Malignant Fibrous Histiocytoma of the Eyelid: Differential Diagnosis and Management

Abstract

This study highlights the difficulties in the clinicopathologic diagnosis of periocular MFH and in particular the distinction of more superficial tumors from atypical fibroxanthoma. The mainstay of treatment is complete surgical excision with wide margins, and consideration should be given to histologic margin control in addition to adjuvant radiotherapy.

Case of atypical fibroxanthoma in the palpebral conjunctiva

“…1,2 Most patients have a long history of sun exposure, and an antecedent trauma is also one of the risk factors. The size of most atypical fi broxanthomas is 1-2 cm.…”

“…5 Because an atypical fi broxanthoma is histologically similar to malignant fi brous histiocytoma, discrimination between a malignant fi brous histiocytoma and an atypical fi broxanthoma is diffi cult. 1,2,4 Occupational and therapeutic radiation is a possible predisposing factor for malignant fi brous histiocytoma of the head and neck. 2 Our patient had no history of irradiation.…”

“…1,2 Several spindle cell tumors can be differentiated using immunohistochemical staining. 1,2,4 Negative immunostaining for desmin, α-SMA, S-100, and GFAP were used to rule out leiomyosarcoma and malignant schwannoma. The histiocytic marker CD68 was positive in our case.…”

Fibro-histiocitoma maligno da pálpebra: relato de caso

“…A presença de fibro-histiocitoma associado a melanoma maligno de coróide também já foi descrita, devendo-se atentar a isso, apesar da raridade, no exame primário dos portadores de algum dos dois tipos tumorais (16) . Aproximadamente um terço dos tumores são vascularizados, podendo conter focos de hemorragia e fazem diagnóstico diferencial com o hemangioma e, se durante a ressecção da lesão houver ruptura, pode ser difícil fazer a diferenciação de hemangiopericitoma, hemangioendotelioma e angiossarcoma (1,(17)(18) . As variantes mixóides podem ser confundidas com mixoma e lipossarcoma mixóide.…”

Head and Neck Soft Tissue Sarcoma

“…A single case of MFH in the buccal region was also reported [Ogawa A et al, 2005]. In the literature, in cases of MFH in the head and neck, the onset age ranged from 16 years old in a patient with MFH in the mandible to 85 years old in a patient with MFH in the eyelid, and the mean age of 12 patients with head and neck MFH was reported to be 55 years old [Khong JJ et al, 2005, Barnes L et al, 1988, Narvaez JA et al, 1996. The occurrence of MFH in membranous bones is unusual.…”