Images of Musculoskeletal Oncology
Malignant Fibrous Histiocytoma (MFH)
A 53 year old female has left lower extremity and pelvic pain for two months
This routine AP radiograph of her spine, including the sacrum, demonstrates only subtle changes indicating an osteolytic lesion in the left side of her sacrum, which was not appreciated until the following CT was obtained.
CT scan of the sacrum. Compare the large irregular osteolytic lesion in the left half of the pelvis as seen on this CT scan with the routine radiograph of the spine, and the importance of this CT scan can be appreciated.
Low and high power photomicrographs of core needle CT directed biopsies. This cellular pleomorphic neoplasm with many bizarre nuclei is quite typical of malignant fibrous histiocytoma (MFH) and is classified as IIB.

Treatment included hemisacral resection with spinal instrumentation and bone allografts. She also received radiation and chemotherapy. Unfortunately, she developed local recurrence and died two years later of metastatic disease.

Learning Issues:

1. Initially the differential diagnosis included metastatic carcinoma. However, the biopsy clearly demonstrates a malignant fibrous histiocytoma, and in the absence of metastatic disease warranted an attempt at surgical resection, as well as radiation and chemotherapy.

2. Chemotherapy, although often used, so far is of little proven benefit.

Images of Musculoskeletal Oncology
University at Buffalo Department of Orthopaedics