The histiocyte in radiology; with case reports of retroperitoneal xanthogranuloma and malignant fibrous xanthoma

Benign fibrous histiocytoma involving the ends of long bone

Five bone tumors, previously labelled as benign fibrous histicytoma in our Bone Tumor registry were reviewed. All the cases were reexamined clinically, radiologically, and histologically. Ages of the patients ranged from 17 to 68 years and all tumors involved the epiphysis or epiphysiometaphysis of long tubular bones. A diagnosis of giant cell tumor was suggested from initial radiographs in all cases. Three cases proved to be giant cell tumors of bone after thorough examination of previous histological specimens. In the diagnosis of benign fibrous histocytoma of epiphyseal origin in adults, the possibility of giant cell tumor of bone should always be kept in mind, and painstaking histological examination is required.

The varied radiographic manifestations of retroperitoneal malignant fibrous histiocytoma revealed through 27 cases

Malignant fibrous histiocytoma, a pleomorphic sarcoma, represents the most common soft tissue sarcoma of late adult life. Approximately 15 per cent of the cases of malignant fibrous histiocytoma arise within the abdominal cavity or retroperitoneum. Although tumors in this series arose in many different sites, their proximity to the kidney necessitated a nephrectomy in 44 per cent of the cases (12 of 27). In 3 cases calcification was noted, which varied from a few small speckled areas to extensive large, coarse densities. The masses tended to compress or displace adjacent structures and vessels radiographically. Renal, duodenal and cecal invasion occasionally occurred. Ultrasonically, most tumors were hypoechoic (9 cases), with a few having a mixed pattern (2). On computerized tomography the masses were well circumscribed, with computerized tomography numbers in the range of solid tissue except for a few small areas of decreased density. The vascularity was variable, with 8 tumors being hypovascular and 8 showing a moderate to hypervascular pattern. Interestingly, the tumor derived a part of its blood supply from the renal vasculature in 12 cases (44 per cent). Even though malignant fibrous histiocytoma often was diagnosed incorrectly as an intrarenal or adrenal neoplasm, a cleavage plane usually could be identified between the tumor and the renal parenchyma in 1 of the studies, especially on the angiogram. This finding suggested its extrarenal origin. Knowing the tendency of malignant fibrous histiocytoma to arise from or be physically near the kidney and/or adrenal gland in elderly men may be of some diagnostic value.

Malignant fibrous histocytoma producing spinal cord compression

Three cases of malignant fibrous histiocytoma presented as primary paraspinal tumours causing extradural spinal cord compression. Study of these cases suggests that pain relief is considerable after laminectomy but pain may recur with further tumour growth. Total removal is unrealistic and diagnosis, difficult. The prognosis in terms of continuing neurological deficit after surgery followed by local radiotherapy appears poor.

Malignant (fibrous) histiocytoma of bone--fact or fancy?

Malignant (fibrous) histiocytoma is currently defined as a malignant primary bone tumor that contains a mixture of fibrogenic cells and cells that are histologically similar but which appear to be histiocytic. In this type of histiocytoma the nuclei are often indented; cytoplasm is usually abundant and may be slightly foamy; nucleoli are often large; and multinucleated malignant cells are usually a prominent feature. Many dedifferentiated chondrosarcomas, osteosarcomas, and fibrosarcomas of bone contain areas that resemble what we regard as malignant (fibrous) histiocytoma. When the entirety of a malignant tumor of bone fits the outlined histologic pattern, the designation of malignant (fibrous) histiocytoma seems appropriate. From 158 fibrosarcomas of bone and 962 osteosarcomas of bone in our files, 35 tumors were segregated because they appeared to be properly designated as malignant (fibrous) histiocytoma. A wide age range was represented by affected patients, and a large variety of bones harbored these tumors. Approximately one-third of patients eligible for 5-year follow-up were long-term, symptom-free survivors. Four deaths occurred from the tumor after more than 5 years, and one patient had radiographic evidence of pulmonary metastasis 7 years after amputation. Radiation therapy has been curative in at least two cases. The correct designation for these tumors in the light of current knowledge is malignant tumor, consistent with malignant (fibrous) histiocytoma.

Malignant fibrous histiocytoma with diffuse spinal nerve involvement

Two cases of malignant fibrous histiocytoma in which paraplegia was a major feature are presented. The histological features of the tumours are discussed with particular emphasis on the neural involvement. A brief review of the literature on the subject is included.