INTERESTING IMAGE
Benign Fibrous Histiocytoma of a Rib Xue Li, MD,* Zhaowei Meng, MD, PhD,* Dong Li, MD, PhD,Þ Jian Tan, MD,* and Xinghua Song, MD* Abstract: Rib benign fibrous histiocytoma (BFH) is an uncommon entity. We came across a 20-year-old Chinese man who complained of right chest pain for 2 weeks. All laboratory examination results were normal. CT of the thorax revealed an expansible bone lesion in the right sixth anterior rib. Whole-body bone scan demonstrated intense tracer uptake in the lesion without other abnormalities. The patient underwent en bloc resection. Pathological diagnosis confirmed the diagnosis of rib BFH. This report underlines that when wholebody bone scan displays solitary uptake of a rib lesion, rib BFH should be considered in the differential diagnosis. Key Words: benign fibrous histiocytoma, rib lesion, whole-body bone scan (Clin Nucl Med 2014;39: 837Y841)
Received for publication January 21, 2014; revision accepted March 14, 2014. From the Departments of *Nuclear Medicine, and †Radiology, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China. Conflicts of interest and sources of funding: none declared. Reprints: Zhaowei Meng, MD, PhD, Department of Nuclear Medicine, Tianjin Medical University General Hospital, Anshan Rd No. 154, Heping District, Tianjin, People’s Republic of China, 300052. E-mail: [email protected]; Jian Tan MD, Department of Nuclear Medicine, Tianjin Medical University General Hospital, Anshan Rd No. 154, Heping District, Tianjin, People’s Republic of China, 300052. E-mail: [email protected]. Copyright * 2014 by Lippincott Williams & Wilkins ISSN: 0363-9762/14/3909Y0837
Clinical Nuclear Medicine
REFERENCES 1. Onovo OD, Eyesan SU, Abdulkareem FB. Benign fibrous histiocytoma of a metacarpal bone. BMJ Case Rep. 2011; doi: 10.1136/bcr.06.2010.3122. 2. Ideguchi M, Kajiwara K, Yoshikawa K, et al. Benign fibrous histiocytoma of the skull with increased intracranial pressure caused by cerebral venous sinus occlusion. J Neurosurg. 2009;111:504Y508. 3. Grohs JG, Nicolakis M, Kainberger F, et al. Benign fibrous histiocytoma of bone: a report of ten cases and review of literature. Wien Klin Wochenschr. 2002;114:56Y63. 4. Ceroni D, Dayer R, De Coulon G, et al. Benign fibrous histiocytoma of bone in a paediatric population: a report of 6 cases. Musculoskelet Surg. 2011;95:107Y114. 5. Kishino M, Murakami S, Toyosawa S, et al. Benign fibrous histiocytoma of the mandible. J Oral Pathol Med. 2005;34:190Y192. 6. Mondal SK. Cytodiagnosis of benign fibrous histiocytoma of rib and diagnostic dilemma: a case report. Diagn Cytopathol. 2010;38:457Y460. 7. Basarir K, Saglik Y, Yildiz Y. Benign fibrous histiocytoma of the hand: a case report and literature review. Hand Surg. 2008;13:99Y102. 8. Ou DM, Zheng GS, Liao GQ, et al. Clinical and pathologic characteristics and surgical management of benign fibrous histiocytoma of the mandible: a case report. J Oral Maxillofac Surg. 2012;70:2719Y2723. 9. Zia SA, Raza SH. Benign fibrous histiocytoma of the rib. J Pak Med Assoc. 2001;51:162Y163. 10. Friedman L, Patel M, Lew E, et al. Benign histiocytic fibroma of rib with CT correlation. Can Assoc Radiol J. 1989;40:114Y116. 11. Clark TD, Stelling CB, Fechner RE. Benign fibrous histiocytoma of the left 8th rib. Case report 328. Skeletal Radiol. 1985;14:149Y151. 12. Simon MA, Miles BJ. Benign fibrous histiocytoma: a rare finding on bone scan staging for prostate adenocarcinoma. Urol Oncol. 2003;21:45Y47.
& Volume 39, Number 9, September 2014
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Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
837
Clinical Nuclear Medicine
Li et al
& Volume 39, Number 9, September 2014
FIGURE 1. A 20-year-old Chinese man complained of right chest pain for 2 weeks. Physical examination revealed tenderness on the right sixth anterior rib. No significant abnormality was observed in laboratory examinations. CT of the thorax revealed a localized expansive destruction lesion with internal septum in the right sixth anterior rib. The bone cortex became thinner and discontinuous, but it did not cause periosteal reaction or invasion to the adjacent soft tissue.
838
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* 2014 Lippincott Williams & Wilkins
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Clinical Nuclear Medicine
& Volume 39, Number 9, September 2014
Benign Fibrous Histiocytoma of a Rib
FIGURE 2. Three-dimensional views (AYD) of the postprocessed CT images by volume rendering technique demonstrated the expansive rib lesion with internal septum much more clearly. Magnification 100 (A) and magnification 400 (B).
