Laryngeal solitary fibrous tumor treated with CO2 laser excision: case report

Laryngeal solitary fibrous tumour: diagnostic challenge in a rare presentation

Solitary fibrous tumours (SFT) are rare spindle cell mesenchymal neoplasms, most commonly appearing as well-circumscribed localised lesions arising from the abdominal or pelvic peritoneum. Their presence in the head and neck region is very rare; even more so in the post-cricoid region, with only one case described in the literature to date. The clinical behaviour of SFT may vary from benign to malignant, but only 10-15% of SFT demonstrate local recurrence or distant metastasis. The usual presenting symptoms of dysphagia and weight loss are very vague to give a definite diagnosis, and examination, even under general anaesthesia, combined with biopsies can sometimes be misleading, as in our case. Here, we describe a very challenging case of supraglottic SFT originating from the post-cricoid area. Our 73-year-old patient presented with dysphagia and upon examination a large supraglottic mass was revealed. Biopsies from the mass pointed to malignancy and the patient underwent total laryngectomy. The laryngeal specimen contradicted the biopsy and revealed a rare solitary fibrous tumour with benign features and thus adjuvant treatment was not necessary. Ever since the patient has been attending regular follow-up sessions and remains disease-free 18 months after surgery.

Solitary Fibrous tumor of Nasal cavity: A case report and review of literature

Introduction and importance

Solitary fibrous tumors (SFTs) involving the nasal cavity are extremely rare with few cases reported in the literature.

Case presentation

We present a case of SFT in a 90 year-old male complaining of a slow-growing mass prolapsing through left nostril. Nasal endoscopy and imaging exams revealed a mass occupying the entire left nasal cavity, pushing the nasal septum to the opposite side and extending up to the nasopharynx. Biopsy specimen examination reported sarcoma. The patient underwent complete surgical resection of the mass through left para-latero-nasal approach. Immuno-histochemical analyses confirmed the diagnosis of SFT. The patient has remained free of tumor 2 years after surgery.

Clinical discussion

Clinical and imaging features of SFTs of nasal cavity are not specific. A broad of differential diagnosis is associated with histopathologic features of SFTs. Therefore, immuno-histochemical analyses are crucial to confirm the diagnosis. Complete resection of the mass with clear margins is mandatory to minimize local recurrence.

Conclusion

SFTs of nasal cavity are very rare neoplasms which continue to pose challenges to practitioner. Pathological examination and mainly immunohistochemical studies are important to establish the diagnosis. Complete resection of the tumor is the key for good outcome.

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Solitary fibrous tumors of nasal cavity are very uncommon neoplasms.

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Clinical and imaging features are not specific.

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Diagnosis is based on immunohistochemical analyses.

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Malignant behavior cannot be predicted even in the absence of atypical histologic features.

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Complete resection of the tumor with clear margins and long term surveillance after surgery are mandatory.

Laryngeal Solitary Fibrous Tumor: A Case Report and Systematic Review

OBJECTIVES/HYPOTHESIS

Solitary fibrous tumors are spindle cell neoplasms of mesenchymal origin that rarely occur in the larynx and may be mistaken for other pathologies. This case presentation and systematic review investigates presentation, treatment modalities, and outcomes of this unusual tumor.

STUDY DESIGN

Systematic review of PubMed, CINAHL, Web of Science, and EMBASE including a novel case presentation METHODS: A systematic search according to the PRISMA guidelines was performed to isolate the reports of solitary fibrous tumors arising in the larynx and its subsites. Variables analyzed included patient demographics, presenting symptoms, smoking status, concurrent tumors, imaging studies, biopsy results, treatment, outcomes, and follow-up. Our additional report provides the second such description of this lesion originating within the true vocal fold.

RESULTS

Systematic review revealed 21 previous reports of solitary fibrous tumors originating from laryngeal subsites. The most common presenting symptom was dysphonia. All patients underwent local excision. Two patients had recurrences. Our patient presented with progressive dysphonia over 4 years. Stroboscopic examination revealed a large translucent mass of the left vocal fold. Local excision of the tumor was achieved with transoral resection with KTP laser. Immunohistochemical staining demonstrated a strong positivity for CD34 and HMW CK34BE12. Nine-month follow-up has not revealed any evidence of persistent or recurrent disease.

CONCLUSION

Laryngeal solitary fibrous tumors are rare and are unlikely to recur in the absence of malignant findings. Complete surgical resection is an acceptable treatment for this lesion accompanied by appropriate follow-up.

