Allah Rakhio Jamali, Seemin Jamali, Anisuddin Bhatti, Abdul Majid, Ghulam Mehboob.
Malignant Fibrous Histiocytoma: Vascular invasion and metastasis to heart.
J Coll Physicians Surg Pak Jan ;13(2):111-3.

A 52 years old male fisherman presented in April 2000, with a history of pain in the left calf while standing and walking with swelling of the ipsilateral foot for the last three months. Clinically he was an overweight, middle aged man. His pulse, blood pressure and respiratory rate were normal. There were no significant findings on the examination of chest and abdomen. Local examination revealed pitting edema along with increased circumference of the left leg and lower thigh. The superficial veins were prominent on the left side. Inguinal lymph nodes were not enlarged. On dorsiflexion of the left foot, pain was experienced in the left calf. His routine investigations were within normal limits. However, Doppler ultrasound reported thrombosis of the left femoral vein. The clot extended from the sub sartorial canal to the upper part of femoral triangle. He was diagnosed as a case of deep vein thrombosis and treated with anticoagulants, stockinnette and analgesics. There was symptomatic improvement in the calf pain and the edema decreased. Three months later he started complaining of vague pain in the anteromedial aspect of the left thigh. On examination an ill-defined, diffuse, firm lump could be felt in the femoral triangle. MRI of the area exhibited a soft tissue mass of 10 x 6 cm size arising from the deep soft tissues of the femoral triangle, 16 surrounding the femoral vessels and infiltrating into the adjoining muscles. Biopsy showed grade IV malignant pleomorphic fibrous histiocytoma. During surgery (wide margin resection planned) femoral vein was solidified and filled with the tumor mass which was extending above the inguinal ligament. The femoral artery was also surrounded by the tumor mass which resulted in iatrogenic injury during dissection, that was immediately repaired. Only debulking was done due to inoperability of the tumour. During the next six weeks, the patient developed a fungating mass in the left femoral triangle culminating in fatal arterial bleeding.

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