Rectus Abdominis Muscle Malignant Fibrous Histiocytoma Causing a Large Abdominal Wall Defect: Reconstruction with Biological Mesh

Malignant fibrous histiocytoma (MFH) is a common soft tissue sarcoma usually involving limbs and retroperitoneum. MFH of the rectus abdominis muscle is extremely rare. Surgery in similar cases leads to large abdominal wall defects needing reconstruction. Biological and synthetic laminar absorbable prostheses are available for the repair of hernia defects in the abdominal wall. They share the important feature of being gradually degraded in the host, resulting the formation of a neotissue. We herein report the case of an 84-year-old man with MFH of the rectus abdominis muscle which was resected and the large abdominal wall defect was successfully repaired with a biological mesh. 1. Introduction Malignant fibrous histiocytoma (MFH) is a pleomorphic sarcoma. It was first described as malignant histiocytoma and fibrous xanthoma by Ozzello et al. [1] and was established a soft tissue sarcoma arising from fibroblasts and histiocytes [1, 2]. MFH is a relatively rare tumor that occurs throughout the body [3]. However, it is also the most common sarcoma appearing during the 6th and 7th decades, while men are more often affected than women. The most frequent site of MFH is the extremities (lower extremity 49%, upper extremity 19%) followed by the retroperitoneum (16%) and peritoneal cavity (5%–10%) [4]. The introduction of biological meshes (BMs) like Permacol (PM), Strattice, and Surgisis has opened new alternatives. BMs products have several potential advantages over other synthetic permanent materials in selected clinical situations. Indications for implantation of a BM in abdominal wall reconstruction include contaminated wounds, complex repairs at high risk for developing wound-healing problems, high likelihood of a cutaneous exposure, and unavoidable direct placement of mesh over bowel [5]. We herein report the case of an 84-year-old man with a MFH in the rectus abdominis muscle, treated by removal of the tumor and the muscle, which was reconstructed with BM. 2. Case Presentation An 84-year-old male was admitted complaining about abdominal pain and a palpable mass in the abdominal wall. His medical history included atrial fibrillation, chronic obstructive pulmonary disease, and open cholecystectomy performed 2 years ago. During the clinical examination, a large, immobile, and slightly painful mass was palpated at the level of the left rectus abdominis muscle. Abnormal laboratory findings included leukocytosis (14,323/mm3), Hb: 9？g/dL, and INR: 4. Although the patient’s reported history of a two-month growing mass, spontaneous rectus abdominis rupture was