Malignant fibrous histiocytoma of the mandible

Malignant fibrous histiocytoma of the mandible - A case report and review of published case reports

The natural history of malignant fibrous histiocytoma (MFH) is still heavily debated. It's anonymous natural history is precisely denoted by its new adapted terminology 'undifferentiated pleomorphic sarcoma (UPS)'. Thus to diagnose a lesion as UPS, it is vital to correlate its histopathological features along with its immunohistochemical (IHC) expressions to confirm the tumor cell lineage. MFH is extremely rare in mandible with the literature search in PubMed database revealing only 13 case reports of MFH involving the mandible. Among these, only 7 case reports provide IHC details of the case. Without IHC data it is not possible to determine the accuracy of the diagnosis in the remaining 6 cases. Here we report an additional 8th case of MFH involving the ramus and angle of the mandible. Histopathology revealed proliferating malignant spindle cells interspersed with histiocyte-like cells. The tumor cells were strongly positive for vimentin and CD68 and were negative for S-100, epithelial membrane antigen (EMA) and cytokeratin (CK). The diagnosis was made by correlating the histopathological findings with the IHC profile. The report also provides the data (clinical, radiographic, histopathological, immunohistochemical features and treatment details) extracted from the 7 confirmed MFH case reports involving the mandible.

Undifferentiated Pleomorphic Sarcoma in Mandible

Undifferentiated pleomorphic sarcoma (UPS), previously known as malignant fibrous histiocytoma, occurs commonly in the soft tissues in adult, but is rare in the maxillofacial region. It consists of undifferentiated mesenchymal tumor cells resembling histiocytes and fibroblasts. The purpose of this article is to report a case of UPS in the mandible. A 44-year-old patient presented with a painful growing mass in the mandible of two months’ duration. Computed tomography and positron emission tomography-computed tomography revealed an ill-defined heterogenous, hypermetabolic mass about 4 cm in size in the left mandible invading adjacent soft tissues. A left mandiblulectomy and reconstruction with a fibular free flap were performed. Immunohistochemical study gave a diagnosis of UPS. The patient was referred for adjuvant chemotherapy after surgical removal of the tumor.

Malignant fibrous histiocytoma: an uncommon sarcoma with pathological fracture of mandible

BACKGROUND

Tumors composed of cells differentiating as both fibroblasts and histiocytes have been designated fibrous histiocytomas. Only a small percentage of these lesions behave in a malignant fashion, they are called malignant fibrous histiocytoma (MFH).The occurrence of MFH in membranous bones including the mandible is quite unusual. Involvement of the mandible accounts for only 3 % of all MFH bone lesions. Recent literature revealed only a few (30) cases of MFH involving the mandible but not a single case of MFH associated with pathological fracture of the mandible, probably the first such kind of case to support antecedent trauma as an initial proliferative response for its occurence.

CASE REPORT

A rare case of MFH involving the mandible and submandibular glands with pathological fracture in a 14-year-old boy is presented with special emphasis on the poor prognosis even after prompt therapy, its controversial histogenesis, high malignant potential, high recurrence rate and tendency to metastasise. The patient was regularly followed up for 11 months post-operatively, during which patient complained of pain in the operated region after 8 to 9 months. Though there was no clinically obvious abnormality seen, the young boy died after 11 months. The clinical, surgical, radiographic and pathological features of this lesion are discussed.

DISCUSSION

Malignant fibrous histiocytoma, the most frequent soft tissue sarcoma of adulthood, was first described as a new malignant tumour by O'Brian and Stout in the 1960s and the details of the histopathological features of MFH were first described by Kempson and Kyriakos. Despite the frequency of diagnosis, MFH has remained an enigma as no true cell of origin has ever been identified. Treatment consists of surgical excision and in some cases chemotherapy and radiation. Early and complete surgical removal using wide or radical resection is indicated because of the aggressive nature of the tumor. The combination of infrequent occurrence, varied pathologic features, uncertain histogenesis, numerous subtypes and the many potential sites of presentation makes these tumors a challenge for the diagnostician, surgeon and oncologist. Close follow-up after treatment is important, as local recurrence is common and early metastasis to the lungs is also frequent, which are the reasons for high mortality rate in MFH.

Malignant fibrous histiocytoma of the mandible and the infratemporal fossa-A case report

Malignant fibrous histiocytoma is a sarcoma which commonly occurs in the soft tissues, joints and tendons of the extremities of adults but its occurrence in the oral and maxillofacial region is very rare. We present a rare case of malignant fibrous histiocytoma of the mandible with recurrence in the infratemporal fossa after surgery and radiotherapy. Patient underwent second surgery and complete tumor excision with minimal loss of function was achieved. Patient survived 8 years after surgery and died of natural cause.

Myxofibrosarcoma arising in the maxillary sinus: a case report with a review of the ultrastructural findings and differential diagnoses

This is a case report of a patient presenting with a destructive lesion with histologic features of a low grade malignancy in a predominantly myxoid matrix. Various low grade myxoid malignancies were considered in the differential diagnosis of which an overview is presented. A literature review of the ultrastructural findings and possible histogenesis is discussed along with the diagnostic criteria and recent change in the terminology regarding the malignancies previously diagnosed as myxoid malignant fibrous histiocytomas. A final diagnosis of a myxofibrosarcoma was only possible after assessing the immuno-histochemical profile, results of histochemical stains and ultrastructural features of this lesion.

Malignant fibrous histiocytoma of the mandible

Malignant fibrous histiocytoma (MFH) of the mandible is rare. We describe a case of MFH of the mandible with metastatic disease to the lungs. To our knowledge only 30 cases have been reported prior to the present case. In previously reported cases, there was a strong tendency for the posterior portion of the mandible to be affected by MFH; ours is only the second reported case involving the anterior portion of the mandible. We review the diagnosis, pathology, and treatment of this rare malignancy.

Malignant fibrous histiocytoma: a case report

Malignant Fibrous Histiocytoma (MFH) is a controversial soft tissue malignancy whose pathogenesis continues to be redefined. It remains the most often used term for soft tissue sarcomas of late adult life. It has also been described to originate from the bone and rarely found in the mandible. Primary involvement of the mandible with MFH is an unusual presentation. A case of malignant fibrous histiocytoma, which posed a diagnostic difficulty, is presented here.

Malignant fibrous histiocytoma of the mandible

We report a case of malignant fibrous histiocytoma (MFH) primary within the mandible of a 32-year-old female. The mandible is a rare location of MFH, accounting for only 3% of all tumours of this type occurring within bone. The clinical, pathological and radiographic features are discussed with special emphasis on the radiographic features of this lesion.

Malignant fibrous histiocytoma of the mandible: the importance of an accurate histopathological diagnosis

A case is presented of a malignant fibrous histiocytoma arising in the mandible and oral cavity of a 62-year old woman. The histopathological features were typical and the diagnosis was confirmed on immunohistochemistry. The exact nature of this usually soft tissue sarcoma is uncertain, but it is a well defined clinicopathological tumour entity which only rarely arises in the jaws. Microscopically, it may resemble other neoplasms, such as sarcomatoid squamous carcinoma, and an accurate diagnosis requires the use of immunohistochemistry or electron microscopy. Treatment is primarily surgical, but because of the difficulties at this site of complete removal with adequate margins, recurrence, metastasis and death due to disease are a likely outcome.