Malignant fibrous histiocytoma developing in bone 44 years after shrapnel trauma

Lindeman, Geoffrey J.; McKay, Michael J.; Taubman, Kim; Bilous, A. Michael

doi:10.1002/1097-0142(19901115)66:10<2229::aid-cncr2820661032>3.0.co;2-x

Cited by 46 publications

(18 citation statements)

References 10 publications

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“…[9][10][11][12][13][14][15][16][17] In fact, several reports have described malignant fibrous histiocytomas associated with bone infarction or trauma, 9,10 artificial implants, 11-13 surgical incisions 14 or burn scars, 15 chronic ulcerations, 16 and tuberculous pleuritis. 17 In our patient, the rarity of intestinal histiocytoma and the close timely and local relationship between the neoplasm and the previous surgical procedure with a plausible latent period suggest a tumor-promoting role of postoperative repair processes, rather than a preexistent tumor which had secondarily been involved in the pelvic inflammatory process.…”

Section: Discussionmentioning

confidence: 88%

“…The occurrence of a malignant fibrous histiocytoma in a postoperatively adherent ileal loop supports the hypothesis of a promoting role of chronic repair processes in the tumorigenesis of this rare neoplasm, based on the analogy of inflammation-associated malignant fibrous histiocytomas arising at different sites. [9][10][11][12][13][14][15][16][17] …”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8] Several authors have discussed a possible promoting role of chronic repair processes in the tumorigenesis of malignant fibrous histiocytomas arising at different sites. [9][10][11][12][13][14][15][16][17] Intestinal malignant fibrous histiocytomas have been found associated with a history of pelvic radiotherapy 7,18 and, in one case, with diverticulitis. 19 However, to our knowledge, no primary intestinal malignant fibrous histiocytoma attributed to a postoperative adhesive intestinal process has been documented in the available English literature to date (PubMed database of the National Library of Medicine, 1965-January 2000).…”

Section: Introductionmentioning

confidence: 99%

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Malignant Fibrous Histiocytoma of the Ileum at a Site of Previous Surgery: Report of a Case

Froehner¹,

Gaertner²,

Hakenberg³

et al. 2001

Surgery Today

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Sarcomas rarely arise in the intestinum, and leiomyosarcoma represents the majority of cases. With only seven cases reported in the available English literature up to now, malignant fibrous histiocytoma of the small intestine is exceedingly rare. Moreover, follow-up data are almost completely unavailable. We present herein the unique case of a malignant fibrous histiocytoma arising in a postoperatively adherent intestinal loop. To the best of our knowledge, this is the first such case ever to be described. The clinical history and the intraoperative findings suggested that chronic postoperative repair processes might have been a promoting factor in the tumorigenesis of this neoplasm, on the analogy of malignant fibrous histiocytoma arising at different sites. The patient recovered well but 9.5 years after surgical removal, a solitary recurrent tumor developed in the urinary bladder and progressed rapidly, highlighting the need for long-term, possibly life-long, surveillance of patients with this rare type of intestinal cancer.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Malignant Fibrous Histiocytoma of the Ileum at a Site of Previous Surgery: Report of a Case

Froehner¹,

Gaertner²,

Hakenberg³

et al. 2001

Surgery Today

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“…Cases such as malignant fibrous histocytoma presenting 44 years after penetrating arm injury [29], sclerosing cholangitis secondary to retained fragment [30], non-malignant pseudotumor arising 61 years after steel grenade fragment implantation [31], angiosarcoma arising 63 years after implantation of grenade fragments [32], and squamous cell carcinoma arising in skin overlying a retained bullet (containing lead with a steel core), with a chronic draining sinus [33], are among some of the reported cases involving retained fragments. It is suspected that such cases are underreported.…”

Section: Discussionmentioning

confidence: 99%

Embedded Fragments from U.S. Military Personnel—Chemical Analysis and Potential Health Implications

