Skull infarction in a patient with malignant fibrous histiocytoma

The authors describe a case of a skull infarction initially suspected to be an isolated, remote metastasis in a patient diagnosed with soft tissue malignant fibrous histiocytoma. Osseous malignant fibrous histiocytoma has been reported to occur within a bone infarction but the presence of a benign bone infarction remote from a soft tissue malignant fibrous histiocytoma has not been reported previously. Bone infarctions and malignant fibrous histiocytomas are briefly reviewed.     

Retroperitoneal malignant fibrous histiocytoma: The angiographic and computed tomographic features of an unusual tumor

Malignant fibrous histiocytomas are uncommon retroperitoneal soft tissue tumors. We report a case of a malignant fibrous histiocytoma of the retroperitoneum that was angiographically hypervascular and indistinguishable from renal cell carcinoma. Computerized tomography of the abdomen demonstrated extensive psoas muscle infiltration by tumor. This feature may be useful in differentiating a renal cell carcinoma from a primary retroperitoneal sarcoma.     

Primary malignant fibrous histiocytoma (fibrous xanthoma) of bone

The probable histiocytic origin of a group of benign and malignant tumors known as histiocytomas or fibrous xanthomas appears to be well established and is based on a combination of conventional light microscopy, tissue culture and ultrastructural studies. Our experience with 23 cases of primary malignant fibrous histiocytoma of bone is presented, together with a review of additional cases documented in the literature. Particular emphasis has been placed on the radiologic aspects of primary malignant fibrous histiocytoma of bone, together with a brief review of its clinical and histologic features. The fact that the skeleton can be involved de novo rather than by direct extension from neighboring soft tissue tumors or by metastatic spread is a relatively new concept.     

Orbital fibrous histiocytoma: computed tomography in 10 cases and a review of radiological findings.

The computed tomographic features of 10 primary and secondary fibrous histiocytomas arising in the orbit are reviewed. Positive factors indicating the diagnosis were absent; orbital enlargement was more common in malignant tumours, but other indications of the degree of malignancy or invasiveness were present in only one case.     

Roentgenologic aspects of malignant fibrous histiocytomas of soft tissues and of bone (author's transl)

The histiocyte, macrophage or tissue monocyte is a cell of the mononuclear system. The histiocytes have the abilities to phagocytose by utilizing hydrolytic enzymes they have synthesized, and which can synthesize specific proteins to enhance immune responses. The malignant fibrous histiocytoma is a relatively common neoplasm of the mesenchymal tissues derived from histiocytes capables of wide latitude in the expression of differentiation and pleomorphic appearance. This tumor arises as à primary tumor of soft tissue as well as of bone. Four of ten cases of malignant fibrous histiocytomas are documented. This report adds to the understanding of the entity of the tumor in that the diagnosis of malignance was made using roentgenologic criteria and confirmed by biopsy and by autopsy. The most commun locations were of the extremities and extensive local recurrence and metastases are the characteristics. The purpose of this study is to analyse the usefulness the roentgenologic methods in the diagnosis of the malignant histiocytoma: conventional radiography, radionuclide scanning, computed tomography, sonography, xeroradiography, angiography. The differential diagnosis is reported. An algorithmic roentgenologic approach for the evaluation of the malignant fibrous histiocytoma is proposed.     

Pathology of the most common malignant soft tissue tumors

The present article provides an overview on the main pathological criteria of the most frequent malignant soft tissue tumors. Although these malignancies are only rarely observed and amount only to approximately 1% of all malignancies, their exact morphological analysis is of importance, because different therapeutical consequences may be drawn depending on the kind of the tumor and its grade of malignancy. Also, the prognosis of soft tissue sarcomas is extremely variable but is related to the morphology. Therefore, soft tissue sarcomas should be investigated very individually. Proper information of the pathologist by the clinician of each given case is necessary for a proper histological evaluation of biopsies that must be representative. It is recommended, whenever possible to excise the total of the tumor. With regard to these aspects liposarcomas, malignant fibrous histiocytomas, rhabdomyosarcomas, leiomyosarcomas, synovial sarcomas, malignant mesenchymomas, angiosarcomas, and fibrosarcomas are discussed, and their essential properties are reported.     

