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Malignant Fibrous Histiocytoma: An Uncommon Sarcoma with Pathological Fracture of Mandible

  • Pravin N. Lambade
  • Dipti Lambade
  • Tapan K. Saha
  • C. R. Bande
  • Ashwini Ramakrishana
Case Report

Abstract

Background

Tumors composed of cells differentiating as both fibroblasts and histiocytes have been designated fibrous histiocytomas. Only a small percentage of these lesions behave in a malignant fashion, they are called malignant fibrous histiocytoma (MFH).The occurrence of MFH in membranous bones including the mandible is quite unusual. Involvement of the mandible accounts for only 3 % of all MFH bone lesions. Recent literature revealed only a few (30) cases of MFH involving the mandible but not a single case of MFH associated with pathological fracture of the mandible, probably the first such kind of case to support antecedent trauma as an initial proliferative response for its occurence.

Case report

A rare case of MFH involving the mandible and submandibular glands with pathological fracture in a 14-year-old boy is presented with special emphasis on the poor prognosis even after prompt therapy, its controversial histogenesis, high malignant potential, high recurrence rate and tendency to metastasise. The patient was regularly followed up for 11 months post-operatively, during which patient complained of pain in the operated region after 8 to 9 months. Though there was no clinically obvious abnormality seen, the young boy died after 11 months. The clinical, surgical, radiographic and pathological features of this lesion are discussed.

Discussion

Malignant fibrous histiocytoma, the most frequent soft tissue sarcoma of adulthood, was first described as a new malignant tumour by O’Brian and Stout in the 1960s and the details of the histopathological features of MFH were first described by Kempson and Kyriakos. Despite the frequency of diagnosis, MFH has remained an enigma as no true cell of origin has ever been identified. Treatment consists of surgical excision and in some cases chemotherapy and radiation. Early and complete surgical removal using wide or radical resection is indicated because of the aggressive nature of the tumor. The combination of infrequent occurrence, varied pathologic features, uncertain histogenesis, numerous subtypes and the many potential sites of presentation makes these tumors a challenge for the diagnostician, surgeon and oncologist. Close follow-up after treatment is important, as local recurrence is common and early metastasis to the lungs is also frequent, which are the reasons for high mortality rate in MFH.

Keywords

Malignant fibrous histiocytoma Jaw neoplasms Uncommon sarcoma Pathological fracture Schwannoma of maxilla Plexiform schwannoma Intraosseous schwannoma Neurilemmoma 

Notes

Conflict of interest

None.

References

  1. 1.
    Senel FC, Bektas D, Caylan R, Onder E, Gunhan O (2006) Malignant fibrous histiocytoma of the mandible. Dentomaxillofac Radiol 35:125–128CrossRefPubMedGoogle Scholar
  2. 2.
    AL-Salihi KA, Samsudin AR (2004) Malignant fibrous histiocytoma (MFH) of the mandible and submandibular salivary gland: report of a case. Oral Oncol 40:123–125CrossRefGoogle Scholar
  3. 3.
    Sohail D, Kerr R, Simpson RHW, Babajews AV (1995) Malignant fibrous histiocytoma of the mandible: the importance of an accurate histopathological diagnosis. Br J Oral Maxillofac Surg 33:166–168Google Scholar
  4. 4.
    Amjad M, Bari AU (2009) Malignant fibrous histiocytoma: an uncommon soft tissue sarcoma. J Pak Assoc Dermatol 19:243–246Google Scholar
  5. 5.
    Feldman F, Norman D (1972) Intra and extraosseous malignant histiocytoma (fibrous xanthoma) of bone. Radiology 104:497–499CrossRefPubMedGoogle Scholar
  6. 6.
    Bali A, Singh MP, Padmavathi, Khorate M, Ahmed J (2010) Malignant fibrous histiocytoma: an unusual transformation from benign to malignant. J Cancer Sci Ther 2:53–57Google Scholar
  7. 7.
    Vargas A, Echevarria E, Guzman JE (1987) Primary malignant fibrous histiocytoma of the mandible. J Oral Maxillofac Surg 45:634–638CrossRefPubMedGoogle Scholar
  8. 8.
    Narvaez JA, Muntane A, Narvaez J, Martin F, Monfort JL, Pons LC (1996) Malignant fibrous histiocytoma of the mandible. Skeletal Radiol 25:96–99CrossRefPubMedGoogle Scholar
  9. 9.
    Kanazawa H, Watanabe T, Kasamatru A (2003) Primary malignant fibrous histiocytoma of mandible: review of the literature and report of a case. J Oral Maxillofac Surg 61:1224–1227CrossRefPubMedGoogle Scholar
  10. 10.
    Abdul-Karim FW, Ayala AG, Chawla SP, Jing BS, Goepfert H (1985) Malignant fibrous histiocytoma of jaws. A clinicopathologic study of 11 cases. Cancer 56:1590–1596CrossRefPubMedGoogle Scholar
  11. 11.
    Anavi Y, Herman G, Graybill S, Macintosh RB (1989) Malignant fibrous histiocytoma of the mandible. Oral Surg Oral Med Oral Pathol 68:436–443CrossRefPubMedGoogle Scholar

Copyright information

© Association of Oral and Maxillofacial Surgeons of India 2013

Authors and Affiliations

  • Pravin N. Lambade
    • 1
  • Dipti Lambade
    • 2
  • Tapan K. Saha
    • 3
  • C. R. Bande
    • 1
  • Ashwini Ramakrishana
    • 4
  1. 1.Department of Oral and Maxillofacial SurgerySwargiya Dadasaheb Kalmegh Smruti Dental College and HospitalNagpurIndia
  2. 2.V.S.P.M. Dental CollegeNagpurIndia
  3. 3.Department of Oral and Maxillofacial SurgeryGuru Nanak College of Dental SciencesKolkataIndia
  4. 4.Department of Oral PathologyCollege of Dental ScienceDavangereIndia

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