Journal article
A Case of Malignant Fibrous Histiocytoma of the Petrous Bone presenting with Facial Nerve Palsy
Japanese Journal of Neurosurgery, Vol.22(4), pp.306-312
2013
DOI: 10.7887/jcns.22.306
Abstract
Malignant fibrous histiocytoma (MFH) is a soft tissue sarcoma that predominantly affects the extremities in the elderly. MFH originating in the head and neck region is relatively rare. We report a case of a 77 year old man with a rapidly enlarging MFH of the petrous bone, manifesting as left-sided neck pain with a suboccipital subcuta-neous mass and progressive facial nerve palsy. Computed tomography (CT), at presentation, revealed a mass lesion between the foramen magnum and the mastoid process with extensive erosion of the occipital and the petrous bones. Magnetic resonance (MR) images revealed a heterogeneous low signal intensity lesion on T1-weighted images and slightly high signal intensity on T2-weighted images. Non-specific imaging findings were obscure and did not aid in the diagnosis. The entire lesion was removed with extensive osteotomy of the petrous bone and translocation of the facial nerve. Histopathology confirmed the diagnosis. The patient underwent fractionated local radiation therapy at a dose of 50 Gy. His facial nerve palsy completely recovered in a month after surgery. At three years post-surgery, the patient is well without any relapse. Management of soft tissue sarcoma of the head is primarily surgical. Since MFH is a malignant tumor with poor prognosis, the first line treatment of the choice is radical resection with safety margin followed by a free flap reconstruction. However, it is not always feasible to take such a radical resection while retaining normal functions because of the adjoining critical structures. In this case, we performed a conservation surgery with negative surgical margin and sought to retain normal functions as much as possible. Considering the age of the patient, we chose conservation surgery rather than extensive extirpation with reconstruction to keep surgical invasiveness adequate while preserving functions as the second best treatment option.
Details
- Title: Subtitle
- A Case of Malignant Fibrous Histiocytoma of the Petrous Bone presenting with Facial Nerve Palsy
- Creators
- Masashi KuwabaraKuniki EguchiSatoshi YamaguchiTakafumi MitsuharaMasaya TakumidaYukio TakeshimaAmatya VJKazuhiko SugiyamaKatsuhiro HirakawaKaoru Kurisu
- Resource Type
- Journal article
- Publication Details
- Japanese Journal of Neurosurgery, Vol.22(4), pp.306-312
- DOI
- 10.7887/jcns.22.306
- ISSN
- 0917-950X
- eISSN
- 2187-3100
- Language
- English
- Date published
- 2013
- Academic Unit
- Neurosurgery
- Record Identifier
- 9984303905302771
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