Malignant fibrous histiocytoma in the craniocervical junction presenting with severe occipitalgia.
We report a patient who complained of severe occipitalgia caused by destruction of the atlantooccipital joint by tumor invasion. Her symptoms were relieved by tumor resection and occipitocervical fixation. Histological examination of the resected tumor revealed that the tumor cells had an irregular arrangement, remarkable atypia, and pleomorphism with multinucleated bizarre giant cells. The tumor demonstrated no definitive sarcoma differentiation and was identified as malignant fibrous histiocytoma. After tumor resection, the patient received adjuvant radiation and chemotherapy. The tumor regrew outside the radiation field. Chemotherapy with ifosfamide, cisplatin, and etoposide caused remarkable tumor reduction, but suspension of chemotherapy resulted in tumor recurrence. The results of our drug protocol suggest that this regimen is feasible as postoperative adjuvant chemotherapy for malignant fibrous histiocytoma. The role of adjuvant chemotherapy and radiation therapy for this highly malignant rare tumor should be evaluated in a prospective study with precise histological diagnosis.
Akai
Takuya
T
Department of Neurosurgery, Kanazawa Medical University, 1-1 Uchinada-machi, Kahoku, Ishikawa, 920-0293, Japan. akai@kanazawa-med.ac.jp
Yamamoto
Kenji
K
Iida
Takaaki
T
Iizuka
Hideaki
H
Nojima
Takayuki
T
D001269:Atlanto-Occipital Joint / Q000473:pathology* / Q000601:surgery; D003131:Combined Modality Therapy; D017809:Fatal Outcome; D005260:Female; D005592:Fracture Fixation; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D006261:Headache / Q000209:etiology*; D051677:Histiocytoma, Malignant Fibrous / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009334:Neck Muscles / Q000473:pathology; D019635:Neurosurgical Procedures; D009778:Occipital Lobe; D014057:Tomography, X-Ray Computed