290
Brief reports
components. The dual staining of the rhabdomyoblasts and the demonstration of intermediate forms between the spindle cell and glandular elements, both morphologically and on staining with cytokeratin, may perhaps be regarded as further evidence of divergent differentiation of uncommitted malignant cells.
Acknowledgements We should like to thank Lynn Trute for the immunohistochemistry, and Miss S. Van Noorden for the confirmatory double staining.
Peripheral nerve tumors showing glandular differen2. Woodruff JM, tiation (glandularschwannomas). Cancer 1976; 37; 2399-241 3. 3. Daimaru Y, Hashimoto H, Enjoji M. Malignant 'Triton' tumors: A clinicopathologic and immunohistochemical study of nine cases. Hum. Pathol. 1984; 15; 768-778. 4. Christensen WN. WoodruffJM.Neuroendocrine(NE)differentiation in peripheral nerve sheath tumors (PNSTs).Lab. Invest. 1988: 58; 17A. 5. Daimaru Y. Hashimoto H, Enjoji M. Malignant peripheral nervesheath tumors (malignant schwannomas). An irnmunohistochemica1 study of 29 cases. Am. 1. Surg. Pathol. 1985; 9; 434-444. 6. Wick MR,Swanson PR, Scheithauer BW, Manivel JG. Malignant peripheral nerve sheath tumor. An immunohistochemicalstudy of 62 cases. Am. J. Clin. Pathol. 1987; 87; 425-433.
References 1 . Enanger PM,Weiss SW. Malignanttumors of peripheral nerves. In Soft Tissue Tumors. 2nd edn. St.Louis: CV Mosby. 1988: 781-815.
Histopathologll 1992, 21, 290-292
BRIEF REPORT
Recurrent malignant fibrous histiocytorna of the liver B.J.MCGRADY & M.M.MIRAKHUR Institute of Pathology, Royal Victoria Hospital, Bevast, UK Date of submission 20 January 1992 Accepted for publication 23 March 1992
Keywords: liver, malignant fibrous histiocytoma
Introduction Primary liver mesenchymal malignancies are uncommon: most are classifled as angiosarcoma, leiomyosarcoma or embryonal sarcoma. We report an example of a primary hepatic malignant fibrous histiocytoma with an unusual clinical presentation, subsequent recurrence and survival in good health 9 years after the initial diagnosis.
Address for correspondence:Dr B.J.McGrady,Institute of Pathology. Royal Victoria Hospital,Belfast. UK.
Case report The patient, a 53-year-old female, was admitted with acute severe left-sided chest pain. An ultrasound and CAT scan of abdomen suggested the presence of a splenic tumour. Laparotomy revealed a 14 cm diameter tumour that was confined to the left lobe of liver. The initial diagnosis was a malignant mesenchymal tumour, possibly leiomyosarcoma. The patient made a good recovery. Five years later she developed anorexia and weight loss. Ultrasound scanning revealed the presence of a tumour mass in the right lobe of the liver. At laparotomy a 6.5 cm diameter lesion was removed. The tumour had the histological, immunocytochemical and ultrastructural features of a malignant fibrous histiocytoma (MFH), The original tumour w a reassessed ~ and found to have identical features to the later recurrence. The patient is currently alive and well.
Brief reports
291
Figure.1. Malignant Bbrous hlstiocytoma of liver. a Primary tumour mass showlng a high cellular lesion with a prominent storifom pattern. H & E x 100. b Recurrent tumour. Use the primary lesion this is composed of pleomorphic spindle cells. H & E. x 400.
PATHOLOGICAL FINDINGS
The original and recurrent tumour showed a similar gross appearance. They were histologically identical (Figure 1):both lesions were highly cellular tumours with a prominent storifom growth pattern. Areas of haemorrhage and necrosis were present. The tumours were composed of large atypical spindle cells with some multi-nucleated tumour giant cells. Both had compressive margins, with occasional foci of infiltration of adjacent hepatocytes. Immunocytochemical stainiig was positive for ctl-antitrypsin, al-antichymotrypsin and vimentii in both lesions. Significantly, neither reacted with antibodies to s-100 protein, desmin, factor VIII-related antigen, leucocyte common antigen or cytokeratins
(CAM 5.2). Ultrastructural studies of the recurrence were consistent with malignant fibrous histiocytoma. Many of the cells contained extensive rough endoplasmic reticulum, others were rich in lysosomes. There was no evidence of any specific pattern of mesenchymal differentiation.