Centeno¹,

Rogers²,

Voet³

et al. 2014

IJERPH

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Background: The majority of modern war wounds are characterized by high-energy blast injuries containing a wide range of retained foreign materials of a metallic or composite nature. Health effects of retained fragments range from local or systemic toxicities to foreign body reactions or malignancies, and dependent on the chemical composition and corrosiveness of the fragments in vivo. Information obtained by chemical analysis of excised fragments can be used to guide clinical decisions regarding the need for fragment removal, to develop therapeutic interventions, and to better anticipate future medical problems from retained fragment related injuries. In response to this need, a new U.S Department of Defense (DoD) directive has been issued requiring characterization of all removed fragments to provide a database of fragment types occurring in combat injuries. Objectives: The objective of this study is to determine the chemical composition of retained embedded fragments removed from injured military personnel, and to relate results to histological findings in tissue adjacent to fragment material. Methods: We describe an approach for the chemical analysis and characterization of retained fragments and adjacent tissues, and include case examples describing fragments containing depleted uranium (DU), tungsten (W), lead (Pb), and non-metal foreign bodies composed of natural and composite materials. Fragments obtained from four patients with penetrating blast wounds to the limbs were studied employing a wide range of chemical and microscopy techniques. Available adjacent tissues from three of the cases were histologically, microscopically, and chemically examined. The physical and compositional properties of the removed foreign material surfaces were examined with energy dispersive x-ray fluorescence spectrometry (EDXRF), scanning electron microscopy (SEM), laser ablation inductively-coupled plasma mass-spectrometry (LA-ICP-MS), and confocal laser Raman microspectroscopy (CLRM). Quantitative chemical analysis of both fragments and available tissues was conducted employing ICP-MS. Results: Over 800 fragments have been characterized and included as part of the Joint Pathology Center Embedded Fragment Registry. Most fragments were obtained from penetrating wounds sustained to the extremities, particularly soft tissue injuries. The majority of the fragments were primarily composed of a single metal such as iron, copper, or aluminum with traces of antimony, titanium, uranium, and lead. One case demonstrated tungsten in both the fragment and the connected tissue, together with lead. Capsular tissue and fragments from a case from the 1991 Kuwait conflict showed evidence of uranium that was further characterized by uranium isotopic ratios analysis to contain depleted uranium. Conclusions: The present study provides a systematic approach for obtaining a full chemical characterization of retained embedded fragments. Given the vast number of combat casualties with retained fragments, it is expected that fragment analysis will ha...

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“…The health risk of embedded fragments was considered low because they were considered to be inert once in the body. However, there began appearing in the scientifi c literature occasional reports on medical issues associated with embedded fragment wounds (Eylon et al, 2005;Knox & Wilkinson, 1981;Ligtenstein, Krijnen, Jansen, & Eulderink, 1994;Lindeman, McKay, Taubman, & Bilous, 1990;Schenck & Kronman, 1977;Symonds, Mackay, & Morley, 1985). In most cases, these wounds were suffered during wartime many years prior to the manifestation of the adverse health effect and, in all cases, the fragment was not characterized.…”

Section: Health Effects Of Embedded Fragments: the Human Experiencementioning

confidence: 99%

Embedded Metal Fragments

Kalinich¹,

Vane²,

Centeno³

et al. 2014

Annu Rev Nurs Res

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The continued evolution of military munitions and armor on the battlefield, as well as the insurgent use of improvised explosive devices, has led to embedded fragment wounds containing metal and metal mixtures whose long-term toxicologic and carcinogenic properties are not as yet known. Advances in medical care have greatly increased the survival from these types of injuries. Standard surgical guidelines suggest leaving embedded fragments in place, thus individuals may carry these retained metal fragments for the rest of their lives. Nursing professionals will be at the forefront in caring for these wounded individuals, both immediately after the trauma and during the healing and rehabilitation process. Therefore, an understanding of the potential health effects of embedded metal fragment wounds is essential. This review will explore the history of embedded fragment wounds, current research in the field, and Department of Defense and Department of Veterans Affairs guidelines for the identification and long-term monitoring of individuals with embedded fragments.

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Malignant fibrous histiocytoma developing in bone 44 years after shrapnel trauma

Cited by 46 publications

References 10 publications

Malignant Fibrous Histiocytoma of the Ileum at a Site of Previous Surgery: Report of a Case

Malignant Fibrous Histiocytoma of the Ileum at a Site of Previous Surgery: Report of a Case

Embedded Fragments from U.S. Military Personnel—Chemical Analysis and Potential Health Implications

Embedded Metal Fragments

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