MRI of malignant fibrous histiocytoma of soft tissue: analysis of 13 cases with pathologic correlation

We reviewed the magnetic resonance (MR) appearances of 13 malignant fibrous histiocytomas (MFH) of soft tissue and correlated each with the respective lesion's histopathology. The MR images were evaluated for signal intensity on T1- and T2-weighted spin echo sequences, homogeneity of the lesion, presence of internal low signal septations, and margin definition. Histologic subtypes of MFH included storiform-pleomorphic, giant cell, myxoid, and inflammatory. We could not establish a correlation between MR appearance and histopathology. Instead, our series exhibited general features suggestive of malignant soft tissue neoplasms, namely poor margin definition, internal low signal septation, and heterogeneous high signal intensity on T2-weighted images.     

99mTc-HMDP accumulation in soft tissue tumor

Accumulation with bone scintigraphy using technetium-99m hydroxymethylene diphosphonate (99mTc-HMDP) in 68 cases with radiographically or pathologically verified soft tissue tumor was examined. Radiographical or histopathologic diagnoses of the 68 cases included; 14 lipomas, 11 liposarcomas, 11 neurinomas or neurofibromas, 6 malignant lymphomas, 5 malignant fibrous histiocytomas, 5 hemangioma, rhabdomyosarcomas, 2 Langerhans cell histiocytoses, 2 desmoid tumors and one each of neuroblastoma, hemangiopericytoma, angiomyxoma, plasmacytoma, liomyosarcoma, lymphangioma, fibrosarcoma, elastofibroma, synovial sarcoma, and ganglion. Thirty-seven (54%) showed positive accumulation and 31 were negative. One half of soft tissue tumors can be accumulated by 99mTc-HMDP.     

Radiology and pathology of malignant fibrous histiocytomas of the soft tissues: A report of ten cases

Malignant fibrous histiocytomas (MFH) are believed to originate from histiocytes and are composed of malignant cells with spindle or round shapes. We evaluated ten MFH of the soft tissues by plain roentgenograms, computed tomography (CT), and angiography and subdivided them into four grades of anaplasia and five predominant histologic variants. The variants of MFH demonstrated different vascular patterns. The extension of the lesions could be determined by CT and angiography. CT is the method of choice in the assessment of size and extent of MFH of the soft tissues. When intra-arterial chemotherapy is indicated the angiograms obtained at each catheter placement may substitute CT in follow-up studies obviating additional diagnostic procedures.     

Fibrous histiocytoma (fibroxanthoma) of a cervical vertebra

A patient with a benign appearing intraosseous fibrous lesion of the cervical vertebra is presented. The lesion had the histologic features of non-ossifying fibroma (metaphyseal fibrous defect). Because of its atypical location and unusual radiologic appearance, the lesion was diagnosed as a fibrous histiocytoma, a tumor whose histology is similar to non-ossifying fibroma. The literature was reviewed for similar cases located outside the metaphysis of the long bones. Support is given for designating such lesions as fibrous histiocytomas rather than non-ossifying fibromas.     

CT Features of calcifications in abdominal malignant fibrous histiocytoma

The purpose of this study was to describe the computed tomographic (CT) features of intralesional calcifications in abdominal malignant fibrous histiocytomas (MFH). Forty-three pathologically proven abdominal MFH with preoperative CT were retrospectively reviewed, of which seven tumors with intralesional calcifications were studied with pathohistologic correlation. All seven calcified abdominal MFH belonged to the storiform-pleomorphic subtype with peripherally located calcifications that appeared as either lumpy (three cases) or ringlike (four cases), which were due to the presence of variable amounts of osseous (six cases) and chondroid metaplasia (two cases). About 16% of abdominal MFH, especially the storiform-pleomorphic subtype, exhibited metaplastic calcifications which were characteristically located at the periphery of the tumor and appeared as either lumpy or ringlike on CT.     

Intra-arterial neoadjuvant chemotherapy of sarcoma of the extremities

Since 1987 we have treated 17 patients with bone sarcomas of the extremities (14 osteosarcomas, 3 malignant fibrous histiocytomas), with 2 cycles of neoadjuvant chemotherapy, consisting in iv high dose Methotrexate, Cis-Platin in 3 days in continuous infusion, and iv Adriamycin every 29th day. We obtained "good necrosis" (greater than 90%) in 13 patients (76.5%). We briefly report the possible correlations between angiographic findings after the first cycle and response to chemotherapy. All patients but one (94%), underwent conservative surgery. To date no patients have had local recurrence; 12 patients (70.5%) are disease free at a median follow up of 21.5 months; in 5 patients lung metastases appeared. To define overall survival and disease-free survival a longer follow up is required.     

