Solitary Fibrous Tumors of the Head and Neck

Solitary fibrous tumor of the larynx: case report demonstrating the value of MRI in guiding surgical management

A 74-year-old woman presented with persistent dysphagia, dysphonia, and throat gurgling. Prior intraoperative biopsies were negative, and outside imaging revealed supraglottic swelling. Magnetic resonance imaging (MRI) demonstrated a well-defined T1 and T2 hypointense, avidly enhancing hypopharyngeal mass. Deep intraoperative rebiopsies revealed a tumor with CD34+ tissue, diagnostic of a solitary fibrous tumor. A broad range of nonsquamous cell tumors should be considered when a submucosal laryngeal mass is encountered. MRI may be particularly helpful in guiding appropriate biopsy.

Solitary fibrous tumor of the hypopharynx: case report and literature review

Solitary fibrous tumors are rare mesenchymal neoplasms that are increasingly being described in the head and neck. Clinical presentations may include compression by these tumors on vital surrounding structures. While malignant transformation is rare, treatment entails wide local excision. We present the case of a 74 year-old female with an increasingly enlarging symptomatic hypopharyngeal solitary fibrous tumor that was found on carotid duplex ultrasound. Transoral surgical excision resulted in relief of symptoms. Treatment options are discussed and a literature review of this uncommon disorder presented.

[Solitary fibrous tumor of the orbit: Possibly recurrent in the long-run]

Solitary fibrous tumor (SFT) is a rare etiology of progressive unilateral exophthalmia. The tumor is of mesenchymal origin and it is usually well defined. But recurrences can occur despite of complete surgical resection. Metastases have been observed. Tumors of the SFT spectrum are considered as benign or low-grade malignant. Histological features do not currently allow any prognosis. The most important prognostic factor is complete surgical resection. Craniofacial approaches provide a good view of the tumor extensions and orbital contents. Recurrent tumors must be surgically removed when possible. Complementary treatments have not proved effective. A very long-term follow-up is mandatory.

Solitary fibrous tumor of the sinonasal cavity: CT and MR imaging findings

SUMMARY

SFT is a rare lesion of the sinonasal cavity. We retrospectively reviewed 5 patients with histopathologically proved sinonasal SFTs to determine their CT and MR imaging features. All patients underwent paranasal sinus CT and MR imaging. Four SFTs occurred in the nasal cavity, and 1, in the maxillary sinus. All SFTs had well-defined margins, and the mean maximum diameter was 55 mm. On nonenhanced CT, 5 SFTs appeared homogeneously isoattenuating to gray matter. The most common manifestations of bony involvement were bony remodeling and thinning. On MR imaging, 5 SFTs were isointense to gray matter on T1-weighted images, and the lesions were isointense in 3 and hypointense in 2 patients on T2-weighted images. The lesions showed heterogeneously marked enhancement on postenhanced MR images. Four patients underwent dynamic contrast-enhanced MR imaging, and the TICs showed a washout pattern. A familiarity with the imaging findings of sinonasal SFT may help to diagnose this entity.

Value of MR imaging in differentiation between solitary fibrous tumor and schwannoma in the orbit

BACKGROUND AND PURPOSE

Orbital SFT is a rare tumor, often misdiagnosed as orbital schwannoma preoperatively but with different prognosis and treatment. Our aim was to evaluate MR imaging features that might distinguish orbital SFT from schwannoma.

MATERIALS AND METHODS

MR imaging including DCE scanning was performed in 9 patients with SFT and 22 patients with schwannoma in the orbit confirmed by pathology. Location, shape, margin, signal intensity, homogeneity, enhancement pattern, ER, and TIC of the tumors were retrospectively evaluated.

RESULTS

There was a statistically significant difference between SFT and schwannoma in location and T2 signal intensity (P < .05). A statistically significant difference was also found regarding the enhancement pattern of the very high-signal-intensity areas shown on T2-weighted imaging and the type of TICs (P < .01).

CONCLUSIONS

MR imaging is useful in differentiating orbital SFT and schwannoma. The enhancement pattern of the very high-signal-intensity areas shown on T2-weighted imaging and the type of TICs on DCE MR imaging played an important role in differentiating orbital SFT from schwannoma.

MRI study of solitary fibrous tumor in the orbit

OBJECTIVE

Solitary fibrous tumor (SFT) is a rare lesion of the orbit. The purpose of this study is to determine the MRI features of orbital SFTs.

