AJR 2001; 176:549-550
© American Roentgen Ray Society
Cystic Malignant Fibrous Histiocytoma of the Mesovarium
Sheung-Fat Ko,
Shu-Hang Ng,
Jui-Wei Lin and
Tze-Yu Lee
Chang Gung University Chang Gung Memorial Hospital Kaohsiung Hsien
833, Taiwan
Malignant fibrous histiocytoma (MFH) is one of the most common sarcomas of
late adult life. This mesenchymal sarcoma is ubiquitous but generally affects
the extremities and retroperitoneum
[1,
2]. We report the imaging
findings of an unusual case of cystic MFH of the mesovarium, which, to our
knowledge, has not been previously described.
A 38-year-old unmarried woman was admitted because of intensifying
abdominal pain of 3-months' duration with aggravation in the 3 days before
examination. We found mild pallor and a large tender mass in the lower
abdomen. Pulse rate and blood pressure were normal. Mild anemia and
leukocytosis were also noted. Sonography revealed an 18 x 10 cm
multicystic pelvic mass (Fig.
2A), but the ovaries were not identified. CT showed a
multiloculated pelviabdominal mass with intracystic fluid—fluid levels
and mildly thickened septa (Figs.
2B and
2C). Surgery revealed an 18-cm
multicystic left adnexal tumor with invasion to the bladder wall. A frozen
section showed a mesenchymal tumor; subsequently, tumor resection, left
salpingo-oophorectomy, partial cystectomy, and cystostomy were performed.
Histologic examination revealed extensive hemorrhage in the cystic spaces and
histiocytelike and fibroblastlike tumor cells with pleomorphic nuclei
(Fig. 2D). The left fallopian
tube and ovary were normal. The final diagnosis was pleomorphic MFH with
extensive intratumoral hemorrhage. This patient recovered uneventfully and
underwent adjuvant radiotherapy 3 weeks later. She was well at a 7-year
follow-up.
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Fig. 2A. —38-year-old woman with cystic malignant fibrous histiocytoma
(MFH) who presented with lower abdominal pain. Transabdominal left oblique
sagittal sonogram shows multicystic tumor (arrowheads) superior to
uterus (thick arrow) with echogenic material (thin arrow) in
inferior cystic space.
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Fig. 2B. —38-year-old woman with cystic malignant fibrous histiocytoma
(MFH) who presented with lower abdominal pain. Enhanced CT scans at levels of
lower abdomen (B) and mid pelvis (C) show huge multicystic
pelviabdominal tumor with enhancing thick septa (thick arrow),
hyperdense content (arrowheads), and fluid-fluid levels (thin
arrows) caused by intracystic hemorrhage.
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Fig. 2C. —38-year-old woman with cystic malignant fibrous histiocytoma
(MFH) who presented with lower abdominal pain. Enhanced CT scans at levels of
lower abdomen (B) and mid pelvis (C) show huge multicystic
pelviabdominal tumor with enhancing thick septa (thick arrow),
hyperdense content (arrowheads), and fluid-fluid levels (thin
arrows) caused by intracystic hemorrhage.
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Fig. 2D. —38-year-old woman with cystic malignant fibrous histiocytoma
(MFH) who presented with lower abdominal pain. Photomicrograph of
histopathologic specimen shows MFH (thick white arrows) with outer
mantle composed of fibroblastlike and histiocytelike pleomorphic cells and
large cystic space (black arrows) in mesovarium. Note adjacent normal
ovary (thin white arrows). (H and E, x80)
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Paraovarian cystic lesions can arise from the mesovarium in remnants of
Gartner's duct, with approximately 2% of such lesions being malignant
[3]. Sonographic identification
of a normal ovary is helpful in differentiating ovarian or nonovarian masses
[3], but normal ovaries were
obscured by a mass in this patient. MFH usually appears as hypoechoic or
heteroechoic solid masses on sonography
[2]. In our patient, sonography
showed a large cystic tumor with thick septations suggestive of malignancy,
but this lesion was virtually indistinguishable from more common cystic
ovarian neoplasms. Nevertheless, MFH may be considered as a rare differential
diagnosis of cystic adnexal masses.
On CT, MFH typically presents as heterogeneous solid masses with some tumor
necrosis or hemorrhage. In MFH, massive hemorrhage induced by chemotherapy
simulating tumor growth has been described
[4]. However, as illustrated in
our patient, even without chemotherapy, MFH may exhibit a propensity to bleed
intratumorally, simulating a hemorrhagic cyst on CT. This finding is in
accordance with a pathologic analysis of 200 cases of MFH in which 5% of cases
exhibited extensive hemorrhage, mimicking a hematoma
[1].
References
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Weiss SW, Enzinger FM. Malignant fibrous histiocytoma: an analysis
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Goldman SM, Hartman DS, Weiss SW. The varied radiographic
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1986;135:33
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Cohen DJ. Ovary and adnexa. In: Thurmond AS, Jones MK, Cohen DJ,
eds. Gynecologic, obstetric and breast radiology.
Cambridge, MA: Blackwell Science, 1996:255
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Panicek DM, Casper ES, Brennan MF, Hajdu SI, Heelan RT. Hemorrhage
simulating tumor growth in malignant fibrous histiocytoma at MR imaging.
Radiology
1991;181:398
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