ABSTRACT
Abstract We are going to present a case of malignant fibrous histiocytoma in the right atrium, which is a very rare entity. The patient had a right atrial mass, which prolapsed through the tricuspid valve into the right ventricle, causing functional tricuspid valve stenosis. The tumor was completely resected and the patient had an uneventful postoperative period. Histopathological examination reported malignant fibrous histiocytoma. The patient presented to the emergency department five weeks after discharge with dyspnea and palpitation. Echocardiography and magnetic resonance imaging revealed recurrent right atrial tumor mass. His clinical status has worsened, with syncope and acute renal failure. On the repeated echocardiography, suspected tumor recurrence was observed in left atrium, which probably caused systemic embolization. Considering the aggressive nature of the tumor and systemic involvement, our Heart Council decided to provide palliative treatment by nonsurgical management. His status deteriorated for the next few days and the patient succumbed to a cardiac arrest on the 4th day.
Subject(s)
Humans , Male , Histiocytoma, Malignant Fibrous/pathology , Heart Neoplasms/pathology , Magnetic Resonance Imaging , Echocardiography , Tomography, X-Ray Computed , Tricuspid Valve Prolapse/pathology , Tricuspid Valve Prolapse/diagnostic imaging , Coronary Angiography , Fatal Outcome , Rare Diseases , Histiocytoma, Malignant Fibrous/diagnostic imaging , Heart Atria/pathology , Heart Atria/diagnostic imaging , Heart Neoplasms/diagnostic imaging , Neoplasm Recurrence, LocalSubject(s)
Humans , Female , Middle Aged , Sarcoma/diagnostic imaging , Paranasal Sinus Neoplasms/diagnostic imaging , Histiocytoma, Malignant Fibrous/diagnostic imaging , Ethmoid Sinus/diagnostic imaging , Sarcoma/surgery , Sarcoma/pathology , Paranasal Sinus Neoplasms/surgery , Paranasal Sinus Neoplasms/pathology , Magnetic Resonance Imaging , Tomography, X-Ray Computed , Diagnosis, Differential , Histiocytoma, Malignant Fibrous/surgery , Histiocytoma, Malignant Fibrous/pathology , Ethmoid Sinus/surgery , Ethmoid Sinus/pathologyABSTRACT
Summary Malignant fibrous histiocytoma is a rare tumor. It is most commonly seen in individuals between the fifth and seventh decades of life, in extremities, and less frequently in the retroperitoneum. Although its etiology is not clearly known, radiotherapy, chemical agents, previous history of surgery, trauma and fracture, and Hodgkin lymphoma have been blamed. Leiomyosarcoma, liposarcoma and rhabdomyosarcoma should be taken into account in differential diagnosis. It is seen on computed tomography as a mass lesion with irregular borders and density similar to that of the surrounding muscle tissue. Necrotic and hemorrhagic components in the mass are characterized as heterogeneous low density areas. Fluid-fluid levels can be detected by computed tomography and magnetic resonance imaging.
Subject(s)
Humans , Female , Histiocytoma, Malignant Fibrous/diagnostic imaging , Rhabdomyosarcoma/diagnostic imaging , Magnetic Resonance Imaging , Tomography, X-Ray Computed , Diagnosis, Differential , Histiocytoma, Malignant Fibrous/therapy , Leiomyosarcoma/diagnostic imaging , Liposarcoma/diagnostic imaging , Middle AgedABSTRACT
Aims: Various features have been described in the literature to differentiate benign from malignant lesions. The aim of the present study was to study the accuracy of each of these features and that of magnetic resonance imaging (MRI) in diagnosing malignant lesions. Materials and Methods: Fifty-five consecutive patients presenting with neoplastic (both benign and malignant) lesions diagnosed clinically and on ultrasound were studied and their MRI features were compared with the findings on surgical exploration and histopathologic examination. Results: There were 32 (58%) benign and 23 (42%) malignant masses. Malignant masses were more common in patients older than 20 years (83%), and these had symptoms of less than 6 months duration (75%), as against benign lesions. The swelling was painful in 8 malignant masses and these were more common in the upper limbs (61%). Various features of malignant lesions were size more than 5 cm in 83%, change in signal intensity from homogenous on T1-weighted images to heterogenous on T2-weighted images in 74%, irregular margins in 74%, and heterogenous contrast enhancement in 91%. The accuracy of these features was 76%, 58%, 78%, and 60%, respectively. Most benign and malignant lesions were intramuscular in location. A significant number (38%) of benign lesions were located in the intermuscular facial plane. Definitive diagnosis was made in 42% of the lesions. Conclusions: MRI is an excellent modality for evaluating soft tissue neoplasms; however, prediction of a specific diagnosis and differentiation of malignant and benign lesions is not always possible.
Subject(s)
Diagnosis, Differential , Feasibility Studies , Female , Histiocytoma, Malignant Fibrous/diagnosis , Histiocytoma, Malignant Fibrous/pathology , Histiocytoma, Malignant Fibrous/physiopathology , Histiocytoma, Malignant Fibrous/diagnostic imaging , Humans , Magnetic Resonance Imaging/methods , Male , Muscle Neoplasms/diagnosis , Muscle Neoplasms/pathology , Muscle Neoplasms/physiopathology , Muscle Neoplasms/diagnostic imaging , Predictive Value of Tests , Prognosis , Sensitivity and Specificity , Soft Tissue Neoplasms/diagnosis , Soft Tissue Neoplasms/pathology , Soft Tissue Neoplasms/physiopathology , Soft Tissue Neoplasms/diagnostic imagingABSTRACT
We report a rare case of primary cardiac malignant fibroushistiocytoma. A 65-year-oldmanpresentedwithepigastric tenderness. Echocardiography detected large pericardial effusion and right ventricular mass 5 x 4 cm. Tumor biopsy revealed malignant fibroushistiocytoma. Thorough investigation did not detect any extra-cardiac primary source or metastasis. Tumor resection was offered to the patient but he refused. Despite refusal the patient was still alive one year after diagnosis