Primary intestinal malignant fibrous histiocytoma: Two case reports

Pediatric Undifferentiated Pleomorphic Sarcoma of the Cecum

Background: Undifferentiated pleomorphic sarcoma (UPS) is a high-grade neoplasm typically diagnosed in older adults and localized to the extremities or retroperitoneum. Because of poor response to therapy and high rates of recurrence, this neoplasm is associated with a poor prognosis. Case Report: A 12-year-old female presented with weight loss, abdominal pain, fatigue, and diarrhea. She was profoundly anemic with occult blood-positive stools. On endoscopy, a fungating cecal mass was biopsied and diagnosed as malignant sarcomatoid neoplasm. The neoplasm was resected with clear margins during subsequent surgery, and on final pathology was diagnosed as UPS. A suspicious lung nodule was also removed via video-assisted thoracoscopic surgery and found to be a granuloma positive for Histoplasma capsulatum for which the patient received antifungal therapy. The patient did not receive additional chemotherapy or radiotherapy and was doing well without signs of recurrence at 12 months postresection. Conclusion: This report of cecal UPS in a 12-year-old is rare because of the patient's age and tumor location. We have identified only 2 other case reports of pediatric gastrointestinal UPS. This case illustrates the need for a broad differential and prompt workup in pediatric patients presenting with weight loss and abdominal complaints. More information regarding the management and outcomes in cases of gastrointestinal UPS is needed to assist providers in determining the best treatment course and to allow for better prognostication.

Surgical management of primary undifferentiated pleomorphic sarcoma of the rectum: a case report and review of the literature

Background

Undifferentiated pleomorphic sarcoma (UPS) is a malignant soft tissue tumor that has been reclassified from malignant fibrous histiocytoma with the development of the pathological diagnosis. It principally occurs in the extremities but rarely occurs in the rectum. We herein report a rare case of UPS arising in the rectum.

Case presentation

A 85-year-old woman was referred to our hospital with a complaint of anal pain, which had persisted for several months. Computed tomography (CT) showed a 53 × 58 × 75 mm mass on the left side of the rectum. Colonoscopy revealed a submucosal elevation in the rectum without any exposure of the tumor to the surface. Contrast-enhanced CT and magnetic resonance imaging revealed an 80-mm mass that originated in the rectal muscular propria, and we suspected a gastrointestinal stromal tumor. No lymph node metastasis or distant metastasis was observed. We performed a laparoscopic Hartmann’s operation. Intraoperatively, severe adhesion around the tumor caused tumor injury and right ureteral dissection. Thus, laparoscopic right ureteral anastomosis and ureteral stenting were additionally performed. The operation time was 6 h and 3 min, and the estimated blood loss was small. The patient was discharged without complications 25 days after surgery. A pathological examination showed that the tumor was composed of highly heterogeneous cells with no specific differentiation traits, leading to a diagnosis of UPS. Contrast-enhanced CT performed 2 months after surgery showed bilateral pelvic lymph node enlargement, which indicated recurrence. Considering the patient’s age, we performed radiotherapy (50 Gy/25 Fr targeting the pelvic region). At present, 16 months have passed since the completion of radiotherapy. Contrast-enhanced CT shows that the recurrent lymph nodes have disappeared, and no new distant metastasis has been observed.

Conclusions

We reported a case of UPS arising in the rectum. The surgical procedure and indication of preoperative therapy should be carefully selected because complete removal of the tumor is desirable in UPS.

Undifferentiated high-grade pleomorphic sarcoma of the colon: a rare case report and literature review

Background

Undifferentiated pleomorphic sarcoma (UPS), also known as malignant fibrous histiocytoma (MFH), hardly originates from the colorectum.

Case presentation

We reported a 65-year-old female presented with UPS in the descending colon. Computed tomography (CT) revealed an irregularly thickened descending colon. On colonoscopy examination, an ulcerative tumour was identified. The patient received radical resection of the left colon and partial enterectomy. The resected tumor was ulcerative, 10 cm × 8 cm × 5 cm in size, and infiltrated the serosa layer. Postsurgical pathology showed that the tumor was high-graded UPS in the colon with large amounts of necrotic tissues.

