Benign fibrous histiocytoma of the thoracic spine as the cause of pyrexia of unknown origin identified by positron emission tomography/computed tomography

The first total vertebral involvement of benign fibrous histiocytoma: A case report and literature review

BACKGROUND

Benign fibrous histiocytoma (BFH) is a rare bone tumor, extremely seldom in the spine.

METHODS

We present a 52-year-old patient diagnosed with a BFH in the thoracic spine treated with total en bloc spondylectomy. A review of the published literature was also conducted.

RESULTS

Non-ossifying fibroma (NOF) and BFH are named as one tumor called NOF/BFH. A total of 20 spinal BFHs have been previously reported, mainly involving the posterior elements. We present a BFH with total vertebral involvement. Curettage and excision are the main treatment options with limited recurrence.

CONCLUSIONS

This is the first total vertebral BFH up to now. Spinal BFH occupies rather low aggressiveness. With rather limited recurrence and malignant degeneration, surgical interventions seem enough for its management.

Management of giant benign fibrous histiocytoma in the spinal region with pleural involvement: A case report

RATIONALE

Benign fibrous histiocytoma with pleural involvement in spinal region is a highly unusual disease with no standard curative managements yet. The objective of this study is to report an extremely rare case of a giant benign fibrous histiocytoma with pleural involvement in spinal region successfully operated by posterior spinal surgery. The management of these unique cases has yet to be well-documented.

PATIENT CONCERNS

A 23-year-old man presented with a 2-month history of continuous and progressive back pain. A giant, expanding lesion of the T7 vertebral and paraspinal region with pleural involvement was identified.

DIAGNOSES

Computed tomography scan and magnetic resonance imaging of spine showed expanding lesion of the T7 vertebral and paraspinal region involving the right thoracic cavity, which presented as a solid tumor. Postoperative pathology confirmed the diagnosis of thoracic benign fibrous histiocytoma.

INTERVENTIONS

The patient underwent thoracic spinal canal decompression, complete tumor resection, pleural defect repair, and T4 to T10 internal fixation procedure via a posterior approach.

OUTCOMES

The patient's symptom improved significantly after the surgery, and the postoperative period was uneventful at the 2-year follow-up visit. There were no complications associated with the operation during the follow-up period.

LESSONS

In summary, the tumor's clinical features, imaging results, and pathological characteristics are unique. Combined efforts of specialists from orthopedics, thoracic surgery, neurosurgery, pathology, and medical oncology led to the successful diagnosis and management of this patient. Giant benign fibrous histiocytoma with pleural involvement in spinal region, although rare, should be part of the differential diagnosis when the patient presents with back pain and radiculopathy. We recommend the posterior or 1-stage anterior-posterior combined approach for complete resection of the giant thoracic benign fibrous histiocytoma when the tumor has caused severe symptoms or neurological deficits.

Intraspinal extradural benign fibrous histiocytoma of the lumbar spine in a pediatric patient. Case report and literature review

INTRODUCTION

Benign fibrous histiocytoma (BFH) is a rare skeletal tumor. Spinal localizations have been previously described in 17 cases, and this is the first report of BFH occurring at the lumbar spine in a pediatric patient.

CASE REPORT

A 13-year-old male complained lower limb motor and sensory impairment with severe claudication and urination disorders. A huge intraspinal, extradural mass at L4-L5 level, clearly evident on a preoperative MRI, caused dislocation and severe compression of the cauda equina nerve roots. After a biopsy, confirming BFH, a tumor resection and L4-S1 vertebral arthrodesis was carried out. At 1 year follow-up, no recurrence was detached on postoperative MRI, with complete neurological recovery.

DISCUSSION AND CONCLUSION

Review of the literature is discussed. Histological examination is mandatory for a correct diagnosis and plan of treatment. None of the pediatric patients treated for BFH have ever shown local relapse.