Palliative Care of Malignant Fibrous Histiocytoma of Spine with Cord Compression and Multiple Bone Metastases Treated by Multidisciplinary Therapy: Case Report

Abstract

Malignant fibrous histiocytoma (MFH) of the spine is rare, with only a few dozen cases reported in the literature. A 60-year-old male was referred to us with symptoms of thoracic myelopathy. A solid tumor in the Th8 right costovertebral junction invading the spinal canal and compressing the spinal cord, and multiple bony metastases were discovered. Biopsy confirmed MFH. The thoracic spine tumor showed good response to irradiation followed by embolization and partial resection. The patient was followed until his death 22 months later. A good quality of life was sustained for more than 18 months. Despite a poor prognosis and an aggressive course of MFH of the spine, a good quality of life could be sustained for more than a year with palliative interventions.

Keywords: Malignant fibrous histiocytoma of spine; Spine sarcoma.

Fig. 1

Axial view of Th8 right rib junction tumor. A MRI T1. B MRI T2. C MRI fat suppression. D CT showing bone destruction without periosteal reaction or new bone formation.

Fig. 2

A H&E stain. ×20 magnification. B H&E stain. ×200 magnification showing whorls of undifferentiated cells with atypical nuclei. C CD68 immunohistochemistry. ×400 magnification showing diffusely positively stained cells.

Fig. 3

Th8 tumor MRI T2 sagittal (A) and axial (B) slice at 1 year postoperatively showing significant tumor shrinking after irradiation, embolization, and partial resection.