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Solitary fibrous tumors of the head and neck region revisited: a single-institution study of 20 cases and review of the literature. Hum Pathol 2020; 99:1-12. [PMID: 32217090 DOI: 10.1016/j.humpath.2020.03.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 03/07/2020] [Accepted: 03/16/2020] [Indexed: 01/18/2023]
Abstract
A solitary fibrous tumor (SFT) is a rare, NAB2-STAT6 fusion gene-associated mesenchymal neoplasm. It most commonly arises in the pleural site, but it can occur at many other sites, and rarely also in the head and neck (H&N) region. STFs may show many growth patterns and therefore can be easily mistaken for other more common H&N spindle cell or epithelial lesions. In this study, we present our experience in the diagnosis of 20 cases of SFT in the H&N region and discuss their most notable mimickers. In all cases, STAT6 expression was found positive by immunohistochemistry, and the NAB2-STAT6 fusion was confirmed by next-generation sequencing. Three major fusion variants were detected: NAB2ex2-STAT6int1 (5/20, 25%), NAB2ex6-STAT6ex16 (4/20, 20%), and NAB2ex4-STAT6ex2 (3/20, 15%). Clinical follow-up was available for 16 patients (median follow-up time: 84 months). One patient with a morphologically malignant SFT experienced multiple local recurrences, followed by dissemination into the lungs and meninges. This malignant SFT also displayed an aberrant FLI1 expression, which was not previously reported in SFT cases. We also summarize findings from 200 cases of SFT of the H&N region, which included cases from our study, and from previous studies that reported on the fusion status of the STAT6 gene. The results suggest that metastatic disease developed only in cases with STAT6 variants that included the DNA-binding domain (STAT6-full variants), which contradicts expectations from previous reports and deserves further investigation.
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A case of meningeal myxoid solitary fibrous tumor/hemangiopericytoma with unique NAB2-STAT6 fusion gene and symptomatic intratumoral hemorrhage. HUMAN PATHOLOGY: CASE REPORTS 2017. [DOI: 10.1016/j.ehpc.2017.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Oda Y, Yamamoto H, Kohashi K, Yamada Y, Iura K, Ishii T, Maekawa A, Bekki H. Soft tissue sarcomas: From a morphological to a molecular biological approach. Pathol Int 2017; 67:435-446. [DOI: 10.1111/pin.12565] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 07/05/2017] [Indexed: 01/07/2023]
Affiliation(s)
- Yoshinao Oda
- Department of Anatomic Pathology; Graduate School of Medical Sciences; Kyushu University; 3-1-1 Maidashi Higashi-ku Fukuoka 812-8582 Japan
| | - Hidetaka Yamamoto
- Department of Anatomic Pathology; Graduate School of Medical Sciences; Kyushu University; 3-1-1 Maidashi Higashi-ku Fukuoka 812-8582 Japan
| | - Kenichi Kohashi
- Department of Anatomic Pathology; Graduate School of Medical Sciences; Kyushu University; 3-1-1 Maidashi Higashi-ku Fukuoka 812-8582 Japan
| | - Yuichi Yamada
- Department of Anatomic Pathology; Graduate School of Medical Sciences; Kyushu University; 3-1-1 Maidashi Higashi-ku Fukuoka 812-8582 Japan
| | - Kunio Iura
- Department of Anatomic Pathology; Graduate School of Medical Sciences; Kyushu University; 3-1-1 Maidashi Higashi-ku Fukuoka 812-8582 Japan
- Department of Orthopedic Surgery; Graduate School of Medical Sciences; Kyushu University; 3-1-1 Maidashi Higashi-ku Fukuoka 812-8582 Japan
| | - Takeaki Ishii
- Department of Anatomic Pathology; Graduate School of Medical Sciences; Kyushu University; 3-1-1 Maidashi Higashi-ku Fukuoka 812-8582 Japan
- Department of Orthopedic Surgery; Graduate School of Medical Sciences; Kyushu University; 3-1-1 Maidashi Higashi-ku Fukuoka 812-8582 Japan
| | - Akira Maekawa
- Department of Anatomic Pathology; Graduate School of Medical Sciences; Kyushu University; 3-1-1 Maidashi Higashi-ku Fukuoka 812-8582 Japan
- Department of Orthopedic Surgery; Graduate School of Medical Sciences; Kyushu University; 3-1-1 Maidashi Higashi-ku Fukuoka 812-8582 Japan
| | - Hirofumi Bekki
- Department of Anatomic Pathology; Graduate School of Medical Sciences; Kyushu University; 3-1-1 Maidashi Higashi-ku Fukuoka 812-8582 Japan
- Department of Orthopedic Surgery; Graduate School of Medical Sciences; Kyushu University; 3-1-1 Maidashi Higashi-ku Fukuoka 812-8582 Japan
