Malignant Fibrous Histiocytoma of the Thoracic Spine Manifesting as Rapidly Progressive Compressive Myelopathy -Case Report-

Abstract

A 75-year-old woman presented with an extremely rare case of malignant fibrous histiocytoma (MFH) arising in the thoracic spine, causing compression fracture and manifesting as rapidly progressive compressive myelopathy resulting in progressive gait disturbance and weakness of the bilateral legs. Computed tomography and magnetic resonance imaging demonstrated a solid enhanced intravertebral mass destroying the vertebral bodies at the T7 and T8 levels. Maximum resection of the lesion was performed through wide laminectomy from T7 through T9, followed by vertebroplasty using calcium phosphate paste and posterior fixation with a spinal fixation system. Histological examination showed proliferation of pleomorphic spindle-shaped cells having large irregular nuclei with hyperchromasia with storiform pattern and collagenous stroma, consistent with a diagnosis of MFH. This case illustrates the possibility of rapid maximum decompression surgery from the posterolateral side if MFH manifests as progressive transverse myelopathy.

Malignant Fibrous Histiocytoma of the Spine

“…19 In the review pared with none had 5-year survival in the 10 of 17 cases of the literature group. Therefore, the survival of the MFH in the spine was even worse than that of MFH in other sites.…”

“…[30][31][32] The apparent radiographic feature of the MFH in the spine was the osteolytic destruction of the vertebrae without periosteal reaction or new bone formation. 9,19 And meanwhile, soft tissue invasion could lead to slight to huge paraspinal mass, or epidural mass, causing cord compression or even infi ltration of adjacent organs.…”

“…36 It is no doubt that although MFH arising in the spine is rare, it includes cases orignating from the paravertebral tissues with secondary extensions to the vertebrae and the spinal canal. 6,9,13,15,17,19,28 Accordingly, the prognosis of the MFH in the spine partly resembled that of the MFH in the trunk or even worse. In the authors' series of 13 cases, only 7.7% of 5-year survival was observed, com-➢ Key Points MFH, a soft tissue sarcoma, rarely occurs at the spine.…”

“…These were compared with the pooled results of 17 cases in total that were reported in the literature to date. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] …”

En bloc spondylectomy for primary malignant fibrous histiocytoma of the thoracic spine with aortic involvement: case report

“…[1][2][3]5,6,8,[12][13][14][16][17][18]20,21,[24][25][26] Since the first description of spondylectomy for a giant cell tumor of the lumbar spine in 1966, total spondylectomy has become a viable treatment option for many primary spinal tumors. 23,27 Tomita and colleagues in 1994 subsequently described a method of total en bloc spondylectomy, which minimized the intratumoral cutting edge to the bilateral pedicles.…”