Malignant fibrous histiocytoma of the ovary: a case report

Malignant fibrous histiocytoma (MFH) is the most common soft-tissue sarcoma of late adult life occurring predominantly in the extremities and the retroperitoneum. MFH of the ovary is very rare, with only six cases previously reported. A 67-year-old woman with a right pelvic tumor highly suspicious of ovarian carcinoma was submitted to exploratory laparotomy. Total abdominal hysterectomy, bilateral salpingo-oophorectomy, total omentectomy, pelvic and paraaortic lymphadenectomy with right hemicolectomy along with permanent cutaneous ileostomy were performed. Since a storiform-pleomorphic type of MHF was diagnosed from histopathological and immunohistochemical findings, chemotherapy was proposed as the postoperative treatment. Despite extensive surgery with negative surgical margins, the patient had recurrence of the tumor within four months, and was submitted to secondary surgery. A combination of chemo- and radiotherapy was performed postoperatively, but the patient developed respiratory problems and died one year later from the primary diagnosis.

Malignant fibrous histiocytoma; Ovary; Storiform-pleomorphic type; Prognosis

[1] Canter R.J., Beal S., Borys D., Martinez S.R., Bold R.J., Robbins A.S.: “Interreaction of histologic subtype and histologic grade in predicting survival for soft-tissue sarcomas”. J. Am. Coll. Surg., 2010, 210, 191.

[2] O’Brien J.E., Stout A.P.: “Malignant fibrous xanthomas”. Cancer, 1964, 17, 1445.

[3] Al-Agha O.M., Igbokwe A.A.: “Malignant fibrous histiocytoma: between the past and the present”. Arch. Pathol. Lab. Med., 2008, 132, 1030.

[4] Dilek T.U.K., Dielek S., Pata O., Tataroglu C., Tok E.: “Malignant fibrous histiocytoma of the ovary: a case report”. Int. J. Gynecol. Cancer, 2006, 16 (suppl.), 352.

[5] Zagars C.K., Mullen J.R., Pollack A.: “Malignant fibrous histiocytoma: outcome and prognostic factors following conservation surgery and radiotherapy”. Int. J. Radiol. Oncol. Bios. Phys., 1996, 34, 983.

[6] Su H.W., Hin C.S., Lin Y.H., Hsu M.J., Chiang H.K., Chan S.Y.: “Malignant fibrous histiocytoma during pregnancy: a case report”. Taiwanese J. Obstet. Gynecol., 2006, 45, 86.

[7] Kempson R.L., Kyriakos M.: “Fibroxanthosarcoma of the soft tissues. A type of malignant fibrous histiocytoma”. Cancer, 1972, 29, 961.

[8] Salernis N.S., Gourgiotis S., Tsiambas E., Panagiotoulos N., Karamenis A., Tsohataridis E.: “Primary intra-abdominal malignant fibrous histiocytoma: a highly aggressive tumor”. J. Gastrointest. Cancer, 2010, 41, 238.

[9] Sekine Y., Kazunari O., Okamoto K., Nomura M., Tomita H., Ohtare N. et al.: “Malignant fibrous histiocytoma of the right spermatic cord. A case report”. Intern. J. Urol., 2001, 8, 581.

[10] Roque D.M., Jones D.F., Carter G., Kelley J.L.: “Primary giant cell malignant fibrous histiocytoma of the ovary: case report and review of the literature”. Gynecol. Oncol., 2010, 118, 397.

[11] Mitsumori K., Horri Y., Akao T., Ohbayashi T., Sawada S., Nakagama T.: “Malignant fibrous histiocytoma of the spermatic cord: A case report”. Acta Urol. Jpn., 1993, 39, 1063.

[12] Gronchi A., Lo Vullo S., Colombo C., Collini P., Stacchiotti S., Mariani L. et al.: “Extremity soft tissue sarcoma in a series of patient treated at a single institution: local control directly inpacts survival”. Ann. Surg., 2010, 251, 506.

[13] Zagars C.K., Ballo M.T., Pisters P.W.: “Prognostic factors for patients with localized soft tissue sarcoma treated with conservation surgery and radiation therapy. an analysis of 1225 patients”. Cancer, 2003, 97, 2530.

[14] Equiluz Lumbreras P., Palacios Hernandez A., Heredero Zorzo O., Garcia Garcia J., Canada de Arriba F., Perez Herrero F., Gomez Zancajo A.: “Retroperitoneal malignant fibrous histiocytoma: case report”. Arch. Esp. Urol., 2010, 63, 477.

[15] Weiss S.W., Enzinger F.M.: “Malignant fibrous histiocytoma: an analysis of 200 cases”. Cancer, 1978, 41, 2250.

[16] Kearney M.M., Soule E.H., Ivins J.C.: “Malignant fibrous histiocytoma: A retrospective study of 167 cases”. Cancer, 1980, 45, 167.

[17] Pezzi C.M., Rowlings M.S. Jr., Esgro J.J., Pollock R.E., Romsdahl M.M.: “Prognostic factors in 227 patients with malignant fibrous histiocytoma”. Cancer, 1992, 69, 2098.

[18] van Glabbeke M., van Oosterom A.T., Oosterhuis J.W., Mouridsen H., Crowther D., Somers J. et al.: “Prognostic factors for the outcome of chemotherapy in advanced soft tissue sarcoma: an analysis of 2185 patients treated with anthracycline-containing first-line regiments - a European Organization for Research and Treatment of Cancer Soft Tissue and Bone Sarcoma Group Study”. J. Clin. Oncol., 1999, 17, 150.

[19] Santoro A., Tursz T., Mouridsen H., Verweij J., Stewart W., Somers R., Buesa J. et al.: “Doxorubicin versus CYVA-DIC versus doxorubicin plus ifosfamide in first-line treatment of advanced soft tissue sarcomas: a randomized study of the European Organization for Research and Treatment of Cancer Soft Tissue and Bone Sarcoma Group”. J. Clin. Oncol., 1999, 13, 1357.

[20] Choong P.F.M., Mandahl N., Murtens F., Willen H., Alvegart T., Kreichergs A. et al.: “19p+ marker chromosome correlates with relapse in malignant fibrous histiocytoma”. Genes Chromosomes Cancer 1996, 16, 88.

[21] Labarta R.S., Gil Sanz M.J., Gonzales G.M., Rioja Sanza L.A.: “A new case of malignant fibrous histiocytoma arising from the renal capsule”. Actas Urol. Esp., 2010, 34, 116.