Conclusions

UPS in the large intestine is a rare malignant tumor with a poor prognosis and unknown pathogenesis. The main treatment for UPS is early complete resection. Postsurgery adjuvant radiotherapy or chemotherapy can be attempted.

OUP accepted manuscript

Primary adrenal pleomorphic spindle cell sarcoma (PSCS) is an exceedingly rare mesenchymal tumour that was previously known as malignant fibrous histiocytoma. It commonly occurs in extremities, retroperitoneum, peritoneal cavity and rarely in visceral organs. We report the first case of PSCS in the left adrenal gland in a 65-year-old female who presented with a large abdominal mass with vague symptoms. The wide range of differential diagnoses posed a challenge in establishing the diagnosis. However, this was overcome by appropriate radiological, intra-operative, histological and most importantly, comprehensive immunohistochemical findings. The patient underwent complete surgical resection of the tumour and had an unremarkable recovery. She remains without metastasis or recurrences to date through her 18 months of post-operative follow-up despite the poor prognosis of this tumour.

G-CSF-producing Undifferentiated Pleomorphic Sarcoma Adjacent to the Ascending Colon and in the Right Iliopsoas Muscle: A Case Report and Review of the Literature

Undifferentiated pleomorphic sarcoma (UPS) is a soft tissue sarcoma, occurring most commonly on the lower extremities. We herein report a rare case of primary UPS adjacent to the ascending colon and in the right iliopsoas muscle. Computed tomography of the abdomen revealed large masses, and the patient experienced a high-grade fever, leukocytosis, elevated serum C-reactive protein level, and hematopoietic activation on ¹⁸F-fluorodeoxyglucose-positron emission tomography. This inflammatory reaction was caused by granulocyte colony-stimulating factor secreted by tumor cells. Surgical resection was performed, and the inflammatory reaction disappeared immediately. The patient received adjuvant chemotherapy and survived one year after the operation without evidence of recurrence.

A rare case of primary malignant fibrous histiocytoma: a sarcoma of the kidney

Background

Primary malignant fibrous histiocytoma of the kidney (MFH) is an extremely rare tumor which is indistinguishable from its’ mimics in particular renal cell carcinoma (RCC) by clinical features and preoperative imaging evaluation. Due to its high predilection to local recurrence and distant metastases, early diagnosis has great value.

Case presentation

Herein, we describe a 62 year-old man with a 3-month history of abdominal discomfort and a palpable right loin mass whom computerized tomography (CT) showed a large heterogeneous solid mass in the right kidney. With the suspicious to RCC; the patient underwent radical nephrectomy. However, histopathological report revealed pleomorphic-storiform malignant fibrous histiocytoma. Immunohistochemistry study was also confirmed the diagnosis of MFH. Six month follow up showed no evidence of any recurrence.

Conclusions

The therapeutic options for MFH differ from other renal tumors, hence histopathology and immunohistochemistry studies are required to establish a definite diagnosis of the disease. Despite of progress made in clinical studies and advances in diagnostic modalities, early diagnosis of MFH has not achieved yet. Further studies and accumulated experience with renal MFH are required to determine the approach to prolong survival in selected cases along with management and prognostic factors of such tumors.

Primary hepatic malignant fibrous histiocytoma combined with invasion of inferior vena cava: A case report and literature review

RATIONALE

Malignant fibrous histiocytoma (MFH), primary presented in liver, was very rare and displayed a poor prognosis because of high aggression. As a few of cases had been reported merely, we shared the case of primary hepatic MFH combined with invasion of inferior vena cava (IVC).

PATIENTS CONCERNS

A 69-year-old women presented with abdominal pain.

DIAGNOSES

Abdominal computed tomography and magnetic resonance imaging indicated a soft mass about 5.4 × 4.2 cm in the caudate lobe, accompanied with IVC invaded.

INTERVENTIONS

After the multidisciplinary consultation, laparotomy was performed, followed by chemotherapy and radiotherapy. Primary hepatic MFH was demonstrated pathologically. Till now, the patient was alive for >22 months after surgery and no evidence of recurrence or distant metastasis was suspected.