MATERIALS AND METHODS

We retrospectively reviewed 15 patients with histopathologically proven orbital SFTs. All patients underwent orbital MRI. The location, size, shape, margin, and MRI signal of 15 lesions were reviewed. The time-intensity curve (TIC) of dynamic contrast-enhanced MRI in 14 patients and diffusion-weighted imaging in four patients were also analyzed.

RESULTS

Ten orbital SFTs were located in the extraconal space (seven at the superior aspect and three at the lateral aspect), three in the retrobulbar intraconal space, one in the superomedial aspect of the intraconal space, and one in the lacrimal sac region. All SFTs appeared ovoid in configuration and had well-defined margins. The mean maximum diameter was 30.2 mm (range, 15-56 mm). Fourteen SFTs appeared homogeneously isointense to gray matter on T1-weighted images. On T2-weighted images, the lesions showed heterogeneous isointensity in nine patients and hypointensity in five patients. The lesions showed heterogeneous marked enhancement on contrast-enhanced MRI. Streaky high-signal-intensity areas on T2-weighted images with marked enhancement were observed in nine patients. Flow-void signal was identified in six patients. The TICs of 14 patients showed a washout pattern. The contrast index was 1.61±0.42, the time to peak enhancement was 34.15±14.04 seconds, and the washout ratio was 37.32%±14.37%. The mean apparent diffusion coefficient value of four patients was 1.28±0.23×10(-3) mm2/s. Another case exhibited multicystic appearance.

CONCLUSION

Isointense or hypointense signal on T2-weighted images, marked enhancement, and a washout TIC pattern are the characteristic MRI features of orbital SFTs.

Suboccipital malignant solitary fibrous tumor: report of a case

Solitary fibrous tumors (SFTs) are rare soft-tissue sarcomas usually arising in the pleura of the thoracic cavity. Thirty percent of SFTs present in extrapleural locations, and infrequently in the head and neck region. While the majority of SFTs are benign, aggressive variants have been described. We report a case of a patient with a malignant SFT arising in the suboccipital soft tissues of the neck. We elucidate the diagnostic and therapeutic challenges in managing this tumor in this unusual location.

Solitary fibrous tumor of filum terminale

Solitary fibrous tumor (SFT) is a mesenchymal neoplasm that most commonly arises from the visceral or parietal pleura. Solitary fibrous tumor with a primary site in the filum terminale has not been reported previously in the literature. Here we report a case of SFT occurring in the filum terminale. The characteristic imaging feature of this tumor is hypointensity on T2-weighted images. Even though rare, SFT should be considered in the differential diagnosis of tumors occurring intraspinally, even in the filum terminale.

Head and neck solitary fibrous tumors: diagnostic and therapeutic challenges

OBJECTIVES/HYPOTHESIS

Head and neck solitary fibrous tumors (SFTs) are quite rare, with <200 cases reported in the literature. The purpose of this study was to analyze the diagnostic and therapeutic challenges of this rare disease while reporting the largest head and neck case series.

STUDY DESIGN

Retrospective review.

METHODS

Between 1991 and 2011, 13 cases of head and neck SFTs from the pathology database were identified. Demographic, clinical, radiologic, and pathologic data were then abstracted and compiled for review.

RESULTS

SFT presented nearly equally as asymptomatic slow-growing masses or with local symptoms due to compression. All tumors imaged by computed tomography or magnetic resonance imaging with contrast showed a well-defined strongly enhancing mass. Two patients had evidence of bone erosion on imaging, but no histopathologic features of malignancy. Treatment consisted of surgical resection and in two cases postoperative radiation. Two patients had pathologic findings of malignancy, but are alive without recurrence at 26 and 51 months follow-up. Two patients had recurrence, one with paraspinal disease and grossly positive surgical margins, and another with endoscopic resection and poor margin control.

CONCLUSIONS

SFTs of the head and neck are exceedingly rare and those with aggressive behavior even more so. Diagnosis is often difficult and not definitive until morphologic and immunohistochemical evaluation is performed. In most cases, complete surgical excision is the only necessary treatment. Although in patients with malignant components or positive surgical margins, adjuvant radiation may be beneficial. Regardless, all patients require close clinical follow-up for several years.

