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Year : 2000  |  Volume : 10  |  Issue : 2  |  Page : 116-117
Malignant fibrous histiocytoma of ligamentum teres


Department of Radio Diagnosis and Imaging, Kasturba Hospital, Manipal, India

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How to cite this article:
Shetty C, Banavali S, Lakhkar BN. Malignant fibrous histiocytoma of ligamentum teres. Indian J Radiol Imaging 2000;10:116-7

How to cite this URL:
Shetty C, Banavali S, Lakhkar BN. Malignant fibrous histiocytoma of ligamentum teres. Indian J Radiol Imaging [serial online] 2000 [cited 2019 Jul 20];10:116-7. Available from: http://www.ijri.org/text.asp?2000/10/2/116/30621
Sir,

We wish to report a case of malignant fibrous histiocytoma (MFH) arising from the ligamentum teres, an extremely rare site of origin for this tumor.

A middle-aged man came with complaints of an abdominal mass and pain in the abdomen for three months. He had no bowel complaints. On examination, a firm tender mass was felt in the anterior aspect of the abdomen. The mass did not move with respiration. No organomegaly was noted.

The patient was referred for CT scan [Figure - 1]. CT showed a solid mass extending from the epigastrium to the level of umbilicus. Central areas of the mass were hypodense and non-enhancing on contrast-enhanced scans, suggesting necrosis. The mass was seen infiltrating the anterior abdominal wall. No intra-abdominal lymphadenopathy was detected. Differential diagnoses of dermoid tumor, malignant fibrous histiocytoma and rhabdomyosarcoma were considered.

The patient underwent surgery. During surgery, the mass was found to be arising from the ligamentum teres extending upto the umbilicus. The mass was infiltrating the anterior abdominal wall and a wide excision was done with reconstruction of the anterior abdominal wall. Histopathology showed malignant fibrous histiocytoma.

Malignant fibrous histiocytoma is the most frequent soft tissue sarcoma of late adult life, the majority of cases occurring between the ages of 50 and 70 years. These neoplasms are rare in childhood and approximately two thirds occur in men. Malignant fibrous histiocytoma often presents as a painless, slowly enlarging mass. Pregnancy may however, accelerate the growth rate, resulting in pain [1].

Weiss et al [2] in an analysis of 200 cases of MFH showed that the tumor occurred principally as a mass involving an extremity or in the abdominal cavity or retroperitoneum (16%). It occurred mainly in adults (peak incidence between 61-70 years of age) and typically involved the deep fascia (19%) or skeletal muscle (59%) and was rarely confined to the subcutis without fascial involvement (7%). The rate of local recurrence of the tumor was 44% and of metastases 42%. Metastases were frequently seen to the lungs (82%) and lymph nodes (32%).

They also noted that the tumors that were small, superficially located or had a prominent inflammatory component metastasized less frequently than larger, more deeply located tumors. They noted that many tumors previously diagnosed as pleomorphic variants of liposarcoma, fibrosarcoma or rhabdomyosarcoma were probably examples of MFH.

They reported the development of MFH within radiated areas following therapy for breast cancer, Hodgkin's lymphoma and myeloma. Grossly, malignant fibrous histiocytoma tends to be loculated and to spread for considerable distances along the fascial planes or between muscle fibres accounting for its high recurrence rate following resection. Histologically the tumor has a variable morphologic pattern, ranging from well-differentiated elongated spindle cells to highly anaplastic pleomorphic histiocyte-like cells.

MFH of primary omental origin has been reported in an infant [3]. Sonography showed huge, lobulated, echogenic masses with cystic areas. CT demonstrated heterogeneously enhancing masses with central cystic and necrotic areas.

We have not come across any reported case of malignant fibrous histiocytoma specifically arising from the ligamentum teres in English literature.

 
   References Top

1.Shields, T. Text book of General Thoracic Surgery. 4th ed.Williams and Wilkins, 1994: 587   Back to cited text no. 1    
2.Weiss SW, Enzinger, FM. Malignant fibrous histiocytoma. Cancer 1978; 41: 2250-2266.   Back to cited text no. 2    
3.Kim OH, Lee-KY. Pediatric Radiol. 1994; 24: 285-287.   Back to cited text no. 3    

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Correspondence Address:
Chandrakanth Shetty
Department of Radio Diagnosis and Imaging, Kasturba Hospital, Manipal
India
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Source of Support: None, Conflict of Interest: None


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