Malignant fibrous histiocytoma of the cecum: report of a case and review of the literature.

Malignant fibrous histiocytoma (MFH) of the gastrointestinal tract is extremely rare. Here we report a case of MFH of the cecum and review other cases of large bowel MFH in the literature. A 64-year-old man had a large tumor mass in the cecum associated with multiple small peritoneal implants. Histologically, most of the lesion showed inflammatory pseudotumor-like appearance; that is, a mixed proliferation of fibroblasts and myofibroblasts loosely arranged in sweeping fascicles or whorled structures and an admixture of chronic inflammatory cell infiltrate. The myofibroblastic nature of the spindle-shaped cells was confirmed by their immunohistochemical and ultrastructural findings. In addition, there was atypical histiocytic cells infiltrate in some areas and marked lymphatic involvement and lymph node metastasis by such histiocytic cells. These features were interpreted as MFH, although it had to be distinguished from inflammatory fibrosarcoma and leiomyosarcoma. The differential diagnosis is discussed here.