Primary Malignant Fibrous Histiocytoma of Skin

Three fibrous histiocytomas, primary in skin, were studied by light and electron microscopy and by frozen section histochemistry. The term malignant was applied to cutaneous tumors which demonstrated aggressive multinodular local growth, including angioinvasion and/or extension into bone, muscle, and fascia. Metastases were not found. Strongly positive reactions for hydrolytic enzymes, particularly acid phosphatase will help differentiate malignant fibrous histiocytoma from most other primary soft tissue malignancies of skin. Electron microscopic studies reaffirm the presence of both histiocyte-like and fibroblast-like cells. Langerhans' granules were not identified. Primary malignant fibrous histiocytoma of skin may have a prognosis superior to homologous tumors arising in deeper soft tissue and the retroperitoneum.     

Fibroblastic/myofibroblastic sarcoma of the skin: a report of five cases

BACKGROUND: A number of malignant soft tissue tumors, particularly those of fibroblastic and fibrohistiocytic derivation, have been found to display myofibroblastic differentiation focally. The term myofibroblastic sarcoma, a controversial presumably distinctive entity, defines a malignant soft tissue tumor in which myofibroblasts are quantitatively the predominant cell type. METHODS: Five cases of cutaneous spindle-cell sarcomas showing fibroblastic-myofibroblastic differentiation with predominance of fibroblasts were retrieved from the files of three large centers of dermatopathology. Tumors were analyzed histopathologically, immunophenotypically, and, in two cases, ultrastructurally. Results were compared with those previously reported in fibrosarcoma, malignant fibrous histiocytoma, and myofibroblastic sarcoma. RESULTS: Immunophenotypic and ultrastructural profiles of the cases analyzed in this series were closer to fibrosarcoma and to malignant fibrous histiocytoma than to myofibroblastic sarcoma by virtue of quantitative predominance of fibroblasts over myofibroblasts. On the other hand, histopathologic findings were in keeping with those reported in myofibroblastic sarcoma. CONCLUSIONS: Our series highlights the intrinsic problems in attaching certain cutaneous sarcomas with fibroblastic-myofibroblastic differentiation to one of the recognized entities and gives support to the hypothesis that fibrosarcoma, malignant fibrous histiocytoma, and myofibroblastic sarcoma are related histogenetically.     

Atypical fibroxanthoma: two unusual variants

Two unusual fibroxanthomas were studied by light microscopy. The first case contained numerous osteoclast-like cells and resembled malignant giant cell tumour of soft tissues, a variant of malignant fibrous histiocytoma. Osteoclast-like giant cells were negative for lysozyme and alpha-1-antitrypsin. The second case contained areas of chondroid differentiation which resembled chondrosarcoma. Tumour cells within the cartilaginous areas were positive for S100 protein.     

Benign fibrous histiocytoma with osteoclast-like giant cells in an infant

Abstract:  Benign fibrous histiocytoma is a common soft tissue tumor that usually occurs in adults and is relatively rare in childhood. This report describes a 7-month-old Caucasian boy with an enlarging firm congenital nodule on his occipital scalp. Histologic analysis revealed a benign fibrous histiocytoma with osteoclast-like giant cells. Benign fibrous histiocytoma with osteoclast-like giant cells is a rare histologic variant.     

A case of malignant fibrous histiocytoma

A case of malignant fibrous histiocytoma is reported. Due to the histological features of cellular pleomorphism and myxoid degeneration seen also in other soft tissue sarcomas (rhabdomyosarcoma, liposarcoma), differential diagnosis was difficult. However, electron microscopic studies led to a distinct diagnosis of malignant fibrous histiocytoma.     

