What is Fibrous Histiocytoma: Types, Causes, Treatment, Surgery, Recovery, Prognosis

Fibrous histiocytoma is an infrequent type of sarcoma of uncertain basis that appears both in bone and soft tissue. Fibrous histiocytoma is of 2 types which includes benign and malignant. This article explains about the types, causes, signs and symptoms, tests, treatment including surgery, prevention, recovery period/healing time, prognosis, yoga, teeth braces, risk factors and complications.

Benign fibrous histiocytoma which is also referred as dermatofibroma, dermal dendrocytoma, sclerosing hemangioma, fibrous dermatofibroma, fibroma simplex fibrous, nodular subepidermal fibrosis and histiocytoma are benign type of growths on the skin or can occur in bones.

Malignant fibrous histiocytoma is soft tissue sarcoma that usually occurs in the limbs and most commonly the legs and may also occur in the abdomen.

Causes of Benign Fibrous Histiocytoma: There are no exact causes and mechanism of benign fibrous histiocytoma as it is unknown. They are thought to occur spontaneously.

Causes of Malignant Fibrous Histiocytoma: No one really knows the cause of malignant fibrous histiocytoma. However a number of likely suspects have emerged considering it a cancer like any other cancerous growth. The causes might include:

• Genetics: Genetic abnormalities can cause malignant fibrous histiocytoma.
• Radiation Exposure: Radiation therapy has become the most established risk factor for all soft tissues sarcomas including the malignant fibrous histiocytoma. People who receive radiations for cancer are more likely to get malignant fibrous histiocytoma.
• Chemical Exposure: Doctors believe exposure to certain chemicals may increase the risk of getting malignant fibrous histiocytoma although it is not a certain fact. These chemicals include vinyl chloride, arsenic, some herbicides and wood preservatives that contain chlorophenols.

The patients suffering from benign fibrous histiocytoma report symptoms of pain from the injury often of different duration. The pain suffered by the patients may also be due to pathological fracture. There may also be softness without any inflammation and usually without any symptoms.

It can cause neurologic defect by applying pressure on the spinal cord. In certain cases there are always a lipid abnormalities and cholesterol metabolism. Radiographically the lesions occur commonly in the legs, trachea, kidney, head, body trunk, pelvis, ribs, neck, including the sacrum and Ilium. These lesions may also occur in tubular bones (epiphysis). They have also been reported in the jaws and associated soft tissues.

There are few signs and symptoms of malignant fibrous histiocytoma. It is always highly crucial to meet a physician whenever you find a growth of lump which is unusual despite most of them being non cancerous. Soft tissue lumps manages to develop rapidly inside 2 to 3 months without causing any kind of pain until once the mass is large enough to compresses a nerve and can be painful. Signs and symptoms may include:

• Limited range of movement with the leg or arm is a symptom of malignant fibrous histiocytoma.
• Pain from a compressed nerve or muscle.
• Pain also is felt because of muscle compression.
• Limping.

Fibrous histiocytoma is tested using the below mentioned methods:

• Physical exam with evaluation of medical history of the patient is the initial test to diagnose fibrous histiocytoma.
• CT scan and MRI (Magnetic resonance imaging) scan of the affected area or regions is done to diagnose fibrous histiocytoma.
• Histopathological studies carried on a biopsy specimen. The specimen is examined using a microscope by a pathologist, to arrive at a precise diagnosis for fibrous histiocytoma. A high cell division is noted with fibrous histiocytoma.
• Since fibrous histiocytoma is a frequent misdiagnosed tumor, a differential diagnosis is used to eliminate various other types of tumors which include: Synovial sarcoma, hemangiopericytoma, endometrial stromal sarcoma, glomangiopericytoma, myopericytoma, sinonasal hemangiopericytoma, glomus tumor, cellular angiofibroma, myofibroma, solitary fibrous tumor, leiomyo sarcoma, mesenchymal chondro sarcoma and infantile fibrosarcoma.

Several other conditions however might have similar signs and symptoms and therefore it is advisable to consult a healthcare provider who will conduct additional exams to eliminate other medical illnesses to arrive at a precise diagnosis for fibrous histiocytoma.

Magnetic resonance imaging (MRI) can be used to detect the condition however there is a need for biopsy for definitive diagnosis. The MRI results will show confined mass which is dark on the T-one weighted MRI image (also called as also referred to as T1WI or “spin-lattice” relaxation time) and vivid on the T-two weighted MRI images. By imaging in the masses which are larger, the central necrosis is often present.

