Introduction MFH and fibrosarcoma are now considered the same entity A malignant fibrogenic tumor of the bone that usually affects older patients (> 50 yrs), although it may occur in all age groups the majority are high grade Prognosis is poor high grade has 30% survival at 5 years low grade has 80% survival at 10 years Symptoms Presentation pain and swelling Imaging Radiographic characteristics purely lytic lesion with bone destruction in a permeative pattern ill defined features looks like osteosarcoma Bone scan is very hot Histology Same as soft tissue sarcoma atypical spindle cells herringbone pattern variable levels of collagen production Treatment Operative wide surgical resection and multiagent chemotherapy indications all malignant cases chemotherapy multiagent chemotherapy only if high grade (most cases) Location Xray Xray CT B. Scan MRI MRI Histo(1) Case A distal tibia Case A femur Case A tibia (1) - histology does not always correspond to case