Malignant fibrous histiocytoma of bone

Introduction to bone malignant fibrous histiocytoma Malignant fibrous histiocytoma is a rare tumor characterized by both histiocytic and fibrous components. The concept of benign or malignant tissue in a tissue cell, tumor in bone or soft tissue is based on the idea that tissue cells can act as facultative fibroblasts, or that primitive mesenchymal cells can develop into fibroblasts and Tissue cells are the two cells. basic knowledge The proportion of illness: 0.005% Susceptible people: good for men aged 50 to 60 Mode of infection: non-infectious Complications: fracture

Cause of bone malignant fibrous histiocytoma

(1) Causes of the disease

Malignant fibrous histiocytoma, either primary or secondary to bone infarction, Paget's disease or radiation therapy, indicates osteonecrosis or benign chronic repair processes, rich in mononuclear and multinucleated tissue cells and Proliferation of fibroblasts is responsible for secondary malignancies.

(two) pathogenesis

Visual observation of the tumor in the bone extensively, the late erosion of the cortical bone involving adjacent soft tissue, the tumor itself is grayish white, fish-like, can be different degrees of different degrees of hemorrhage and necrosis, the main components seen under the microscope are two kinds of tumor Fibroblasts and interstitial tissue cells, the former are spindle-shaped cells, fertile and fusiform, and there are a number of collagen fibers between cells. The cells have different degrees of heteromorphism and mitotic phase, and the cells are densely arranged, often showing characteristic features. Storiform pattern, tissue cells are larger, round or oval, cytoplasm rich eosinophilic, phagocytic, swallowing lipids, cytoplasm can be granular, foamy or vacuolated, The nucleus is round, oval, kidney-shaped or multilaterally lobulated, with clear nucleoli, obvious abnormality of tissue cells, and frequent nuclear division. Other components can be seen in giant cells, multinuclear giant cells, Totun giant cells, and yellow tumors. Cell and tissue necrosis, calcification, mucous degeneration, collagen hyalinosis, lymphocytic infiltration and hemangioma components.

The MWH electron microscopy showed that the fibroblasts were oval or fusiform, cytoplasmic, containing a large number of lysosomes, and had a Golgi apparatus, a rough endoplasmic reticulum and mitochondria, with less differentiation and a rounded nucleus. Oval or irregular, often with binuclear, a large number of heterochromatin under the nuclear membrane, organized cells are oval or irregular, with pseudo-foot protruding from the cell surface, fluffy folds, and a Golgi apparatus. Rough endoplasmic reticulum and mitochondria, and a large amount of lipid droplets and glycogen particles.

Bone malignant fibrous histiocytoma prevention

There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.

Bone malignant fibrous histiocytoma complications Complications

Nearly 1/2 of the cases can be associated with rational fractures.

Bone malignant fibrous histiocytoma symptoms Common symptoms Shoulder joint mobility limitation severe pain

The incidence of malignant fibrous histiocytoma in men is more than that of females, and the proportion is about 3:2. The age of onset is 50-60 years old.

1. Symptoms and signs: The incidence of malignant fibrous histiocytoma is slow. Usually, the history is several months to several years. The pain and gradually growing mass are common clinical symptoms. Local depression may occur. For example, joint activity is limited. It may be that the tumor invades the joint, and the patient suddenly has severe pain, which may be a pathological fracture. The incidence of pathological fracture can account for 30% to 50% of all patients.

2. The predilection site: the distribution of bone malignant fibrous histiocytoma on the bone is similar to that of osteosarcoma, mainly invading the long tubular bone end (about 75% of all cases), and the lower extremity bone is more susceptible to disease than the upper limb bone. The ratio is about 6:1, the femur (about 45%), the tibia (20%), and the tibia (9%). It is the most common part of the tumor. The incidence of the tibia is about 10%. The other sites are the skull and facial bone. %), ribs (3%), humerus, spine, scapula and clavicle are not common sites, invading the hands, small bones are rare.

In long tubular bone, the tumor is located at the metaphysis, and often extends to the epiphysis or backbone, or both, and the incidence of bone around the knee is about 50% of all tumors in the long tubular bone.

Subperiosteal and multi-lesional or multi-bone lesions are rare in bone malignant fibrous histiocytoma.

Examination of bone malignant fibrous histiocytoma

X-ray inspection

X-ray findings of malignant fibrous histiocytoma are worm-like, perforated osteolytic lesions (Fig. 1), cortical erosion, localized periosteal reaction, and soft tissue masses, with different lesion sizes in the tubular bone. It can be invaded from the epiphysis to the backbone; the humeral lesion can occupy most of it or invade the entire humerus; the spine can develop from the vertebral body to the posterior vertebral attachment, and the swelling of the bone is generally not common, but sometimes In flat bones and irregular bones such as: ribs, shoulder blades and sternum can be seen, pathological fractures are more frequent.

2. Other imaging technologies

CT examination, magnetic resonance and other imaging techniques can help to understand the extent of the tumor and surrounding soft tissue, but not specific to malignant fibrous histiocytoma.

Diagnosis and diagnosis of malignant fibrous histiocytoma

The histological diagnosis of MFH is very important and is the basis for diagnosis. The diagnostic criteria are as follows: 1 There are both tumor fibroblasts and tissue cells, and 2 special "petal" or "wheel" arrangements of spindle cells, 3 The presence of multinuclear giant cells, 4 inflammatory cells, especially lymphocytes infiltration.

Differential diagnosis

Since the first report of O'Brien in 1964, it has gradually appeared in various literatures, indicating that there is no previous understanding of MFH, and it is likely to be misdiagnosed as other malignant tumors. The main needs to be identified are fibrosarcoma, osteosarcoma, giant cell tumor of bone, etc. Especially fibrosarcoma, before the MFH has not yet "appeared", most of them are misdiagnosed as fibrosarcoma, histologically fibrosarcoma is a single tumor fibroblast, but MFH still has neoplastic tissue cells as the main identification point, microscopic collagen Fiber components are easily mistaken for bone-like tissue and misdiagnosed as osteosarcoma.

X-ray findings only indicate that these lesions are invasive, but not specific, plus bone malignant fibrous histiocytoma, bone metastases (especially from lung and breast metastasis), plasmacytoma, lymphoma, osteolytic Osteosarcoma and fibrosarcoma have the same performance on the X-ray. Sometimes the age of onset and clinical manifestations can contribute to the differential diagnosis of the above-mentioned diseases, such as younger patients with osteosarcoma, accompanied by elevated alkaline phosphatase, etc. Pathological fracture without extensive periosteal reaction is more consistent with the diagnosis of malignant fibrous histiocytoma. The most difficult problem in diagnosis is to identify malignant fibrous histiocytoma and osteofibrosarcoma, although some people say that malignant fibrous histiocytoma has more Invasive, tumors grow more rapidly, but it is difficult to distinguish between the two lesions in clinical practice.

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