We read with interest the recent report by Krishna Sharma1 of a case of malignant fibrous histiocytoma, metastatic to the lung, with spontaneous expectoration of large tumour fragments. We felt it would be illustrative to present a similar case with a much more favourable outcome.
This patient presented in 1975 at the age of 42 years with a slowly enlarging mass, involving the right patellar tendon. A biopsy revealed it to be a malignant sarcoma, and a subsequent wide local excision was accomplished with clear margins. Pathology review confirmed the diagnosis of malignant fibrous histiocytoma. No adjuvant treatment was administered.
Five years after primary resection, the patient developed pulmonary nodules, one adjacent to each hilum, visible on both routine posteroanterior chest radiographs and lung tomograms. He was asymptomatic, and no further treatment was recommended. Over the next 8 months, he developed mild but progressive wheezing. This culminated in the spontaneous expectoration of a tumour nodule described as a plug of tissue measuring 2.5 х 1 cm and found to be histologically identical to his primary cancer. The wheezing completely resolved at this point but because of the enlargement of his remaining disease site, with the largest nodule measuring 5 cm in diameter, a course of radiation therapy was recommended. He received 30 Gy in 15 fractions, encompassing both hila and the carina, using cobalt 60. This was well tolerated aside from transient fatigue. The patient's tumour masses began to shrink promptly, and he was eventually left with a small amount of residual scarring near his left hilum.
When last seen in follow-up in 2003, some 22 years after the spontaneous expectoration of one of his lung nodules and subsequent “palliative” radiation treatment of his residual disease, the patient remained alive and well, without disease recurrence.
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