Solitary Fibrous Tumors of the Pleura: Surgical Outcome and Clinical Course

Solitary fibrous tumor of the pancreas: a case report

Solitary fibrous tumor (SFT) is an unusual mesenchymal neoplasm that most often arises in the pleura; however, it has recently been described in a number of extrapleural sites. This report describes an extremely rare case of a benign SFT arising in the pancreas. A 41-year-old woman presented in the clinic with right upper abdominal pain. Subsequent ultrasonographic studies revealed a 1.5x1.5x1.4 cm hypoechoic mass within the pancreatic body, which was later confirmed on both helical computerized tomography and magnetic resonance imaging studies. An endocrine tumor was clinically suspected. Laparoscopic enucleation of the mass was performed. Microscopically, the tumor was composed of bland uniform spindle cells arranged between collagen bundles. On immunohistochemical studies, these spindle cells were positive for CD34 and bcl-2 but negative for cytokeratin (AE1+AE3 and Cam5.2), smooth muscle actin, desmin, S-100, and c-kit. Based on the light microscopic morphology and immunohistochemical staining profile, the diagnosis of SFT was rendered.

Cardiac intracavitary metastasis of a malignant solitary fibrous tumor: case report and review of the literature on sarcomas with left intracavitary extension

BACKGROUND

Solitary fibrous tumor (SFT) of the pleura with malignant progression occurs uncommonly. Cardiac intracavitary extension of tumors is rarely seen, with left side location being exceptional.

METHODS AND RESULTS

The authors report the first case of a malignant SFT metastatic to the heart occurring in a 74-year-old woman. The tumor first presented as a slow-growing pleural SFT that in 6 years reached a size of 16 cm. Two months after a complete surgical resection, the tumor was found to spread to the left atrium by intracavitary extension from the left upper pulmonary vein, simulating a cardiac myxoma. The primary tumor showed established features of malignancy including size greater than 10 cm; gross findings of necrosis; high cellularity, cytological atypia, and eight mitoses per 10 high-power fields. Immunohistochemical study revealed positivity of the tumor cells for CD34, bcl-2, and CD99. Aside from the present report, 52 previous cases of sarcoma with intracavitary extension to the left side of the heart have been described. Bone sarcoma is the type most frequently found. Peripheral arterial embolism can be a complication of advanced mesenchymal malignancy in 21% (11/53) of reported cases.

CONCLUSION

Accurate histopathologic recognition of this rare type of metastatic disease is important because of the adverse prognosis as compared to cardiac myxoma.

Advanced malignant solitary fibrous tumor in pelvis responding to radiation therapy

Solitary fibrous tumor (SFT) is a rare spindle cell neoplasm that is benign in most cases. Although SFT was first recognized to arise only in the pleura, recent reports indicate that SFT can involve a wide range of anatomical sites. To date, 17 cases of pelvic SFT have been reported. Herein is reported a case of a 74-year-old woman with a giant malignant SFT in the pelvis. Along with massive invasion to adjacent organs and multiple lung metastases detected on radiography, biopsy from the tumor through the vaginal wall showed malignant looking spindle-cell neoplasm with increased cellularity, areas of necrosis, and high mitotic activity (5/10 high-power fields). Immunohistochemically, the tumor cells were diffusely and strongly positive for CD34, CD99, and bcl-2. Based on pathological features and clinical presentation, diagnosis of malignant SFT was made. The patient received systemic and the intra-arterial chemotherapy followed by whole pelvic radiation therapy (50 Gy). Initial chemotherapies failed to control the tumor. Afterwards, improvement was observed radiologically and pathologically in the 12 months' follow up after the radiation therapy. This is the first report related to therapeutic remarks on advanced malignant SFT.

Solitary fibrous tumor of the thyroid gland

Solitary fibrous tumor (SFT) is a rare spindle-cell neoplasm more commonly involving the pleura, but recognized also in other tissues. Nineteen patients with SFT arising from the thyroid gland have been reported in the literature. The present report reviews these cases and discusses epidemiology, etio-pathogenesis, clinical-pathologic characteristics, differential diagnosis, therapy, and prognosis of thyroid SFT.

