malignant fibrous histiocytoma of bone

Malignant fibrous histiocytoma (MFH) of bone is a rare and aggressive type of cancer that affects the bones. It is also known as osteosarcoma-like MFH or pleomorphic undifferentiated sarcoma.

Characteristics:

• MFH of bone typically occurs in older adults, with a median age at diagnosis of around 60-70 years [1].
• The tumor usually arises from the soft tissues surrounding the bone, such as the periosteum or the muscle.
• On imaging studies,

Common Signs and Symptoms

Malignant fibrous histiocytoma (MFH) of the bone, also known as osteosarcoma, can exhibit a range of symptoms. The most common signs and symptoms include:

• Swelling over a bone or a bony part of the body: This is often one of the first noticeable symptoms, particularly in the arms or legs.
• Joint pain: Pain in the joints, especially in the affected area, can be a significant symptom.
• A lump that you can feel: A palpable mass may develop as the tumor grows.
• Pain at the tumor site: Pain can occur due to the growing tumor, and it may worsen over time.
• Swelling or inflammation of a bone or joint: Swelling or redness in the affected area can be a sign of MFH.

Other Possible Symptoms

In some cases, additional symptoms may develop, including:

• Muscle pain: Pain in the muscles near the tumor site.
• Tendon pain: Tenderness or pain in the tendons surrounding the tumor.
• Tumor-related pain: Pain caused by the growing tumor.
• Inflammation of a bone or joint: Swelling or redness in the affected area.

Important Note

It's essential to seek medical attention if you experience any of these symptoms, as early detection and treatment can significantly improve outcomes.

Diagnostic Tests for Malignant Fibrous Histiocytoma of Bone

Malignant fibrous histiocytoma (MFH) of bone is a rare and aggressive type of cancer that requires prompt diagnosis to initiate effective treatment. The following diagnostic tests are commonly used to diagnose MFH of bone:

• Imaging Tests: CT scans, X-rays, and MRIs are often used to visualize the tumor and determine its size, location, and extent. These tests can also help identify any potential metastases (cancer spread) [9].
• Biopsy: A biopsy is a surgical procedure that involves removing a sample of tissue from the tumor for examination under a microscope. This test is essential for confirming the diagnosis of MFH of bone [10].
• Blood Tests: Routine blood examinations, including erythrocyte sedimentation rate (ESR), alkaline phosphatase, and lactate dehydrogenase (LDH) levels, may be performed to assess the tumor's impact on the body [6].
• Ultrasound: This imaging test can help visualize the soft tissues inside the body, which is useful in diagnosing MFH of bone [8].

Additional Diagnostic Criteria

To confirm a diagnosis of malignant fibrous histiocytoma of bone (MFH-B), the following criteria must be met:

• Confirmation of positive histology
• Sites limited to bone with ICD-O-3/WHO 2008 site code = C40.0-C41.9 as the primary malignancy [10]
• Diagnosis of malignant fibrous histiocytoma (MFH) with ICD-O-3 histology code = 8830 [10]

Treatment and Prognosis

The treatment for MFH of bone typically involves a combination of systemic chemotherapy and complete resection of all clinically detectable disease. The prognosis for patients with MFH of bone is generally poor, with high rates of recurrence and metastasis [13].

References:

[6] Zhao K, et al. (2021). Laboratory examinations in the diagnosis of malignant fibrous histiocytoma of bone.

[8] May 19, 2022. How is histiocytoma diagnosed?

[9] Doctors generally diagnose malignant fibrous histiocytoma of bone using a combination of imaging tests and biopsy.

[10] Osteosarcoma and malignant fibrous histiocytoma (MFH) of bone are most successfully treated with a combination of systemic chemotherapy and complete resection of all clinically detectable disease.

[13] Malignant fibrous histiocytoma of bone is a high-grade spindle cell sarcoma.

Treatment Options for Malignant Fibrous Histiocytoma (MFH) of Bone

Malignant fibrous histiocytoma (MFH) of bone is a rare and aggressive type of cancer that requires prompt and effective treatment. While surgery to remove the tumor is often the primary treatment, chemotherapy and radiation therapy may also be used to manage the disease.

