Malignes Fibröses Histiozytom im Bereich einer Totalendoprothese des Hüftgelenkes - Koinzidenz oder Komplikation?

Zusammenfassung

Das Maligne Fibröse Histiozytom (MFH) ist das häufigste Sarkom des Erwachsenenalters. Prädisponierende Faktoren für das MFH stellen der Morbus Paget, Knocheninfarkte, maligne Erkrankungen des hämatopoetischen Systems oder Kortisoneinnahme dar. In letzter Zeit wird das MFH immer öfter in Verbindung mit orthopädischen Implantaten beschrieben und diesen bzw. deren Legierungen zugeschrieben. Das MFH im Bereich der Totalendoprothese des Hüftgelenkes stellt jedoch eine ausgesprochene Rarität dar. Unseres Wissens nach sind in der Weltliteratur bisher 13 Fälle beschrieben. Die in der Literatur beschriebene Therapie reicht von der lokalen Tumorexstirpation bis zur Hemipelvektomie. Wir stellen den Fall einer 66-jährigen Rheumatikerin vor, bei der im Rahmen einer Wechseloperation einer gelockerten Titan-Hüfttotalendoprothese der histopathologische Befund des Granulomgewebes ein MFH III° vom storiform-pleomorphen Typ ergab. Die Standzeit der Primärprothese betrug 8 Jahre. Die Patientin verstarb ein Jahr nach Hemipelvektomie. Bei Lockerungen von (Hüft-)Totalendoprothesen muss auch an maligne Tumoren gedacht werden, wir empfehlen die histopathologische Untersuchung des Granulomgewebes. Es wird ein Literaturüberblick gegeben, die verschiedenen Therapieoptionen aufgezeigt und die mögliche Ursache der Entwicklung von MFH im Zusammenhang mit Endoprothesen diskutiert.

Abstract

The Malignant Fibrous Histiocytoma (MFH) is the most frequent sarcoma in adulthood. Predisposing factors for MFH are Paget's disease, bone infarcts, malignant disorders of the haematopoetic system or the ingestion of corticosteroids. In recent times, MFH is described with increasing frequency in connection with orthopaedic implants, being attributed thereto or to their alloying constituents. MFH at the site of the total endoprosthesis of the hip joint does, however, constitute a distinct rarity. As far as we know, 13 cases have, to date, been described in world literature. The therapy described in the literature ranges from a local tumour extirpation to a hemipelvectomy. We present the case of a 66-year-old female patient suffering from rheumatism, in respect of whom the histopathological findings of the granuloma tissue, undertaken within the framework of an operation to exchange a loosened total titanium hip endoprosthesis, showed a 3^rd degree MFH of the storiform-pleomorphic type. The life of the primary prosthesis was 8 years. The patient died a year after revision arthroplasty. In cases where there is a loosening of total (hip) endoprostheses, consideration must also be given to malignant tumours, and we recommend the histopathological examination of the granuloma tissue. An overview of the literature is given, various treatment options are shown, and the possible causes for the development of MFH, in conjunction with endoprostheses, are discussed.

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