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1/32. Malignant fibrous histiocytoma of the vulva: a case report.

    BACKGROUND: Primary sarcomas of the vulva are rare tumors that account for 1.8-3% of all vulvar malignancies. Malignant fibrous histiocytoma occurs infrequently on the vulva but nonetheless is the second most frequent sarcoma of this region. The purpose of this report is to review the diagnosis and therapy of this exceedingly rare tumor. CASE: A 72-year-old woman was presented with a vulvar mass that was ultimately found to be a vulvar malignant fibrous histiocytoma. After surgical excision and 9 months of initial diagnosis, she returned with rapid localized progression and pulmonary metastases. CONCLUSION: Malignant fibrous histiocytoma arising in the vulva represents an example of vulvar sarcomas. Since the diagnostic criteria and natural history of this tumor still remain poorly defined, further case studies may be helpful to elucidate these issues as well as the optimal therapeutic approach of this heterogeneous group of malignancies. ( info)

2/32. Nutritional intervention with omega-3 fatty acids in a case of malignant fibrous histiocytoma of the lungs.

    We present a case of a 78-yr-old man with malignant fibrous histiocytoma with multiple lesions in both lungs. Following diagnosis, he declined conventional chemotherapy and elected nutritional intervention by increasing intake of omega-3 fatty acids and lowering intake of omega-6 fatty acids. We estimated that he consumed 15 g of the long-chain omega-3 fatty acids eicosapentaenoic (EPA) and docosahexaenoic acid (DHA) per day, and the ratio of linoleic acid/long-chain omega-3 fatty acids in his diet was 0.81. Serial computed tomography scans and pulmonary x-rays revealed remarkably a slow and steady decrease in the size and number of bilateral nodules. He has no apparent side effects from consuming large quantities of fish and algae oils rich in DHA and EPA and he remains asymptomatic. ( info)

3/32. case reports: malignant fibrous histiocytoma of bone arising in chronic osteomyelitis.

    This case report shows the importance of frozen section and/or permanent section pathology for diagnosis of tumorous conditions in patients with chronic osteomyelitis. According to published reports, a coincidence of malignant fibrous histiocytoma of bone and post-fracture osteomyelitis has occurred in only four patients. Our report details the treatment of 51-year-old man with a fracture 15 years previously and subsequent chronic osteomyelitis of the left distal femur. The original treatment was open reduction and casting. Fifteen years after the injury, the patient presented to the emergency room with increasing pain, erythema, swelling, and increased purulent discharge from the distal femur. Irrigation and debridement was done, but no frozen section or permanent pathology specimens were obtained. The left distal femur was radically resected for treatment of osteomyelitis. Histologic samples of the specimen revealed malignant fibrous histiocytoma of bone. A metastatic workup was negative. Subsequently, the left hip was disarticulated for wide resection of the tumor. One of two inguinal lymph nodes removed at that time was positive for malignant fibrous histiocytoma. The patient had additional chemotherapy. He was still alive 27 months after the operation. ( info)

4/32. Combined Merkel cell carcinoma and atypical fibroxanthoma.

    BACKGROUND: Although there are reports of squamous cell carcinoma arising within and adjacent to Merkel cell carcinoma, and one report of an atypical fibroxanthoma-like tumor arising in an irradiated recurrent Merkel cell carcinoma, there have previously been no reports of an immunohistochemically verified atypical fibroxanthoma occurring in conjunction with a Merkel cell carcinoma. OBJECTIVE: We report on a neoplasm with distinct features of both Merkel cell carcinoma and atypical fibroxanthoma. methods: Histologic and immunohistochemical evaluations were performed. RESULTS: Our results verify the finding of a combined Merkel cell carcinoma and atypical fibroxanthoma. CONCLUSION: This case is an interesting and unusual combination of tumors. The origin of the Merkel cell carcinoma is revisited. Debated origins include neuroendocrine, epithelial, and pleuripotent stem cell. ( info)

5/32. Extended pedicle rectus abdominis myocutaneous flap for thigh reconstruction.

