Benign Fibrous Histiocytoma
Synonyms: BFH, fibrous histiocytoma of Bone
Diagnosis of exclusion - must rule out Malignant Fibrous histiocytoma and other Fibrous lesions
Quick Facts
Behaviour
Benign
Category
Bone
Synonyms
- BFH
- fibrous histiocytoma of Bone
Category
Bone
Behaviour
Benign
Gender
M = F
Tissue of Origin
Fibrous
Epidemiology
- Rare tumour accounting for <1% of primary Bone tumours
- Wide age range but peak incidence in 2nd–4th decades
Clinical Features
- Usually presents with pain and swelling
- May be asymptomatic and incidentally discovered
- Rarely causes pathological fracture
Location
- Femur most common
- Tibia
- Pelvis and flat bones occasionally
Imaging
- Geographic lytic lesion with well-defined sclerotic margins
- No periosteal reaction in most cases
- May show cortical thinning or expansion
- No matrix mineralisation
Pathology
- Storiform pattern of spindle cells
- Histiocyte-like cells and giant cells present
- Foamy macrophages frequently seen
- Low mitotic activity
Genetics
- No recurrent cytogenetic abnormalities identified
- Polyclonal lesion in most cases
Treatment
- Curettage with or without Bone grafting
- Extended curettage with adjuvants (phenol, liquid nitrogen) for recurrent lesions
- Wide excision reserved for aggressive or recurrent cases
Prognosis
- Excellent prognosis after complete excision
- Local recurrence rate approximately 10–20%
- Malignant transformation exceedingly rare
Key Points
- Diagnosis of exclusion - must rule out Malignant Fibrous histiocytoma and other Fibrous lesions
- Histologically identical to soft tissue counterpart
- Close follow-up recommended due to recurrence risk
Workup - Blood Tests
FBC, U&E, LFTs, Bone profile - pre-operative baseline
Workup - Local Imaging
- Plain radiograph - geographic lytic lesion with well-defined sclerotic margins
- MRI primary site - characterise lesion and exclude Malignant features
- CT - cortical integrity assessment
Workup - Biopsy
Core needle biopsy or excision biopsy - diagnosis of exclusion
Workup - Staging
No staging required
Workup - Other
MDT discussion - extensive IHC panel required to confirm diagnosis of exclusion
Follow-up Summary
- 1
Post-op visit within 6 weeks; plain X-ray at 6 weeks to confirm healing
- 2
Year 1
6-monthly clinical review with plain X-ray to detect early local recurrence
- 3
Year 2
Annual clinical review; plain X-ray if symptoms return
- 4
Discharge at 2 years if no evidence of recurrence
- 5
No CT or MRI routinely required unless recurrence suspected
- 6
Recurrence (10–20%) should prompt repeat imaging (MRI) and MDT discussion
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