Surgical management of giant secondary malignant fibrous histiocytoma following radiotherapy for nasopharyngeal carcinoma: A case report and literature review

Abstract

Malignant fibrous histiocytoma (MFH) is rare in the chest wall, particularly in patients who have undergone radiotherapy for primary nasopharyngeal cancer. In the present study, a case of MFH of the upper chest wall that appeared four years after initial radiotherapy for squamous cell carcinoma of the nasopharynx is reported. Furthermore, two-step surgical management was successfully performed consisting of i) tumor-reductive excision and ii) limb salvage surgery, including wide resection of the tumor mass, defect reconstruction of the chest wall using left latissimus dorsi myocutaneous flap and dermatoplasty of the flap-supplied region. The progress of the clinical characteristics, the reasons for radiation-induced carcinogenesis, the treatment options and the prognostic factors of MFH are also reviewed. Finally, the importance of prevention and follow-up of this malignancy are highlighted and specific advice is offered.

Keywords: malignant fibrous histiocytoma; radiotherapy; surgical treatment.

Figure 1

(A) Mushroom-shaped mass (20×20×6 cm) in the left anterior-superior chest wall, with the odor of necrotic tissue. (B) Sugical defect measuring 22×22×8 cm following excision of the whole tumor mass, the left clavicle, part of the first rib, the affected sternum and the sternoclavicular joint. (C) Defect reconstruction using left latissimus dorsi myocutaneous flap. (D) Two weeks after the surgery.

Figure 2

(A) Computed tomography (CT) and (B) magnetic resonance imaging showing an expansive mass in the left anterior-superior chest wall with an irregular margin, but with no evidence of invasion of the pleural cavity. (C) Three-dimensional imaging of the thoracic cage showing tumor invasion of the left clavicle, the first rib, superior segment of the sternum and the sternoclavicular joint. (D) The CT angiography indicated that the main blood supply of the tumor came from the proximal end of the left subclavian artery, particularly the internal thoracic artery. (E and F) The thoracic CT was rechecked and no signs of a remaining tumor were detected.

Figure 3

(A) High-power photomicrograph showing proliferation of pleomorphic spindle-shaped cells woith large irregular nuclei with hyperchromasia. A giant cell is shown in the center of the field, with sparse lymphocytes. Photomicrographs of the tumor with immunohistochemical staining: (B) Vimentin demonstrating a strongly positive reaction in the tumor cells. (C) CD68 demonstrating a weakly positive reaction in the tumor cells. (D) Ki-67 (MIB-1) demonstrating a positive reaction in the tumor cells. The MIB-1 labeling index was 30%. CD68, cluster of differentiation 68.