A MFH is the most common soft tissue tumor found in adults. It is primarily located in the extremities or retroperitoneum; however, it rarely appears on the chest wall. A MFH was first reported by O’Brien and Stout in 1964 . They described it as “malignant fibrous xanthoma”. The tumor preferentially involves the deep fascia, skeletal muscles, or superficial subcutaneous tissue. A MFH has a high propensity for local recurrence and distant metastases. Weiss and Enzinger  reported that a local recurrence rate of 44% and metastatic recurrence rate of 42% for MFHs. Several MFH subtypes have been described in the literature: storiform-pleomorphic, giant cell, inflammatory, and myxoid . The mean survival of patients without surgery is 11.7 months; it is 23.2 months for patients who undergo surgery . MFHs have been reported to occur with increasing frequency in patients treated with radiotherapy for other malignant diseases; however, no prior exposure to ionizing radiation or history of malignancy was documented in our case. The role of either chemotherapy or radiotherapy as primary or adjuvant treatment for MFHs is currently unclear. Favorable factors for MFHs are: UICC/AJCC stage I and II, superficial location, myxoid type, and patient under 50 years of age. Under these conditions, the rational for radical en-block resection of the tumor is supported [6–10].
CT and magnetic resonance imaging are useful for the radiological evaluation of the soft tissue component. According to one report, the imaging features of MFHs in the chest wall are nonspecific and only the myxoid type showed a high-intensity pattern with T1 weighed images (T1WI) and T2 weighted images (T2WI). The mass usually shows intense enhancement on CT with a clear margin separating it from the surrounding tissue .
For a chest wall MFH, wide resection is the first treatment choice; chemotherapy should also be considered. King reported the relationship between the distance of the lateral margin of the excision from the tumor and the recurrence rate. They found a distance of 4 cm was associated with a recurrence rate of 44%; whereas a distance of 2 cm was associated with a 71% recurrence rate . They recommended an excisional distance of 4 cm. Naoya Yoshida et al. reviewed 39 MFH cases and found that patients with a negative surgical margin were alive without recurrence, irrespective of the surgical margin distance .
After radical en-block resection, the chest wall should be reconstructed. Classically, various flaps such as a major pectoral muscle flap, a major pectoral myocutaneous flap, or a latissimus dorsi myocutaneous flap and pedicled omentum have been utilized for reconstruction. Currently, reconstruction with Marlex mesh is widely used. Several studies have reported that a chest wall reconstruction with Marlex mesh is successful and inexpensive. In this case, the chest wall defect was too large for reconstruction with a flap. We performed the reconstruction with a polyester surgical patch (knitted type), and we joined four 10 × 10 cm2 patches into one 20 × 20 cm2 patch to reconstruct the chest wall. Postoperative complications such as skin dehiscence, skin necrosis, and infection did not occur. We found that reconstruction of the chest wall with a polyester surgical patch for a large defect is safe, rapid, and simple. We consider that radical en-block resection for an enormous chest wall MFH and reconstruction is a safe procedure that may increase long-term survival.
In differential diagnosis of a chest wall tumor, malignant fibrous histiocytoma should be seriousely considered.