Malignant fibrous histiocytoma of the humerus

Case contributed by Dr Ian Bickle

Presentation

Large humeral mass identified just prior to childbirth. Developed over several months.

Patient Data

Age: 40
Gender: Female

Lucent destructive lesion in the right humeral head and neck with cortical destruction.

Moth eaten appearance to the proximal humeral diaphysis.

Destructive bone based lesion centred on the right humeral head, extending into the metadiaphysis.

Acromion intact.

MRI

Contrast not administered as patient breast feeding.

The humeral head and neck is replaced with a soft tissue mass with high T2, low T1 signal material, with several high T1 foci in keeping with intra-tumoral haemorrhage.

Extension into the proximal diaphysis.

No synchronus lesion.

CORE BIOPSY - HISTOPATHOLOGY REPORT

Cellular malignant tumour composed of spindle and round cells in a vague storiform pattern.  Bizarre giant cells are noted. No osteoid.

The tumour cells positively for vimentin, CD99, smooth muscle actin and myoglobin.

Conclusion:  Undifferentiated pleomorphic sarcoma

Case Discussion

Malignant fibrous histiocytoma (MFH) has now been re-termed with a more meanful pathological identity as a pleomorphic undifferentiated sarcoma.

It is a soft tissue based tumour, which can occur anywhere in the body. Less than 5% are bone derived as in this case.

MFHs occur in adults (range 32-80; mean 59 years) with a slight male predilection with a M:F ratio of 1.2:1). Presentation is usually with an painless, enlarging palpable mass - as in this case. 

Core biopsy confirmed the diagnosis.   The prognosis, as is usual with all sarcomas, is poor.

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Case information

rID: 29452
Case created: 25th May 2014
Last edited: 25th Oct 2017
Inclusion in quiz mode: Included

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