MALIGNANT FIBROUS HISTIOCYTOMA OF THE MAXILLARY SINUS

A case of malignant fibrous histiocytoma arising primarily in the left maxillary sinus is described. The patient, a 39-year-old male, who had suffered from sinusitis for 20 years, began to have paresthesia or sharp pain of the left side of the face and toothaches of the left maxilla. At operation a white fibrous tumor developing extensively from the lateral wall to the upper and medial walls of the left maxillary sinus and into the ethmoidal sinus was noted. Following gradual progression of dyspnea, he died approximately one year after the onset in spite of radiation therapy and anticancer chemotherapy. An autopsy revealed recurrence of the tumor in the left maxillary sinus with wide-spread metastases to the lungs, pleurae, pancreas, kidneys and bone marrows. The direct cause of death was respiratory failure due to extensive growths of the pulmonary and pleural metastases.     

MALIGNANT FIBROUS HISTIOCYTOMA OF BONE

Existence of an entity called malignant fibrous histiocytoma of bone was emphasized, based on two of our own cases experienced recently and on previous reports related to this tumor. Histologically the tumor resembles markedly the malignant fibrous histiocytoma originating in the soft part. In addition, an attempt was made to clarify its biological behavior, histological subclassification and criteria to be malignant and differential diagnoses from several other bone diseases which sometimes mimic this malignant bone tumor.     

PRIMARY MALIGNANT FIBROUS HISTIOCYTOMA OF THE ENDOMETRIUM

Malignant fibrous histiocytoma (MFH) has become one of the most common malignancies occurring in soft tissue. To our knowledge, the present case is the first of MFH occurring in the endometrium. The uterus removed from a 47-year-old woman demonstrated a large multinodular endometrial lesion with gross invasive foci in the myometrium and the left oviduct. Microscopically, the endometrial tumor and the invasive lesions were composed of dense sheets of markedly pleomorphic cells consisting of fibroblast-like cells, histiocyte-like cells, foamy histiocytes, benign appearing multinucleated giant cells resembling either osteoclasts or Touton giant cells, and bizarre tumor giant cells. Some of the tumor cells showed phagocytic activities. The tumor cells were oriented in a random or haphazard fashion and classical storiform and fascicular patterns were not observed. The tumor was diagnosed as MFH consisting exclusively of so-called pleomorphic pattern. The patient is alive without evidence of disease, months following total hysterectomy and bilateral salpingo-oophorectomy.     

ULTRASTRUCTURAL FEATURES OF MALIGNANT FIBROUS HISTIOCYTOMA OF BONE

Five cases of malignant fibrous histiocytoma originating in the femur and tibia, sometimes with local recurrences, are reported. Histological and clinical characteristics of this lesion were similar to those in soft tissues with the same disease. The present histiocytomas were observed by electron microscopy and shown to consist of 5 types of neoplastic cells which were regarded as undifferentiated cells, histiocyte-like cells, which were predominating, flbroblast-like cells, multinucleated giant cells and xanthomatous cells. These findings led us to confirm the existence of malignant fibrous histiocytoma originating in bone as well as in soft tissues.     

CYSTOSARCOMA PHYLLODES OF THE BREAST WITH FEATURES OF MALIGNANT FIBROUS HISTIOCYTOMA

A case of a 33-year-old female with metastasizing malignant cystosarcoma phyllodes of the left breast showing histologic features of malignant fibrous histiocytoma is reported. Metastases consisting of only undifferentiated mesenchymal cells were found in the lungs, liver, pleurae, kidneys, ileum, and vertebrae. Seven cases of fibrohistiocytic tumors of the breast previously recorded in the literature were reviewed. Although rare, this type of tumor should be included in the differential diagnosis of mesenchymal mammary tumors.     

CYTOLOGIC FEATURES OF ASCITES IN MALIGNANT FIBROUS HISTIOCYTOMA OF THE COLON

The cytologic features of ascitic fluid in a case of malignant fibrous histiocytoma (MFH) of the colon are described. At autopsy, two solid tumor masses were found around the ascending and transverse colon, accompanied by about 3,000 ml of ascites. Tumor cells had infiltrated diffusely into the outer layers of almost all of the gastrointestinal wall, simulating peritonitis carcinomatosa. Cytologic examination of the ascites revealed various kinds of tumor cells; short spindle-like cells, multinucleated giant cells, and round cells with an invaginated nuclear margin, forming small clusters. These cytologic findings were considered to be very useful in the diagnosis of MFH, especially in cytologic examinations of ascites. ACTA PATHOL JPN 38: 921 ∼ 928, 1988.     

MULTIPLE PRIMARY MALIGNANT FIBROUS HISTIOCYTOMA OF THE STOMACH AND SMALL INTESTINE

A case of multicentric malignant fibrous histiocytoma of the stomach and small intestine is reported. The patient was a 60-year-old man who had total gastrectomy under an impression of a gastric carcinoma. The resected stomach revealed a large polypoid mass in the antral portion at the greater curvature. Three months later, he developed ileus and an 80 cm segment of the jejunum was removed. It contained two polypoid masses identical to that seen in the stomach. The tumors showed, in addition to the characteristic light microscopic appearances, strong positivity for alpha-1-antitrypsin by an immunoperoxidase technique, indicating the diagnosis of malignant fibrous histiocytoma (MFH). Electron microscopic findings were also consistent with MFH. We believe that this is the first well-documented case of MFH arising from the stomach and small intestine, to the best of our knowledge.     

