1992 年 7 巻 3 号 p. 316-320
We presented a 58-year-old female with malignant fibrous histiocytoma developing in a burn scar. She had sustained thermal burn on the right side of her head when she was a baby. An atrophic scar with loss of hair had been present since that time. For the last 10 years, she had suffered from a recalcitrant ulcer in the burn scar. In 1982, the ulcer was resected and covered with a local skin flap. The histologic section showed large, atypical tumor cells with slit-like spaces among them, and extravasation of erythrocytes. A tentative diagnosis of malignant hemangioendothelioma was made. After 9 years of a disease-free period, a small ulcer recurred after minor trauma near the previous lesion. In the following 2 months, a fist-sized, easily bleeding tumor developed rapidly. Examination by CT-scan and MRI revealed the tumor destroyed cranial bone and invaded dura mater. A course of extensive radiotherapy consisting of 80Gy of 15MeV electron-beam was instituted and the tumor regressed clinically. The remaining ulcerative lesion was excised, including bone and dura underneath. The histological examination of this lesion revealed proliferaton of atypical, spindle cells in a storif orm pattern. Immunohistochemical stainings of specimens obtained before and after irradiation showed that the tumor cells were positive for α1-antichymotrypsin, while negative for factor VIII related antigen and UEA-1. Pulmonary metastases were detected in a short time. In spite of a combination chemotherapy (CYVA-DIC) and X-ray irradiation to lung lesions, the patient's condition rapidly deteriorated and she died of respiratory failure. Extensive irradiation in combination with excision may be the choice of treatments for primary lesions of malignant fibrous histiocytoma. This is the tenth case of malignant fibrous histiocytoma developing in a burn scar among Japanese.