Queenie's 微笑的黃金

有時候還是會想   這真是條不歸路  偏偏又沒悔意~~
今天msn上遇到彭   回應了她的無敵簡訊   害我的手機徹底沒電
另外又告訴了她星期六小弟弟的故事   
好吧   她是稍微安慰我一下啦   不過星期六小弟下午會來   我決定還是躲在供應室裡
順便問起今天的op   我還是忍住沒說出真正的感覺    只說了"我有台刀沒跟   長刀的那個JP一直鼓起來   只好再suture" .
明天→→所以去辦手機好了 徹底被打敗!!還以為我生意做多大 其實一整天都沒講到話只是收14封簡訊和當個早起鬧鐘就死了
今天的op→Malignant fibrous histiocytoma is the most frequently soft tissue sarcoma of adulthood, was first described by O’Brien and Stout in the 1964. Malignant fibrous histiocytoma is an uncommon, aggressive pleomorphic tumor that originates from the tissue histiocyte or “facultative fibroblast”. Extremely rare cases of MFH have been reported in the skull. The mandibulomaxillary was the most common site for MFH of the skull followed by calvarium.

In a review of the medical literature we found a number of recognized MFH cases have been published. Fourteen cases were reported in the literature in 12 years, and 19 cases of histologically verified MFH of the mandible with sufficient documentation.MFH tend to show a distinct gender predilection, there were 13 (65%) men and 7 (35%) women; in addition mandible MFH is more common in the latter half of life, with a mean age of 41. 

The site of MFH mandibular lesion was found to have a strong tendency for localization in the posterior part of the mandible. No anterior region of the mandible was reported. Mandibular lesions were usually, noticed by swelling, pain, paresthesia and loosing of teeth. Clinical symptoms were presented from two weeks to six months before diagnosis. In our case the site of lesion was found in the left mandibular alveolar ridge at the molar region but did not reach ascending ramus. Numbness underwent period of un-sensation with paraesthesia affecting the left lip due to increase in the size of the lesion.

MFH of bone aggressively infiltrates adjacent tissues along fascial planes or between muscle fibers, accounting for a high local recurrence rate.Frankenhaler et al. (1990) reviewed the related literature and collected 118 cases of head and neck MFH. They found only two cases of primary MFH arising in parotid gland. The authors recent review of literature yielded 24 reported cases of MFH arising in major salivary gland including 18 cases of parotid MFH, 2 cases not described  and only 4 cases of submandibular MFH.In our case submandibular salivary gland was enlarged mobile and palpable. Histopathological examination disclosed proliferative infiltration of spindle-shaped tumor cells with a large irregular nucleus circumferential tissue in a storiform pattern.

Immunohistochemistry is of little value in the diagnosis of malignant fibrous histiocytoma because no specific marker for these lesions exists. The diagnosis is made on the basis of the histologic appearance. The presented patient was diagnosed with MFH of the Storiform-pleomorphic type, which is the most frequent. In a review of the literature, we could find five cases of histologically identified MFH of the submandibular salivary gland together with a clinical and pathological study of the current case. Regarding the site of MFH lesion, the present case showed both locations in mandible and submadibular salivary gland.

Complete surgical resection is the treatment of choice for malignant fibrous histiocytoma. Because regional lymph node metastases are present in fewer than 15% of patients, lymph node dissection is not indicated in the absence of palpable cervical metastases, with the exception of tumors in the oral cavity, which appear to have a higher incidence of regional nodal involvement. Anavi et al. (1989), reported in their review of mandibular MFH that the overall survival estimate at five years was 46% regardless of the kind of treatment. In comparison, the 5-year survival rate of MFH of bone at other sites was reported to be 36.5% to 53%, which may not differ significantly from that of the mandible. Of five cases of submandibular MFH including four cases reported in literature and the present case, three survived more than two years.