title: Malignant fibrous histiocytoma of the eyelid: differential diagnosis and management.
abstract: OBJECTIVE
  Malignant fibrous histiocytoma (MFH) is a pleomorphic soft tissue sarcoma that occurs rarely in the periocular region. The purpose of this study was to present a case series of periocular MFH and to discuss the differential diagnosis and management.
  
  
  METHODS
  This is a retrospective case review of patients diagnosed with periocular MFH from tertiary hospitals and private practices.
  
  
  RESULTS
  Four patients, two women and two men with periocular MFH, had a mean age of 81 years (range, 72 to 85 years). All tumors were <5 cm in diameter and of storiform pleomorphic histologic subtype. One was located deep and 3 presented superficially. The initial diagnoses were sarcomatoid carcinoma, atypical fibroxanthoma, and leiomyosarcoma that were subsequently reclassified as MFH. One patient had a frozen section, 1 had fast track paraffin section margin control, and 2 had no frozen section margins at the initial excisions. Histology showed 2 negative margins, 1 close margin, and 1 positive margin that were cleared with wide local excision. Local recurrence occurred in 3 cases, and of these, 1 required orbital exenteration. Adjuvant radiotherapy was given to 3 patients. One had regional node metastases. There were no distant metastases or tumor-related deaths. Mean follow-up period was 36 +/- 35 months (median, 30; range, 1 to 84 months).
  
  
  CONCLUSIONS
  This study highlights the difficulties in the clinicopathologic diagnosis of periocular MFH and in particular the distinction of more superficial tumors from atypical fibroxanthoma. The mainstay of treatment is complete surgical excision with wide margins, and consideration should be given to histologic margin control in addition to adjuvant radiotherapy.
authors.affiliation: Oculoplastic and Orbital Unit, Department of Ophthalmology, Royal Adelaide Hospital, University of Adelaide, Adelaide, South Australia.
authors.forename: Jwu Jin
authors.initials: JJ
authors.lastname: Khong
authors.forename: Celia S
authors.initials: CS
authors.lastname: Chen
authors.forename: Craig L
authors.initials: CL
authors.lastname: James
authors.forename: Shyamala C
authors.initials: SC
authors.lastname: Huilgol
authors.forename: Brett A
authors.initials: BA
authors.lastname: O'Donnell
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Sullivan
authors.forename: Dinesh
authors.initials: D
authors.lastname: Selva
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D003937:Diagnosis, Differential; D005142:Eyelid Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D005260:Female; D018219:Histiocytoma, Benign Fibrous / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D009364:Neoplasm Recurrence, Local; D013508:Ophthalmologic Surgical Procedures; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies