High serum alkaline phosphatase cooperating with MMP-9 predicts metastasis and poor prognosis in patients with primary osteosarcoma in Southern China

Background

A malignant fibrous histiocytoma is a soft tissue tumor that most commonly occurs in the extremities, but rarely involves the liver. The clinical characteristics and therapeutic experiences of primary hepatic malignant fibrous histiocytoma are still limited.

Methods

Two cases of primary hepatic malignant fibrous histiocytoma were analyzed retrospectively, and all the literature concerning primary hepatic malignant fibrous histiocytoma was analyzed.

Results

In China, a total of 76 cases had been reported, among which 50 were men, with a male to female ratio of 1.9:1. Mean age of the patients was 51.0 years old, and more than 85 percent were older than 40 years. 82.9 percent (63/76) of hepatic MFH were solitary lesions, with tumor size ranging from 2.5 to 23.5 cm (average 10.3 cm). Major clinical presentation (78.4%) was abdominal pain or discomfort, accompanied with some other non-specific symptoms such as malaise, anorexia, weight loss, jaundice and fever, and small cases (14.9%) were asymptomatic. Computed tomography and ultrasound usually revealed the location of lesions. The rate of pre-operative misdiagnosis was extremely high, and 14.9 percent of patients were even misdiagnosed as a benign liver cyst, liver abscess or hematoma. Integrated resection was performed among the most cases (49/68), among which only a few ones (12 cases) were introduced to have no recurrence or metastasis or be still alive with no detail information provided, while among the cases with palliative operation or only a biopsy, the cases that were followed-up all died.

Conclusions

Hepatic malignant fibrous histiocytoma is a rare malignant mesenchymal tumor. The variable features of clinical presentations and images make the diagnosis difficult. Though the prognosis of primary hepatic malignant fibrous histiocytoma was rather poor, integrated resection might provide a few cases a good opportunity for surviving, suggesting that surgery might be an effective treatment.     

Malignant fibrous histiocytoma in a bonnet macaque (Macaca radiata)

Spontaneous sarcomas, not associated with an underlying disease, appear to be relatively rare in nonhuman primates. Since 1970, there have been few reported cases of naturally-occurring sarcomas of any kind in these species. A malignant histiocytoma and malignant fibrous histiocytoma have been described in a rhesus macaque and baboon, respectively. A malignant fibrous histiocytoma is defined as a sarcoma of varied pattern consisting of a mixture of histiocytic and fibroblastic elements. It is thought that the two cells types arise from a common precursor or that the fibroblastic elements are derived from the histiocytes. These tumors are relatively common in humans. Here we report a case of spontaneously-occurring malignant fibrous histiocytoma in an adult bonnet macaque.     

Primary hepatic malignant fibrous histiocytoma: a case report and review of the literature

Primary malignant fibrous histiocytoma (MFH) of the liver remains extremely rare with only several cases having been reported in literature. We report a case of hepatic MFH in a 53-year-old man who presented with upper abdominal pain, and weight loss for one month. Ultrasound and computed tomography (CT) scan showed a large mass with fine tumor vessels over the left lobe of the liver. Histopathological findings indicated a mesenchymal tumor consisting of spindle cells in storiform pattern intermingled with histiocyte-like cells and giant cells. Immunohistochemically, most tumor cells expressed vimentin, alpha-1 anti-chymotrypsin, alpha-1 antitrypsin and CD68. Morphological and immunohistochemical findings support that the tumor should be classified as a primary malignant fibrous histiocytoma. The literatures is briefly reviewed.     

Fine needle aspiration biopsy of primary malignant fibrous histiocytoma of the lung

Malignant cells were found on the fine needle aspiration (FNA) biopsy smears from a primary tumor of the lung. The cytologic specimen contained a mixture of fibroblastlike cells, histiocytelike cells, giant cells and undifferentiated cells; mitotic figures were also found. Histologic, histochemical and electron microscopic studies confirmed the FNA cytologic suggestion of a primary malignant fibrous histiocytoma of the lung.     

