AN AUTOPSIED CASE OF MALIGNANT FIBROUS HISTIOCYTOMA OF THE SUBCUTANEOUS TISSUE OF THE BACK ASSOCIATED WITH PRIMARY ADENOCARCINOMA OF THE LUNG

Abstract

A 91-year-old woman was seen at the hospital because of fever up and languidness. Pneumonia of the right lung was diagnosed and she was admitted to the hospital, with an improvement. After admission an elastic hard subcutaneous tumor of her right scapulal area was recognized. The tumor showed a rapid growth to 9cm in diameter and swelled. On an aspiration cytology, class IV was revealed, and sarcoma was suspected. Hard lymph nodes of her right axilla and right supraclavicle were palpable. There was a suspicion of metastatic lymph nodes. CT scan revealed a tumor of S6-bifurcation of the right bronchiole and primary lung cancer was suspected. Considering the patient's great age, a resection of the tumor of the back, a biopsy of the lymph node of the supraclavicle and a bronchoscopy were performed under general anesthesia. Histological examination revealed malignant fibrous histiocytoma (MFH), ordinary type, of the back, the metastatic lymph node of the supraclavicle and the primary adenocarcinoma of the lung. Thereafter, a rapid growth of the residual tumor in the supraclavicle was started. Intra-arterial injection of pirarubicin (50mg/body) was performed twice, but in vain. Multiple lung metastasis appeared and grew rapidly. Then she died and autopsy was performed. Reported cases of MFH associated with cancer are generally classified into two groups, namely MFH induced by radiotherapy for cancer (former group) and MFH without relation with radiotherapy (later group). There have been 30 cases in the latter group in Japan. We think that multiplicity of cancer and MFH of no relation with radiotherapy might occur incidentally in this case.