J Korean Bone Joint Tumor Soc.  2012 Dec;18(2):113-117. 10.5292/jkbjts.2012.18.2.113.

Repeated Unplanned Excision of Malignant Fibrous Histiocytoma (Malignant Fibrous Histiocytoma Misdiagnosed as the Simple Cyst): A Case Report

• Soh JW
• Kim WJ
• Kim CH
• Kwon SW
• Kim HJ

• KMID: 1431681
• DOI: http://doi.org/10.5292/jkbjts.2012.18.2.113

Abstract

A 73-year-old male was admitted for unhealed wound. Eight months ago, the patient had been operated for excision of soft tissue mass on left distal thigh area in previous hospital and after 4 months from first operation, had been reoperated because of recurrence. The pathologic diagnosis of previous operation was simple cyst. In operating finding, the mass invaded the vastus lateralis fascia and had irregular margin and adhesion. We carried out simple excision with retaining 5 cm of free margin from the mass. The pathologic diagnosis of our hospital was malignant fibrous histiocytoma, and then the patient was performed radiation therapy. In 1 year follow-up, there was no significant finding either increasing mass size or metastasis. We misdiagnosed as simple cyst and then performed simple excision, however finally pathologic diagnosis confirmed as malignant fibrous histiocytoma. It is considered to operate a mass that preoperative proper evaluation and diagnosis are required.

Keyword

thigh; malignant fibrous histiocytoma; simple excision

MeSH Terms

Fascia
Follow-Up Studies
Histiocytoma, Benign Fibrous
Histiocytoma, Malignant Fibrous
Humans
Male
Neoplasm Metastasis
Quadriceps Muscle
Recurrence
Thigh

Figure

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  Figure 1 (A) The photograph shows the skin lesion after simple excision in previous hospital. (B) Plain radiograph shows the soft tissue lesion contained air-shadow on the lateral aspect of the left distal thigh and no gross bony abnormalities.

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  Figure 2 The gross photograph shows the mass specimen after simple excision.

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  Figure 3 High power field microscopic view of the biopsied specimen shows storiform cellular pattern including pleomorphic spindle cells, inflammatory cells and giant cells.

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  Figure 4 Postoperative MR images show the remnant malignant fibrous histiocytoma (arrows). (A) T1-weighted MR image shows heterogeneous low signal intensity combined with focal high signal intensity. (B) T2-weighted MR image shows combined heterogeneous high signal intensity and low signal intensity. (C) Gd enhanced T1-weighted MR image mostly shows no evidence of contrast enhancement.

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