Primary Osseous Inflammatory Malignant Fibrous Histiocytoma Masquerading as Chronic Osteomyelitis

Abstract

Inflammatory malignant fibrous histiocytoma, in addition to a mass lesion, may present with fever and other constitutional symptoms, mimicking an infectious process. This article presents an extremely rare and unique case of primary osseous inflammatory malignant fibrous histiocytoma, highlighting retrospectively the subtle clinical, radiologic, and pathologic features that can suggest this diagnosis. A 63-year-old woman with a history of nephrectomy for right kidney tuberculosis 20 years ago presented with slowly increasing left hip pain for 6 months. The relatively benign-appearing radiograph and biopsy report of chronic inflammation resulted in curettage and nailing of the lesion. The pathologic diagnosis was chronic osteomyelitis, but culture findings for bacteria and tuberculosis were negative. The patient remained well until 4 months later, when left thigh pain returned with fever and leukocytosis (white blood cell count as high as 20.7×10(9)/L, 80% neutrophils). No source of infection was localized. The patient showed no response to broad-spectrum antibiotics and antituberculous drugs. Radiographs showed substantial enlargement of the femoral lesion and extraosseous extension; biopsy results and review of previous histopathologic findings led to a diagnosis of inflammatory malignant fibrous histiocytoma. The fever gradually resolved and the white blood cell count returned to normal within a few days after segmental resection of the proximal femur tumor and its soft tissue extension. However, deep venous thrombosis developed, resulting in left foot ischemia and toe gangrene, necessitating left below-the-knee amputation. Disseminated metastasis occurred 3 months after tumor resection. The patient declined further aggressive treatment and died 13 months after initial presentation.

Primary synovial epithelioid sarcoma of the knee: distinctly unusual location leading to its confusion with pigmented villonodular synovitis

“…From our literature review, it can be appreciated that genuine primary synovial ES is an exceedingly rare neoplasm that affects almost exclusively the knee and presents clinically as painful swelling, thereby mimicking monoarthritis. Despite such rarity, malignant bone and synovial tumors as a differential diagnosis of acute or chronic osteomyelitis or arthritis merit recognition and exclusion before proceeding to definitive surgical treatment; otherwise, any suboptimal procedure or operation such as arthroscopic lavage or synovectomy may result in a disastrous outcome as in our patient and in previously reported cases (19,20).…”

Functional Ulnar Nerve Paraganglioma: First Documented Occurrence in the Extremity With Hitherto Undescribed Associated Extensive Glomus Cell Hyperplasia and Tumorlet Formation

“…As in any unusual circumstances, 16-18 we have been careful in correlating all clinical, radiological, pathological, and biochemical features and excluding every possible differential diagnoses before accepting the present case as a bona fide functional ulnar nerve paraganglioma. The positive Tinel’s sign, the ultrasonographic, MRI, and operative findings all confirm that it is a highly vascular tumor attached to the ulnar nerve, some branches of which are inseparable from the tumor.…”

Subacute metacarpal osteomyelitis in a child

“…In diaphyseal lesions with periosteal reaction, a core of the bone should be taken which includes periosteum, cortex and medullary contents (18). The diagnosis is usually confi rmed by histologic examination, which shows an infl ammatory component with scattered lymphocytes, plasma cells and granulation tissue (11,17,18). Staphylococcus aureus is regarded as the causative agent by most authors.…”