* 2014 Lippincott Williams & Wilkins
www.nuclearmed.com
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
839
Clinical Nuclear Medicine
Li et al
& Volume 39, Number 9, September 2014
FIGURE 3. Whole-body bone scan was performed 3 hours after the injection of 25mCi 99mTc-MDP. Anterior view (A) and posterior view (B) of the whole-body bone scan showed an intense uptake lesion in the right sixth anterior rib. No other abnormal distribution of 99mTc-MDP was displayed.
840
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* 2014 Lippincott Williams & Wilkins
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Clinical Nuclear Medicine
& Volume 39, Number 9, September 2014
Benign Fibrous Histiocytoma of a Rib
FIGURE 4. The patient underwent en bloc resection of the rib lesion. Microscopically, the tumor was composed of spindle cells arranged in a whorled or storiform pattern. The tumor cells were surrounded by abundant collagen fibers. Foamy cells were also present. No nuclear atypia or mitosis was found. All the above findings were suggestive for a diagnosis of rib benign fibrous histiocytoma (BFH). Benign fibrous histiocytoma is a well-known tumor of the soft tissue, whereas bone BFH is very rare. It accounts for approximately just 1% of all surgically treated benign bone tumors.1Y4 Bone BFH is most frequently found in the pelvic bone, femur, and tibia.2,5 The age of patients with bone BFH ranges from 6 to 74 years, 60% of whom are older than 20 years, with a slight female preponderance.6 Local pain is the main symptom in such patients.1 Radiologically, a bone BFH is generally a well-defined lytic lesion with sclerotic margins; sometimes the lesion may have internal septum within the tumor. The bone cortex may become thinner and sometimes disrupted, but it does not cause periosteal reaction or invade the soft tissue.1,4,6Y8 To our knowledge, there have been only 5 case reports of rib BFHs,6,9Y12 2 cases used whole-body bone scan for diagnosis (the present case included).12 Simon and Miles12 used whole-body bone scan for clinical staging of a prostate cancer patient, which accidentally found a rib BFH. We know that differential diagnosis of a positive lesion in a bone scan includes metastatic disease, inflammatory conditions, degenerative changes, arthritis, Paget disease, osteomyelitis, metabolic bone disease, and so on. From our experience, we believe it is also important that when a whole-body bone scan displayed a solitary uptake in a rib lesion, rib BFH should be considered in the differential diagnosis.
* 2014 Lippincott Williams & Wilkins
www.nuclearmed.com
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
841
Benign Fibrous Histiocytoma of a Rib Xue Li, MD,* Zhaowei Meng, MD, PhD,* Dong Li, MD, PhD,Þ Jian Tan, MD,* and Xinghua Song, MD* Abstract: Rib benign fibrous histiocytoma (BFH) is an uncommon entity. We came across a 20-year-old Chinese man who complained of right chest pain for 2 weeks. All laboratory examination results were normal. CT of the thorax revealed an expansible bone lesion in the right sixth anterior rib. Whole-body bone scan demonstrated intense tracer uptake in the lesion without other abnormalities. The patient underwent en bloc resection. Pathological diagnosis confirmed the diagnosis of rib BFH. This report underlines that when wholebody bone scan displays solitary uptake of a rib lesion, rib BFH should be considered in the differential diagnosis. Key Words: benign fibrous histiocytoma, rib lesion, whole-body bone scan (Clin Nucl Med 2014;39: 837Y841)
Received for publication January 21, 2014; revision accepted March 14, 2014. From the Departments of *Nuclear Medicine, and †Radiology, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China. Conflicts of interest and sources of funding: none declared. Reprints: Zhaowei Meng, MD, PhD, Department of Nuclear Medicine, Tianjin Medical University General Hospital, Anshan Rd No. 154, Heping District, Tianjin, People’s Republic of China, 300052. E-mail: [email protected]; Jian Tan MD, Department of Nuclear Medicine, Tianjin Medical University General Hospital, Anshan Rd No. 154, Heping District, Tianjin, People’s Republic of China, 300052. E-mail: [email protected]. Copyright * 2014 by Lippincott Williams & Wilkins ISSN: 0363-9762/14/3909Y0837
Clinical Nuclear Medicine
