title: Multiple metachronous malignant fibrous histiocytomas of the upper limbs -  a case report.
abstract: BACKGROUND
  Soft-tissue sarcomas are rare tumors with the incidence of multiple metachronous or synchronous lesions in the extremities being even more uncommon. In effort to preserve the function of upper extremities, limb-salvage surgery became the treatment of choice for soft-tissue sarcomas. Subsequent adjuvant chemotherapy, as well as radiotherapy, is believed to decrease local recurrence rates, however, their effect on overall survival remains unclear.
  
  
  METHODS
  We report herein a case of symmetrical bilateral metachronous malignant fibrous histiocytomas of the shoulder. A 19-year-old patient presented with stiffness and pain in the right shoulder. The same symptoms developed 1.5 years later in the other shoulder. The culprit tumors are reported metachronous with regard to the succession in the onset of symptoms. Wide tumor resection was performed in both shoulders, and postoperative radiotherapy was then conducted. Chemotherapy was not indicated after the first surgery; whereas, in the second case it was the patient who refused the recommended adjuvant chemotherapy.
  
  
  CONCLUSIONS
  The phenomenon of either metachronous or synchronous incidence of multiple soft tissue sarcomas is very rare and systematic reporting of every new case in the literature could contribute to further knowledge of tumors unique behavior.Key words: malignant fibrous histiocytoma - radiotherapy - upper extremity - neoplasms - multiple primary.
authors.forename: D
authors.initials: D
authors.lastname: Scepanovic
authors.forename: A
authors.initials: A
authors.lastname: Masarykova
authors.forename: M
authors.initials: M
authors.lastname: Pobijakova
authors.forename: A
authors.initials: A
authors.lastname: Hanicova
authors.forename: M
authors.initials: M
authors.lastname: Fekete
mesh_terms: D005260:Female; D051677:Histiocytoma, Malignant Fibrous / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D008279:Magnetic Resonance Imaging; D016609:Neoplasms, Second Primary / Q000175:diagnosis / Q000628:therapy*; D012509:Sarcoma / Q000175:diagnosis / Q000628:therapy*; D012782:Shoulder; D055815:Young Adult