[Locally recurrent malignant fibrous histiocytoma of the kidney and spermatic cord].
OBJECTIVE
In this study, 26 patients with locally recurrent malignant fibrous histiocytoma of the kidney and spermatic cord after initial R0 resection were reviewed with regard to therapeutic options and prognosis.


METHODS
Based on a literature query in the PubMed database, we identified 24 cases with locally recurrent malignant fibrous histiocytoma of the kidney and spermatic cord after initial R0 resection. Two of our own patients were included and afterwards the entire patient group was analyzed with regard to the time period of the first local recurrence and the overall survival rate.


RESULTS
The average patient age was 58 years; in 17 cases (65%) the left side was affected. After primary therapy the 5-year survival rate was 25%; adjuvant therapy did not achieve any significant improvement in survival time ( p=0.259). The local recurrence was on average diagnosed after 13 months (with a median of 12 months). The prognosis of malignant fibrous histiocytoma after detection of the local recurrence was extraordinary poor, only 4 of 26 patients survived for longer than 3 years. The 1-, 2- and 5-year survival rates then were 34%, 28%, and 14%, respectively. The mean survival time was 31 months with a median survival of 9 months. Patients with a locally recurrent malignant fibrous histiocytoma of the spermatic cord showed a significant better survival prognosis than patients with a local recurrence of a renal malignant fibrous histiocytoma ( p=0.04).


CONCLUSIONS
Malignant fibrous histiocytoma of the genitourinary tract are rare tumors with a high rate of local recurrence. If there are no distant metastases a R0 resection can result in a curative objective. Nevertheless, the prognosis of this disease is poor. Even early detection of local therapy failure and promptly initiated aggressive salvage therapy may offer the chance of long-term survival only in selected cases. Lifelong follow-up is necessary for patients with a malignant fibrous histiocytoma of the kidney or spermatic cord.
May
M
M
Chirurgische Klinik des Carl-Thiem-Klinikums Cottbus. m.may@ctk.de
Marusch
F
F
Helke
C
C
Gunia
S
S
Gastinger
I
I
Hoschke
B
B
D018572:Disease-Free Survival; D005260:Female; D005834:Genital Neoplasms, Male / Q000401:mortality* / Q000601:surgery*; D018219:Histiocytoma, Benign Fibrous / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000601:surgery; D011379:Prognosis; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000706:statistics & numerical data; D013085:Spermatic Cord / Q000601:surgery; D016019:Survival Analysis; D016896:Treatment Outcome