CASTROENTEROLOGY 1985;89:890-3 Malignant Fibrous Histiocytoma of the Liver JUAN J. ALBERTI-FLOR, MICHAEL F. O’HARA, FRED WEAVER, JAN EVANS, ROBERT MCCLURE, and G. DEWEY DUNN Departments of Medicine (Gastroenterology), Pathology, and Surgery, Vanderbilt University School of Medicine and Veterans Administration Medical Center, Nashville, Tennessee A 59-yr-oId man was admitted to the hospital for evaluation of right upper quadrant pain, anorexia, weight loss, and low-grade fever of 2-mo duration. During his evaluation, an abnormal liver ultrasound and computed tomography scan demonstrated what proved to be an avascular hepatic lesion. At surgery, the diagnosis of malignant fibrous histiocytoma was established. We present herein our findings of what we believe to be the first reported study of malignant fibrous histiocytoma of the liver. Primary sarcomas of the liver are uncommon tumors occurring both in children (1) and adults (2,3), the most common being hemangiosarcoma (3). Malig- nant fibrous histiocytoma (MFH) (4) is a sarcoma occurring for the most part in the lower extremities of adult men, and not previously reported as occur- ring in the liver. We present herein what we believe to be the first report of hepatic fibrous histiocytoma. Case Report A 5%yr-old man was admitted to the hospital for evaluation of right upper quadrant pain, anorexia, low- grade fever, and a 50-lb weight loss of 2-mo duration. The patient denied history of abdominal trauma, hepatitis, alcohol intake, or blood transfusions. Two years previ- ously he had a lipoma removed from the right shoulder. The outside slide was reviewed and the histologic picture was consistent with a lipoma. Physical examination re- vealed a well-developed, chronically ill, nonicteric white man with a blood pressure of 150/90 and a temperature of lOOoF. Cardiopulmonary examination was unremarkable. Abdominal examination revealed normal bowel sounds. There was right upper quadrant tenderness, but no re- Received January 7, 1985. Accepted April 25, 1985. Address requests for reprints to: Juan J. Alberti-Flor, M.D., Division of Gastroenterology (Ill-B), Veterans Administration Medical Center, 1310 24th Avenue, South, Nashville, Tennessee 37203. 0 1985 by the American Gastroenterological Association 0016-5085/85/$3.30 bound. The liver was felt -5 cm below the right costal margin and a hepatic rub was present. There was no splenomegaly or ascites. Rectal examination was normal and the Hemoccult test (SmithKline Diagnostics, Inc., Sunnyvale, Calif.) was negative. The hematocrit was 30.8%, the white blood cell count was 32,900 cells/mm3, and the platelet count was 682,000. Serum glucose, elec- trolytes, and creatinine were normal. Alkaline phospha- tase was 305 U/L (normal 30-115 U/L). Total serum pro- tein, bilirubin, transaminases, and calcium were normal. Tests for a-fetoprotein and hepatitis B surface antigen and antibody were negative. The chest x-ray was negative except for an elevated right hemidiaphragm. Abdominal ultrasound revealed the pres- ence of a large mass localized to the right lobe of the liver, which in the computed tomography scan (Figure 1) was measured to have a diameter of -16 cm. There were no retroperitoneal masses or adenopathy and the pancreas was normal. Hepatic arteriogram [Figure 2) demonstrated that the mass was avascular. At surgery a firm, hard, tumor mass was palpated in the dome of the liver occupying -70% of the right lobe and extending across the major hepatic fissure into the medial segment of the left lobe. The rest of the intraabdominal examination was unremarkable. Microscopically, the tu- mor was composed of pleomorphic spindle cells arranged in sheets and fascicles with a prominent storiform pattern (Figure 3). Cytologically, the cells had a large bizarre nuclei with prominent nucleoli and eosinophilic cyto- plasm. Occasional cells displayed clear or vacuolated cytoplasm and mitotic figures were abundant. Myxoid, angiomatoid, or inflammatory features were not present. These features were considered to be diagnostic of malig- nant fibrous histiocytoma, storiform-pleomorphic type. Electron microscopic studies demonstrated elongated nu- clei with increased numbers of dilated cisternae of rough endoplasmic reticulum and occasional actinlike, nonspe- cific filamentous elements (Figure 4). Other cells appeared very primitive or displayed features of histiocytelike cells with cytoplasmic processes, prominent Golgi apparatus, Abbreviation used in this paper: MFH, malignant fibrous histiocytoma.
Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Related Documents