Discussion Enzinger 81 Weiss’ initially described the MFH as a tumour of the deep soft tissues, characterized by a
storiform growth pattern, cellular pleomorphism, associated chronic inflammation and ultrastructural features of fibroblastic and histiocytic differentiation. More recently this concept has come under attack2. Some authors suggest that the lesion represents a final common pathway of ‘dedifferentiation’ of mesenchymal malignancies of diverse origin. The pattern of immunocytochemical reactivity and the ultrastructural feqtures in this present case closely resemble those reported in a previous study3. To date, four cases of primary MFH of the liver have been The patients ranged in age between 38 and 78 years with an average of 51 years of age. The reported tumour size has varied from 7 cm to total liver replacement. In three of the previous cases the patient died as a result of their tumour: only one patient was alive and well at the time of reporting6.The survival data from the small number of reported cases imply a poor prognosis. However, it seems that the diagnosis is not incompatible with prolonged survival, even after tumour recurrence.
References 1. Enzinger FM. Weiss SW. Malignant fibrous histiocytoma: an analysis of 200 cases. Cancer 1978: 41: 336-348. 2. Fletcher CDM. Soft tissue tumours: an update. In Anthony P.
292
Brief reports
MacSween RNM eds. Recent Advances in Histoputhology. London: Churchill Livingstone, 1991;15. 3. Arends JW, Willebrand D, BIaauw AMM et al. Primary malignant fibrous histiocytoma at the liver-a case report with immunocytochemical observations. Histopathologu 1987;11; 427-431. 4. Conran RM. Stocker JT.Malignant fibrous histiocytoma of the liver-a case report. Am. 1. Gastroenterol. 1985;80; 813-815.
5. Alberti-Flor JT.OHara MF. Weaver F e l al. Malignant fibrous histiocytoma of the liver. Gastroenterologu 1985;89; 890-893. 6. Fukayma M. Kocke M. Malignant Bbrous histiocytoma arising in the liver. Arch. Pathol. Lab. Med. 1986;1 1 0 203-206.
Brief reports
components. The dual staining of the rhabdomyoblasts and the demonstration of intermediate forms between the spindle cell and glandular elements, both morphologically and on staining with cytokeratin, may perhaps be regarded as further evidence of divergent differentiation of uncommitted malignant cells.
Acknowledgements We should like to thank Lynn Trute for the immunohistochemistry, and Miss S. Van Noorden for the confirmatory double staining.
Peripheral nerve tumors showing glandular differen2. Woodruff JM, tiation (glandularschwannomas). Cancer 1976; 37; 2399-241 3. 3. Daimaru Y, Hashimoto H, Enjoji M. Malignant 'Triton' tumors: A clinicopathologic and immunohistochemical study of nine cases. Hum. Pathol. 1984; 15; 768-778. 4. Christensen WN. WoodruffJM.Neuroendocrine(NE)differentiation in peripheral nerve sheath tumors (PNSTs).Lab. Invest. 1988: 58; 17A. 5. Daimaru Y. Hashimoto H, Enjoji M. Malignant peripheral nervesheath tumors (malignant schwannomas). An irnmunohistochemica1 study of 29 cases. Am. 1. Surg. Pathol. 1985; 9; 434-444. 6. Wick MR,Swanson PR, Scheithauer BW, Manivel JG. Malignant peripheral nerve sheath tumor. An immunohistochemicalstudy of 62 cases. Am. J. Clin. Pathol. 1987; 87; 425-433.
References 1 . Enanger PM,Weiss SW. Malignanttumors of peripheral nerves. In Soft Tissue Tumors. 2nd edn. St.Louis: CV Mosby. 1988: 781-815.
Histopathologll 1992, 21, 290-292
BRIEF REPORT
Recurrent malignant fibrous histiocytorna of the liver B.J.MCGRADY & M.M.MIRAKHUR Institute of Pathology, Royal Victoria Hospital, Bevast, UK Date of submission 20 January 1992 Accepted for publication 23 March 1992
Keywords: liver, malignant fibrous histiocytoma
Introduction Primary liver mesenchymal malignancies are uncommon: most are classifled as angiosarcoma, leiomyosarcoma or embryonal sarcoma. We report an example of a primary hepatic malignant fibrous histiocytoma with an unusual clinical presentation, subsequent recurrence and survival in good health 9 years after the initial diagnosis.
