Malignant fibrous histiocytoma: a report of two cases arising in sites of previous irradiation

Malignant Fibrous Histiocytoma of the Maxillary Sinus. A Case Report

We report a case of malignant fibrous histiocytoma of the left maxillary sinus in a 30 year-old man. The major problem encountered was the histological diagnosis of the first biopsy, which showed a non specific fasciculated, myxoid, alveolar pattern suggestive of a mesenchymal malignancy, thus preventing the correct diagnosis that became possible only when the surgical specimen was available.

Malignant fibrous histiocytoma of the nasal cavity and paranasal sinuses

Malignant fibrous histiocytomas are uncommon in the head and neck, the sinonasal tract being the most common location. This report describes 5 cases in this area: two in the nasal cavity, two in the maxillary sinus, and one in the frontal sinus. Four were primary cases and one was secondary to previous irradiation. All patients received surgical treatment, one of them with postoperative irradiation. All five patients experienced local recurrences and three also experienced distant metastases. Only one of these recurrences was successfully salvaged and the patient is alive and free of disease 3 years after resection. A summary of knowledge about the entity is reviewed.

Factors in the pathogenesis of tumors of the sphenoid and maxillary sinuses: a comparative study

OBJECTIVES/HYPOTHESIS

To explain the processes that lead to the development of tumors in the maxillary and sphenoid sinuses.

STUDY DESIGN

A 32-year review of the world's literature on neoplasms of these two sinuses and a randomized case-controlled study comparing the normal mucosal architecture of the maxillary to the sphenoid sinus.

METHODS

Analysis of a 32-year world literature review reporting series of cases of maxillary and sphenoid sinus tumors. Tumors were classified by histological type and separated into subgroups if an individual incidence rate was reported. Histomorphometry of normal maxillary and sphenoid sinus mucosa was performed in 14 randomly selected patients (10 sphenoid and 4 maxillary specimens). Specimens were fixed in 10% formalin, embedded in paraffin, and stained with periodic acid-Schiff (PAS) and hematoxylin. Histomorphometric analysis was performed with a Zeiss Axioscope light microscope (Carl Zeiss Inc., Thornwood, NY) mounted with a Hamamatsu (Hamamatsu Photonics, Tokyo, Japan) color-chilled 3 charge coupled device digital camera. The images were captured on a 17-inch Sony (Sony Corp., Tokyo, Japan) multiscan monitor and analyzed with a Samba 4000 Image Analysis Program (Samba Corp., Los Angeles, CA). Five random areas were selected from strips of epithelium removed from each sinus, and goblet and basal cell measurements were made at magnifications x 100 and x 400.

RESULTS

The literature review revealed that the number and variety of tumors in the maxillary sinus are much greater than those in the sphenoid. The incidence of metastatic lesions to each sinus is approximately equal. No recognized pattern of spread from any particular organ system could be determined. On histomorphometric study there were no statistically significant differences between the sinuses in the concentration of goblet cells, basal cells, or seromucinous glands.

CONCLUSIONS

Factors involved in the pathogenesis of tumors of the maxillary and sphenoid sinuses include differences in nasal physiology, embryology, morphology, and topography. There are no significant histological differences in the epithelium and submucous glands between the two sinuses to explain the dissimilar formation of neoplasms.

Role of skull base surgery for local control of sarcoma of the nasal cavity and paranasal sinuses

Sarcomas of the nose and paranasal sinuses are rare neoplasms and comprise less than 1% of the malignancies arising in the sinonasal tract. From 1977 to 1989, we had the opportunity to treat 15 patients presenting with these tumors at The Eye & Ear Institute of the University of Pittsburgh. The clinical charts of these patients were reviewed retrospectively for demographic data, characteristics of disease, treatment considerations and clinical outcome. Data were also analyzed with special attention to the role of skull base surgery for the local control of tumors. Seven patients underwent cranial base surgery as part of their original therapy. Two of these patients are alive with no evidence of disease, one patient died of other causes, and four are dead of disease. Two patients died with local disease. Although not statistically significant due to the small number of patients, these data suggest that cranial base surgery can improve the local control of sarcomas of the sinonasal tract that approach or invade the skull base.

Oral post-radiation malignant fibrous histiocytoma: a clinicopathological study

Five cases of oral malignant fibrous histiocytoma (MFH) in patients who had previously received radiotherapy in the head or neck region were included in this study. There were 3 men and 2 women. Four patients had been irradiated for nasopharyngeal carcinoma (NPC) and the other for a squamous cell carcinoma (SCC) involving the tongue and mouth floor. The MFH developed 2.5-11 years after the initial radiotherapy. Two cases of MFH occurred in the maxilla, two in the mandible, and the remaining one in the tongue, floor of mouth and mandible. Clinically, the oral post-radiation MFH presented as tender, reddish, elastic, lobulated masses with surface ulceration. Radiographic examination of the involved jaws revealed a poorly defined radiolucent lesion without any periosteal or endosteal reaction. The prognosis of these tumors was very poor. Although aggressive multimodality treatment had been applied, 3 of 5 patients eventually died of the disease, with a mean survival time of 17 months after establishing the diagnosis of MFH. In order to ensure the early diagnosis and treatment of this radiation-induced second malignancy, close oral follow-up is mandatory for patients who have received radiotherapy for head and neck malignancies.

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.