Management of giant benign fibrous histiocytoma in the spinal region with pleural involvement: A case report

Abstract

Rationale: Benign fibrous histiocytoma with pleural involvement in spinal region is a highly unusual disease with no standard curative managements yet. The objective of this study is to report an extremely rare case of a giant benign fibrous histiocytoma with pleural involvement in spinal region successfully operated by posterior spinal surgery. The management of these unique cases has yet to be well-documented.

Patient concerns: A 23-year-old man presented with a 2-month history of continuous and progressive back pain. A giant, expanding lesion of the T7 vertebral and paraspinal region with pleural involvement was identified.

Diagnoses: Computed tomography scan and magnetic resonance imaging of spine showed expanding lesion of the T7 vertebral and paraspinal region involving the right thoracic cavity, which presented as a solid tumor. Postoperative pathology confirmed the diagnosis of thoracic benign fibrous histiocytoma.

Interventions: The patient underwent thoracic spinal canal decompression, complete tumor resection, pleural defect repair, and T4 to T10 internal fixation procedure via a posterior approach.

Outcomes: The patient's symptom improved significantly after the surgery, and the postoperative period was uneventful at the 2-year follow-up visit. There were no complications associated with the operation during the follow-up period.

Lessons: In summary, the tumor's clinical features, imaging results, and pathological characteristics are unique. Combined efforts of specialists from orthopedics, thoracic surgery, neurosurgery, pathology, and medical oncology led to the successful diagnosis and management of this patient. Giant benign fibrous histiocytoma with pleural involvement in spinal region, although rare, should be part of the differential diagnosis when the patient presents with back pain and radiculopathy. We recommend the posterior or 1-stage anterior-posterior combined approach for complete resection of the giant thoracic benign fibrous histiocytoma when the tumor has caused severe symptoms or neurological deficits.

Figure 1

(A, B) Preoperative X-rays revealing thoracic lesions with high suspicion of spinal soft tissue tumors.

Figure 2

(A–H) Preoperative transverse CT scan revealing the density of soft tissue measuring 7.5 × 7.0 × 5.5 cm, obvious bony destruction in the T7, and pleural involvement caused by thoracic mass. CT = computed tomography.

Figure 3

(A–H) Preoperative sagittal MRI showing the thoracic BFH. BFH = benign fibrous histiocytoma, MRI = magnetic resonance imaging.

Figure 4

(A–H) Preoperative transverse MRI showing the thoracic BFH. BFH = benign fibrous histiocytoma, MRI = magnetic resonance imaging.

Figure 5

Bone scan revealed high intake in the thoracic region, with high suspicion of a solid tumor.

Figure 6

(A) Intraoperative photography depicting the exposed spinal cord. (B) Intraoperative photography depicting entirely resected tumor.

Figure 7

(A, B) Posteroanterior and lateral x-ray images of the thoracic spine obtained postoperatively.

Figure 8

Pathologic histology of spinal tumors. (A, B) Microphotography showing characteristic nests of tumor cells separated by vascular septa (Zellballen) with cells showing a stroma of spindle-shaped fibrohistiocytic cells (H&E, original magnification 100× and 200×). (C) CD68 immunostaining is strongly positive in the tumor cells. (D) S-100 immunostaining shows positive staining in the tumor cells. (E) SMA immunostaining shows positive staining in the tumor cells. (F–H) CD34, CD99, Desmin immunostaining shows positive staining in the tumor cells. (I) Ki-67 immunostaining shows 1% Ki-67 positive cells. Ki-67 staining is localized in the tumor nuclei. SMA = smooth muscle actin.