Striking pathology gold: a singular experience with daily reverberations: sinonasal hemangiopericytoma (glomangiopericytoma) and oncogenic osteomalacia

Sinonasal hemangiopericytoma-like tumors(SNHPC)(glomangiopericytomas)were originally conceived as histologically similar to, but biologically distinct from, their soft tissue counterparts. Re-evaluation of "hemangiopericytiomas" has determined that SNHPC (glomangiopericytomas) represent bona-fide pericyte-derived tumors, whereas most soft tissue neoplasms previously designated as hemangiopericytomas represent cellular variants of solitary fibrous tumors or other lesions with a hemangiopericytomalike growth pattern. We present an interesting case of a woman with SNHPC (glomangiopericytomas) causing oncogenic osteomalacia, and discuss the recent advances in our understanding of phosphaturic mesenchymal tumors. This particular case is an example of "Striking Pathology Gold"-a situation where the pathologist actively guides the diagnostic process, and witnesses its repercussions. "Striking Pathology Gold" may be a rare event in one's career. However it serves to remind us of our place in the world as physicians. Working behind the scenes, we quietly change the course of countless individual destinies for the better.

MRI of a microcystic adnexal carcinoma of the skin mimicking a fibrous tumour: case report and literature review

Microcystic adnexal carcinoma of the skin is a very rare malignant tumour arising from the sweat glands. As far as we know, the MRI features of this tumour have not been described in the literature before. In this report we present the MRI features and pathological description of a case of a microcystic adnexal carcinoma in the cheek that was incidentally imaged during brain MRI examination. A review of the relevant literature as well as a discussion of MRI of skin tumours is also presented.

Sinonasal glomangiopericytoma: case report with emphasis on the differential diagnosis

Glomangiopericytoma (sinonasal-type hemangiopericytoma) is an uncommon sinonasal neoplasm with a perivascular myoid phenotype. This tumor differs from conventional soft tissue hemangiopericytoma in location, biologic behavior, and histologic features. The proposed cell of origin is a modified perivascular glomuslike myoid cell. Glomangiopericytoma is an indolent tumor that tends to arise in the sinonasal tract of older adults and has a low malignant potential with excellent prognosis after surgical resection. Histologically, this lesion is composed of a diffuse, subepithelial proliferation of bland, uniform, closely packed spindled cells growing in a variety of patterns. A distinctive vascular network composed of variably sized vascular channels, the smaller of which demonstrate perivascular hyalinization, is often present. We report the case of a 48-year-old woman with epistaxis and nasal obstruction who was diagnosed with glomangiopericytoma and discuss the histologic differential diagnosis.

Solitary fibrous tumor of the head and neck

OBJECTIVE

The aim of this study was to review the reported cases of solitary fibrous tumor (SFT) in the head and neck and to evaluate this tumor regarding histologic features, treatment, and recurrence. SFT has been described in many extrapleural sites, including the head and neck. Uniform overexpression of CD34 differentiates SFT from other spindle cell neoplasms. SFT is a slow-growing neoplasm that can be successfully treated by complete excision. A rare malignant counterpart has also been described.

STUDY DESIGN

In this case series and review of published cases from English-language journals in the National Library of Medicine, we reviewed 142 cases of SFT reported in English-language literature and add 11 new cases. We compared the features reported in the previous publications of SFT from the head and neck with our series, including cases described as malignant or atypical SFT.

RESULTS

Four out of 9 cases with positive margins recurred, whereas only 1 out of 10 cases with atypical or malignant features recurred.

CONCLUSIONS

An important finding in SFT of the head and neck is that recurrence appears more related to incomplete excision than to microscopic grade.

Intra- and extracranial solitary fibrous tumor of the trigeminal nerve: CT and MR imaging appearance

We describe a rare case of SFT existing along the mandibular division of the trigeminal nerve and extending down into the infratemporal fossa through the foramen ovale. The tumor showed heterogeneous hypointensity on T2-weighted images and marked enhancement on CT and MR images.

Solitary fibrous tumor arising from the sphenoid sinus

Solitary fibrous tumor (SFT) is an uncommon neoplasm that usually arises from the pleura. To our knowledge, only 30 cases of SFTs in the nasal cavity and paranasal sinuses have been reported in the literature. We describe an SFT that arose from the right sphenoid sinus and extended to the nasal cavity and epipharynx. The tumor was completely removed by endoscopic sinus surgery without complication. The patient is taking an uneventful course without any evidence of recurrence of the disease 8 months after surgery now.

