title: A rare presentation of hepatic and splenic cystic malignant fibrous histiocytoma: A case report and literature review.
abstract: BACKGROUND
  Malignant fibrous histiocytoma is one of the most common soft tissue sarcomas in late adult life. But primary visceral malignant fibrous histiocytoma is a very rare entity. In peripheries, it is known to have an aggressive behavior but its biological pattern when involving liver and spleen is not well understood due to the rarity of its occurrence.
  
  
  METHODS
  A case of malignant fibrous histiocytoma of the liver and spleen as multiple cystic lesions in a 30 years old man is reported. The patient presented with hepatosplenomegaly resulting in central abdominal distention. Pre-operative investigations pointed toward the diagnosis of malignant cystic disease. The tumor presented as multiple hepatic cysts with massive hepatomegaly and splenomegaly. These cysts contained hemorrhagic fluid. Biopsy revealed highly cellular pleomorphic spindle cells fascicles arranged in storiform pattern at places with frequent mitoses. Immunohistochemistry revealed viamentin positivity. The tumor is compared with previous case reports.
  
  
  CONCLUSIONS
  Malignant fibrous histiocytoma of liver and spleen has been mentioned in the literature as isolated case reports and most of these present as solid lesions but presentation as multiple cysts is also a possibility as was seen in this patient. It can be confirmed only on histo-pathology supported by immunohistochemistry. The disease carries guarded prognosis due to its rapid progression and diagnostic dilemma pre-operatively.
  
  
  CONCLUSIONS
  This rare malignancy affecting the viscera can be diagnosed only with high index of suspicion and awareness regarding its presentation can help surgeons deal with it.
authors.affiliation: Department of General Surgery, Vardhman Mahavir Medical College, Safdarjung Hospital, New Delhi, India. Electronic address: dr.anupam@rediffmail.com.
authors.forename: Anupam
authors.initials: A
authors.lastname: Das
authors.forename: S V
authors.initials: SV
authors.lastname: Arya
authors.forename: Nikhil
authors.initials: N
authors.lastname: Soni
authors.forename: Ganesh G
authors.initials: GG
authors.lastname: Gowda
authors.forename: Dheer Singh
authors.initials: DS
authors.lastname: Kalwaniya