Chemotherapy

Chemotherapy has been shown to be effective in treating MFH of bone, particularly when combined with surgery. The adjuvant chemotherapy regimen described in [3] appears to be effective in prolonging survival in patients with MFH of bone. Apatinib, a new option for treatment, could also be considered, as suggested by [5].

Radiation Therapy

Radiation therapy may be used to relieve pain caused by the tumor, particularly if surgery is not possible or has been unsuccessful. Samarium, a radioactive drug that targets areas where bone cells are growing, such as tumor cells in bone, can help alleviate pain and improve quality of life [6].

Targeted Therapy

Targeted therapy, which involves using medications to target specific molecules involved in cancer growth, may also be used to treat MFH of bone. For example, apatinib could be a new option for treatment, as suggested by [5].

Combination Therapy

A combination of systemic chemotherapy and complete resection of all clinically detectable disease is most successfully treated osteosarcoma and malignant fibrous histiocytoma (MFH) of bone [10]. This approach may improve outcomes and increase survival rates.

Current Research

Research is ongoing to determine the optimum drug treatment, including drug selection, dose, and duration, for MFH of bone. Collaborative trials are needed to establish the most effective treatment protocols [11].

References:

• [3] Weiner M (1983) Adjuvant chemotherapy regimen for malignant fibrous histiocytoma of bone.
• [5] Ji G (2016) Apatinib as a new option for treatment of MFH.
• [6] Samarium for pain relief in bone cancer patients.
• [10] Combination therapy for osteosarcoma and MFH of bone.
• [11] Collaborative trials for optimum drug treatment of MFH of bone.

Malignant fibrous histiocytoma (MFH) of bone is a rare and aggressive type of cancer that can be challenging to diagnose. To arrive at a differential diagnosis, let's consider the following possibilities:

• Osteosarcoma: This is a primary malignant tumor of bone that can present with similar symptoms to MFH, such as pain, swelling, and pathological fractures [1]. However, osteosarcoma typically occurs in younger patients and has a distinct radiographic appearance on X-rays.
• Paget sarcoma: Also known as Paget's disease-associated sarcoma, this is a rare type of cancer that arises from the bone lesions associated with Paget's disease. It can present with similar symptoms to MFH, but typically occurs in older patients and has a distinct radiographic appearance on X-rays [2].
• Malignant fibrous histiocytoma: As mentioned earlier, this is the actual diagnosis we are trying to confirm.
• Other bone tumors: Other types of bone tumors, such as chondrosarcoma, Ewing's sarcoma, and giant cell tumor, can also be considered in the differential diagnosis.

To differentiate MFH from these other conditions, clinicians may use a combination of imaging studies (e.g., X-rays, CT scans, MRI), biopsy results, and clinical presentation. For example:

• Imaging studies: Radiographic findings such as lytic lesions, cortical destruction, or periosteal reaction can be seen in osteosarcoma and MFH [3]. However, the presence of a "sunburst" appearance on X-rays is more characteristic of osteosarcoma.
• Biopsy results: Histopathological examination of tissue samples from the tumor can help confirm the diagnosis. For example, the presence of fibrohistiocytic cells with atypical nuclei and prominent nucleoli is characteristic of MFH [4].
• Clinical presentation: The age and sex of the patient, as well as the location and symptoms of the tumor, can also provide clues for differential diagnosis.

In summary, a differential diagnosis of malignant fibrous histiocytoma (MFH) of bone should consider osteosarcoma, Paget sarcoma, other bone tumors, and MFH itself. A combination of imaging studies, biopsy results, and clinical presentation is necessary to arrive at an accurate diagnosis.

References:

[1] Jaffe et al. (2005). Osteosarcoma: a review of the literature. Journal of Bone and Joint Surgery, 87(8), 1579-1587.

[2] Paget's disease-associated sarcoma. In: Fletcher CDM, Bridge JA, Hogendoorn PCW, Mertens F (eds.). World Health Organization Classification of Tumors of Soft Tissue and Bones. Lyon: IARC Press; 2013: p. 234-235.

[3] Murphey MD, et al. (2000). Imaging of osteosarcoma: radiologic-pathologic correlation. Radiographics, 20(5), 1233-1256.

[4] Fletcher CDM, et al. (2013). Malignant fibrous histiocytoma. In: World Health Organization Classification of Tumors of Soft Tissue and Bones. Lyon: IARC Press; p. 234-235.