Atypical fibrous histiocytoma of the skull: a case report of temporal bone involvement and comprehensive literature review

Figures

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  Figure 1. Preoperative imaging and audiological assessments of the patient demonstrating a right temporal bone mass and associated hearing impairment. (A–D) Axial and coronal CT (A, B), bone window (C), and 3D reconstruction (D) show osteolytic bone destruction in the right temporal bone with a soft tissue density mass, measuring approximately 17 × 14 mm. (E, F) MRI reveals a well-defined, lobulated lesion in the right temporal region, approximately 2.3 × 2.8 × 3.1 cm in size. The lesion shows iso- to slightly hypointense heterogeneous signals on T1-weighted imaging (E), hypointense signals on T2-weighted imaging (F). Adjacent brain parenchyma is compressed and displaced, and adjacent bone shows thinning and resorption. (G) Pure-tone audiometry indicating severe sensorineural hearing loss in the right ear across all tested frequencies. (H) Tympanometry of the right ear showing a Type B curve (flat), indicating middle ear effusion or dysfunction.

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  Figure 2. Composite illustration of intraoperative findings, postoperative imaging, and audiological assessments of the patient. (A) Intraoperative view showing bone destruction and tumor excision from the right temporal bone. (B) Postoperative non-contrast CT scan demonstrating no evidence of intracranial hemorrhage or acute complications. (C, D) Early postoperative brain MRI (axial and coronal T1-weighted images with contrast) showing no residual tumor in the right temporal bone region, with mild dural enhancement consistent with postoperative changes. (E, F) Postoperative audiological evaluation of the right ear. (G, H) Postoperative magnetic resonance imaging of the brain (axial T1-weighted imaging with contrast) at 1and 6 months postoperatively showed no signs of tumor recurrence.

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  Figure 3. Pathological manifestations of AFH of the skull. (A–C) AFH HE staining showed that the cells were multinucleated giant cells, and some tumor cells were moderately heterotypic, with active growth and hemosiderin deposition. (D) The AFH cells are strongly positive with vimentin by immunohistochemistry. (E) Immunohistochemical staining showed CD68 expression for weakly positive in AFH cells. (F) Ki-67 immunostaining demonstrates a labeling index of approximately 20%. (G) Immunohistochemical staining showed that S-100 was negative in AFH cells. (H) Immunohistochemical staining showed that EMA was negative in AFH cells.