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LETTERS TO EDITOR
Year : 2019  |  Volume : 67  |  Issue : 1  |  Page : 306-308

Benign fibrous histiocytoma of the cervical vertebra: A rare case


1 Department of Neurosurgery, Gulhane Training And Research Hospital, University of Health Sciences, Ankara, Turkey
2 Department of Pathology, Gulhane Training And Research Hospital, University of Health Sciences, Ankara, Turkey

Date of Web Publication7-Mar-2019

Correspondence Address:
Dr. Mehmet C Ezgu
Gulhane Egitim ve Arastirma Hastanesi Beyin Cerrahisi Klinigi Etlik, Ankara
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.253644

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How to cite this article:
Ezgu MC, Cicek AF, Yasar S. Benign fibrous histiocytoma of the cervical vertebra: A rare case. Neurol India 2019;67:306-8

How to cite this URL:
Ezgu MC, Cicek AF, Yasar S. Benign fibrous histiocytoma of the cervical vertebra: A rare case. Neurol India [serial online] 2019 [cited 2019 May 23];67:306-8. Available from: http://www.neurologyindia.com/text.asp?2019/67/1/306/253644




Sir,

Benign fibrous histiocytoma (BFH) is a well-recognized tumor with fibroblastic and histiocytic differentiation.[1] The spinal location is very rare, and its management can be challenging, involving excision of the tumor, and spinal reconstruction and stabilization.

A 22-year-old male patient presented at our clinic due to pain in his neck and left arm, which had started 1 month ago and had gradually increased in the last one week. On physical examination, tenderness and hypoaesthesia were found particularly on the left side of the neck, and a severe pain was observed with movement. Anteroposterior and lateral radiographs of the cervical spine showed an osteolytic, sharply demarcated lesion involving the left lamina of C3 vertebra [Figure 1]. Computed tomography confirmed the presence of an expansile lesion involving the lamina, pedicle, and posterolateral aspect of the body [Figure 2]. Magnetic resonance images confirmed the extension of the tumor into the adjacent spinal canal, forming an extradural mass. Postcontrast T1-weighted images showed extensive gadolinium enhancement [Figure 3]a. On T2-weighted images, the signal intensity was heterogeneous with intermediate and low signal areas [Figure 3]b. The lesion was removed totally with a C3 hemilaminectomy. The lesion consisted of fibrohistiocytic with storiform pattern, with significant atypia and fibrous-oval nuclei and no mitotic activity.
Figure 1: Anteroposterior and lateral radiographs show the lesion at C3 level and the disruption of anterior sclerotic rim of the spinous process

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Figure 2: Axial CT image of the expansile lesion, measuring 2.5 cm in width, 1.6 cm in anteroposterior diameter, and 2.0 cm in height. Erosion of the left lamina and facet were also appreciated on CT images

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Figure 3: (a) Sagittal view of the cervical MRI. Contrast enhancement can be seen. (b) Axial T2-weighted cervical MRI reveals the mass lesion

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Occasionally, osteoclastic multinuclear giant cells with foam cells were observed [Figure 4]a. CD68 receptor was positive in histiocytic cells [Figure 4]b. These morphological immunohistopathological findings show that the tumor was a BFH.
Figure 4: (a) Spindle cells and foamy macrophages partially forming a storiform pattern are seen. Osteoclast-type multinucleated giant cells are seen in places (inset) (H and E ×400). (b) CD68 positivity was found in histiocytic cells immunohistochemically (CD68, biotin-streptavidin peroxidase ×200)

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The patient's pain was completely relieved postoperatively. Postoperative imaging studies showed no residual tumor at the operative site at C3 [Figure 5]a and [Figure 5]b.
Figure 5: (a) Sagittal view of the cervical MRI. There is no residual tumor or contrast enhancement. (b) Axial MRI view of the C3 level, with no findings of any residual tumor

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BFH accounts for approximately 1% of all surgically treated benign bony tumors.[2] BFH of the bone constitutes a diagnostic challenge because this lesion shares common clinical symptoms, radiological characteristics, and histological features with other benign lesions such as nonossifying fibroma, giant cell tumor, fibrous dysplasia, aneurysmal bone cyst, osteoblastoma, and eosinophilic granuloma. Histologically, BFH consists of a variable amount of spindle-shaped fibrohistiocytic cells, multinucleated giant cells, and foam cells showing a storiform arrangement.[1] Immunohistochemically, the most widespread reactivity is found for vimentin and CD68, S-100 protein, lysozyme, a1-antitrypsin, and antichymotrypsin, indicating histiocytic differentiation. Complete surgical excision is the recommended treatment for BFH. Prognosis is usually good after excision.

Spinal BFH can be distinguished from other benign lesions by its characteristic, clinical, and radiographic features and through histological evaluation. Treated patients have had excellent clinical outcomes.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Unni KK. Dahlin's Bone Tumors. 5th ed. Philadelphia: Lippincott-Raven; 1996.  Back to cited text no. 1
    
2.
Grohs JG, Nicolakis M, Kainberger F, Lang S, Kotz R. Benign fibrous histiocytoma of bone: A report of ten cases and review of literature. Wien Klin Wochenschr 2002;114:56-63.  Back to cited text no. 2
    


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  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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