Treatment for fibrous histiocytoma consists of careful and complete curettage and filling of the defect with graft material, bone cement, or other suitable bone void filler. Any pain is controlled with the use of pain relieving drugs medications. Radiation therapy is administered to prevent recurrence of the tumor. Post operative care is important where a minimum activity level is ensured until the surgical wound heels. Sometimes surgery is not necessary as some tumors will often resolve and heal if fibrous histiocytoma is caused by a fracture.

The common location of metastatic diseases is in the human lungs. Inoperable or unresectable lung metastasis are treated with SBRT or stereotactic body radiation therapy. Nevertheless, neither SBRT nor surgery will stop the development of additional metastasis somewhere else in the human lung. Radiations or chemotherapy are used to kill off any remaining cancer cells in the process of treating malignant fibrous histiocytoma.

Surgical excision with complete removal of the entire lesion is normally done as the most sufficient treatment for fibrous histiocytoma. Some tumors such as osteoid osteoma are frequently treated by thermal necrosis. The procedure requires anesthesia and are often done as a combined approach. Patients evaluation is accomplished before the orthopedic surgeon and radiologist examination.

The treatment includes several methods such as surgical excision mainly depending on the ranges of tumor excision to limb amputation, depending on the tumor and almost in all cases radiation. Radiation eliminates the need for limb amputation. Chemotherapy remains controversial in malignant fibrous histiocytoma. The surgeons try as much as possible during surgery to spare much part of the limb but amputation may be necessary especially if the cancer has spread to the bone.

The recovery period/healing time for fibrous histiocytoma depends upon the bone lesion and location. Wound healing takes about two weeks. If the bone healing is necessary the physician may require patients to protect the extremity for six weeks from major forces such as bearing full wait.

Present scientific research has not provided a method to preventing fibrous histiocytoma but routine medical exams at period intervals with radiological scans, physical examinations and blood tests are necessary for those who are diagnosed with the tumor, often many years of resolute follow up is necessary.

The prognosis/outlook for malignant fibrous histiocytoma mainly depends on the grade of the tumor which will be determined under the microscope by a pathologist. It will define the size respectability and with the help of surgical excision, it can be completely removed. 35 to 60% is the five year survival range. Prognosis of benign fibrous is generally excellent when the lesions are small and found closer to the skin surface. Their recurrence can be completely avoided with a proper surgical excision and removal.

Studies to determine effectiveness of yoga as a complementary intervention for cancer have been inconclusive suggesting none to some and others suggesting it reduces the risk factors and aid in a patient’s healing process.

The use of many drugs or types of radiation therapy for cancer treatment affects some patient’s mouth, teeth and salivary glands. Such effects make it difficult to eat, chew, talk or even swallow food. This makes the use of mouth braces for fibrous histiocytoma important to cub these side effects of the treatment.

There are no evident risk factors for benign fibrous histiocytoma. However it is always very important to understand that having a risk factor does not necessarily mean you will get fibrous histiocytoma. A risk factor raises the chance of getting fibrous histiocytoma when compared to a person without any factors of risk. Some factors of risk are usually more crucial than others. Again, when one lacks any risk factors will not mean that they will never get fibrous histiocytoma. Therefore it is always crucial to talk about the effects of risk factors with your health care provider.

There are also no known exact causes or risk factors for malignant fibrous Histiocytoma. However research has shown that people with certain malignant fibrous histiocytoma risk factors are more likely than others to develop the condition. A risk factor is anything that increases a persons’ chances of developing a disease and do not necessary have to mean that you must get the condition. Specific risk factors for malignant fibrous histiocytoma include:

• Having a history of paget’s diseases is a risk factor for malignant fibrous histiocytoma.
• Having undergone radiation treatment for cancer is a risk factor for fibrous histiocytoma.
• Having a history of sickle cell disease non hodgkin’s lymphoma or multiple myeloma.

Complications due to benign fibrous histiocytoma include:

• Recurrence of the tumor after surgery but if only the surgery does not entirely remove the tumor.
• A complication of benign fibrous histiocytoma is the metastasis of the tumor leading to death. This occurrence is however extremely very rare.
• During surgery, there may be vital damage caused to the vital nerves, blood vessels and surrounding structures.

Complications of malignant fibrous histiocytoma are secondary conditions, symptoms or other disorders that are caused by malignant fibrous histiocytoma. In many cases the distinction between symptoms of malignant fibrous histiocytoma is unclear or arbitrary. A complication that has been mentioned severally about malignant fibrous histiocytoma includes metastasis which is a tumor that has spread from its original site of growth to another site close or in a distant from the primary site. It is a characteristic of advanced malignancies but in rare instances can be seen in neoplasm lacking malignant morphology.

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