but it can also arise as a primary tumor in bone. UPS is extremely uncommon in the lower jaw and presents very aggressive clinical behavior with high rate of local recurrences and frequent metastases. Secondary UPS are even rarer than primary forms, and they are usually closely associated with local trauma or radiotherapy. This case report aims at illustrating a rare case of secondary UPS of the mandible in an 81-year-old male affected by HIV, maxillary oral squamous cell carcinoma (and mandibular recurrence), and who underwent head and neck radiotherapy. The complete immunohistochemical pattern of the lesion is reported. Due to his medical history and systemic status, the patient has been considered not eligible for further surgical procedures nor radiotherapy. Therefore, a palliative care treatment has been scheduled.

Malignant fibrous histiocytoma - a case report

Fibrous histiocytoma is a mesenchymal neoplasm with benign and malignant varieties. This tumor mainly affects the skin of extremities in adults and may on rare occasions affect the oral cavity. The tumor has radiographic features in very rare cases. The present case report aims to conduct a clinicopathological-radiographic and immunohistochemical assessment and treatment of a patient with this lesion.

Undifferentiated pleomorphic sarcoma of the mandible

Undifferentiated pleomorphic sarcoma (UPS) is a high-grade neoplasm that is usually located in the extremities and retroperitoneum. In the past, UPS was considered the most common soft tissue sarcoma in adults; due to improvements in diagnostic techniques, most cases have been reclassified as other lineage-specific tumors. Gnathic bones are rarely affected, and the clinicopathological characteristics of this neoplasm when diagnosed in the jaw remain to be better described. In this report, we present a rare case of mandibular UPS affecting an 88-year-old female who demonstrated a painful swelling on the right side of the mandible that was accompanied by a pathological fracture. Microscopic examination revealed a pleomorphic spindle-cell neoplasm with mitotic figures and necrosis. The patient underwent surgery and adjuvant radiotherapy but experienced metastasis after 12 months of follow-up and died. Diagnosis of UPS is challenging, and oral pathologists must be aware of this entity when dealing with aggressive undifferentiated neoplasms.

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.