Primary hepatic malignant fibrous histiocytoma combined with invasion of inferior vena cava: A case report and literature review

Abstract

Rationale: Malignant fibrous histiocytoma (MFH), primary presented in liver, was very rare and displayed a poor prognosis because of high aggression. As a few of cases had been reported merely, we shared the case of primary hepatic MFH combined with invasion of inferior vena cava (IVC).

Patients concerns: A 69-year-old women presented with abdominal pain.

Diagnoses: Abdominal computed tomography and magnetic resonance imaging indicated a soft mass about 5.4 × 4.2 cm in the caudate lobe, accompanied with IVC invaded.

Interventions: After the multidisciplinary consultation, laparotomy was performed, followed by chemotherapy and radiotherapy. Primary hepatic MFH was demonstrated pathologically. Till now, the patient was alive for >22 months after surgery and no evidence of recurrence or distant metastasis was suspected.

Outcomes: We discussed the integrated procedure of diagnosis and treatment, combined with data from literature review.

Lessons: To our knowledge, the primary hepatic MFH combined with invasion of IVC was hardly reported. Despite the poor prognosis, the comprehensive treatment integrating the surgery, chemotherapy, and radiotherapy showed the satisfactory disease-free and overall survival. However, further investigations are definitely warranted.

Figure 1

Liver enhanced magnetic resonance imaging showed a large lesion with low signal in the second hilum on T2-weighted images. The left is arterial phase, circular irregular intensification in the fringe of the mass was observed and the largest size of the tumor was 5.8 × 4.8 cm in dimension. The right is venous phase, the mass presented rapidly attenuation of signal and “Space Occupying Effect” in the inferior vena cava.

Figure 2

Surgical specimens contained left caudate lobe and cancer embolus of inferior vena cava.

Figure 3

Pathological examination showing storiform-pleomorphic spindle cells (hematoxylin and eosin original magnification ×400).

Figure 4

Immunohistological staining for CD68 demonstrating positive reaction in the tumor cells (original magnification ×400).

Figure 5

Immunohistological staining for α1-antichymotrypsin demonstrating positive reaction in the tumor cells (original magnification ×400).

Figure 6

In November 2016, the patient received enhanced computed tomography scan, which showed no evidence of recurrence or metastasis.