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
Modality: X-ray

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

Moth eaten appearance to the proximal humeral diaphysis.

Modality: CT

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

Acromion intact.

Contrast not administered as patient breast feeding.

Modality: MRI

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: 14th Mar 2016
Inclusion in quiz mode: Included

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