Malignant fibrous histiocytoma of the scalp: A rare differential with a dramatic clinical presentation

Surgical Management of Invasive Atypical Fibroxanthomas/Undifferentiated Pleomorphic Sarcomas of the Scalp: A Systematic Review Comparing Outer Table Resection to Full-Thickness Craniectomy

Invasive atypical fibroxanthomas and undifferentiated pleomorphic sarcomas of the scalp are relatively rare spindle cell tumors that recur at high rates. Wide local excision and Mohs surgery alone are not feasible for the definitive management of lesions adhering to the underlying pericranium and/or calvarium. This brief clinical study presents 2 patient cases and includes a systematic review of the literature. In our literature review, 2 of 4 patients treated with outer table resection had no disease recurrence, 1 died due to an unrelated cause, and 1 died due to disease progression. Three of 9 patients treated with full-thickness craniectomy had no disease recurrence, 5 patient outcomes were not specified, and 1 died from disease progression. There are currently no recommendations for the management of these invasive scalp lesions. We believe invasive atypical fibroxanthomas/undifferentiated pleomorphic sarcomas of the scalp without frank calvarial involvement can be effectively treated with outer table resection.

Malignant Fibrous Histiocytoma of the Scalp with Skull Invasion: A Rare and Aggressive Presentation

Malignant fibrous histiocytoma (MFH) is an undifferentiated high-grade pleomorphic sarcoma and is considered the most common primary soft tissue sarcoma in adults. MFH is known to arise in the trunk, extremities and retroperitoneum although it can arise anywhere in the body.MFH of the skin is uncommon and even less frequent is the involvement of the scalp, especially with skull invasion. Most of the MFH cases present as a gradually growing lesion over a period of one to two years and is associated with ulceration and hemorrhage in most of the cases. Treatment of MFH is usually surgical resection.

We present a case of MFH in an 85-year-old gentleman that was invading the skull which required a multidisciplinary surgical treatment for resection and microvascular free flap reconstruction.

Malignant fibrous histiocytoma of the skull base: A neurosurgical nuance

A 69-year-old male, treated for colonic carcinoma 15 years back, presented to our services with status epilepticus. He had complaints of headache and vomiting for 7 days prior to presentation. Computed tomography and magnetic resonance imaging of the brain revealed heterogeneous, lobulated and osteolytic tumor involving middle and posterior cranial fossa. Excision of the tumor was planned in two stages. Middle fossa component was removed through right temporobasal approach. Histopathology was suggestive of malignant fibrous histiocytoma. Patient succumbed to pneumonia and septicemia in the postoperative period. Pathology, clinical features and therapeutic challenges of this clinical entity have been briefly reviewed.