Solitary Fibrous Tumour of the Pleura

Solitary fibrous tumours of the pleura are rare tumours originating from the mesenchymal cells of the submesothelial tissue of the pleura. The tumours may present in a variety of ways, ranging from no symptoms, to local symptoms such as dyspnoea, cough and chest pain, through to systemic symptoms such as clubbing and hypoglycaemia. We present a case of a solitary fibrous tumour, which presented with clubbing.

Giant solitary fibrous tumour of the liver

Background

Solitary fibrous tumour (SFT) is an uncommon mesenchymal neoplasm that most frequently affects the pleura, although it has been reported with increasing frequency in various other sites such as in the peritoneum, pericardium and in non-serosal sites such as lung parenchyma, upper respiratory tract, orbit, thyroid, parotid gland, or thymus. Liver parenchyma is rarely affected. Clinically, SFTs cause symptoms after having reached a certain size or when vital structures are involved. In recent years, SFTs are more often identified and distinguished from other tumours with a similar appearance due to the availability of characteristic immunohistochemical markers.

Case presentation

In this manuscript we report the case of a large tumour of the liver, which was histologically diagnosed as a SFT, and showed involvement of a single hepatic segment. Because of the patient's presentation and clinical course, it may represent a radiation-induced lesion.

Conclusion

When a SFT has been diagnosed, surgery is the treatment of choice. The small number of patients with a SFT of the liver and its unknown natural behaviour creates the need to a careful registration and follow-up of all identified cases

MR imaging of solitary fibrous tumors in the head and neck

Objective

Solitary fibrous tumor (SFT) is a very rare tumor. The purpose of this study is to determine the MR imaging features of SFT in the intracranial and extracranial head and neck regions.

Materials and Methods

We retrospectively reviewed six MR images and two CT images of six histologically proven cases of SFT that occurred in four men and two women, and their ages ranged from 46 to 59 years. These imaging findings were correlated with the microscopic findings of their surgical specimens.

Results

Six SFTs arose in the meninges (the petrous ridge and the pituitary fossa), the parotid gland, the parapharyngeal space, the buccal space and the maxillary sinus. On the MR images, SFTs in the intracranial and extracranial head and neck regions were mostly isointense to the muscle on the T1-weighted images, they were hyperintense on the T2-weighted images and they all had intense enhancement. On the T1- and T2-weighted images, hypointense lines were observed within in five SFTs. On the CT images, the SFTs were hypodense to the muscle on the unenhanced images and they were heterogeneously enhanced on the contrast-enhanced images. An exceptional case of pituitary SFT was hypointense on the T2-weighted images and it was hyperdense on the unenhanced CT images, which correlated with the increased collagenous component and the cellular compactness.

Conclusion

The imaging features of SFT are nonspecific; however, SFT should be included in the differential diagnosis of masses involving the intracranial and extracranial head and neck regions.

Patterns of Recurrence and Long-Term Survival After Curative Resection of Localized Fibrous Tumors of the Pleura

BACKGROUND

Localized fibrous tumors of the pleura (LFTPs) are uncommon thoracic neoplasms with variable malignant potential that were previously classified as benign presentation of mesothelioma. We investigate the clinical presentation, recurrence patterns, and long-term survival of patients undergoing curative resection of LFTPs.

PATIENTS AND METHODS

Thirty-four patients underwent resection of LFTPs in the present study. There were 20 women and 14 men with a median age of 59 years (range, 35-81 years). The malignant potential of the tumor was estimated through histologic assessment of the degree of cellularity, mitotic activity, and nuclear pleomorphism. Patients' clinical outcomes were correlated to pathologic findings.

RESULTS

Seventeen patients (50%) were symptomatic, and 7 tumors (21%) were considered malignant by histologic characteristics. Ipsilateral pleural recurrence remote to the original tumor site occurred in 6 of these patients with malignant microscopic characteristics at a mean of 9 months after resection. Repeated resection was accomplished in 3 of these patients (range, 3-8 repeat operations). There have been no recurrences among the other 27 patients with benign histologic features, and 31 patients remain alive at a median follow-up of 34.5 months.

CONCLUSION

Histologic characteristics are helpful in estimating the risk of recurrence among patients with LFTPs. Close surveillance is recommended for patients with malignant histologic characteristics. Local recurrence is common without evidence of systemic spread among such patients. Surgical resection is definitive therapy; however, patients with tumors with histologic atypia require close postoperative observation because of the frequency of locoregional recurrence.