Primary giant cell tumor of soft tissue

BACKGROUND: Primary giant cell tumor of soft tissue, also known as soft tissue giant cell tumor of low malignant potential, is a rare soft tissue tumor located in both superficial and deep soft tissue. Histologically, these lesions bear a close resemblance to their bony counterparts, giant cell tumor of bone, with round to spindle-shaped cells intimately admixed with uniformly scattered osteoclast-like multinucleated giant cells. In 1989 in the dermatology literature, two malignant giant cell tumors of soft parts were described that filled the dermis and extended into the subcutaneous tissue. METHODS: The authors report the rare occurrence of a giant cell tumor of soft tissue occurring primarily in the dermis that lacks overtly malignant features and clinically was thought to be an epidermal inclusion cyst. RESULTS: Light microscopy revealed a non-encapsulated cellular dermal tumor containing numerous osteoclast-like giant cells. Cytologic atypia was minimal and the mitotic count averaged 2-3/10 HPF. The histologic differential diagnosis is also discussed. CONCLUSION: Giant cell tumor of soft tissue is a rare neoplasm of the skin, however, recognition of this tumor is important due to its behavior as a low-grade malignancy.     

Dermatofibroma with osteoclast-like giant cells.

Dermatofibroma (DF), or cutaneous fibrous histiocytoma, is a common cutaneous tumor with many variants that may arise from alterations in the morphology and composition of its various components. One type that has not received much attention is DF with osteoclast-like giant cells. Two cases of this rare tumor are described. The importance of this tumor lies in the possible histologic confusion with a variety of benign and malignant neoplasms, including giant cell tumor of tendon sheath, giant cell tumor of bone, and giant cell reparative granuloma.     

Mohs micrographic surgery for the treatment of spindle cell tumors of the skin

BACKGROUND: Because of the uncommon nature of dermal spindle cell tumors, the effectiveness of various treatment modalities is difficult to assess. OBJECTIVE: Our purpose was to measure the effectiveness of treating dermatofibrosarcoma protuberans, atypical fibroxanthoma, malignant fibrous histiocytoma, and leiomyosarcoma by means of Mohs micrographic surgery (MMS). In addition, we attempted to determine whether MMS is useful in treating dermal spindle cell tumors when no definitive histopathologic diagnosis can be rendered. METHODS: In a retrospective chart review, demographic data, tumor data, treatment characteristics, recurrence, and follow-up data were tabulated. RESULTS: The recurrence rate for dermatofibrosarcoma protuberans treated by MMS was 3.0%, for atypical fibroxanthoma was 6.9%, for malignant fibrous histiocytoma was 43%, and for leiomyosarcoma was 14%. The recurrence rate for spindle cell tumors not otherwise specified was 0%. CONCLUSION: These data establish the effectiveness of MMS in the treatment of dermal spindle cell tumors, including those for which no definitive histopathologic diagnosis can be rendered.     

Pleomorphic hyalinizing angiectatic tumor of soft parts: case report and literature review

Pleomorphic hyalinizing angiectatic tumor (PHAT) of soft parts is a rare soft tissue neoplasm. Few cases have been reported in the literature thus far. PHAT is a spindle cell neoplasm with a prominent vascular component which displays some features of both neurilemoma and malignant fibrous histiocytoma. Lesions typically occur on the lower extremities of adults, however, lesions in other anatomic locations have been described. In this paper, we report a 60 years old female with PHAT of the right foot and review the current literature. El-Tal A-E-K, Mehregan D. Pleomorphic hyalinizing angiectatic tumor of soft parts: case report and literature review.     

Fibrohistiocytic skin tumors

The fibrohistiocytic tumors of the skin are a heterogeneous group of dermal/subcutaneous mesenchymal neoplasms which show fibroblastic, myofibroblastic and histiocytic (macrophage‐like) differentiation, often one beside the other in the same tumor. “Fibrohistiocytic” means in this context the morphologic similarity of the cells with fibroblasts and histiocytes. The WHO classification of 2005 includes the following entities as fibrohistiocytic tumors of the skin: Benign: 1. Fibrous histiocytoma (FH)/(synonymous: Dermatofibroma. Variants of FH: 1a. cellular fibrous histiocytoma, 1b. atypical (pseudosarcomatous) fibrous histiocytoma, 1c. aneurysmatic fibrous histiocytoma, 1d. epithelioid fibrous histiocytoma; 2. dermatomyofibroma; 3. (juvenile) xanthogranuloma. Intermediate: 4. plexiform fibrohistiocytic tumor; 5. dermatofibrosarcoma protuberans; 6. atypical Fibroxanthoma. Malignant: 7. malignant fibrous histiocytoma. All these entities are reviewed in this paper with particular attention devoted to differential diagnostic considerations.     