MALIGNANT FIBROUS HISTIOCYTOMA OF BONE ASSOCIATED WITH FOCAL HEMANGIOPERICYTOMATOUS PATTERN

A case of malignant fibrous histiocytoma of the tibia of a 49-year-old Japanese farmer was presented. The patient was diagnosed as malignant hemangiopericytoma by biopsy, wheseas the amputated material showed a marked pleomorphism representing features of malignant fibrous histiocytoma. Ultrastructurally, undifferentiated mesenchymal cells, intermediate cells between the undifferentiated mesenchymal cells and fibroblastic cells, fibroblastic cells and histiocytoid cells including bizarre giant cells were confirmed in a broad modulating spectrum. The hemangiopericytomatous lesion was predominated by intermediate cells, the ultrastructure of which bore a close resemblance to that of pericytes, and was regarded to be resulted from a differentiation of undifferentiated mesenchymal cells towards the pericyte.     

POSTIRRADIATION SARCOMA (MALIGNANT FIBROUS HISTIOCYTOMA) IN THE INGUINAL REGION

A female patient who died of apparent postirradiation sarcoma at the age of 39 was reported. Following a traffic accident, she developed squamous cell carcinoma at the injured right heel 20 years later, and also metastasis to both inguinal and popliteal lymph nodes. During the period from September 1966 to May 1968, she had received Co⁶⁰ irradiation to the right inguinal and para-aortic areas, 9,600 and 6,600 Roentgen, respectively. Ten years later, she manifested a huge tumor in the inguinal region which extended further to the retroperitoneum; light and electron microscopic examinations proved to be a malignant fibrous histiocytoma. She died of massive pulmonary metastasis two years later. Histological differentiation of the tumor and relationship between irradiation and sarcoma induction were briefly discussed, and the necessity of reevalution of soft part sarcomas was emphasized.     

EXPERIMENTAL TUMORS OF MYXOID MALIGNANT FIBROUS HISTIOCYTOMA and HYALURONIC ACID PRODUCTION

Using B-10 tumor cells originated from mouse peritoneal macrophages transformed by simian virus 40, we succeeded in producing tumors in an ascitic form similar to human myxoid malignant fibrous histiocytoma. The tumor cells possessed Fc and C₃ receptors, immunophagocytic activity, and lysosomal enzymes. They showed pseudopodic extensions of the cytoplasm containing lysosomes. Therefore, they maintained the functional and morphological characteristics of macrophages. On cellulose acetate electrophoresis with or without enzymatic degradation, the ascitic fluid contained a single component of glycosaminoglycans; hyaluronic acid. Electron microscopy utilizing dia-lyzed iron demonstrated electron-dense reaction products on the cell surfaces. Thus, the histiocytic origin of malignant fibrous histiocytoma was suggested and possibility was expressed, concerning the histogenesis of myxoid malignant fibrous histiocytoma, that the transformed tumor cells could synthesize hyaluronic acid on the cell surface and release it into the stroma. ACTA PATHOL. JPN. 37:975–988, 1987.     

MALIGNANT FIBROUS HISTIOCYTOMA WITH WIDESPREAD METASTASIS AND PULMONARY CANCER

An autopsy case of malignant fibrous histiocytoma (MFH) with widespread metastases and lung carcinoma in a 64-year-old Japanese woman is reported. The initial signs were cough and sputum, followed by hemosputum. A chest X-ray photo showed a right pleural tumor, which could not be identified from a biopsy specimen, but was identified as MFH by light and electron microscopic studies on biopsy specimens of tongue tumors. Autopsy examination revealed metastases of the MFH to the brain, lung, liver, kidney, adrenal, pancreas, retroperitoneum, and some bones, and pulmonary adenocarcinoma.     

FIBROUS HISTIOCYTOMA OF THE NASAL CAVITY AND MAXILLARY SINUS

Two cases of fibrous histiocytoma were presented; Case 1: a 46-year-old man with a tumor filling the left nasal cavity and maxillary sinus, and Case 2: an 80-year-old man with a tumor of the right maxillary sinus destroying its surrounding wall. Histologically, the former was dominated by storiform pattern and onion-like structures, and the latter by osteoclast-like multinucleated giant cells. After radical surgery, Case 1 was free of recurrence for more than one year, and Case 2 showed recurrence although still maintaining fairly good health. A total of 29 cases hitherto reported arising in the nasal, paranasal and nasopharyngeal regions were reviewed, pitfall of differential diagnoses was commented especially in our two cases, criteria of malignancy were discussed, and the necessity of repeated samplings was emphasized because of paucity and unfamiliarity of fibrous histiocytoma arising, in particular, from the upper respiratory tract.     