Solitary fibrous tumour of the supraglottic larynx

Solitary fibrous tumour (SFT) is a rare, benign, mesenchymal neoplasm that usually arises in the pleura, but rarely involves other sites outside the serosal space (mediastinum, lung, liver, thyroid gland); larynx involvement is very rare with only sporadic cases reported in the literature. We report a case of SFT in a 41-year-old woman with supraglottic laryngeal invovlement; symptoms included dysphonia and mild odynophagia lasting 2 years, and fibre-optic laryngeal evaluation showed a sub-mucosal mass involving the left supraglottis and medial wall of the pyriform sinus. MRI represents the gold standard tool for differential diagnosis (with schwannoma, paraganglioma and haemangioma) and correct staging, while immunohistochemical and cytomorphologic analysis (bcl-2 and CD34 positivity in 90% of cases) is needed for definitive diagnosis. Surgery is the main treatment (endoscopic and open conservative technique), and its goal is a balance between safe oncological resection and good preservation of laryngeal functions; in this particular case an open laryngeal approach was scheduled due to the size of the tumour. Prognosis is good and in only a few cases (especially in pleural SFT) does the biological behaviour take a malignant course.

Solitary fibrous tumor of the submandibular region

Solitary fibrous tumors (SFTs) are a rare type of neoplasm that originate from the pleura. Although SFTs may occur in a variety of extrathoracic regions, they are considered to be rare in the submandibular region. The current study presents the case of a 39-year-old female with a 3×4-cm, fibro-elastic, movable, painless nodule in the right side of the submandibular region. The patient exhibited no other clinical manifestations in the head and neck region. A computed tomography scan demonstrated the presence of a well-defined, slightly low-density nodular shadow measuring 2.6×3.3×3.8 cm, in proximity to the right submandibular gland, with mild contrast enhancement and no association with the adjacent lymph nodes. The lesion was surgically excised, and following histopathological and immunohistochemical analysis, immunohistochemical staining determined that the lesion was positive for cluster of differentiation (CD)34, CD99 and vimentin, and negative for desmin, CD31 and S-100; therefore, a diagnosis of an SFT was determined. The patient has so far been followed up for 22 months, with no signs of recurrence or metastases. The present study also discusses the clinical, histopathological and immunohistochemical features, treatment strategies and potential clinical outcomes of SFTs. The study proposes that, although rare, SFTs of the submandibular region should be included in the differential diagnosis of soft-tissue tumors in the submandibular region.

Solitary fibrous tumor of the postcricoid region: a case report and literature review

Solitary fibrous tumor (SFT) is a rare mesenchymal neoplasm that can present essentially anywhere in the body. Presentations in the hypopharynx are extremely rare with only two previous cases reported. We report the first case of postcricoid SFT occurring in a 58-year-old male requiring a microsuspension laryngoscopy excision following an unsuccessful transoral robotic attempt. The excision was uneventful, and the patient is currently without recurrence. Current management strategies of the hypopharyngeal SFT, the unique differential diagnosis, and challenges in surgical approaches in the postcricoid region are discussed.

Malignant solitary fibrous tumor of the nasal cavity

Solitary fibrous tumors (SFTs) are unusual mesenchymal tumors that were first described as primary spindle-cell neoplasms of the pleura. These tumors have been described in many other locations, including the urogenital system, orbit, mediastinum, and upper respiratory tract. Twenty-two cases of an SFT of the paranasal sinuses and nasal cavity have been reported, but none described a malignant SFT extending through the anterior skull base. A 70-year-old man had a 6-month history of unilateral left-sided epiphora and nasal obstruction. Computed tomography and magnetic resonance imaging showed a large left-sided nasal cavity mass with extension into the left extraconal orbit and intracranial extension through the left cribriform plate and ethmoid roof. The patient underwent preoperative embolization of the internal maxillary artery and a subsequent anterior craniofacial resection via a midfacial degloving approach and a left anterior craniotomy. Histopathological analysis of the specimen was consistent with a malignant SFT.

Solitary fibrous tumour of the larynx: a case report

INTRODUCTION

Solitary fibrous tumour (SFT) of the larynx is a rare benign mesenchymal tumour of adults. The diagnosis is based on a combination of histological and immunohistochemical signs.

CASE REPORT

The authors report the case of a patient with chronic laryngeal dysphonia and dyspnoea related to supraglottic SFT.

DISCUSSION/CONCLUSION

The main challenge of surgery is to ensure healthy resection margins to avoid recurrence while preserving the functions of the upper aerodigestive tract. Surgery is the treatment of choice and provides an excellent prognosis. Long-term clinical follow-up is required to detect rare recurrences.

CT, MR, and angiography findings of a solitary fibrous tumor of the larynx: a case report

This report details the CT, MR, and angiography findings of a solitary fibrous tumor involving the larynx of a 34-year-old man. A precontrast CT scan revealed a well-defined isodense mass in the submucosal region of the supraglottic larynx. The tumor appeared as a mixed intensity lesion on the T1- and T2-weighted MR images. A T2-weighted MR image showed a central, round, and low signal intensity area within the mass. For both the CT and MR images, the mass demonstrated heterogeneous enhancement following the administration of contrast material. The angiography showed a hypervascular tumor with heterogeneous persistent staining.