Primary malignant fibrous histiocytoma of the breast

Clinical, light microscopic, electron microscopic and immunocytochemical features of 4 cases (3 women and 1 man) of primary malignant fibrous histiocytoma (MFH) of the breast are presented. The literature is reviewed and the diagnosis and treatment discussed. The good outcome is stressed and local excision or simple mastectomy recommended as appropriate treatment.     

Cytopathologic aspects of pulmonary metastasis of malignant fibrous histiocytoma, myxoid variant: fine needle aspiration biopsy of a case

The cytopathologic findings of a fine needle aspiration biopsy of pulmonary metastasis of a malignant fibrous histiocytoma, myxoid variant, are documented. Isolated and irregular loose clusters or bundles of spindle cells and pleomorphic multinucleated giant cells were found. No signet-ring lipoblastlike cells were identified. The cytologic findings were similar to the histology of the primary tumor removed from the patient's leg 18 months previously.     

Malignant fibrous histiocytoma of the glans penis: a case report

BACKGROUND: Malignant fibrous histiocytoma has been regarded as the most common sarcoma of older adults. However, recent opinion regards pleomorphic malignant fibrous histiocytoma as an undifferentiated high grade pleomorphic sarcoma not otherwise classifiable utilizing current techniques available in surgical pathology. Notwithstanding controversy regarding its nomenclature, malignant fibrous histiocytoma involving the penis is exceedingly rare, with only 4 cases previously described, to our knowledge. CASE: An uncircumcised 73-year-old male presented with a painless, granular, partially necrotic lesion beneath the penile foreskin. There was no history of sexually transmitted disease, constitutional symptoms or dysuria. Examination of penile shaft, testicles, spermatic cord and inguinal lymph nodes were unremarkable. Biopsy revealed a markedly pleomorphic sarcoma. Subsequent, partial penectomy revealed the same lesion with an adjacent area of squamous cell carcinoma in situ. CONCLUSION: Malignant fibrous histiocytoma remains a diagnosis of exclusion. The investigation requires extensive tumor sampling in search of areas of differentiation and a complete battery of immunohistochemical markers. Therapeutically important entities in the differential diagnosis that must be ruled out include other poorly differentiated sarcomas, sarcomatoid squamous cell carcinoma and desmoplastic melanoma.     

Postradiation pleomorphic malignant fibrous histiocytoma of the breast

A case of primary malignant fibrous histiocytoma (MFH) of the breast occurring two years after surgical excision and radiation therapy for a carcinoma of the left breast is reported. Fine needle aspiration was positive for malignant cells, consistent with a pleomorphic sarcoma. Cytologic examination revealed giant cells with marked pleomorphism. Some cells showed single large nuclei with cytoplasmic vacuoles while others revealed multinucleation with foamy cytoplasm, phagocytosed erythrocytes and cellular debris. These findings are considered useful in the cytologic diagnosis of the pleomorphic variant of MFH.     

Malignant fibrous histiocytoma in a baboon

A recurrent, invasive, soft tissue tumor was observed in the subcutaneous tissue of the back of an adult baboon (Papio cynocephalus). The neoplasm was diagnosed as a malignant fibrous histiocytoma.     

Malignant fibrous histiocytoma of the chest wall masquerading as medullary breast carcinoma: a case report

BACKGROUND: Cytologic diagnosis of malignant fibrous histiocytoma can be problematic, as these neoplasms are known to mimic multiple other conditions. CASE: A fine needle aspirate from a 60-year-old woman was diagnosed at 2 institutions as medullary carcinoma of the breast. The patient received neo-adjuvant chemoradiotherapy before the tumor war excised. Gross pathologic examination and histomorphology on routine staining were compatible with the cytologic diagnosis. The accurate diagnosis of pleomorphic-storiform-type malignant fibrous histiocytoma was a surprise and was established with immunocytochemical stains. In retrospect, it was thought that clinical and radiologic overlap, creating a high index of suspicion for a breast neoplasm and compounding the cytologic appearance of a medullary carcinoma with spindle cell metaplasia and syncytial cells, was responsible for the error. CONCLUSION: This case highlights a potential cytodiagnostic pitfall and the importance of establishing a definitive tissue diagnosis in the face of equivocal cytologic findings.     