Malignant giant cell tumor of soft parts presenting as a skin tumor

Malignant giant cell tumor of soft parts is a rare neoplasm that histologically resembles a giant cell tumor of bone. It has a distinctive multinodular growth pattern and is composed of numerous osteoclast-like giant cells, histiocytes, and fibroblasts. Although this tumor is usually found in deep soft tissues, a superficial form has been described in the subcutaneous tissue and fascia. The authors report two patients, aged 75 and 78, with malignant giant cell tumors presenting as ulcerating skin nodules of the arm and foot. The tumors were relatively small, measuring less than 3.5 cm in greatest dimension, and involved the entire dermis and subcutaneous tissue. The clinical differential diagnoses included Kaposi's sarcoma, melanoma, and hematoma. Dermatopathologists and dermatologists should be aware of this entity to avoid confusion with other benign and malignant neoplasms that may contain multinucleated giant cells. The distinguishing histologic and immunohistochemical features of this tumor are discussed.     

Malignant fibrous histiocytoma of the skin with marked inflammatory infiltrate: a sarcoma mimicking malignant lymphoma

Three cases of malignant fibrous histiocytoma of the skin with a marked inflammatory infiltrate in the stroma are reported. The inflammatory infiltrate, composed mainly of T-lymphocytes, obscured the nature of the neoplasms, and immunohistochemical studies were required to establish the diagnosis. Two tumors arose in the sun-damaged skin of the face, and one tumor arose in the chest wall. One patient developed a local recurrence with histopathologic findings similar to those observed in the original lesion, including the inflammatory infiltrate. Possible differential diagnoses include large cell lymphoma, inflammatory pseudotumor, inflammatory leiomyosarcoma, and spindle cell squamous cell carcinoma. The presumed rarity of inflammatory changes in malignant fibrous histiocytoma of the skin is supported by the absence of reported cases.     

A Case of Subcutaneous Malignant Fibrous Histiocytoma Circumscribed by Fibrous Tissue

We report a case of malignant fibrous histiocytoma (MFH) located in the subcutaneous tissue on the right axilla. We excised the tumor sufficiently beyond the clinical margin. It was pathologically diagnosed as a storiform-pleomorphic type of malignant fibrous histiocytoma almost completely circumscribed by fibrous tissue, including fascicles of fibroblasts; this is a rare histological picture. The tumor has not recurred for three years. Although MFH frequently undergoes metastasis, the circumscribed-type subcutaneous MFH characteristic of superficiality and of histologically well-defined structure seems to have a relatively more favorable prognosis after adequate radical excision.     

硬皮病样皮肤转移性恶性纤维组织细胞瘤1例

报告1例硬皮病样皮肤转移性恶性纤维组织细胞瘤。患者男,60岁。面颊及颈部皮肤硬韧1个半月。病理检查示:真皮浅中层胶原纤维间见散在或密集的类似成纤维细胞样细胞、组织细胞样细胞浸润,细胞核大而深染,呈长梭形及圆形,小血管腔内也见核大深染的细胞及多核巨细胞。免疫组化示:CD68(+),CD34,CK,SMA均阴性。诊断:皮肤转移性恶性纤维组织细胞瘤。     

Malignant fibrous histiocytoma arising from chronic ulcer

A patient had malignant fibrous histiocytoma that developed in a chronic ulcer. Squamous cell carcinoma can develop on long-standing ulcers, but malignant fibrous histiocytoma developing in an ulcer is extremely rare.     

