Malignant fibrous histiocytoma of the liver

We report on a 43-year-old man with a primary sarcoma of the liver. The pat ient was admitted to the hospital for evaluation of dyspnea, abdominal pain in the right upper quadrant, diarrheal and fever. Physical examination rev ealed hepatomegaly. Increased laboratory values were found for gamma-GT, LD H, CA 125, and NSE, but not for aspartate and alanine aminotransferase. Com puted tomography presented a tumor in the right lobe of the liver. Venous c avography revealed a caval turner thrombus reaching up to the right atrium. Major liver resection combined with replacement of the vena cava inferior was proposed, but before operation the patient complained about short ness of breath. Spontenous fragmentation of the tumor thrombus with consecutive embolization of the lungs was suspected. Despite lysis therapy the patient died because of right ventricular failure. Autopsy revealed a tumor measuri ng 8 cm in diameter: which was located in the right lobe of the liver and i nvaded the inferior vena cava. Because of multiple tumor aggregates seen in the left and right main pulmonary arteries acute tumor embolization of the lungs was regarded as cause of death. Histologically the tumor was compose d of bizarre giant cells surrounded hi irregular spindle cells. The positiv e immunoreactivity pattern of the tumor cells for vimentin, lysozym, and CD 68 justified the diagnosis of a malignant fibrous his tiocytoma (MFH) of th e liver.