Address for correspondence:Dr B.J.McGrady,Institute of Pathology. Royal Victoria Hospital,Belfast. UK.
Case report The patient, a 53-year-old female, was admitted with acute severe left-sided chest pain. An ultrasound and CAT scan of abdomen suggested the presence of a splenic tumour. Laparotomy revealed a 14 cm diameter tumour that was confined to the left lobe of liver. The initial diagnosis was a malignant mesenchymal tumour, possibly leiomyosarcoma. The patient made a good recovery. Five years later she developed anorexia and weight loss. Ultrasound scanning revealed the presence of a tumour mass in the right lobe of the liver. At laparotomy a 6.5 cm diameter lesion was removed. The tumour had the histological, immunocytochemical and ultrastructural features of a malignant fibrous histiocytoma (MFH), The original tumour w a reassessed ~ and found to have identical features to the later recurrence. The patient is currently alive and well.
Brief reports
291
Figure.1. Malignant Bbrous hlstiocytoma of liver. a Primary tumour mass showlng a high cellular lesion with a prominent storifom pattern. H & E x 100. b Recurrent tumour. Use the primary lesion this is composed of pleomorphic spindle cells. H & E. x 400.
PATHOLOGICAL FINDINGS
The original and recurrent tumour showed a similar gross appearance. They were histologically identical (Figure 1):both lesions were highly cellular tumours with a prominent storifom growth pattern. Areas of haemorrhage and necrosis were present. The tumours were composed of large atypical spindle cells with some multi-nucleated tumour giant cells. Both had compressive margins, with occasional foci of infiltration of adjacent hepatocytes. Immunocytochemical stainiig was positive for ctl-antitrypsin, al-antichymotrypsin and vimentii in both lesions. Significantly, neither reacted with antibodies to s-100 protein, desmin, factor VIII-related antigen, leucocyte common antigen or cytokeratins
(CAM 5.2). Ultrastructural studies of the recurrence were consistent with malignant fibrous histiocytoma. Many of the cells contained extensive rough endoplasmic reticulum, others were rich in lysosomes. There was no evidence of any specific pattern of mesenchymal differentiation.
Discussion Enzinger 81 Weiss’ initially described the MFH as a tumour of the deep soft tissues, characterized by a
storiform growth pattern, cellular pleomorphism, associated chronic inflammation and ultrastructural features of fibroblastic and histiocytic differentiation. More recently this concept has come under attack2. Some authors suggest that the lesion represents a final common pathway of ‘dedifferentiation’ of mesenchymal malignancies of diverse origin. The pattern of immunocytochemical reactivity and the ultrastructural feqtures in this present case closely resemble those reported in a previous study3. To date, four cases of primary MFH of the liver have been The patients ranged in age between 38 and 78 years with an average of 51 years of age. The reported tumour size has varied from 7 cm to total liver replacement. In three of the previous cases the patient died as a result of their tumour: only one patient was alive and well at the time of reporting6.The survival data from the small number of reported cases imply a poor prognosis. However, it seems that the diagnosis is not incompatible with prolonged survival, even after tumour recurrence.
References 1. Enzinger FM. Weiss SW. Malignant fibrous histiocytoma: an analysis of 200 cases. Cancer 1978: 41: 336-348. 2. Fletcher CDM. Soft tissue tumours: an update. In Anthony P.
292
Brief reports
MacSween RNM eds. Recent Advances in Histoputhology. London: Churchill Livingstone, 1991;15. 3. Arends JW, Willebrand D, BIaauw AMM et al. Primary malignant fibrous histiocytoma at the liver-a case report with immunocytochemical observations. Histopathologu 1987;11; 427-431. 4. Conran RM. Stocker JT.Malignant fibrous histiocytoma of the liver-a case report. Am. 1. Gastroenterol. 1985;80; 813-815.
5. Alberti-Flor JT.OHara MF. Weaver F e l al. Malignant fibrous histiocytoma of the liver. Gastroenterologu 1985;89; 890-893. 6. Fukayma M. Kocke M. Malignant Bbrous histiocytoma arising in the liver. Arch. Pathol. Lab. Med. 1986;1 1 0 203-206.
