Benign Fibrous Histiocytoma of the Sacrum – Diagnostic Difficulties Facing This Rare Bone Tumor

Abstract

Benign fibrous histiocytoma of bone is rare, and this is the first report of the tumor arising from the sacrum. The descriptive histopathological picture makes the diagnosis more difficult as it resembles many benign and malignant myxoid tumors. In this case report, the diagnostic difficulties involved and a review of the literature in order to describe the optimal management of this condition, have been presented. The clinical presentation of this 18-year-old girl was that of low back ache, radiating along the right posterior leg, of 1 month’s duration. On the straight leg raising test, right-sided sciatic nerve compression was detected. Magnetic resonance imaging revealed a large tumor involving and destroying sacral segments S₃–S₄, homogeneous in intensity and extending into the vertebral canal and the presacral space. There was no enhancement with gadolinium contrast. Core needle biopsy revealed fibrous histiocytoma. Excision through a posterior midline incision was performed taking care to preserve the S₁–S₂ sacral segments and also the sacral nerves. Additional cauterization with phenol was performed. Postoperatively, the patient had significant improvement in pain with no major residual neurological deficit.

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

“…To the best of our knowledge, spinal localizations of BFH has been previously described in 17 cases (12 M, 5 F) [2][3][4][5][6][7][8][9][10][11][12][13][14][15], only 4 cases involved patients younger than 18 years old, 1 cervical and 3 thoracic (Table 1). Kim et al described a similar case of intraspinal extradural BFH, involving the lumbar spine [14] of a 66-year-old female.…”

“…Spinal involvement is very rare: to the best of our knowledge, 17 cases have been previously described since 1979 [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15]. Among the four cases involving pediatric patients [1,5,8,9], this report is the first case of tumor located in the intraspinal, extradural lumbar spine.…”

Benign fibrous histiocytoma of bone in a paediatric population: a report of 6 cases

“…The lesion may have a loculated appearance with septa or ridges or a soap-bubble appearance [5,6,9]. The lesion occurs commonly in the spine, ribs, pelvis [1,5,6,8,12,15,16,[18][19][20][21][22] or in the epiphysis Thirty-three months after surgery, bone healing was achieved with advanced phosphocalcic cement incorporation and no evidence of disease Fig. 6 A 10.75-year-old girl presented with pain and swelling around her right knee lasting 3 months.…”

“…The diagnosis of BFH was made based on clinical presentation, the radiological features and recurrence of the lesion after the initial surgery (Figs. 6,7,8,9,10,11,12,13).…”

“…Because the diagnostic criteria are very restrictive with regard to the age of the patient, BFH is seldom diagnosed in patients under 20 years of age [6][7][8][9]. Because of this fact, there are only 7 reports on BFH that have been described in children and adolescents [2,9,[11][12][13][14][15]. The purpose of this study is to highlight BFH in a paediatric population and discuss their clinical, radiological and therapeutic features.…”