A primary malignant fibrous histiocytoma of the scalp and intracranial tumor bleeding: a case report

INTRODUCTION: A malignant fibrous histiocytoma occurring on the scalp near a primary operation site is extremely rare. CASE PRESENTATION: A 74-year-old Chinese man presented with a one-month history of recurrent headaches, vomiting and left limb atony. He had undergone a successful clipping operation through the pterional approach for an anterior communicating aneurysm five years previously. One month before presentation, he developed a headache without apparent cause that was especially severe in the right frontal region. He also had a small tumor on the right side of his forehead at the original incision site. The tumor had gradually increased from soybean size to egg size in one month; this growth was accompanied by nausea, projectile vomiting of gastric contents and left limb atony. The subcutaneous tumor was totally resected along with some affected cranial tissues. Our patient’s postoperative recovery was good, and he was safely discharged 20 days after the surgery. He was free of recurrence over two years of follow-up. CONCLUSIONS: Dissection of the temporal muscles and deep fascia using electric resection and electrocoagulation through the pterional approach may cause tissue degeneration, which may in turn lead to cancer development. In our patient’s case, the reason for the development of the tumor five years after his surgical aneurysm repair was unclear; it may have represented a primary malignant fibrous histiocytoma of the scalp that had no relationship to the operation. We followed up our patient for two years and he had no tumor recurrence. Because malignant fibrous histiocytoma of the scalp has a high degree of malignancy and readily recurs in situ, early diagnosis and radical surgical resection are key to a successful outcome.