Skip to main content

Advertisement

SpringerLink
Log in

Angiomatoid fibrous histiocytoma: novel MR imaging findings

  • Scientific Article
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

Objective

To describe novel MR imaging features, and clinical characteristics of soft tissue angiomatoid fibrous histiocytoma (AFH) at presentation, local recurrence, and metastases.

Materials and methods

We described the MRI findings of six cases of histologically proven AFH. Pathologic findings, clinical presentation, and outcome were reviewed.

Results

Lesions were primarily cystic. At initial presentation, tumors were surrounded by low signal intensity fibrous pseudocapsule. High signal intensity consistent with the lymphoplasmacytic infiltrate was seen in T2-weighted and post-contrast images as a rim over the hypointense pseudocapsule (double rim sign). High signal intensity infiltrating tumoral cords extended into adjacent tissues, through pseudocapsular defects on T2-weighted and post-contrast images. The cystic component and tumor cell nodularity were demonstrated at post-contrast images. Clinically, lesions were often thought to be benign, underwent marginal resection, developed local recurrence, and one developed second recurrence consisting of metastases. Recurrent tumors appeared as multiple masses, misinterpreted as post-surgical changes. An intramuscular recurrence demonstrated double rim and infiltrating margin.

Conclusions

A predominantly well-circumscribed, primarily cystic mass with double-rim and marginal infiltration on MRI suggests the possibility of AFH, in particular in child or young adult. Inclusion of these novel observations in AFH differential diagnosis may have a significant impact on treatment and prevention of recurrence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9

Similar content being viewed by others

Reference

  1. Enzinger FM. Angiomatoid malignant fibrous histiocytoma: a distinct fibrohistiocytic tumor of children and young adults simulating a vascular neoplasm. Cancer. 1979;44:2147–57.

    Article  CAS  PubMed  Google Scholar 

  2. Costa MJ, Weiss SW. Angiomatoid malignant fibrous histiocytoma: a follow-up study of 108 cases with evaluation of possible histologic predictors of outcome. Am J Surg Pathol. 1990;14:1126–32.

    Article  CAS  PubMed  Google Scholar 

  3. Fanburg-Smith JC, Miettinen M. Angiomatoid “malignant” fibrous histiocytoma: a clinicopathologic study of 158 cases and further exploration of the myoid phenotype. Hum Pathol. 1999;30:1336–43.

    Article  CAS  PubMed  Google Scholar 

  4. Koletsa T, Hytiroglou P, Semoglou C, Drevelegas A, Karkavelas G. Angiomatoid fibrous histiocytoma with cystic structures of sweat duct origin. Pathol Int. 2007;57:513–6.

    Article  PubMed  Google Scholar 

  5. Tanas MR, Rubin BP, Montgomery EA, et al. Utility of FISH in the diagnosis of angiomatoid fibrous histiocytoma: a series of 18 cases. Mod Pathol. 2010;23:93–7.

    Article  CAS  PubMed  Google Scholar 

  6. Chen G, Folpe AL, Colby TV, et al. Angiomatoid fibrous histiocytoma: unusual sites and unusual morphology. Mod Pathol. 2011;24:1560–70.

    Article  CAS  PubMed  Google Scholar 

  7. Fletcher CDM, Bridge JA, Hogendoorn PCW, Mertens F, editors. WHO classification of tumours of soft tissue and bone. 4th ed. Geneva: WHO Press; 2013. p. 204–5.

    Google Scholar 

  8. Hasegawa T, Seki K, Ono K, Hirohashi S. Angiomatoid (malignant) fibrous histiocytoma: a peculiar low-grade tumor showing immunophenotypic heterogeneity and ultrastructural variations. Pathol Int. 2000;50:731–8.

    Article  CAS  PubMed  Google Scholar 

  9. Pettinato G, Manivel JC, De Rosa G, Petrella G, Jaszcz W. Angiomatoid malignant fibrous histiocytoma: cytologic, immunohistochemical, ultrastructural, and flow cytometric study of 20 cases. Mod Pathol. 1990;3(4):479–87.

    CAS  PubMed  Google Scholar 

  10. Fletcher CDM. Angiomatoid “malignant fibrous histiocytoma”: an immunohistochemical study indicative of myoid differentiation. Human Pathol. 1991;22(6):563–8.

    Article  CAS  Google Scholar 

  11. Thway K. Angiomatoid fibrous histiocytoma: a review with recent genetic findings. Arch Pathol Lab Med. 2008;132:273–7.

