Malignant fibrous histiocytoma: Outcome of tumors in the head and neck compared with those in the trunk and extremities
Malignant fibrous histiocytoma is one of the commonest soft tissue sarcomas in adults, affecting, in order of frequency, the extremities, trunk and head and neck. We treated 131 patients with malignant fibrous histiocytoma by radical, wide, or marginal resection. Their mean age was 43 years, and there were 54 in the head and neck and 77 in the trunk and extremities. The extent of clearance of the tumour, local recurrence, and 5-year survival were studied in these two groups. In the head and neck group, local recurrences developed in 86% after marginal resection, 66% after wide resection and 27% after radical resection. The comparative figures in the trunk and extremities group were 75, 71 and 18%, respectively. The overall 5-year survival was 48% in the head and neck group and 77% in the trunk and extremities group (p=0.03). Repeat operations for recurrences of tumour offered a 'cure rate' of 23% in the head and neck group and 61% in the trunk and extremities group. Inadequate resection of the sarcoma in the head and neck was associated with a high incidence of local recurrence and a poor prognosis. Therefore, we suggest that the initial operation for sarcoma in the head and neck should be as radical as possible to reduce the chance of local recurrence and to improve the outcome.
Available from: Guo-Bin Zhang
- "Radical en bloc resection is required because of the aggressiveness of MFH, both locally and remotely . Sabesan et al.  reported that marginal resection of MFH of the head and neck carries a local recurrence rate of up to 85%, whereas radical resection has a local recurrence risk of only 27%. Because of the technical difficulty of determining adequate surgical margins and the poor healing and wound complications associated with radiation changes, surgical management of RIS in the posterior fossa is also challenging. "
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ABSTRACT: Malignant fibrous histiocytoma (MFH) is a rare neoplasm exhibiting a propensity for aggressive clinical behavior. Effective treatment modality is surgical resection with wide margins, but its rate of recurrence and metastasis is still high. Early detection and complete excision of the tumor is necessary. A MFH of the occipital developed in a 51-year-old woman eight years after surgery and radiation for medulloblastoma of the cerebellar vermis. The secondary neoplasm arose at the site of tumor resection 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. Radiation-induced sarcoma (RIS) is well known, but radiation-induced MFH is relatively rare in the head and neck region, especially in the occipital. The imaging findings are not diagnosis specific, but strict follow-up within the radiation field by computerized tomography (CT) and magnetic resonance imaging (MRI) and appreciation of the expected latency period may help in providing the diagnosis of RIS.
Available from: Sanjay Rastogi
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ABSTRACT: Malignant fibrous histiocytoma (MFH) is the most common soft-tissue sarcoma, but is relatively uncommon in head and neck area. Histologically, it is difficult to distinguish this tumor from other sarcomas and carcinomas. Surgery is the most reliable treatment for MFH, but the 5-year survival rate for cases of this tumor in the head and neck is low in comparison with MFH of the extremities and trunk. Around 61 cases reported in the international literature since 1974. We present a rare case of primary MFH of the maxilla in the unusual location of maxilla in a 20-year-old female. The tumor was located in the maxillary anterior region mimicking periodontal ulcer. We have described the difficulty in diagnosing the tumor along with differential diagnosis, histopathological diagnosis, and current methods in diagnosing the tumor i.e. immunohistochemical analysis. The literature was reviewed briefly along with treatment guidelines.
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