Bronchial brushing cytology features of primary malignant fibrous histiocytoma of the lung - A case report

BACKGROUND: Malignant fibrous histiocytoma (MFH) of the lung is rare. Early diagnosis is very important because of its pool prognosis. Long-term survi vors of pulmonary MFH ale patients who had surgical resection. When the pat ient call undergo surgery after a prompt diagnosis, the prognosis improves more than with other therapy. However, it is not easy to establish the diag nosis of thoracic MFH. ill general, the small fragments from bronchial or p ercutaneous transthoracic needle aspiration (FNA) biopsies are inadequate f or cytologic or pathologic analysis. Bronchial brushing cytology is greatly superior to FNA cytology because one can obtain a large amount of cells. T herefore, bronchial brushing cytology may play a useful role ill diagnosis when endobronchial involvement is found. CASE: A 65-year-old female mns admitted with a cough, yellow sputum and exe rtion -al dyspnea. A chest roentgenogram showed a 12 x 12-cm mass in the le ft lung field. Bronchial brushing cytology revealed many fibroblastlike, hi stiocytelike, bizarre and multinucleated giant cells in a background of nec rosis. Afypical mitotic figures were also found. The cytologic findings str ongly suggested MFH. Although the pathologic findings from FNA biopsy showe d storiform clusters structured by pleomorphic, fibroblastlike cells with b izarre nuclei and mitotic figures, the material was too small to diagnose i t definitively. Six months later the patient died. An autopsy confirmed the diagnosis of MFH: the typical storiform clusters were composed of many fib roblastlike and histiocytelike cells that were positive for CD68 (PGM1) ant ibody. CONCLUSION: Bronchial brushing cytology may be a useful method for early, d efinitive diagnosis of MFH. The presence of pleomorphic, spindle-shaped fib roblastlike and histiocytelike cells with the clusters showing a storiform pattern may permit the diagnosis of MFH.