OUTCOMES

We discussed the integrated procedure of diagnosis and treatment, combined with data from literature review.

LESSONS

To our knowledge, the primary hepatic MFH combined with invasion of IVC was hardly reported. Despite the poor prognosis, the comprehensive treatment integrating the surgery, chemotherapy, and radiotherapy showed the satisfactory disease-free and overall survival. However, further investigations are definitely warranted.

Primary Malignant Fibrous Histiocytoma of the Thyroid: Two Case Reports and Review of the Literature

Primary malignant fibrous histiocytoma of the thyroid is an uncommon malignancy of the thyroid. Because it is rare, fewer than 20 cases have been reported in the literature, and the sonographic features of only 2 cases have been reported between the 1980s and 2014. Here we report 2 cases of primary malignant fibrous histiocytoma of the thyroid with an emphasis on the sonographic findings, and we review the published literature.

Primary malignant fibrous histiocytoma of the colon: A case report and review of the literature

A 68-year-old woman was admitted to the Peking Union Medical College Hospital with a 6-week history of fever of undetermined origin. The computed tomography scan revealed a space-occupying lesion in the ascending colon and colonic endoscopy revealed a protrusive lesion in the initial segment of the ascending colon, occupying 3/5 of the lumen. Pathological examination of a biopsy specimen revealed malignant fibrous histiocytoma (MFH). The patient then underwent a laparotomy for right hemicolectomy and en bloc lymph node dissection. The histopathological examination confirmed the diagnosis of MFH and administration of adjuvant radiotherapy was decided. MFH is a high-grade sarcoma that rarely arises in the alimentary tract. To the best of our knowledge, there has only been one case of primary colorectal MFH treated by radiotherapy recorded to date, which makes our case the second trial. We herein present a case of MFH in the ascending colon and a review of previous case reports of patients presenting with this unusual type of MFH.

Metastatic Malignant Fibrous Histiocytoma Infiltrating Sigmoid Colon: A Case Diagnosed With the Help of 18F-FDG PET/CT

Metastatic malignant fibrous histiocytoma (MFH) in the colon is extremely rare, although MFH is one of the most common soft tissue sarcomas in adults. We report the case of a 45-year-old woman with metastatic MFH in the sigmoid colon, descending colon, and right lung with FDG PET/CT findings.

Contrast-enhanced sonographic appearance of malignant fibrous histiocytoma in the sigmoid colon: a case report

Malignant fibrous histiocytoma (MFH) of the sigmoid colon is extremely rare and imaging characteristics of MFH during contrast-enhanced sonography have not been described yet. Here we report the case of a 55-year-old man suffering from MFH in the sigmoid colon, with an emphasis on contrast-enhanced sonography findings.

Primary malignant fibrous histiocytoma of the abdominal cavity: CT findings and pathological correlation

AIM: To study computed tomography (CT) features of abdominal malignant fibrous histiocytoma (MFH) in various rare locations.

METHODS: We retroprospectively identified cases of MFH involving the abdominal cavity. Particular attention was paid to details regarding imaging features and histological types.

RESULTS: The study population consisted of seven men and one woman, with a mean age of 52.5 years. Seven patients had some physical symptoms, while one was incidentally detected. The sites of origin were liver (n = 3), greater omentum (n = 1), superior mesentery (n = 1), ileum (n = 1), right psoas muscle (n = 1) and right kidney (n = 1). With the exception of the ileum lesion, all were of huge size. The contour of the lesions was more or less clear. Foci of necrosis were present in six lesions (n = 6). On plain CT scan, all lesions were hypo to iso dense. The lesion in the greater omentum was cystic. One lesion (n = 1) showed significant enhancement and the cystic lesion showed mild peripheral enhancement. An abundance of blood vessels surrounding the mass was seen in two lesions (n = 2) and both were of the inflammatory variety. Pathological examination revealed storiform-pleomorphic variety (n = 4), inflammatory variety (n = 3) and myxoid variety (n = 1). Two of the patients with inflammatory MFH had a clinical presentation of fever and one was afebrile, however, blood investigations in all three showed leukocytosis.

