Diagnostic and therapeutic strategy and the most efficient prognostic factors of breast malignant fibrous histiocytoma

Abstract

We analyzed the clinicopathological features of 9 breast malignant fibrous histiocytoma (MFH) patients. Immunohistochemistry was used to make both diagnosis and differential diagnosis, and to identify prognostic factors. All tumors lacked epithelial markers but expressed mesenchymal markers, suggesting a mesenchymal origin. Of the five cases expressing Ki-67, two of three patients with axillary lymph node involvement died between 6–8 months, and two died at 17 and 26 months after diagnosis. The two remaining cases, with low Ki-67 expression, had no recurrent or metastatic disease at 145 months after diagnosis. Previous studies have shown that surgery is the primary treatment of choice, but no clear benefit from adjuvant chemotherapy was observed. We demonstrate that axillary lymph node involvement and high expression of Ki-67 are associated with poorer prognosis. A literature review indicates surgery remains the first choice for MFH, but benefits from adjuvant chemotherapy remain unclear.

Mesenchymal breast lesions

“…44,47 One series of nine patients described the presentation as a painless breast mass in all patients. 48 Alternatively, cases have also been reported of slowly growing or painful masses. 47,49 There is great variability in size, with MFHs in one series reported as ranging from 1.3e15 cm with a mean of 6.3 cm.…”

“…45,47 MFHs are sarcomas made of fibroblast-like and histiocyte-like cells mixed with pleomorphic giant and inflammatory cells. 44,48,50 They contain mesenchymal markers. 48 In the past, they were divided into three subtypes: storiformepleomorphic MFH, giant cell MFH, and inflammatory MFH.…”

“…44,48,50 They contain mesenchymal markers. 48 In the past, they were divided into three subtypes: storiformepleomorphic MFH, giant cell MFH, and inflammatory MFH. Pleomorphic MFH is the most common subtype.…”

Imaging Findings of Metastatic Breast Malignant Fibrous Histiocytoma: A Case Report

“…The most frequent primary sites of MFH are the lower limbs (49%), upper limbs (19%), and abdominal cavity or retroperitoneum (16%) of adults (2). MFH of the breast is extremely rare, only 65 cases have previously been reported so far (3). And most of the case reports were about histopathological diagnosis of primary breast MFH or therapeutic strategy and prognostic factors (3).…”

“…MFH of the breast is extremely rare, only 65 cases have previously been reported so far (3). And most of the case reports were about histopathological diagnosis of primary breast MFH or therapeutic strategy and prognostic factors (3). In recent study, there was an attempt to describe the imaging feature of primary breast sarcoma (4), but including only one breast MFH among 24 breast sarcoma cases.…”