Case Report Liver metastasis of malignant fibrous histiocytoma: A case report Fethi Derbel a, * , Hassene Hajji a , Abdallah Mtimet a , Mehdi Ben Hadj Hamida a , Jaafar Mazhoud a , Sabri Youssef a , Ali Ben Ali a , Habib Khochtali d , Ajmi Chaouch a , Moncef Mokni b , Hela Jemni c , Ridha Ben Hadj Hamida a a Department of Surgery, University Hospital Sahloul, Sousse 4051,Tunisia b Department of Pathology, University Hospital Farhat Hached, Sousse, 4051, Tunisia c Department of Radiology, University Hospital Sahloul, Sousse 4051, Tunisia d Department of Maxillo-Facial Surgery, University Hospital, Sahloul, Sousse 4051, Tunisia article info Article history: Received 29 November 2009 Accepted 25 March 2010 Keywords: Liver metastasis Malignant fibrous histiocytoma Neck Surgery Hepatectomy abstract Malignant fibrous histiocytoma (MFH) is the most common soft-tissue sarcoma occurring in adult life. It is relatively uncommon in the head and neck area. Surgery is the most reliable treatment for MFH, but the 5-year survival rate for cases of this tumour in the head and neck region is low in comparison with MFH of the extremities and trunk. Most metastases occurred in the lungs (90%), followed by bone (8%). Liver metastases of MFH are very rare (1%). We report on a case of a 62-year-old woman undergoing repeat surgery for an MFH of the neck, with liver metastasis found 14 months after the first surgery. She under- went liver resection and the postoperative course was uneventful. Ó 2010 Arab Journal of Gastroenterology. Published by Elsevier B.V. All rights reserved. Case report In November 2004, a 62-year-old woman presented with a mass in the neck region, the largest diameter being 12 cm. She had been operated upon 11 months earlier for a mass in the same location. She underwent surgical resection and a histologic examination re- vealed a malignant fibrous histiocytoma (MFH). Repeat surgeries, 7 and 11 months later, were conducted for local recurrence without metastatic locations. Tumour free margins were obtained in all resections. Fourteen months after the first surgery, a third local recurrence appeared and a liver metastasis was found after abdom- inal computed tomography and magnetic resonance imaging. A 5-cm mass was located in segment V (Figs. 1 and 2). She first under- went a neck surgery and was later admitted to the abdominal surgery department for liver resection. The patient underwent lapa- rotomy in April 2006. During the operation, a large firm mass was found occupying segments V and VI (Couinaud’s system) (Figs. 3 and 4). A wedged liver resection of the mass was performed. The postoperative course was uneventful and the patient was afebrile. She was discharged from hospital on the seventh day after liver sur- gery. A histological examination showed that the tumour was com- posed of spindle-shaped and pleomorphic malignant cells arranged in sheets and fascicles with a prominent storiform pattern intermin- gled with bizarre giant cells and inflammatory cells (Fig. 5). These features were consistent with those of an MFH of the storiform– pleomorphic type. The same MFH type was also found at a histolog- ical examination of the primary neck tumour. Neither radiotherapy nor chemotherapy was given. The patient died 5 months later due to diffuse lung metastasis. Discussion Sarcomas constitute less than 1% of all body malignancies, including the head and neck area [1,2]. MFH is the most common (10%) soft-tissue sarcoma. It is a pleomorphic sarcoma described initially by O’Brien and Stout in 1964 [3]. This tumour typically oc- curs in late adult life with a peak incidence in the fifth and sixth decades and is rare in young persons [4]. Pezzi et al. reported that most metastases of MFH occurred in the lungs (90%), followed by bone (8%). However, liver metastases of this tumour are very rare (1%) [5]. It is the most common sarcoma in late adulthood; men are affected twice as frequent as women. MFH is microscopically characterised by areas of spindle cells arranged in a storiform pat- tern and pleomorphic areas with haphazardly arranged sheets of fibroblasts and histiocytes. This neoplasm has a variety of histo- logic subtypes, including storiform–pleomorphic, myxoid, giant cell, inflammatory and angiomatoid. MFH generally affects the extremities and the retroperitoneum. Histologically, it is difficult to distinguish this tumour from other sarcomas and carcinomas. 1687-1979/$ - see front matter Ó 2010 Arab Journal of Gastroenterology. Published by Elsevier B.V. All rights reserved. doi:10.1016/j.ajg.2010.03.003 * Corresponding author. Tel.: +216 98 547 896; fax: +216 73 367 451. E-mail address: fethi.derbel@gmail.com (F. Derbel). Arab Journal of Gastroenterology 11 (2010) 113–115 Contents lists available at ScienceDirect Arab Journal of Gastroenterology journal homepage: www.elsevier.com/locate/ajg