Radiation-induced malignant fibrous histiocytoma of the maxilla

Abstract

Malignant fibrous histiocytoma (MFH) originates from primitive mesenchymal cells and has the capacity for dual histiocytic and fibroblastic differentiation. We report on an MFH of the left maxilla that developed in a 79-year old woman 20 years after surgery and radiation for squamous cell carcinoma (SCC). Postoperative radiotherapy with 70 Gy was administered for a primary neoplasm of SCC of the left maxilla to a localized field through two lateral ports. This secondary neoplasm arose at the site of tumor resection (partial maxillectomy) within the irradiated field, and was resected. The development of sarcomas is a recognized complication of radiation therapy. The final diagnosis after the operation was MFH. The patient died of tumor recurrence at the skull base and within the cranium, 19 months after the operation. Radiation-induced sarcoma is well known, but radiation-induced MFH is relatively rare in the head and neck region. The details of this case are presented with a review of literature.

Malignant Fibrous Histiocytoma of the Preauricular Area

“…Although the imaging studies are very helpful for surgical planning by adequate demonstration of the MFH extent, the specific radiologic diagnosis can be difficult [4]. In addition, the morphology of MFH is highly variable, even within an individual tumor; diagnosis is difficult with small biopsy specimens [5]. A preoperative radiologic and pathologic diagnosis was not achieved in our case.…”

“…Location in the preauricular area without involvement of parotid gland is not common, as like our case. The most common presenting symptoms of MFH are a painless, wellcircumscribed mass that is firmly adherent to the surrounding tissue [5].…”

“…The head and neck MFH can be confused with a variety of fibrous tumors, inflammatory conditions and sarcomas, such as neurilemmoma, fibromatosis, pleomorphic leiomyosarcoma, malignant peripheral nerve sheath tumor, soft-tissue osteosarcoma, gliosarcoma, or malignant gliomas [1,4,5].…”

Primary Malignant Fibrous Histiocytoma in Mediastinum: Imaging with 18F-FDG PET/CT

“…In the present case, MFH was mainly located in the superior mediastinum, extending to the anterior, middle mediastinum and the lower neck. Most MFHs developed de novo; however, several cases were associated with radiation therapy [10] or previous operation procedures [11]. Our patient had no previous operation and radiation therapy.…”

Computed tomography and magnetic resonance imaging findings of malignant fibrous histiocytoma of the head and neck

“…MFHs most commonly occur in the lower extremities and the retroperitoneum, whereas they are relatively uncommon in the head and neck, accounting for 3-10% of all MFHs (5). Thus far, there have been only a limited number of case reports on MFHs in the head and neck, and only a few studies have included a description of the radiological findings (6)(7)(8)(9). Due to its rare occurrence, there are few reports focusing on the computed tomography (CT) or magnetic resonance imaging (MRI) findings of MFH of the head and neck.…”