    A rectus abdominis myocutaneous flap can provide a large amount of tissue for defect coverage. Rarely a flabby and redundant abdominal tissue was used as a huge extended flap. We report a case of recurrence malignant fibrous histiocytoma of the thigh which was radically resected. The resultant massive defect was success reconstructed with an extended pedicle inferiorly based rectus abdominis myocutaneous flap. ( info)

6/32. Mediastinal malignant fibrous histiocytoma developing from a foreign body granuloma.

    A patient with mediastinal malignant fibrous histiocytoma (MFH) apparently developing from a foreign body granuloma is reported. A 72-year-old man was admitted to our hospital complaining of generalized fatigue and palpitations. He had undergone surgery for pulmonary tuberculosis 46 years previously. radiography and computed tomography of the chest showed a round 5-cm mass with marginal calcification in the right side of the anterior mediastinum. The mass was resected completely via median sternotomy. Intraoperative diagnosis of foreign body granuloma was made, based on gauze fragments found in the mass and intraoperative pathologic findings suggesting benign granulation tissue. The postoperative histopathologic diagnosis was myxoid MFH. To our knowledge, mediastinal MFH developing from a foreign body granuloma has not been reported previously. ( info)

7/32. Malignant fibrous histiocytoma arising from the renal capsule.

    We report a case of malignant fibrous histiocytoma arising from the renal capsule which is a rare condition. The patient was treated with surgical excision of the tumor including the renal capsule and subsequent radiotherapy of 6,600 rad. No recurrence was detected 15 months after surgery. ( info)

8/32. Direct cryosurgery for inoperable metastatic disease of the lung.

    A 50-year-old woman presented with dyspnea associated with two isolated metastases in the right lung, which was 1 year after the resection of a primary pleomorphic fibrous histiocytoma from her left thigh. At a planned thoracotomy, the tumor was found to be advanced, contraindicating lobectomy. We aimed to completely destroy the tumor by applying cryosurgery. ( info)

9/32. Tandem high-dose chemotherapy supported by autologous peripheral blood stem-cell transplantation and radiotherapy for recurrent malignant fibrous histiocytoma.

    Malignant fibrous histiocytoma (MFH) is a soft-tissue sarcoma created from fibroblast cells and characterized by a high rate of metastasis or recurrence with poor prognosis. We report a case of initially well differentiated (G1) MFH of the trunk in a 33-year-old woman. Two years after primary diagnosis, metastases were found in the lung, trunk, gluteus region, upper extremities and brain. Histopathological findings indicated a stromal tumor consisting of spindle cells, and immunohistochemical examination of resected specimens established the definite diagnosis of poorly differentiated MFH (G3). Initial surgery of several solid tumors on the trunk, lung and extremities was performed. There was a high local recurrence and metastasis rate, and the patient was treated with radiotherapy and conventional chemotherapy followed by tandem high-dose chemotherapy and peripheral blood stem-cell transplantation. She is currently well seven years after the transplant, with no signs of metastasis and recurrence. We review the clinical picture of the tumor in this patient and discuss its diagnosis, pathogenesis and treatment. ( info)

10/32. Malignant fibrous histiocytoma of the ovary: a case report.

    Malignant fibrous histiocytoma is the most common type of soft tissue sarcoma in adults. Primary malignant fibrous histiocytoma of the ovary is extremely rare, with only three previously reported cases. We reported a rare and uncommon localization of malignant fibrous histiocytoma in a 22-year-old woman. She was referred for adjuvant chemotherapy to our center with the diagnosis of storiform-pleomorphic malignant fibrous histiocytoma. A left adnexal mass was detected by computed tomography of the lower abdomen. Therefore, we decided to perform reoperation for debulking, and left salpingo-oopherectomy, total hysterectomy, infracolic omentectomy, and resection of all visible peritoneal implants were performed. Histopathologic examination revealed inflammatory, malignant fibrous histiocytoma. Immunohistochemical staining confirmed positive reactions to alpha 1-antitrypsin, vimentin, CD68, and S100. The management of malignant fibrous histiocytoma is controversial because of the heterogenous nature of the disease. Resection of all macroscopic disease is independently associated with improved disease-specific survival, and adjuvant chemotherapy for nonmyxoid variants could be acceptable alternatives if the surgical margins are tumor free. ( info)
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