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Malignant fibrous histiocytoma of the face: report of a case.

Seper L, Schwab R, Kiattavorncharoen S, Büchter A, Bánkfalvi A, Joos U, Piffkó J, Kruse-Loesler B - Head Face Med (2007)

Bottom Line: Radical tumour resection was completed by extended parotidectomy and neck dissection; the skin defect was covered by a regional bi-lobed flap.Full functional and cosmetic recovery was achieved; follow-up has been uneventful more than two years postoperatively.Malignant transformation of BFH is extremely rare and if so, extended radical surgery may give a fair chance for a favourable outcome even in patients with advanced age.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Cranio-Maxillofacial Surgery, University of Muenster, Waldeyerstr, 30, 48149 Muenster, Germany. seper@uni-muenster.de

ABSTRACT

Background: Soft tissue sarcomas in the head and neck region are rare and often present a difficult differential diagnosis. The aim of our presentation is to point out the complexity of the diagnosis, treatment and follow up.

Case presentation: An eighty-seven year old female patient was referred to our unit with a fast growing brownish lump on the face. Four months beforehand, a benign fibrous histiocytoma (BFH) had been removed from the same location by excision biopsy with wide tumour-free resection margins. Excision biopsy of the recurrent lesion revealed a malignant fibrous histiocytoma (MFH). Radical tumour resection was completed by extended parotidectomy and neck dissection; the skin defect was covered by a regional bi-lobed flap. No adjuvant radio- or chemotherapy was administered. Full functional and cosmetic recovery was achieved; follow-up has been uneventful more than two years postoperatively.

Discussion: Malignant transformation of BFH is extremely rare and if so, extended radical surgery may give a fair chance for a favourable outcome even in patients with advanced age.

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(A-D). Histopathological and immunohistochemical findings of the recurrent lesion diagnosed as malignant fibrous histiocytoma of myxoid type: (A) Heterogeneous fibroblastic spindle cells, histiocytic, inflammatory and pleomorphic giant cells are scattered throughout the tumour mass embedded in myxoid stroma containing plentiful collagen fibres. (H&E, 200×). (B) Negative immunohistochemical reaction for cytokeratins [pan-anti-cytokeratin antibody; KL-1 (Ventana, Germany)], (C) Strong positive reaction with the MIB1 antibody showing a high proliferative activity of the tumor, MIB-1 labelling index: 50%(100×), (D) Strongly positive immunohistochemical reaction for vimentin in the vast majority of tumour cells (400×)
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Figure 3: (A-D). Histopathological and immunohistochemical findings of the recurrent lesion diagnosed as malignant fibrous histiocytoma of myxoid type: (A) Heterogeneous fibroblastic spindle cells, histiocytic, inflammatory and pleomorphic giant cells are scattered throughout the tumour mass embedded in myxoid stroma containing plentiful collagen fibres. (H&E, 200×). (B) Negative immunohistochemical reaction for cytokeratins [pan-anti-cytokeratin antibody; KL-1 (Ventana, Germany)], (C) Strong positive reaction with the MIB1 antibody showing a high proliferative activity of the tumor, MIB-1 labelling index: 50%(100×), (D) Strongly positive immunohistochemical reaction for vimentin in the vast majority of tumour cells (400×)

Mentions: Excision biopsy of the current lesion revealed an infiltrative, well-vascularised mesenchymal neoplasm containing pleomorphic tumour cells, increased mitotic count with some atypical mitoses, and myxoid stroma rich in collagen fibres. Immunohistochemistry was strongly positive for vimentin, and negative for cytokeratin, smooth-muscle actin, desmin, S-100 and melanoma-specific antigen. The MIB1 positive proliferative fraction was 50% (Fig. 3a–d). The histological diagnosis of a "myxoid-type malignant fibrous histiocytoma (MFH)" with tumour-free surgical margins up to 3 cm was made [pT1a, pN0 (26/0), pMx, R0]. Histological re-evaluation of the primary tumour by an independent pathologist confirmed the original diagnosis of benign fibrous histiocytoma with ulceration, inflammation and increased cellularity ("irritated BFH").


