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Published on: April 12, 2019
CASE REPORTS: malignant fibrous histiocytoma of bone arising in chronic osteomyelitis
Michael Zlowodzki1, Bret Allen, Ken L Schreibman
1Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada.
Abstract:
This case report shows the importance of frozen section and/or permanent section pathology for diagnosis of tumorous conditions in patients with chronic osteomyelitis. According to published reports, a coincidence of malignant fibrous histiocytoma of bone and post-fracture osteomyelitis has occurred in only four patients. Our report details the treatment of 51-year-old man with a fracture 15 years previously and subsequent chronic osteomyelitis of the left distal femur. The original treatment was open reduction and casting. Fifteen years after the injury, the patient presented to the emergency room with increasing pain, erythema, swelling, and increased purulent discharge from the distal femur. Irrigation and debridement was done, but no frozen section or permanent pathology specimens were obtained. The left distal femur was radically resected for treatment of osteomyelitis. Histologic samples of the specimen revealed malignant fibrous histiocytoma of bone. A metastatic workup was negative. Subsequently, the left hip was disarticulated for wide resection of the tumor. One of two inguinal lymph nodes removed at that time was positive for malignant fibrous histiocytoma. The patient had additional chemotherapy. He was still alive 27 months after the operation.
Insights
This case report highlights the critical role of pathology in diagnosing bone tumors, especially malignant fibrous histiocytoma, in patients with chronic osteomyelitis. Early diagnosis through frozen section or permanent section pathology is crucial for effective treatment.
Area of Science:
- Orthopedic Surgery
- Skeletal Pathology
- Oncology
Background:
- Chronic osteomyelitis poses diagnostic challenges, sometimes masking underlying neoplastic conditions.
- Malignant fibrous histiocytoma (MFH) co-occurring with osteomyelitis is exceptionally rare, with few documented cases.
- Accurate histopathological diagnosis is paramount for appropriate patient management.
Observation:
- A 51-year-old male with a 15-year history of left distal femur chronic osteomyelitis presented with acute exacerbation.
- Initial debridement lacked frozen section or permanent pathology analysis.
- Radical resection of the distal femur revealed malignant fibrous histiocytoma of bone.
Findings:
- Histologic examination confirmed malignant fibrous histiocytoma of bone.
- Metastatic workup was negative.
- Inguinal lymph node metastasis was identified following hip disarticulation and wide tumor resection.
Implications:
- This case underscores the necessity of thorough histopathological evaluation, including frozen section and permanent section pathology, in chronic osteomyelitis cases.
- Timely diagnosis and surgical intervention, including adjuvant chemotherapy, can improve outcomes for rare bone tumors like MFH.
- Emphasizes the importance of considering neoplastic processes in non-healing or recurrent bone infections.