EXPERIMENTAL APPROACH TO FIBROUS HISTIOCYTOMA

A transplantable tumor was produced in syngeneic mice inoculated with transformed bone marrow macrophages (28–12– and L-18 cell lines). The tumor composed of proliferative spindle cells was arranged in a storiform pattern, and was similar to that of human fibrous histiocytoma. Electron microscopically, the tumorous spindle cells had fibroblastic characteristics, while functionally, the tumor cells had histiocytic characteristics, and consisted of a transitional form between histiocytes and fibroblasts. We consider the spindle cells to be facultative fibroblasts. This Anding is compatible with the hypothesis that fibrous histiocytoma is derived from histiocytes.     

MALIGNANT CHANGE IN A SOLITARY HAMARTOMA OF THE LUNG

A case report of a malignant hamartoma of the lung observed in a 36-year-old housewife was presented. The hamartoma was non-chondromatous (fibromyomatous), located beneath the pleura of the left upper lobe. The malignant lesion corresponded to anaplastic carcinoma of the lung. A review of the literatures on the malignant hamartoma of the lung revealed rare incidences of the tumor, but hamartoma and hamartomatous lesions of the lung should be regarded as one of the histopathological backgrounds where pulmonary carcinoma may arise. ACTA PATH. JAP. 27: 541–546, 1977.     

MALIGNANT FIBROUS HISTIOCYTOMA WITH GRANULAR CELLS, MIMICKING A GRANULAR CELL TUMOR: Light, Electron Microscopic and Immunohistochemical Observation of a Case

The tumor that occurred subcutaneously in the left hypochondriac region of an 87-year-old female is reported. Light microscopically, this tumor was composed of two kinds of cells, spindle cells and granular cells. The spindle cells showed various pictures such as fascicular arrangement, pleomorphic giant cells in the myxoid stroma and areas with abundant blood vessels. The granular cells contained PAS positive and diastase-resistant granules, and these granules, being electron microscopically phagocytic lysosomes, showed the same findings as the granules seen in the granular cell tumor. The immunohistochemical studies for S-100 protein, neuron specific enolase, CEA, myoglobin, and lysosome were negative, but α-antichymotrypsin was positive. From the microscopic and immunohistochemical findings, this tumor was diagnosed as a malignant fibrous histiocytoma with granular cell changes of tumor cells. ACTA PATHOL. JPN. 35 : 1555–1560, 1985.     

MALIGNANT FIBROUS HISTIOCYTOMA SHOWING CYTOPLASMIC HYALINE GLOBULES AND STROMAL OSTEOIDS: A Case Report with Light and Electron Microscopic, Histochemical, and Immunohistochemical Study

A 56-year-old man died of widespread metastases of malignant fibrous histiocytoma (MFH) primarily developed in the left lower gingiva after a rapid clinical course is reported. Primary and metastatic tumors showed light and electron microscopic, histochemical and immunohistochemical characteristics of MFH together with cytoplasmic hyaline globules and stromal osteoids. Hyaline globules revealed periodic acid-Schiff positive and diastase resistant reactions but not positive with any histochemical and immunohistochemical reactions. Osteoids were partially calcified and rimmed by osteoblastic tumor cells. The present case of MFH may provide difficulties in the differential diagnosis from some osteoid-forming sarcomas in soft tissues with relation to the histogenesis.     

MALIGNANT MESENCHYMOMA OF THE HEART

A case of a rare primary cardiac tumor in a 46-year-old woman is described. The tumor arose from the left atrium and was histologically composed of multiple mesenchymal elements of fibrosarcoma, rhabdomyosarcoma, chondrosarcoma, myxosarcoma, and liposarcoma. Metastasis of this tumor occurred in the left femur, lung, and hilar lymph nodes after the second heart operation. Histogenesis of malignant mesenchyoma was considered with a survey of the literature.     

MALIGNANT MESENCHYMOMA OF THE HEART

An autopsy case of malignant cardiac mesenchymoma, which arose in the atrial septum was presented. This tumor contained Abrosar-comatous, rhabdomyosarcomatous, chondroaarcomatous and oseeous elements. A small metastatic leeion was found in the lung. Histogenesis of this tumor was also considered with a survey of literature.     

BRUSHITE IN FIBROUS DYSPLASIA OF THE JAW BONE

Crystals associated with the maxillary bone in a case of fibrous dysplasia were investigated histopathologically, crystallo-graphically and by infrared absorption spectroscopy. Light microscopically, the crystals showed a transparent and plate-like appearance, and were revealed to be piled, incomplete monoclinic structures up to 250μm in size by scanning electron microscopy. These crystals were identified as brushite, dicalcium phosphate dihydrate CaHP0₄ 2H₂0, by X-ray microdiffraction and infrared absorption spectroscopic analysis. From consideration of the equilibrium of brushite, it was assumed in this case that inflammation had occurred initially and that the tissue fluid conditions at the site of the lesion had deviated from normal, eventually resulting in the deposition of brushite crystals on the bone apatite. From a crystallographic view point, the mode of occurrence of brushite suggested that the bone at the lesion site would not recover through normal healing. ACTA PATHOL. JPN. 37: 1699-1705, 1987.