Clinical Features and Treatment of Fibrous Histiocytomas of the Tongue: A Systematic Review

Nguyen, Austin; Vaudreuil, Adam; Haun, Paul; Caponetti, Gabriel; Huerter, Christopher

doi:10.1055/s-0037-1602819

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International Archives of Otorhinolaryngology

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Systematic Review • Int. Arch. Otorhinolaryngol. 22 (01) • Jan-Mar 2018 • https://doi.org/10.1055/s-0037-1602819 copy

Clinical Features and Treatment of Fibrous Histiocytomas of the Tongue: A Systematic Review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction

Benign fibrous histiocytomas are common lesions of the skin that rarely affect the tongue. Such cases are available in the literature exclusively as case reports. Similarly, malignant fibrous histiocytoma, now classified as undifferentiated pleomorphic sarcoma, is exceedingly rare in the tongue and not fully understood.

Objectives

This study systematically reviews the available literature discussing the clinical and pathological features of malignant and benign fibrous histiocytomas.

Data Synthesis

A total of 20 cases were included in this review. Patient-level data were extracted from cases to include clinical presentation, workup, treatment, and outcome.

Conclusion

Benign fibrous histiocytomas are consistent in clinical and histopathologic presentation. Surgical treatment provides excellent outcome, with no recurrence in all excised cases. Malignant tumors have a more aggressive clinical and pathological presentation. Surgical treatment with possible adjuvant radiotherapy resulted in recurrence in 40% of cases (follow-up of 24 months), and death due to disease in 47% of patients (follow-up of 19 months).

Keywords:
dermatofibrosarcoma; dermatofibroma; fibrous histiocytoma; tongue neoplasm

Characteristic	Benign Fibrous Histiocytoma, n (%)	Malignant Fibrous Histiocytoma, n (%)
Demographics
Mean, range of age (years)	25.8, 8–51	46.6, 0.4–72
Female	4 (80.0)	8 (40.0)
Male	1 (20.0)	9 (60.0)
Presentation
Mean, range of tumor diameter (cm)	2.5, 0.4–5.5	2.9, 1–5.6
Duration of symptoms (months)	5.0	3.6
Painful*	0 (0.0)	2 (13.3)
Firm*	4 (80.0)	2 (13.3)
Epithelial disruption (gray/white, ulcerated, fungating)*	0 (0.0)	8 (53.3)
Location
Anterior	1 (20.0)	2 (13.3)
Posterior	0 (0.0)	3 (20.0)
Left lateral	2 (40.0)	6 (40.0)
Right lateral	1 (20.0)	3 (20.0)
Base	1 (20.0)	2 (13.3)
Dorsal	2 (40.0)	3 (20.0)
Ventral	1 (20.0)	0 (0.0)
Unspecified	0 (0.0)	2 (13.3)

Characteristic	Benign Fibrous Histiocytoma, n (%)	Malignant Fibrous Histiocytoma, n (%)
Histologic finding*
Pleomorphic	2 (40.0)	8 (61.5)
Mitotic figures	2 (40.0)	8 (61.5)
Storiform pattern	3 (60.0)	10 (76.9)
Spindle, fibroblast-like cells	5 (100.0)	13 (100.0)
Histiocyte-like cells	5 (100.0)	12 (92.3)
Multinucleated giant cells	0 (0.0)	8 (61.5)
Immunohistochemical expression	4 (100.0)^†	6 (100.0)^†
α-chymotrypsin	1 (25.0)	2 (33.3)
CD34	2 (50.0)	0 (0.0)
Cytokeratin	0 (0.0)	0 (0.0)
Desmin	0 (0.0)	0 (0.0)
Keratin	0 (0.0)	0 (0.0)
S100	0 (0.0)	0 (0.0)
Vimentin	2 (50.0)	1 (16.7)

	Benign Fibrous Histiocytoma, n (%)	Malignant Fibrous Histiocytoma, n (%)
Treatment
Resection/excision	4 (80.0)	4 (26.7)
Partial/hemiglossectomy	1 (20.0)	6 (40.0)
Total glossectomy	0 (0.0)	1 (6.7)
Neck dissection	0 (0.0)	4 (26.7)
Chemotherapy	0 (0.0)	4 (26.7)
Radiotherapy	0 (0.0)	8 (53.3)
CO₂ laser excision/debulking	1 (20.0)	2 (13.3)
Outcomes
Recurrence	1 (20.0)	6 (40.0)
Disease free	5 (100.0)	8 (53.3)
Death due to the disease	0 (0.0)	7 (46.6)
Mean, range of follow-up (months)	44.6, 1–144	21.7, 9–37