Malignant fibrous histiocytoma of the face: report of a case.

Seper L, Schwab R, Kiattavorncharoen S, Büchter A, Bánkfalvi A, Joos U, Piffkó J, Kruse-Loesler B - Head Face Med (2007)

(A-D). Histopathological and immunohistochemical findings of the recurrent lesion diagnosed as malignant fibrous histiocytoma of myxoid type: (A) Heterogeneous fibroblastic spindle cells, histiocytic, inflammatory and pleomorphic giant cells are scattered throughout the tumour mass embedded in myxoid stroma containing plentiful collagen fibres. (H&E, 200×). (B) Negative immunohistochemical reaction for cytokeratins [pan-anti-cytokeratin antibody; KL-1 (Ventana, Germany)], (C) Strong positive reaction with the MIB1 antibody showing a high proliferative activity of the tumor, MIB-1 labelling index: 50%(100×), (D) Strongly positive immunohistochemical reaction for vimentin in the vast majority of tumour cells (400×)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2211745&req=5

Figure 3: (A-D). Histopathological and immunohistochemical findings of the recurrent lesion diagnosed as malignant fibrous histiocytoma of myxoid type: (A) Heterogeneous fibroblastic spindle cells, histiocytic, inflammatory and pleomorphic giant cells are scattered throughout the tumour mass embedded in myxoid stroma containing plentiful collagen fibres. (H&E, 200×). (B) Negative immunohistochemical reaction for cytokeratins [pan-anti-cytokeratin antibody; KL-1 (Ventana, Germany)], (C) Strong positive reaction with the MIB1 antibody showing a high proliferative activity of the tumor, MIB-1 labelling index: 50%(100×), (D) Strongly positive immunohistochemical reaction for vimentin in the vast majority of tumour cells (400×)
Mentions: Excision biopsy of the current lesion revealed an infiltrative, well-vascularised mesenchymal neoplasm containing pleomorphic tumour cells, increased mitotic count with some atypical mitoses, and myxoid stroma rich in collagen fibres. Immunohistochemistry was strongly positive for vimentin, and negative for cytokeratin, smooth-muscle actin, desmin, S-100 and melanoma-specific antigen. The MIB1 positive proliferative fraction was 50% (Fig. 3a–d). The histological diagnosis of a "myxoid-type malignant fibrous histiocytoma (MFH)" with tumour-free surgical margins up to 3 cm was made [pT1a, pN0 (26/0), pMx, R0]. Histological re-evaluation of the primary tumour by an independent pathologist confirmed the original diagnosis of benign fibrous histiocytoma with ulceration, inflammation and increased cellularity ("irritated BFH").

Bottom Line: Radical tumour resection was completed by extended parotidectomy and neck dissection; the skin defect was covered by a regional bi-lobed flap.Full functional and cosmetic recovery was achieved; follow-up has been uneventful more than two years postoperatively.Malignant transformation of BFH is extremely rare and if so, extended radical surgery may give a fair chance for a favourable outcome even in patients with advanced age.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Cranio-Maxillofacial Surgery, University of Muenster, Waldeyerstr, 30, 48149 Muenster, Germany. seper@uni-muenster.de

ABSTRACT

Background: Soft tissue sarcomas in the head and neck region are rare and often present a difficult differential diagnosis. The aim of our presentation is to point out the complexity of the diagnosis, treatment and follow up.

Case presentation: An eighty-seven year old female patient was referred to our unit with a fast growing brownish lump on the face. Four months beforehand, a benign fibrous histiocytoma (BFH) had been removed from the same location by excision biopsy with wide tumour-free resection margins. Excision biopsy of the recurrent lesion revealed a malignant fibrous histiocytoma (MFH). Radical tumour resection was completed by extended parotidectomy and neck dissection; the skin defect was covered by a regional bi-lobed flap. No adjuvant radio- or chemotherapy was administered. Full functional and cosmetic recovery was achieved; follow-up has been uneventful more than two years postoperatively.

Discussion: Malignant transformation of BFH is extremely rare and if so, extended radical surgery may give a fair chance for a favourable outcome even in patients with advanced age.

Show MeSH
Related in: MedlinePlus