Primary cutaneous malignant fibrous histiocytoma: a case report

Malignant fibrous histiocytoma (MFH) is one of the commonest soft tissue sarcomas to occur in the extremities, but presentation as a primary cutaneous lesion is rare. MFH can present as a cutaneous lesion in the form of a primary tumor or as metastasis from MFH at other sites, such as primary MFH of the breast; however, both presentations are very rare.

We report here a 55-year-old male patient with cutaneous MFH on the right thigh region. The patient presented with two swellings on the outer aspect of the thigh of three months' duration, which ulcerated following the first month. The swellings were non-tender, soft, compressible, and not fixed to underlying structures. Histopathologic examination of the excised tumor revealed highly pleomorphic spindle-shaped cells arranged in sheets and irregular fascicles with a focal storiform pattern. Many thin-walled blood vessels and focal inflammatory cell infiltration with occasional focus of myxoid change was seen. Storiform-pleomorphic type of MFH grade II was diagnosed. Wide local excision was done. The patient made an uneventful recovery.

Although MFH is one of the commonest soft tissue sarcomas, cutaneous presentation is very rare. A high index of suspicion is necessary to keep this possibility in mind, as it can present in different forms, including the pedunculated types, which can be compressible. MFH variants such as atypical fibrous histiocytoma or atypical fibroxanthoma can occur sometimes as cutaneous MFH. Wide local excision is commonly possible in most of the cases for therapy.