Laryngeal solitary fibrous tumour

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.

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 petrous bone: a successful treatment option

The patient was a 48-year-old man complaining about right hemicranial pain and deafness of 1 year's duration. MRI showed a solid well-vascularized mass destroying the mastoid and petrous bone, and with an epidural component that pulled the right cerebellar hemisphere. The patient underwent a right modified type A infratemporal approach, which allowed complete resection of the tumor, with a low morbidity. The pathological diagnosis was solitary fibrous tumor. The patient received complementary treatment with radiotherapy. At 24 months after the initial treatment the patient is free of disease. We conclude that solitary fibrous tumor of the petrous bone can be satisfactorily treated with surgical excision followed by radiotherapy, with low morbidity and excellent facial function. To our knowledge this is the first description of a solitary fibrous tumor of the petrous bone. Due to the lack of consensus in treating rare tumors, we want to offer this management approach for treating this kind of tumor.

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.