REFERENCES 1. Onovo OD, Eyesan SU, Abdulkareem FB. Benign fibrous histiocytoma of a metacarpal bone. BMJ Case Rep. 2011; doi: 10.1136/bcr.06.2010.3122. 2. Ideguchi M, Kajiwara K, Yoshikawa K, et al. Benign fibrous histiocytoma of the skull with increased intracranial pressure caused by cerebral venous sinus occlusion. J Neurosurg. 2009;111:504Y508. 3. Grohs JG, Nicolakis M, Kainberger F, et al. Benign fibrous histiocytoma of bone: a report of ten cases and review of literature. Wien Klin Wochenschr. 2002;114:56Y63. 4. Ceroni D, Dayer R, De Coulon G, et al. Benign fibrous histiocytoma of bone in a paediatric population: a report of 6 cases. Musculoskelet Surg. 2011;95:107Y114. 5. Kishino M, Murakami S, Toyosawa S, et al. Benign fibrous histiocytoma of the mandible. J Oral Pathol Med. 2005;34:190Y192. 6. Mondal SK. Cytodiagnosis of benign fibrous histiocytoma of rib and diagnostic dilemma: a case report. Diagn Cytopathol. 2010;38:457Y460. 7. Basarir K, Saglik Y, Yildiz Y. Benign fibrous histiocytoma of the hand: a case report and literature review. Hand Surg. 2008;13:99Y102. 8. Ou DM, Zheng GS, Liao GQ, et al. Clinical and pathologic characteristics and surgical management of benign fibrous histiocytoma of the mandible: a case report. J Oral Maxillofac Surg. 2012;70:2719Y2723. 9. Zia SA, Raza SH. Benign fibrous histiocytoma of the rib. J Pak Med Assoc. 2001;51:162Y163. 10. Friedman L, Patel M, Lew E, et al. Benign histiocytic fibroma of rib with CT correlation. Can Assoc Radiol J. 1989;40:114Y116. 11. Clark TD, Stelling CB, Fechner RE. Benign fibrous histiocytoma of the left 8th rib. Case report 328. Skeletal Radiol. 1985;14:149Y151. 12. Simon MA, Miles BJ. Benign fibrous histiocytoma: a rare finding on bone scan staging for prostate adenocarcinoma. Urol Oncol. 2003;21:45Y47.
& Volume 39, Number 9, September 2014
www.nuclearmed.com
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
837
Clinical Nuclear Medicine
Li et al
& Volume 39, Number 9, September 2014
FIGURE 1. A 20-year-old Chinese man complained of right chest pain for 2 weeks. Physical examination revealed tenderness on the right sixth anterior rib. No significant abnormality was observed in laboratory examinations. CT of the thorax revealed a localized expansive destruction lesion with internal septum in the right sixth anterior rib. The bone cortex became thinner and discontinuous, but it did not cause periosteal reaction or invasion to the adjacent soft tissue.
838
www.nuclearmed.com
* 2014 Lippincott Williams & Wilkins
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Clinical Nuclear Medicine
& Volume 39, Number 9, September 2014
Benign Fibrous Histiocytoma of a Rib
FIGURE 2. Three-dimensional views (AYD) of the postprocessed CT images by volume rendering technique demonstrated the expansive rib lesion with internal septum much more clearly. Magnification 100 (A) and magnification 400 (B).
* 2014 Lippincott Williams & Wilkins
www.nuclearmed.com
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
839
Clinical Nuclear Medicine
Li et al
& Volume 39, Number 9, September 2014
FIGURE 3. Whole-body bone scan was performed 3 hours after the injection of 25mCi 99mTc-MDP. Anterior view (A) and posterior view (B) of the whole-body bone scan showed an intense uptake lesion in the right sixth anterior rib. No other abnormal distribution of 99mTc-MDP was displayed.
840
www.nuclearmed.com
* 2014 Lippincott Williams & Wilkins
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Clinical Nuclear Medicine
& Volume 39, Number 9, September 2014
Benign Fibrous Histiocytoma of a Rib
FIGURE 4. The patient underwent en bloc resection of the rib lesion. Microscopically, the tumor was composed of spindle cells arranged in a whorled or storiform pattern. The tumor cells were surrounded by abundant collagen fibers. Foamy cells were also present. No nuclear atypia or mitosis was found. All the above findings were suggestive for a diagnosis of rib benign fibrous histiocytoma (BFH). Benign fibrous histiocytoma is a well-known tumor of the soft tissue, whereas bone BFH is very rare. It accounts for approximately just 1% of all surgically treated benign bone tumors.1Y4 Bone BFH is most frequently found in the pelvic bone, femur, and tibia.2,5 The age of patients with bone BFH ranges from 6 to 74 years, 60% of whom are older than 20 years, with a slight female preponderance.6 Local pain is the main symptom in such patients.1 Radiologically, a bone BFH is generally a well-defined lytic lesion with sclerotic margins; sometimes the lesion may have internal septum within the tumor. The bone cortex may become thinner and sometimes disrupted, but it does not cause periosteal reaction or invade the soft tissue.1,4,6Y8 To our knowledge, there have been only 5 case reports of rib BFHs,6,9Y12 2 cases used whole-body bone scan for diagnosis (the present case included).12 Simon and Miles12 used whole-body bone scan for clinical staging of a prostate cancer patient, which accidentally found a rib BFH. We know that differential diagnosis of a positive lesion in a bone scan includes metastatic disease, inflammatory conditions, degenerative changes, arthritis, Paget disease, osteomyelitis, metabolic bone disease, and so on. From our experience, we believe it is also important that when a whole-body bone scan displayed a solitary uptake in a rib lesion, rib BFH should be considered in the differential diagnosis.
* 2014 Lippincott Williams & Wilkins
www.nuclearmed.com
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
841