Solitary fibrous tumor of the oral cavity: clinicopathologic and immunohistochemical study of 21 cases

We describe clinical, morphologic, and immunohistochemical features of 21 cases of solitary fibrous tumor presenting in the oral cavity. There were 9 male and 12 female patients with a median age of 51 years (range 37-83). The most common locations included the buccal mucosa (the most common site), lip, maxillary or mandibular vestibule and tongue. Histopathologic examination showed well-circumscribed tumors with two well-defined patterns: the classic pattern with densely cellular areas alternating with hypocellular areas in a variably collagenous, vascular stroma and a more uniformly sclerotic pattern with only subtle classic areas. The spindle-shaped neoplastic cells consistently showed immunoreactivity for antibodies directed against CD34. Five of nineteen cases (26%) were reactive for CD99 and 19 of 19 for Bcl-2. Follow-up information was available in 17 cases and averaged 54 months, with no evidence of recurrence or metastasis in any of these patients. Awareness that solitary fibrous tumor may present in the oral cavity is important so that confusion with other spindle cell neoplasms can be avoided. We also briefly describe the differential diagnosis and compare this series, the largest single series of intraoral SFT, to cases previously reported in the literature.

An unusual sinonasal tumor: soft tissue perineurioma

Soft tissue perineuriomas are an unusual type of peripheral nerve sheath tumors distinct from schwannomas and neurofibromas, with interesting histologic findings. They are not well characterized on radiographic examination. We report this case of a patient with sinonasal perineurioma to help define the imaging and pathologic features of this rare head and neck tumor.

Solitary fibrous tumor of the trachea: CT findings with a pathological correlation

We present the multidetector CT findings with a pathologic correlation for the case of a solitary fibrous tumor located in the trachea. The MDCT revealed a well-circumscribed intraluminal mass arising from the trachea, with strong nodular enhancement in the periphery of the mass. The enhancement pattern of the mass corresponded histopathologically to a focal hypocellular area in the center and prominent blood vessels along the periphery of the mass. We also present volume-rendered and virtual bronchoscopic images of this rare submucosal tracheal tumor.

An aggressive solitary fibrous tumor with evidence of malignancy: a rare case report

Solitary fibrous tumor (SFT) is rare mesenchymal neoplasm that has been originally and most often documented in the pleura. Recently, the ubiquitous nature of the SFT has been recognized with reports of involvement of numerous sites all over the body, i.e, upper respiratory tract, breast, somatic tissue, mediastinum, head, and neck, etc. The diagnosis of SFT still remains an enigma in our field. Furthermore, malignant SFT is extremely rare and only two cases have been reported in the oral cavity till date. Here, we present a rare case report of an aggressive solitary fibrous tumor which presented as a palatal mass and extended throughout the middle cranial fossa and exhibited features of malignancy.

Solitary fibrous tumor of the orbit: CT and MR imaging findings

BACKGROUND AND PURPOSE

Solitary fibrous tumor (SFT) is a rare spindle-cell neoplasm originating from mesenchymal fibroblast-like cells. The purpose of this study was to describe the CT and MR imaging features of SFTs in the orbit.

MATERIALS AND METHODS

We retrospectively reviewed CT and MR images in 6 patients (2 men and 4 women), aged 18 to 51 years, with SFT proved on histologic examination located in and around the orbit. All patients underwent CT (including dual-phase CT in 3), and MR imaging was obtained in 3. We evaluated the imaging findings with emphasis on the location, size, margin, internal architecture, and pattern of enhancement of the lesion.

RESULTS

All 6 lesions were found as a solitary, well-defined mass, ranging in size from 18 to 30 mm (mean, 24 mm). Three were located in the postseptal orbit, 2 in the lacrimal sac, and 1 on the lower eyelid. Compared with the cerebral cortex, all 3 lesions examined by MR imaging showed homogeneous isointense signal intensity on T1-weighted images and heterogeneous mixed isointense and hyperintense signal intensity on T2-weighted images. On visual inspection, all 6 lesions showed marked homogeneous (n = 4) or heterogeneous (n = 2) enhancement on postcontrast CT and MR images. In 3 patients examined with dual-phase CT, all lesions demonstrated rapid enhancement with early washout of contrast material.

CONCLUSION

SFT might be included in the differential diagnosis of soft tissue masses in the orbit, if one sees a markedly enhancing mass showing the similar characteristics to those of the internal carotid artery on postcontrast CT or MR images.

Solitary fibrous tumor of the buccal space: treatment with percutaneous cryoablation

Solitary fibrous tumors are rare spindle cell neoplasms that typically occur in the thorax but have been described in various locations within the abdomen and head and neck region. The most common extrapleural site is the oral cavity, but these tumors have been also described in the orbit, nasopharynx, paranasal sinuses, salivary glands, and larynx. We describe a case of a solitary fibrous tumor of the buccal space successfully treated with percutaneous CT-guided cryoablation.