CONCLUSION: Primary MFHs of the abdominal viscera and gastrointestinal tract are generally huge soft tissue masses containing areas of low attenuation and mild to moderate contrast enhancement.

Primary malignant fibrous histiocytoma: a rare case

Malignant fibrous histiocytoma (MFH) of the small intestine is an extremely rare condition. It occurs most commonly in the extremities and the trunk. We report a case of a 67-year-old woman who admitted with fever, myalgia, and altered status. After thorough investigation, a tumor of the jejunum was found. The patient underwent complete surgical removal of the tumor. A diagnosis of MFN (undifferentiated high-grade pleomorphic sarcoma) was made. The patient received adjuvant chemotherapy with Gemcitabine. Two years after the operation, the patient died due to recurrence of the disease. MFH of the small intestine is an extremely rare neoplasm with an aggressive biological behaviour. In this paper, pathogenesis, natural history, and treatment are reviewed.

Malignant fibrous histiocytoma of rectum: Report of a case

Malignant fibrous histiocytoma (MFH) is the most common soft tissue sarcoma of adults, mostly distributed in the thigh, buttock and groin (46%) and presents rarely in the gastrointestinal tract, classified as gastrointestinal stromal tumors (GIST). MFH is regarded as a diagnosis of exclusion, essentially synonymous with an undifferentiated pleomorphic sarcoma. The recent report presents an 80-year-old man with clinical manifestations of rectal bleeding and final diagnosis of MFH of rectum. It seems that radical resection and adjuvant radiation is important in the management strategy of a patient with such a rare rectal tumor.

Primary intra-abdominal malignant fibrous histiocytoma: a highly aggressive tumor

BACKGROUND AND PURPOSE

Malignant fibrous histiocytoma (MFH) is the most common soft-tissue sarcoma of late adult life occurring predominantly in the extremities. Primary intra-abdominal MFH is a very rare occurrence. The aim of this study is to describe a very rare case of an intra-abdominal MFH with a highly aggressive clinical course.

METHODS

A 67-year-old male was referred to our department with a 2-week history of dull lower abdominal pain and a gradually enlarging right lower abdominal mass, which he first noticed 2 months prior to admission. Computed tomography (CT) scan demonstrated a mass in the right iliac fossa.

RESULTS

On exploratory laparotomy, a tumor was found in the right iliac fossa attached to the parietal lateral peritoneum without any evidence of invasion into the adjacent structures. Complete excision of the tumor with clear margins was performed. Histological and immunohistochemical examinations showed a MFH. One month after surgery, while on adjuvant chemotherapy, the patient was readmitted with dyspnea and a slightly palpable mass in the area of the previous radical resection. CT scan revealed local tumor recurrence along with multiple pulmonary metastatic deposits. Unfortunately, despite treatment, the patient died of progressive disease 5 weeks later.

CONCLUSIONS

Primary intra-abdominal MFH is a very rare but aggressive malignancy with a high tendency of local recurrence and metastatic spread. Early detection and complete surgical excision with clear margins is the treatment of choice. In some cases, however, the tumor can exhibit a highly aggressive clinical course despite radical surgery and adjuvant therapy.

A case of primary malignant fibrous histiocytoma of the pancreas: CT and MRI findings

Primary malignant fibrous histiocytoma (MFH) of the pancreas is rare and a distinct clinical entity. We report a case of recurrence of pancreatic MFH with computed tomography (CT) and magnetic resonance imaging (MRI) findings. A 67-year-old man presented with a history of decreased body weight over the past 6 mo. Abdominal CT revealed a large, multilocular cystic mass in the head of the pancreas with obvious atrophy in the body and tail of the pancreas. After 6 mo postoperatively, MRI demonstrated a recurrent large mass in the primary area of the head of the pancreas. The lesion was heterogeneous, hypointense to the liver on T1-weighted imaging, and heterogeneously hyperintense to the liver with a hypointense area in the central part of the tumor on fat-saturated T2-weighted imaging. Contrast-enhanced T1-weighted imaging demonstrated a large multilocular cystic mass with a cystic wall, fibrous septa and enhancement of solid components. To the best of our knowledge, this is the first report on recurrence of primary MFH of the pancreas, and the first with MRI findings.