    PubMed  Google Scholar 

  12. Matsumura T, Yamaguchi T, Tochigi N, Wada T, Yamashita T, Hasegawa T. Angiomatoid fibrous histiocytoma including cases with pleomorphic features analysed by fluorescence in situ hybridisation. J Clin Pathol. 2010;63(2):124–8.

    Article  CAS  PubMed  Google Scholar 

  13. Li CS, Chan WP, Chen WT, Chang CP, Shih LS, Chen RC, et al. MRI of angiomatoid fibrous histiocytoma. Skelet Radiol. 2004;33:604–8.

    Article  Google Scholar 

  14. Ajlan AM, Sayegh KS, Powell T, et al. Angiomatoid fibrous histiocytoma: magnetic resonance imaging appearance in 2 cases. J Comput Assist Tomogr. 2010;34:791–4.

    Article  PubMed  Google Scholar 

  15. Bauer A, Jackson B, Marner E, Gilbertson-Dahdal D. Angiomatoid fibrous histiocytoma: a case report and review of the literature. J Radiol Case Rep. 2012;6:8–15.

    PubMed  PubMed Central  Google Scholar 

  16. Yikilmaz A, Bo-Yee, Navarro OM. Imaging of childhood angiomatoid fibrous histiocytoma with pathological correlation. Pediatr Radiol. 2015;45:1796–802.

    Article  PubMed  Google Scholar 

  17. Murphey MD, Gross TM, Rosenthal HG. From the archives of the AFIP. Musculoskeletal malignant fibrous histiocytoma: radiologic-pathologic correlation. RadioGraphics. 1994;14:807–26.

    Article  CAS  PubMed  Google Scholar 

  18. Wang H, Jabean J, Recant W, Montag AG. Pathologic quiz case: a large cystic thigh mass in a 10-year-old boy. Arch Pathol Lab Med. 2000;124:783–4.

    CAS  PubMed  Google Scholar 

  19. Mansfield A, Larson B, Stafford SL, Shives TC, Haddock MG, Dingli D. Angiomatoid fibrous histiocytoma in a 25-year-old male. Rare Tumors. 2010;2:e20. doi:10.4081/rt.2010.e20.

  20. Sutthiruangwong P, Thanakit V, Assavamongkolkul A. Case report: angiomatoid fibrous histiocytoma with pain in a child. J Med Assoc Thail. 2005;88:1453–7.

    Google Scholar 

  21. Makis W, Ciarallo A, Hickeson M, Derbekyan V. Angiomatoid fibrous histiocytoma. Staging and evaluation of response to therapy with F-18 FDG PET/CT. Clin Nucl Med. 2011;36:376–9.

    Article  PubMed  Google Scholar 

  22. Murphey MD, McRae GA, Fanburg-Smith JC, Temple HT, Levine AM, Aboulafia AJ. Imaging of soft-tissue myxoma with emphasis on CT and MR and comparison of radiologic and pathologic findings. Radiology. 2002;225:215–24.

    Article  PubMed  Google Scholar 

  23. Daw NC, Billups CA, Pappo AS, Jenkins JJ, Mahmoud HH, Krasin MJ, et al. Malignant fibrous histiocytoma and other fibrohistiocytic tumors in pediatric patients: the St Jude Children’s Research Hospital experience. Cancer. 2003;97:2840–7.

    Article  Google Scholar 

  24. Jacobs IA, Chevinsky A. Angiomatoid fibrous histiocytoma: a case report and review of the literature. Dermatol Surg. 2000;26:491–2.

    Article  CAS  PubMed  Google Scholar 

  25. Costa MA, Silva I, Carvalhido L, Azevedo I, Alves L, Leal C, et al. Angiomatoid fibrous histiocytoma of the arm treated by radiotherapy for local recurrence-case report. Med Pediatr Oncol. 1997;28:373–6.

    Article  CAS  PubMed  Google Scholar 

  26. Song JY, Lee SK, Kim SG, Rotaru H, Baciut M, Dinu C. Angiomatoid fibrous histiocytoma of the hard palate: case report. Oral Maxillofac Surg. 2012;16:237–42.

    Article  PubMed  Google Scholar 

  27. Asakura S, Tezuka N, Inoue S, Kihara N, Fujino S. Angiomatoid fibrous histiocytoma in mediastinum. Ann Thorac Surg. 2001;72:283–5.

    Article  CAS  PubMed  Google Scholar 

  28. Ren L, Guo S-P, Zhou X-G, Chan JKC. Angiomatoid fibrous histiocytoma. First report of primary pulmonary origin. Am J Surg Pathol. 2009;33:1570–4.

