Primary malignant fibrous histiocytoma of the liver MRI findings

Primary malignant fibrous histiocytoma of the renal pelvis: a 78-month follow-up case report

Primary malignant fibrous histiocytoma of the renal pelvis is extremely rare. This article reports a pathologically confirmed case. Surgery is the main treatment for this disease. Chemotherapy and radiotherapy have been reported to be ineffective. It is difficult to differentiate it from urothelial tumor of the renal pelvis and renal cell carcinoma by preoperative laboratory and radiological evaluation. Immunohistochemical study is helpful in confirming the diagnosis of the disease. This report discusses the clinical manifestations, pathohistological characteristics, treatment, and prognosis of the case reported.

Primary malignant fibrous histiocytoma of the liver: CT findings in five histopathological proven patients

BACKGROUND

To describe imaging features of primary hepatic malignant fibrous histiocytoma (MFH), especially its dynamic enhancement pattern.

MATERIALS

The CT manifestations of five patients with histopathological proven primary hepatic MFH retrospectively reviewed.

RESULTS

Six hepatic masses were detected in the five patients at CT examinations. All tumors were hypodense on plain CT scanning related to adjacent hepatic parenchyma. Five lesions were heterogeneous with predominantly cystic or necrosis areas and one lesion was homogeneous solid. After administration of contrast material, solid components of the four tumors with cystic or necrotic areas and the solid lesion showed a "fast rushing in and washing out" enhancement pattern with marked enhancement at the arterial dominated phase and fast decreasing at the portal vein dominated phase and the delay phase. The remaining one tumor showed slight enhancement of its solid components. Portal lymph node enlargement was observed in one patient and the inferior vena cava was invaded in one patient, respectively.

CONCLUSION

The CT manifestations of primary hepatic MFH are various and nonspecific. A "fast rushing in and washing out" enhancement pattern of MFH in our series has not been reported before. These manifestations could help radiologists to include primary hepatic MFH in the differential diagnosis list.

Clinical characteristics of the primary hepatic malignant fibrous histiocytoma in China: case report and review of the literature

Background

A malignant fibrous histiocytoma is a soft tissue tumor that most commonly occurs in the extremities, but rarely involves the liver. The clinical characteristics and therapeutic experiences of primary hepatic malignant fibrous histiocytoma are still limited.

Methods

Two cases of primary hepatic malignant fibrous histiocytoma were analyzed retrospectively, and all the literature concerning primary hepatic malignant fibrous histiocytoma was analyzed.

Results

In China, a total of 76 cases had been reported, among which 50 were men, with a male to female ratio of 1.9:1. Mean age of the patients was 51.0 years old, and more than 85 percent were older than 40 years. 82.9 percent (63/76) of hepatic MFH were solitary lesions, with tumor size ranging from 2.5 to 23.5 cm (average 10.3 cm). Major clinical presentation (78.4%) was abdominal pain or discomfort, accompanied with some other non-specific symptoms such as malaise, anorexia, weight loss, jaundice and fever, and small cases (14.9%) were asymptomatic. Computed tomography and ultrasound usually revealed the location of lesions. The rate of pre-operative misdiagnosis was extremely high, and 14.9 percent of patients were even misdiagnosed as a benign liver cyst, liver abscess or hematoma. Integrated resection was performed among the most cases (49/68), among which only a few ones (12 cases) were introduced to have no recurrence or metastasis or be still alive with no detail information provided, while among the cases with palliative operation or only a biopsy, the cases that were followed-up all died.

Conclusions

Hepatic malignant fibrous histiocytoma is a rare malignant mesenchymal tumor. The variable features of clinical presentations and images make the diagnosis difficult. Though the prognosis of primary hepatic malignant fibrous histiocytoma was rather poor, integrated resection might provide a few cases a good opportunity for surviving, suggesting that surgery might be an effective treatment.

Primary hepatic malignant fibrous histiocytoma: clinicopathologic characteristics and prognostic value of ezrin expression

Primary hepatic malignant fibrous histiocytoma (MFH) is a rare entity with ill-defined clinicopathologic characteristics. We present the largest series to date (7 cases) of primary hepatic MFH, a systematic review of 27 cases published in the English literature, and an analysis of prognostic factors including ezrin expression. The 2 men and 5 women in our series were 34 to 80 years old (average 61 y) and presented with abdominal pain (6/7), systemic symptoms of low-grade fever, malaise, anorexia and weight loss (4/7), and spiking fever (1/7). One case was an incidental finding. Computed tomography and ultrasound revealed a well-demarcated solitary heterogeneous low-density mass ranging from 5.5 to 20 cm (average 12 cm) in largest dimension (5/7), or multiple small nodules up to 2 cm in diameter (1/7) or a 10 cm multiloculated cystic lesion owing to extensive necrosis (1/7). Histologically, a storiform-pleomorphic pattern with variable degrees of necrosis predominated (6/7). A myxoid pattern was seen in only 1 case and this case lacked necrosis. Lymphoplasmacytic infiltration was seen in 3/7 of the cases. Tumors were grade I (1/7), grade II (2/7), grade III (4/7), stage pT1 (4/7), pT2 (1/7), pT4 (1/7), and pT4, cM1 (1/7) at diagnosis. Three patients with tumor cell ezrin immunoreactivity score >or=1 died of tumor within 1 year. Two patients with tumor cell ezrin immunoreactivity score <1 survived >4 years after surgery. Combined analysis of our series and previously reported cases suggest that primary hepatic MFH possess certain characteristic clinicopathologic features that may help in making the diagnosis and in differentiating it from other more common neoplasms in the liver. The prognosis of hepatic MFH depends primarily on tumor size and stage at the time of diagnosis. Ezrin expression in tumor cells can provide additional prognostic information and may be a potential target for new adjuvant therapies.

Primary hepatic sarcomas: CT findings

Primary hepatic sarcomas are rare tumors that are difficult to diagnose clinically. Different primary hepatic sarcomas may have different clinical, morphologic, and radiological features. In this pictorial review, we summarized computed tomography (CT) findings of some relatively common types of hepatic sarcomas, including angiosarcoma, epithelioid hemangioendothelioma (EHE), liposarcoma, undifferentiated embryonal sarcoma (UES), leiomyosarcoma, malignant fibrous histiocytoma (MFH), and carcinosarcoma (including cystadenocarcinosarcoma). To our knowledge, hepatic cystadenocarcinosarcoma has not been described in the English literature. The CT findings in our case are similar to that of cystadenocarcinoma, a huge, multilocular cystic mass with a large mural nodule and solid portion. The advent of CT has allowed earlier detection of primary hepatic sarcomas as well as more accurate diagnosis and characterization. In addition, we briefly discuss the MRI findings and diagnostic value of primary hepatic sarcomas.

Hepatic malignant fibrous histiocytoma: CT findings

Although malignant fibrous histiocytoma represents the most common soft tissue sarcoma in adults, its origination in visceral organs is very unusual and the liver is an exceptional site of involvement, with only 22 cases reported in the last 12 years. This controversial tumour, first described in 1964, probably originates from undifferentiated mesenchymal cells and has five different histological subtypes: storiform pleomorphic, myxoid, giant cells, inflammatory and angiomatoid. We describe herein the rather variable CT findings of three malignant fibrous histiocytomas of the liver and discuss their differential diagnosis.