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Indian Journal of Cancer, Vol. 47, No. 2, April-June, 2010, pp. 231-233 Letter To Editor Deep benign fibrous histiocytoma in the posterior mediastinum Vijayasaradhi Annam, Krishna AT, Vamseedhar Annam1 Departments of Radiodiagnosis and 1 Pathology, Sree Siddhartha Medical College and Research Centre, Tumkur, India. Correspondence Address: Dr. Vijayasaradhi Annam, Department of Radiodiagnosis, Sree Siddhartha Medical College and Research Centre, Tumkur, India dravs73@yahoo.com Code Number: cn10060 PMID: 20448398 DOI: 10.4103/0019-509X.63018 Sir, Benign fibrous histiocytomas (BFH) are tumors of unknown etiology, which are believed to be of mixed origin, i.e., fibroblastic and histiocytic origin. [1],[2] The most common sites of incidence of deep BFH are the lower limb and the head and neck region. [3] Mediastinal location is relatively rare. [4] A 25-year-old female presented with a history of dry cough, intermittent fever and chest pain since 1 year. Clinical examination revealed fullness in the supra and infraclavicular regions, decreased breath sounds and increased vocal resonance. A plain chest roentgenogram of the posteroanterior view revealed a right paraspinal soft tissue density lesion with well-defined margins extending from the D1 to the D8 vertebra. Cervicothoracic sign was positive. Widening of the posterior fifth intercostal space was noted. Basal consolidation and pleural effusion/thickening were also seen on the right side. Barium esophagogram showed the mass to be indenting and pushing the barium-filled esophagus anterior and to the left, indicating that the mass was extraluminal. On mediastinal window, an axial computed tomography (CT) scan showed a large, well-defined, heterogenous, solid mass lesion in the posterior mediastinum on the right side. It measured 12 cm craniocaudally, 9.6 cm anteroposteriorly and 7.8 cm transversely. Areas of breakdown and coarse, speckled calcifications were noted within th lesion. On contrast study, the mass lesion showed heterogenous attenuations across a background of mild enhancements [Figure - 1]. Lung window showed few emphysematous bullae, randomly distributed across the right lung. Also, perilesional pleural thickening was seen. On bone window, scalloping of the D4 vertebral body was noted [Figure - 2]. No significant mediastinal lymphadenopathy or distant metastasis was noted. Based on these findings, a diagnosis of benign posterior mediastinal mass, possibly neurogenic tumor with emphysematous bullae, was made. Fine needle aspiration cytology performed under CT guidance was noncontributory. Thereafter, right-sided thoracotomy was performed, which showed a well-encapsulated, soft tissue mass easily separable from the paraspinal soft tissues and unrelated to the lung, pleura, esophagus and other mediastinal structures. The postoperative course of the patient was uneventful. A final diagnosis of benign fibrous histiocytoma was made on histopathology [Figure - 3]. In the literature review, Pachter et al. reported three cases of mediastinal benign fibrous histiocytoma in a retrospective study.5 Sood and Singhal reported a case of benign fibrous histiocytoma in the posterior mediastinum. [4] BFH are well circumscribed and pseudoencapsulated, with central hemorrhage or cystic changes being an occasional feature. [2] Occasionally, focal areas of necrosis are seen. [3] These lesions are generally larger and better circumscribed than their cutaneous counterparts. Nearly half of these tumors are 5 cm or greater when excised compared with the majority of cutaneous fibrous histiocytomas, which are < 3cm. [1] They are predominant in males. [2] Although they can develop at any age, the majority occurs between 20 and 40 years. [1] Lesions located in deep soft tissue have a recurrence rate that is somewhat higher than their cutaneous counterparts and is reflective of the larger size and incompleteness of surgical excisions. [1] In our case, the patient has been on regular follow-up and is doing well. References
Copyright 2010 - Indian Journal of Cancer The following images related to this document are available:Photo images[cn10060f3.jpg] [cn10060f1.jpg] [cn10060f2.jpg] |
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