FDG-PET for preoperative differential diagnosis between benign and malignant soft tissue masses

OBJECTIVE: To evaluate the standardized uptake value (SUV) of [(18)F]2-deoxy-2-fluoro- d-glucose at positron emission tomography (FDG-PET) for preoperative differential diagnosis between benign and malignant soft tissue masses. DESIGN: One hundred and fourteen soft tissue masses (80 benign, 34 malignant) were examined by FDG-PET prior to tissue diagnosis. The SUVs were calculated and compared between benign and malignant lesions and among different histologic subgroups which included three or more cases. RESULTS: There was a statistically significant difference in SUV between benign (1.80+/-1.42 [SD]) and malignant (4.20+/-3.16) soft tissue masses in total (P<0.0001). However, a considerable overlap in SUV was observed between many benign and malignant lesions. Liposarcomas (2.16+/-1.72) and synovial sarcomas (1.60+/-0.43) did not show significantly higher SUV than any benign lesions. Metastases (4.23+/-2.35) showed no statistically significant difference in SUV as compared with schwannomas (1.75+/-0.84), desmoids (2.77+/-1.32), sarcoidosis (3.62+/-1.53), or giant cell tumors of tendon sheath (GCT of TS; 5.06+/-1.63). Even malignant fibrous histiocytomas (5.37+/-1.40) could not be differentiated from sarcoidosis or GCT of TS, based on the SUV. CONCLUSIONS: A large accumulation of FDG can be observed in both benign and malignant histiocytic, fibroblastic, or neurogenic lesions. SUV at conventional FDG-PET is limited to differentiating benign from malignant soft tissue masses, when all kinds of histologic subtypes are included.     

Manifestations and therapy of malignant fibrous histiocytomas of the head and neck

From 1982 through 1987, ten patients with malignant fibrous histiocytomas (MFH) in the head and neck area were treated at the ORL Department of the Central Hospital of Bremen. The primary tumor was situated in the region of the paranasal sinuses in six cases and in the parotid gland, the thyroid gland, the inferior maxilla, and the petrosal bone in one case, each. Nine patients were submitted to primary surgery. A postoperative irradiation was performed in four cases, and in four further cases this was done only when a recurrent tumor had been demonstrated. Three patients received a combined chemotherapeutical treatment. Eight patients died, the median survival time was 15 months. Besides local recurrences which occurred frequently, remote metastases are the decisive factor for the further evolution of the disease. The lung was the most common site of metastatic spread. Only two patients with MFH of the paranasal sinuses are living now without recurrence after an observation time of 24 and 36 months, respectively.     

Value of high frequency (20mhZ) and doppler ultrasound in the diagnosis of pigmented cutaneous tumors]

PURPOSE: Diagnosis of pigmented skin tumors is often difficult. The aim of the present study is to evaluate high frequency ultrasound and Doppler ultrasound in the localization and the characterization of these tumors. MATERIAL AND METHODS: One hundred and seventy six pigmented skin tumors including melanocytic and non melanocytic, benign and malignant lesions have been examined before resection using high frequency ultrasound (20MHz probe) and Doppler ultrasound (13MHz probe-Doppler frequency: 7MHz). Imaging data have been correlated with histological data, available in all cases. RESULTS: Tumors seen at ultrasound were hypoechoic lesions, some of which, particularly malignant melanocytic tumors were vascularized. Precise ultrasonographic location of the tumor was correlated to its histological location: epidermis for purely epidermal proliferations (seborrheic keratoses), superficial dermis for dermal proliferations originating from epidermis (benign dermal nevi, melanomas during vertical growth phase, basal cell carcinomas), middle and deep dermis for dermal proliferations originating from dermis (fibrous histiocytomas, angiomas). CONCLUSION: Ultrasound may help in assessing positive and differential diagnosis of pigmented skin tumors as it precises, before histological examination, the exact location of the lesion within the different skin layers and its origin. As far as malignant melanocytic tumors are concerned, high frequency ultrasound and Doppler ultrasound appear promising in diagnosis algorithm and pronosic of these lesions.     

Postradiation sarcoma of bone in Hodgkin disease

We report 16 cases seen in the Memorial Sloan-Kettering Cancer Center (MSKCC) during the past 50 years. These patients had been treated with external radiation for Hodgkin disease and had developed sarcomas in the field 4–31 years after the diagnosis of Hodgkin disease. Most of the tumors (12 of 16) occurred in the chest wall. There were three tumors of the pelvis and an unusual osteosarcoma of the femur following treatment for a primary Hodgkin disease of the femur. The tumors were predominantly osteosarcomas (9). In addition, there were five malignant fibrous histiocytomas, one fibrosarcoma, and one chondrosarcoma. Prognosis was poor; the mean survival was 12 months. Survival of patients with other primary cancers who developed radiation sarcomas was not significantly different from that of patients with Hodgkin disease. Hodgkin disease is now the most common tumor among radiation-induced sarcomas in previously normal bone and has surpassed breast cancer, which was previously the most common original tumor.     