Aneurysmal Benign Fibrous Histiocytoma with Atrophic Features

Aneurysmal benign fibrous histiocytoma is an uncommon pathologic variant of dermatofibroma. In addition to the features of a typical dermatofibroma, it has large cleft-like or cavernous blood-filled spaces with numerous hemosiderin pigments. It should be differentiated from angiomatoid malignant fibrous histiocytoma, malignant melanoma, and vascular tumors such as Kaposi''s sarcoma and angiosarcoma. Atrophic dermatofibroma is also a rare variant of dermatofibroma, and the combination of aneurysmal and atrophic features is rarer still. We report a case of aneurysmal benign fibrous histiocytoma with atrophic features in a 27-year-old male who had a grayish-brown atrophic patchy lesion on his back for 2 years.     

Benign fibrous histiocytoma of the eyelid with an unusual clinical presentation

Benign fibrous histiocytoma is a common soft tissue tumor that can be deep or superficially located. Although the deep type of fibrous histiocytoma has a predilection for the orbit, the eyelids are an unusual location for the cutaneous type. A 42-year-old woman had bilateral yellowish nodular masses of the eyelids for two years. Pathological examination after excision revealed benign fibrous histiocytoma. Our case is an unusual clinical presentation of cutaneous fibrous histiocytoma as well as a rare location such as the eyelids.     

Malignant fibrous histiocytoma of the scalp. Multidisciplinary treatment

BACKGROUND: Malignant fibrous histiocytomas (MFH) are uncommon in the skin, and even less frequent on the scalp. On the scalp they are often very difficult to excise and it is even more difficult to close the resulting wound. OBJECTIVE: To review all malignant fibrous histiocytomas diagnosed and treated in our Department during the past 6 years, and to describe the multidisciplinary procedure employed to treat one special case of aggressive malignant fibrous histiocytoma on the scalp that recurred twice. RESULT: Malignant fibrous histiocytomas represent 0.01% of malignant cutaneous tumors in our area. The immediate results after a multidisciplinary treatment performed on a recurrent malignant fibrous histiocytoma located on the scalp were excellent, but recurrence was observed 6 months later. Two years later we have also treated another case of MFH on the scalp. The same surgical technique was performed, but the patient received high-dose-methotrexate-based neoadjuvant chemotherapy (HD-MTX). One year later, this patient is still alive and no signs of recurrence have been detected. CONCLUSION: When malignant fibrous histiocytoma occurs on the scalp it must be treated immediately by means of an excision with a large peripheral edge of 2 cm from the visual or CAT limits of the lesion, since the first treatment must be definitive.     

Benign cellular fibrous histiocytoma with erosion of the phalanx

Fibrohistiocytic tumors are characterized by the presence of fibroblast like spindle cells and histiocytes. The benign fibrous histiocytoma (dermatofibroma, BFH) as well as the malignant dermatofibrosarcoma protuberans (DFSP) and the malignant fibrous histiocytoma (MFH) belong to this group. A recurrent painful, hard 2 cm tumor on the left hallux of a 54-year-old woman led to an erosion of the underlying phalanx. The patient had suffered from ingrown toenails for more than 10 years. Histologically there was a deep penetrating fibrohistiocytic tumor that grew in a storiform pattern with interspersed foam cells. The tumor was CD34 negative and mitoses were scarce. The diagnosis was benign cellular fibrous histiocytoma (BZFH). BZFH belong to the group of BFH with a high recurrence rate especially after incomplete removal. Damage to the underlying bone has not been reported so far.     

恶性纤维组织细胞瘤1例

报告1例恶性纤维组织细胞瘤。患者男,78岁,左胫前色素性结节10余年,近两年结节缓慢增大呈紫黑色斑块,无明显自觉症状。组织病理检查示,肿瘤中成分呈多形性表现,主要由增生的内皮细胞构成,部分细胞似成纤维细胞样交织排列呈游涡状,有些细胞似组织细胞样,可见形状怪异的多核巨细胞。