Solitary fibrous tumor of the larynx

BACKGROUND

True mesenchymal, non-cartilaginous neoplasms of the larynx are rare. Extrapleural solitary fibrous tumor (SFT) is a localized neoplasm characterized by proliferation of thin-walled vessels and collagen-producing cells and is considered within the "hemangiopericytoma-solitary fibrous tumor" spectrum. SFT primary in the larynx is exceptional.

DESIGN

Case report set in a comparison with other cases reported in the English literature (MEDLINE 1966 to 2007).

RESULTS

A 49-year old white male presented with difficulty breathing, progressive over the past 2 years. He denied dysphagia and weight loss. Past medical history was significant for asthma. He denied cigarette smoking or alcohol abuse. There were no cervical deformities on physical exam. Fiberoptic laryngoscopy was performed upon stabilization of respiratory function. A smooth, round, submucosal mass measuring 2.3 cm in greatest diameter arising from the inferior surface of left true vocal cord was causing near total obstruction of the endolaryngeal space. The mass was excised. The surface mucosa was intact and unremarkable. A cellular, spindle cell neoplasm was arranged in loose fascicles, associated with heavy collagen fiber deposition. The collagen was wiry and heavy. Cells were bland with cytoplasmic extensions. The nuclei were vesicular to hyperchromatic and elongated with inconspicuous nucleoli. Vessels were prominent and delicate, with patulous spaces. Mitotic figures were easily identified, but atypical forms were not present. The cells were strongly and diffusely immunoreactive with CD34 and bcl-2, while non-reactive with cytokeratin, EMA, actin, ALK-1, S100, desmin, and CD117. These findings confirmed a diagnosis of extraplural solitary fibrous tumor. Without further disease, the patient is alive without evidence of disease, 12 months after surgery.

CONCLUSIONS

The characteristic histologic pattern of solitary fibrous tumor can be noted in extrapulmonary locations. Development in the larynx is uncommon, but the tumor presents as a polypoid mass with characteristic histologic and immunophenotypic features. Conservative local excision is the treatment of choice to yield an excellent prognosis.

[A rare tracheal tumour: solitary fibroma]

INTRODUCTION

Solitary fibromas are rare anatomo-pathological entities, described initially in the pleural cavity. The mesenchymal origin of these tumours explains their widespread distribution.

CASE REPORT

The authors report a case of solitary fibroma of the trachea in a woman of 30 years of age, presenting as acute respiratory distress and preceded by a 2 year history of episodes of dyspnoea diagnosed as unstable asthma. CT and MRI imaging showed evidence of a localised tracheal tumour without mediastinal infiltration. The images and macroscopic appearances were non-specific. Bronchoscopic resection of the tumour gave immediate relief of the symptoms. Histology, which was positive for anti-CD34 antibodies and negative for epithelial, muscular and neurological markers, led to a diagnosis of solitary fibroma with no evidence of malignancy.

CONCLUSION

To our knowledge, this observation is the first description of a primary solitary fibroma localised to the trachea. The clinical and radiological features are no different from those of other tracheal tumours. After excision, the prognosis is good but long-term follow-up is necessary on account of the risk of local recurrence or metastasis.

Laryngeal solitary fibrous tumour

Solitary fibrous tumours (SFT) are rare neoplasms, with an uncommon laryngeal involvement. Only five cases of laryngeal localization have been described in literature. The following is a case of a 75-year-old man with a supraglottic neoplasm of the larynx; after the biopsy immunohistochemical study demonstrated a strong positivity for vimentin, CD34 and Bcl-2. The neoplasm was consequently classified as a SFT. CO(2) laser surgery of the supraglottic larynx, with a wide excision of the neoplasm, was performed. Twenty-four months on, the patient is alive, well and free of disease. Surgical resection is the treatment of choice for laryngeal SFT, but tumour-free resection margins must be achieved to prevent the possibility of local recurrence. Endoscopic resection by means of the CO(2) laser must be accurately planned with MRI or CT imaging to confirm of this kind of surgery.

Solitary fibrous tumor of the larynx: a case report and review of the literature

Solitary fibrous tumors are relatively rare mesenchymal neoplasms that were originally described as pleural- or peritoneal-based lesions. Although they were considered a form of mesothelioma, subsequent investigation failed to reveal mesothelial differentiation. Characterization of their histologic and immunohistochemical features, as well as identification in a multitude of nonmesothelial-based locations has further served to distinguish these lesions from the more diffuse and aggressive mesothelioma. Reports of solitary fibrous tumor in the larynx are extremely rare. We report a case of solitary fibrous tumor of the larynx in a 38-year-old man.