Tissue characterization and assessment of preoperative chemotherapeutic response in musculoskeletal tumors by in vivo 31P magnetic resonance spectroscopy.

This study investigates the potential of in vivo 31P magnetic resonance spectroscopy (MRS) to characterize musculoskeletal tumors and to determine preoperative levels of histological necrosis, which is an important clinical indicator of patient response. Pretherapy MRS was performed on 28 patients with large musculoskeletal tumors: 13 with osteosarcoma, 3 with chondrosarcoma, 5 with malignant fibrous histiocytoma, 1 with desmoid tumor, 1 with Ewing's, 2 with hemangioendothelioma, 1 with myxoid liposarcoma, 1 with synovial cell sarcoma, and 1 with rhabdomyosarcoma. Fifteen patients had follow-up MRS examinations after commencement of chemotherapy (mean of five/patient), eight of whom have now had surgery. Elevated levels of PMEs (P < 0.01), P(i) (P < 0.01), and PDEs (P < 0.02) as well as elevated tumor pH (P < 0.05) were observed in all patients. The synovial cell sarcoma was characterized by high levels of PMEs (> 20%) and low pH (pH 6.76). This contrasted with the spectra obtained from the malignant fibrous histiocytomas which had high levels of PDEs (17 +/- 5%). Reductions in PDE levels postchemotherapy were associated with a high degree of necrosis (> 90%) at surgery, while an increase in PDE levels was associated with a low level of histological necrosis. Likewise, reductions in the ratios PDE/NTP and PDE/PCr and an increase in P(i)/PDE were also associated with a high level of necrosis.     

Intraarterial chemotherapy with limb-sparing resection of large soft-tissue sarcomas of the extremities.

Fifteen patients with large (average, 15-cm), high-grade soft-tissue sarcomas of the extremities received prolonged selective intraarterial infusions of chemotherapeutic agents in an attempt to permit limb-sparing resection of these tumors, which would otherwise have required amputation. There were seven malignant fibrous histiocytomas, four liposarcomas, two fibrosarcomas, one leiomyosarcoma, and one rhabdomyosarcoma; 73% were grade III. Seven patients underwent two catheterizations, for a total of 22 infusions, which averaged 11.3 days each. There were four catheterization-related complications, including catheter occlusion or dislodgement in one patient each and two cases of arterial thromboembolism in patients in whom anticoagulant dose was not adequate. Both of the latter patients required thrombectomy; one developed gangrene, which precluded limb-sparing surgery. Thirteen of the 15 patients underwent limb-sparing resections, and two underwent amputations. No wound complications occurred. With a median follow-up of 36 months (mean, 34 months), life-table analysis indicates overall and disease-free survivals of 72% and 59%, respectively, at 2 years and 64% and 59% at 3 years. In comparison to other reported therapies, this technique permits limb salvage in most patients without the high wound complication rate associated with preoperative radiation therapy, with equivalent local disease control and survival.     

Malignant fibrous histiocytoma of the spine: computed tomography appearance and review of the literature

Malignant fibrous histiocytoma of bone was first described as a separate entity in 1972. It is an uncommon tumor occurring in older age groups and only rarely occurs in the spine. The plain film radiographic features of this condition have been described, however, we have found no reports of the computed tomography appearance. We present a case of spinal malignant fibrous histiocytoma that occurred in a 17-year-old female. The computed tomography characteristics of this lesion are described, and use of computed tomography in the evaluation of malignant fibrous histiocytoma of the spine is defined.     

CT of fibrous tissues and tumors with sonographic correlation

Fibrous tissues and tumors may appear hyperdense relative to muscles and solid viscera on CT both before and after IV contrast injection. In addition, fibrous tissues generally have a homogeneously hypoechoic sonographic appearance. The diagnostic value of these criteria is illustrated in a group of 21 fibrous tissue abnormalities that includes retroperitoneal, mediastinal, and perigraft fibrosis, sclerosing pseudotumor of the orbit, generalized fibromatosis, desmoids, malignant fibrous histiocytoma, and normal tendons and ligaments. It is concluded that while hyperdensity on CT and echopenia on sonography are not pathognomonic of fibrous tissue, they occur with sufficient frequency that their presence raises the possibility of a fibrous lesion.