Article	Age (years)EthnicityGender	Tumor	Size	Chief Complaint	Duration of Symptoms	Prior radiation	Treatment	Results	Follow-up
Chen et al 2001	16-year-old Chinese Female	MFH	2 × 2.5cm	Enlarging painless swelling	5 days	None	Hemiglossectomy with modified radial neck dissection	Negative margins and nodes	Free of disease at 3 years
Geist et al 1990	60-year-old Caucasian Male	MFH in thorax, metastasis to tongue	1.5 × 0.5cm	Progressive weakness and fatigue with painful enlarging mass in tongue	2 months of weakness and fatigue, 1–2 weeks of tongue mass	None	Doxorubicin hydrochloride and DTIC chemotherapy followed by surgical resection with adjuvant radiation for lung persistence and chemo with fludarabine for metastasis	Disease continued to spread	Died of disease 16 months after presentation
Lin et al 1994	57-year-old Taiwanese Male	MFH	−	Painful mass	1 month	2.5 years ago	Total glossectomy and partial mandibulectomy followed by subtotal excision with palliative chemotherapy for recurrence	Recurred 6 months after primary surgery	Died at 26mo
Lopez et al 2011	8-year-old Caucasian Female	BFH	0.4 × 0.4cm	Asymptomatic nodule noticed by parents	6 months	None	Excision	Clearance	No recurrence at 3 years follow-up
Mahajan et al 1989	28-year-old German Female	MFH	−	Pain and trismus progressing to hoarseness and decreased tongue mobility	7 months	None	Neoadjuvant chemo, modified neck dissection, partial mandibulectomy, partial glossectomy, and pharyngectomy with adjuvant radiotherapy and chemotherapy	Clearance with negative lymph nodes	No recurrence at 15 months
Manni et al 1986	61-year-old Caucasian Male	MFH	9 × 5 × 3cm	Progressive tongue swelling, bleeding, and swallowing difficulties	6 months	None	Hemiglossectomy with supraomohyoid neck dissection		No recurrence at 2 years
McMillan et al 1986	42-year-old Female	MFH	2.5cm	Enlarging symptomless swelling	8 weeks	None	Excisional biopsy followed by left hemiglossectomy after histologic diagnosis		No recurrence at 9 months
Pandey et al 2013	26-year-old Indian Male	BFH	6 × 5cm	Slow growing mass	5 months	None	Excision and blunt dissection		Disease-free at 1 month f/u
Priya et al 2013	30-year-old Indian Female	BFH	3 × 3cm	Nodular mass causing speech difficulty	7 months	None	Excision under local anesthesia	Tongue function improvement	No recurrence at 3 years
Rapidis et al 2005	24-year-old Caucasian Male	MFH	3 × 2 × 1cm	Slowly enlarging painless swelling	5 months	None	Surgical resection with 1 cm tumor-free margins		Disease-free at 18 months
Restrepo et al 1987	5-month-old Caucasian Male	MFH	−	Difficulty bottle feeding	−	None	Partial glossectomy with adjuvant iridium implants and 2 years of actinomycin D, vincristine sulfate, cyclophosphamide chemo	Unremarkable metastatic workup	Disease free at 18 months after diagnosis (7 months after therapy completion)
Velez et al 1986	14-year-old African American Female	Atypical FH	3.2 × 2 × 0.7cm	Rapidly growing non-tender mass	2 weeks	None	Excised with CO2 laser under general anesthesia followed by hemiglossectomy after recurrence	Local recurrence within several weeks. Tumor-free margins on hemiglossectomy	Patient died 6 months later due to Cystic Fibrosis
Takimoto et al 1990	51-year-old Japanese Female	FH	2 × 1.5 × 1cm	Sore throat with globus sensation	“several months”	None	Elliptical excision with 5 mm margins		Asymptomatic with no evidence of recurrence at 12 years
Young et al 1989	67-year-old Taiwanese Female	MFH	−	Rapidly growing protruding mass	−	5 years ago	Tumor debulking by CO2 laser followed by excision with tongue flap push back reconstruction and adjuvant radiation for recurrence		No evidence of recurrence at 3 years after excision
Young et al 1989	52-year-old Taiwanese Male	MFH	−	Globus sensation	−	12 years ago	Tumor debulking by CO2 laser	Neck metastasis found 1 month after debulking	Died of disease 16 months after diagnosis
Zapater et al 1995	71-year-old Caucasian Male	MFH	4 × 2cm	Painful gum mass	3 months	None	Telecobaltotherapy of the tongue and oral cavity and then curietherapy on the primary lesion	No evidence of tumor macroscopically	Recurrence at 8 months, patient died of disease one month later
Bras et al 1987	72-year-old Caucasian Male	MFH	−	Painless swelling	3 months	−	Radium implants initially followed by local surgery and modified radical neck dissection for recurrence	Partial response, recurrence	Died of disease after 12 months
Bras et al 1987	65-year-old Caucasian Male	MFH	−	Found on follow-up from prior irradiation for SCC of the tongue	−	10 years ago	Initial resection followed by surgery for local recurrence and radiotherapy + CYVADIC chemo for lung metastasis		Died of disease after 20 months
Barnes et al 1988	21-year-old Female	MFH	3cm	Asymptomatic mass	12 months	None	Partial right glossectomy with right modified radical neck dissection	Negative lymph nodes	No evidence of disease at 37 months
Hiasa et al 1986	63-year-old Japanese Female	Right pleural MFH metastasis to the tongue and other organs	5 × 4 × 3cm	Swelling of the right edge of the tongue	−	1 year ago	Partial resection with adjuvant radiation to primary tumor. Followed by radiation to metastases		Died of disease at 34 months

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[1] Address for correspondence Austin Nguyen, MS, Division of Dermatology, Creighton University School of Medicine, 2500 California Plaza, Omaha, NE 68178, United States (e-mail: ahn30605@creighton.edu).