Malignant fibrous histiocytoma of the parapharyngeal space. Case report.

Of the large variety of tumors that may occur in the parapharyngeal space, malignant fibrous histiocytoma is one of the most rare. We present such a case and discuss the diagnosis, classification, and treatment.     

An unusual pleomorphic sarcoma in a hybrid mallard

An unusual pleomorphic sarcoma from a hybrid mallard (Anas platyrhynchos) is described. Rhabdomyosarcoma was considered in the original differential diagnoses but rejected due to lack of specific characteristics generally seen in these tumors. The histologic characteristics described are consistent with mammalian sarcomas recorded in the literature as malignant fibrous histiocytoma.     

Pleomorphic ("dedifferentiated") chondrosarcoma. Report of a case initially examined by fine needle aspiration biopsy

Fine needle aspiration (FNA) biopsy of a predominantly radiolucent, destructive lesion of the right distal femoral metaphysis of a 69-year-old man produced smears containing spindle-shaped cells with cytologic features consistent with a malignant fibrous histiocytoma. This initial diagnosis was supported by immunoperoxidase staining, which was strongly positive for vimentin and alpha-1-antichymotrypsin, focally positive for S-100 protein and negative for desmin, muscle-specific actin, keratin, carcinoembryonic antigen and epithelial membrane antigen. Subsequent surgical resection revealed a lesion with a predominance of malignant fibrous histiocytoma-type regions; however, focal microscopic areas contained a low-to-medium-grade cartilaginous component. The final diagnosis rendered was thus pleomorphic or so-called "dedifferentiated" chondrosarcoma. This rare lesion should be included in the differential diagnosis of malignant spindle-cell lesions of bone assessed by FNA biopsy.     

Malignant fibrous histiocytoma of the esophagus. Report of a case with cytologic, immunohistologic and ultrastructural studies.

A 65-year-old man presented with an esophageal polyp that proved to be malignant pleomorphic fibrous histiocytoma, extremely rare at that location. Diagnosis of the abrasion cytology specimen was confirmed by immunohistochemical and electron microscopic methods. Differential diagnostic problems of pleomorphic soft tissue tumors and epithelial tumors mimicking them are discussed.     

Fine needle aspiration of pleomorphic giant-cell carcinoma of the pancreas. Case report with ultrastructural observations

The fine needle aspirate in a case of pleomorphic giant-cell carcinoma of the pancreas, an unusual but highly malignant variant of ductal carcinoma of the pancreas, was characterized by bizarre tumor giant cells, "osteoclastlike" giant cells and abundant mitoses. The differential diagnostic possibilities include sarcoma (rhabdomyosarcoma, malignant fibrous histiocytoma and liposarcoma), melanoma, choriocarcinoma, metastatic giant-cell carcinoma of the lung and giant-cell tumor of the pancreas. A combination of clinical history, imaging findings and fine needle aspiration biopsy with transmission electron microscopy could lead to the appropriate diagnosis and help differentiate this entity from the other possible considerations.     

Fine needle aspiration in stromal sarcoma of the breast. Light and electron microscopic findings with histologic correlation

Stromal sarcoma of the breast, according to current concepts, is a rare lesion arising from the stroma surrounding the ductal epithelium. A case of this neoplasm is reported, with light and electron microscopic findings in fine needle aspirates and correlation with histologic findings. The findings, similar to those previously reported for stromal sarcoma of the breast, included a less-pleomorphic morphologic picture than is seen in malignant fibrous histiocytoma, but a more primitive ultrastructural appearance.     

Cytologic features of a primary myxoid malignant fibrous histiocytoma arising in the uterus: a case report.