    Article  PubMed  Google Scholar 

  29. Ochalski PG, Edinger JT, Horowitz MB, et al. Case report. Intracranial angiomatoid fibrous histiocytoma presenting as recurrent multifocal parenchymal hemorrhage. J Neurosurg. 2010;112:978–82.

    Article  PubMed  Google Scholar 

  30. Dunham C, Hussong J, Seiff M, Pfeifer J, Perry A. Primary intracerebral angiomatoid fibrous histiocytoma: report of a case with a t(12;22)(q13;q12) causing type 1 gene fusion of the EWS and ATF-1 genes. Am J Surg Pathol. 2008;l32:478–84.

    Article  Google Scholar 

  31. Petry WB, LeGallo RD, Fox MG, Gaskin CM. Imaging characteristics of angiomatoid fibrous histiocytoma of bone. Skelet Radiol. 2011;40:233–7.

    Article  Google Scholar 

  32. Mangham DC, Williams A, Lalam RK, Brundler M-A, Leahy MG, Cool WP. Angiomatoid fibrous histiocytoma of bone: a calcifying sclerosing variant mimicking osteosarcoma. Am J Surg Pathol. 2010;34:279–85.

    Article  PubMed  Google Scholar 

  33. Sparreboom E, Wetzels C, Verdijk M, Mulder S, Blokx W. Subcutaneous angiomatoid fibrous histiocytoma mimicking metastatic melanoma. Case Reports Pathol. 2012;ID:291623. doi:10.1155/2012/291623.

  34. Thway K, Gonzalez D, Wren D, Daiton M, Swansbury J, Fisher C. Angiomatoid fibrous histiocytoma: comparison of fluorescence in situ hybridization and reverse transcription polymerase chain reaction as adjunct diagnostic modalities. Ann Diagn Pathol. 2015;19:137–42.

    Article  PubMed  Google Scholar 

  35. Maher OM, Prieto VG, Stewart J, Herzog CE. Characterization of metastatic angiomatoid fibrous histiocytoma. J Pediatr Hematol Oncol. 2015;37(4):e268–71.

    Article  PubMed  Google Scholar 

  36. Chow LTC, Allen PW, Kumta SM, Griffith J, Li CK, Leung PC. Angiomatoid malignant fibrous histiocytoma: report of an unusually case with highly aggressive clinical course. J Foot Ankle Surg. 1998;37:235–8.

    Article  CAS  PubMed  Google Scholar 

  37. Qian X, Hornick JL, Cibas ES, Dal Cin P, Domanski HA. Angiomatoid fibrous histiocytoma a series of five cytologic cases with literature review and emphasis on diagnostic pitfalls. Diagn Cytopathol. 2012;40 Suppl 2:E86–93.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We acknowledge the assistance of Dr. Diana M. Cardona for her re-evaluation of the post-surgical histopathological material in two cases and also appreciate and acknowledge the assistance in writing, language editing, and proofreading by Dr. Miriam Feliu.

Author information

Authors and Affiliations

  1. Department of Radiology, Duke University Medical Center, Box 3808 Erwin Road, Durham, NC, 27710, USA

    Salutario J. Martinez & Emily N. Vinson

  2. Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road, NE, Atlanta, GA, 30322, USA

    Courtney Coursey Moreno

  3. Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Campus Box #7525 Brinkhous-Bullitt Building, Chapel Hill, NC, 27599, USA

    Leslie G. Dodd

  4. Department of Orthopedic Surgery, Duke University Medical Center, Box 3312 Erwin Road, Durham, NC, 27710, USA

    Brian E. Brigman

Authors
  1. Salutario J. Martinez
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Courtney Coursey Moreno
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Emily N. Vinson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Leslie G. Dodd
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Brian E. Brigman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Salutario J. Martinez.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Addendum

Addendum

During the submission of this manuscript, a series of seven pediatric cases of AFH was published (Ref. 16). The unspecific features of AFH were discussed. As in other articles, the authors describe a layer that enhances after administration of contrast “due to the presence of a pseudocapsule” (Fig. 1c). Furthermore, a partial double rim is present (deep margin) as well as possible marginal infiltrating in the upper pole, and neither was recognized.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Martinez, S.J., Moreno, C.C., Vinson, E.N. et al. Angiomatoid fibrous histiocytoma: novel MR imaging findings. Skeletal Radiol 45, 661–670 (2016). https://doi.org/10.1007/s00256-016-2344-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-016-2344-4

Keywords

Search

Navigation