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1/156. Renal fibrohistiocytic sarcoma. Three cases and a review of the literature.

    The purpose of this paper is to report three unpublished cases of so-called "renal malignant fibrous histiocytoma" which should be more appropriately called "renal fibrohistiocytic sarcoma", and to review and analyze the data concerning 41 cases collected from the literature and our three new cases, making a total of 44 cases. Our third case is very interesting; in addition to the fact that this condition is rare, this particular patient also had concomitant nonmalignant ascites and compression of the descending colon, both conditions being rarely associated with renal cancer. The average age of the patients was 58 years; in 66% of the cases the tumor involved the left kidney; 57% of the patients were males; the average tumor size was 12 cm; nephrectomy was performed in 93% of the cases; the average survival was 16 months. In none of the cases was a preoperative diagnosis correctly made. It is concluded that a triad of symptoms and signs (renal pain, weight loss, and large tumor size) as well as a triad of imaging characteristics (areas of low density on the CT scan, hypoechoic areas on ultrasound, and hypovascularity on angiography) may hold the promise of a preoperative diagnosis. It is suggested that the tumor arises from the system of Gerota's fascia-renal capsule.
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2/156. Primary giant cell malignant fibrous histocytoma of the lung: a case report.

    A rare case of malignant fibrous histiocytoma of giant cell type originating in the lung of a 46-year-old woman is presented. The patient complained of having a cough that had lasted for a few weeks. A chest X-ray photograph showed a tumor shadow on the left lung. Histological and cytological examination of the biopsy specimen revealed that the tumor was a kind of sarcoma. An operative procedure was selected because of tumor invasion into the trunk of the left pulmonary artery, which was discovered on computed tomography examination, and because metastatic tumor was excluded clinically. The tumor was almost encapsulated and 6 x 6 x 6 cm in size; however, it also showed invasion into the pulmonary artery and bronchial lumen. A histological survey of the tumor showed a wide range of patterns such as fibrous, pleomorphic, fascicular and osteoclast-like giant cell figures; however, the osteoclast-like giant cell area was predominant. Immunohistochemically, the tumor cells were positive for vimentin, CD68 for histiocytic marker and alpha1-antichymotrypsin, and negative for keratin, epithelial membrane antigen, S-100 protein, MT-1, desmin, myoglobin and lysosome. No primary tumor was found clinically in any part of the patient's body at 2 and 4 months after operation. Consequently, she was diagnosed as having primary giant cell malignant fibrous histiocytoma of the lung.
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3/156. Malignant fibrous histiocytoma of the epididymis. Case report and review of the literature.

    A 54-year-old patient was found to have a painless ca. 1.5 cm diameter tumor in the region of the right epipidymis. The right testis was exposed from a scrotal incision. The final pathology surprisingly showed malignant fibrous histiocytoma (MFH) of the epipidymis and the patient subsequently underwent radical inguinal orchiectomy. Complete metastatic screening was normal. Postoperatively, 60 Gy external beam radiation was administered. At the least follow-up (6 years), there were no recurrences or metastases. MFH is an extremely rare, highly malignant connective tissue tumor, which may, occasionally, affect the male genital tract. There are no agreed treatment principles. The overall prognosis is poor.
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4/156. Malignant fibrous histiocytoma of the trachea.

    Primary tracheal sarcomas are rare. Only 23 cases have previously been reported in the English literature. The present case describes a 72-year-old woman with a malignant fibrous histiocytoma of the trachea. She underwent an endoscopic resection followed by radiotherapy and is well at 12 months follow up. Other cases are reviewed. Tracheal resection is the standard care. However, local resection with postoperative radiotherapy remains an option. Adjuvant chemotherapy may improve local control. Long-term survival has been documented.
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5/156. radiation-induced inflammatory malignant fibrous histiocytoma of the ileum.

    A case of inflammatory malignant fibrous histiocytoma of the ileum seemingly induced by radiation is described. A 50-year-old female with a past history of uterine cervical carcinoma and postoperative radiation therapy presented with abdominal pain, fever and leukocytosis. The subserosa of the distal part of the ileum showed a diffuse dense, neutrophilic and lymphocytic infiltrate with dispersed atypical, short spindle- or plump oval-shaped histiocyte-like cells. Pleomorphic mono- or multinucleated giant cells with bizarre nuclei were also intermingled in the lesion. Immunohistochemically, the tumorous atypical cells were positive for vimentin, alpha-smooth muscle actin, alpha-1 antitrypsin and granulocyte colony-stimulating factor. No EBV genomic sequences were detected by in situ hybridization. flow cytometry showed an aneuploid dna content with high S-phase fraction. The patient was well with no evidence of tumor at 5 months after surgery. It is important to include this type of tumor in the differential diagnosis of small intestinal lesions accompanied by fever and leukocytosis following radiation.
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6/156. thallium-201 SPECT of adjacent intracranial tumours: a contrast in thallium kinetics.

    We report a case of adjacent intracranial tumours: malignant fibrous histiocytoma (MFH) and meningioma. thallium-201 single-photon emission computed tomography demonstrated different thallium kinetics between the tumours (slow washout from the MFH and rapid clearance in the meningioma) and could be said to have been useful for preoperative histological estimation.
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7/156. Primary malignant fibrous histiocytoma of the duodenum.

    BACKGROUND/AIM: We report on a case of primary malignant fibrous histiocytoma of the duodenum. methods: Report of a case and review of the literature on the occurrence of this tumor in the alimentary tract. RESULTS: The neoplasm was detected incidentally at the time of diagnostic workup for upper gastrointestinal bleeding. Curative surgery using the Whipple procedure was carried out with uneventful postoperative course; no evidence of liver metastases was detected during intraoperative ultrasonography. The patient died of diffuse metastatic liver disease 2 months after surgical resection. Up-to-date review of the literature has added only 3 cases to those previously reported, including that reported by us. CONCLUSIONS: The biological behavior of malignat fibrous histiocytomas is extremely aggressive and mainly conditioned by size and histological grading. The treatment of choice, whenever possible, is based on early and complete surgical excision of the tumor. copyright copyright 1999 S. Karger AG, Basel
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8/156. Primary renal malignant fibrous histiocytoma: case report.

    We report on a case of primary renal malignant fibrous histiocytoma. Primary manifestation in the kidney is rare with only 22 cases reported in the literature. Preoperatively, a renal cell carcinoma cannot be distinguished from a malignant mesenchymal tumor with clinical or imaging techniques. We discuss the pathologic differential diagnosis, therapeutic strategies and prognosis of this infrequent tumor. copyright copyright 1999 S. Karger AG, Basel
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9/156. Dual phase helical CT of a primary malignant fibrous histiocytoma of the right renal vein.

    A case is reported of primary malignant fibrous histiocytoma of the right renal vein involving the ipsilateral kidney which showed early enhancement on dual phase helical CT. The correct diagnosis of a primary tumour of the renal vein involving the kidney was not made but in retrospect could have been achieved pre-operatively by considering several CT features.
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10/156. Malignant fibrous histiocytoma: a method to control intraoperative hemorrhage by clamping the feeding arteries.

    Malignant fibrous histiocytoma (MFH), also referred to in the past as malignant fibrous xanthoma and fibroxanthosarcoma, is a tumor of mesenchymal tissue origin. A case of retroperitoneal MFH was reported. In this paper, we describe a method of hemostasis and intraoperative control of hemorrhage during resection of retroperitoneal MFH by snaring the feeding arteries. The patient was successfully operated on using this technique.
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