BACKGROUND: Primary malignant fibrous histiocytoma (MFH) of the uterus is extremely rare. The 10 cases reported in the literature all involved the pleomorphic variant, and to the best of our knowledge, the myxoid variant has not been reported before. We describe the cytologic findings of primary uterine myxoid MFH in relation to the myxoid component, potentially leading to an incorrect diagnosis. CASE: A 68-year-old woman presented with a primary uterine tumor. Endometrial cytology showed numerous loosely arranged, spindle-shaped fibroblastlike cells; atypical histiocytelike cells; and giant cells with a necrotic background. The overall cytologic picture was of a degenerated pleomorphic leiomyosarcoma with an inconclusive diagnosis. A diagnosis of myxoid MFH was established after electron microscopic and immunohistochemical studies of the primary tumor and tumor transplanted, as primary cultured cells, in nude mice. The patient underwent an exploratory laparotomy and died of tumor progression 38 days after the initial consultation, without treatment. CONCLUSION: Because of overlapping cytologic features among uterine sarcomas with myxoid stroma, it is important to recognize the histiocytic lineage of tumor cells by immunohistochemistry and electron microscopy in various presentations of fresh samples.     

N- 乙酰转移酶NAT10 在软组织肿瘤中的表达及意义

目的：观察N-乙酰转移酶NAT10蛋白在软组织肉瘤中的表达及与类型、分级的关系。方法：通过原核表达NAT10蛋白免疫制备特异性多克隆抗体,并经免疫印迹鉴定;以组织芯片一免疫组化检测166例软组织肉瘤和28例良性肿瘤及瘤样病变中NAT10蛋白的表达。结果：制备多克隆抗体经Western印迹鉴定与NAT10具有特异结合性。免疫组化显示166例软组织肉瘤中NAT10蛋白阳性95例,阳性率为57％（95／166）,28例良性肿瘤及瘤样病变中4例阳性14％（4／28）。两者间有显著性差异（P〈0．05）。NAT10表达的主要分布为：滑膜肉瘤76％（13／17）、恶性纤维组织细胞瘤75％（15／20）、原始神经外胚叶瘤（PNET）70％（16／23）、横纹肌肉瘤70％（7／10）、恶性外周神经鞘膜瘤50％（11,／22）、隆突性皮肤纤维肉瘤50％（7／14）、平滑肌肉瘤43％（6／14）、脂肪肉瘤42％（8／19）、黏液性纤维肉瘤38％（6／16）。统计比较显示：滑膜肉瘤与黏液性纤维肉瘤和脂肪肉瘤,以及恶性纤维组织细胞瘤与黏液性纤维肉瘤之间NAT10表达具有显著性差异（P〈0．05）;而其它各组间无明显差异（P〉0．05）。同时,NAT10蛋白强阳性表达（≥＋＋）多存在于滑膜肉瘤（53％,9／17）、横纹肌肉瘤（40％,4／10）及恶性纤维组织细胞瘤（40％,8／20）。在FNCLGC分级中,19例I级肉瘤中NAT10阳性表达率为42％（8／19）,44例Ⅱ级肉瘤为43％（19／44）,70例Ⅲ级肉瘤为73％（51／70）。Ⅲ级NAT10阳性率显著高于Ⅱ级组和Ⅰ级组（均为P〈0．05）。结论：研究表明N-乙酰转移酶NAT10表达于多种人软组织肉瘤,尤其在高度恶性肉瘤,因此有可能为软组织肉瘤的分级及预后因子。     

Neutrophilic phagocytosis by tumor cells. A feature to consider in the differential diagnosis in fine needle aspiration smears

OBJECTIVE: To analyze neutrophilic phagocytosis by tumor cells in fine needle aspirate (FNA) smears from different types of tumor. STUDY DESIGN: A retrospective review of a total of 7 cases showing prominent neutrophilic phagocytosis by tumor cells in FNA smears during the period July 2003-December 2004. RESULTS: This feature was seen in malignant fibrous histiocytoma and poorly differentiated renal cell carcinoma in addition to giant cell carcinoma of the lung. CONCLUSION: Neutrophilic phagocytosis by tumor cells is seen in FNA smears and on cytomorphology. The differential diagnoses should include both pleomorphic sarcomas and carcinomas.