Year : 1992 | Volume
: 40 | Issue : 2 | Page : 63--65
Angiomatoid malignant fibrous histiocytoma of the eyelid
Rajiv Nath1, Sandeep Saxena1, Padam K Agarwal2, Satayajit Roy1,
1 Department of Ophthalmology, King George's Medical College, Lucknow, India
2 Department of Pathology & Bacteriology, King George's Medical College, Lucknow, India
G-19, River Bank Colony. Lucknow
A 20 year old female had an angiomatoid malignant fibrous histiocytoma of her left upper eyelid extending into the orbit, frontal and temporal regions. The tumor was excised and radiotherapy was given. Nine months follow-up did not reveal any recurrence.
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Nath R, Saxena S, Agarwal PK, Roy S. Angiomatoid malignant fibrous histiocytoma of the eyelid.Indian J Ophthalmol 1992;40:63-65
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Nath R, Saxena S, Agarwal PK, Roy S. Angiomatoid malignant fibrous histiocytoma of the eyelid. Indian J Ophthalmol [serial online] 1992 [cited 2023 Nov 29 ];40:63-65
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Malignant fibrous histiocytoma is a primitive mesenchymal tumor showing partial fibroblastic and histiocytic differentiation . Angiomatoid malignant fibrous histiocytoma was first described by En�zinger  (1979). It is a rare tumor that combines features of both a fibrohistiocytic and a vascular neoplasm . It is a less aggressive tumor of children and young adults, arising most commonly from the dermis and subcutis of the extremities . Fibro-his�tiocystic malignancies occurs more commonly in males than in females ,,. Metastasis occurs in the lungs and lymph nodes ,. Recurrence is frequent after excision ,,. In our knowledge, angiomatoid malignant fibrous histiocytoma of the upper eyelid extending into the peripheral orbital space, frontal and temporal regions, in a young female, is being reported for the first time.
A 20-year old female was admitted with a seven month history of a painless and gradually progressive swelling which started from the lateral one third of the left upper eyelid. Initially, the mass was excised elsewhere. Two months after this excision the swelling recurred at the same site, increased in size and spread laterally and superiorly till her presentation at this centre. Her general health was good.
Her unaided visual acuity was R.E. 6/6 and L.E. 6/12. A firm, ill-defined, non tender mass measuring 6 X 4 cm was present in the left upper eyelid. The overlying skin had a bluish tint and prominent veins. Mechanical ptosis of the left upper eyelid was present [Figure 1]. The tumor mass extended into the temporal and frontal regions, where it was fixed to the un�derlying structures. The left eyeball was deviated inferonasally, but proptosis was not present. The .anterior and posterior segments of the eye were normal. The right eye and its adenexae were normal. X-ray skull and chest did not reveal any abnormality.
C.T scan showed a nonhomogenous soft tissue mass of the left upper eyelid infiltrating into the anterior part of outer peripheral orbital space, frontal and temporal regions. The eyeball was displaced nasally. Adjoining frontal and zygomatic bones were thickened.
Surgical excision of the mass was done under general anaesthesia. The adjoining periostium of the orbit found to be involved, was removed. Deviation of the eyeball improved after surgery. Postoperative radiotherapy, 4000 CGY/20 fractions (anterior and lateral wedge field were given for four weeks by external beam Co 60. A nine month follow-up did not reveal any recurrence.
The tumor mass was 6 X 4 X 3 cms. in size and lobulated. The cut surface was gray white interspersed with haemorrhagic areas. Many irregular blood filled cystic spaces [Figure 3] were also seen. Multiple paraffin sections were prepared for histopathological examination. All the sections were stained with routine hematoxylin and eosin. Sections revealed multiple haemorrhagic spaces simulating vascular spaces. These were lined by spindle shaped and histiocytic cells [Figure 4][Figure 5]. The cells were highly pleomorphic and contained scanty to moderate amount of cytoplasm. Nuclei were also of variable sizes [Figure 6].
The orbit is a site of predilection for fibrous his�tiocytoma,.The eyelid is an unusual location for fibrous histiocytoma. John, Yanoff & Scheie  (1981) reported fibrous histiocytoma of the lower eyelid. Ronan and Tso (1978) reported a unique case of bilateral multiple pert-orbital fibrous histiocytoma with extensive involvement of the lids.
Angiomatoid malignant fibrous histiocytoma of the orbit has been reported in a 7 years old boy by Cabellero, Rodriguez and Sopelanasub(1981). To the best of our knowledge, it has not been reported from the eyelids previously. Clinically, the bluish tint of the tumor and the blood filled spaces on the cut surface suggested a vascular tumour but the histologic characteristics were consistent with the diagnosis of angiomatoid malignant fibrous histiocytoma.
We are thankful to Prof. R.C. Saxena for his guidance in preparing this paper. We are also thankful to Mr. P.C. Roy for his assistance in photography.
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