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Yang Y, Miller CR, Clement C, Hes O, Eyzaguirre E. Malignant solitary fibrous tumour of the kidney with lymph node and liver metastases. Pathology 2017; 49:450-453. [DOI: 10.1016/j.pathol.2017.01.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 01/09/2017] [Accepted: 01/16/2017] [Indexed: 11/26/2022]
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Ediriwickrema LS, Burnstine M, Saber MS, Rao N. Malignant solitary fibrous tumor of the orbit: Spectrum of histologic features. Am J Ophthalmol Case Rep 2017; 5:7-10. [PMID: 29503937 PMCID: PMC5757752 DOI: 10.1016/j.ajoc.2016.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 09/18/2016] [Accepted: 10/25/2016] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Primary malignant solitary fibrous tumor (SFT) of the orbit is a rare spindle cell neoplasm that requires excisional biopsy for histopathological diagnosis. We present a clinical case using contemporary immunohistochemical stains, report on the latest World Health Organization classification, and provide a review of the literature. OBSERVATIONS Report of a single case of a 65 year old male who presented with right-sided proptosis, limited adduction, ptosis, lateral globe displacement, and cheek festooning. Neuroimaging revealed a 2.2 cm, extraconal heterogeneous mass that diffusely enhanced.En-bloc tumor resection confirmed SFT malignancy based upon nuclear atypia, hypercellularity, and increased mitotic activity (13 mitotic figures/10 high powered fields). Ki-67 showed 2% nuclear staining in the benign tumor and 10-15% staining in the malignant counterpart. Immunohistochemical analysis revealed diffuse Stat6 positivity, CD 34 positivity with partial lack of staining within the malignant portion, S-100 positivity in the malignant portion, and overall negativity for CAM 5.2, desmin, actin, CD 31, and CD 117. CONCLUSIONS AND IMPORTANCE Immunoprofiling is helpful to making the diagnosis of malignant solitary fibrous tumor of the orbit. Complete tumor resection continues to be the preferred treatment. The behavior of extrathoracic SFT is unpredictable, and patients with SFT in all locations require careful, long-term follow-up.
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Affiliation(s)
| | - Michael Burnstine
- Department of Ophthalmology, University of Southern California, Los Angeles, CA, USA
- Eyesthetica, Oculofacial and Cosmetic Surgery Associates, Los Angeles, CA, USA
| | - Maria S. Saber
- Department of Ophthalmology, University of Southern California, Los Angeles, CA, USA
| | - Narsing Rao
- Department of Ophthalmology, University of Southern California, Los Angeles, CA, USA
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Nakada S, Minato H, Nojima T. Clinicopathological differences between variants of the NAB2–STAT6 fusion gene in solitary fibrous tumors of the meninges and extra-central nervous system. Brain Tumor Pathol 2016; 33:169-74. [DOI: 10.1007/s10014-016-0264-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 05/30/2016] [Indexed: 01/06/2023]
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Chuang IC, Liao KC, Huang HY, Kao YC, Li CF, Huang SC, Tsai JW, Chen KC, Lan J, Lin PC. NAB2-STAT6gene fusion and STAT6 immunoexpression in extrathoracic solitary fibrous tumors: the association between fusion variants and locations. Pathol Int 2016; 66:288-96. [DOI: 10.1111/pin.12408] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 03/10/2016] [Accepted: 03/15/2016] [Indexed: 12/26/2022]
Affiliation(s)
- I-Chieh Chuang
- Department of Anatomical Pathology
- Bone and soft tissue study group; Taiwan Society of Pathology
| | | | - Hsuan-Ying Huang
- Department of Anatomical Pathology
- Bone and soft tissue study group; Taiwan Society of Pathology
| | - Yu-Chien Kao
- Department of Pathology; Shuang Ho Hospital, Taipei Medical University; Taipei
- Bone and soft tissue study group; Taiwan Society of Pathology
| | - Chien-Feng Li
- Department of Pathology; Chi-Mei Medical Center; Tainan
- Bone and soft tissue study group; Taiwan Society of Pathology
| | - Shih-Chiang Huang
- Department of Anatomical Pathology; Chang Gung Memorial Hospital, Chang Gung University College of Medicine; Taoyuan
- Bone and soft tissue study group; Taiwan Society of Pathology
| | - Jen-Wei Tsai
- Department of Anatomic Pathology; E-Da Hospital; Kaohsiung Taiwan
- Bone and soft tissue study group; Taiwan Society of Pathology
| | - Ko-Chin Chen
- Department of Pathology; Changhua Christian Hospital; Changhua Taiwan
- Bone and soft tissue study group; Taiwan Society of Pathology
| | - Jui Lan
- Department of Anatomical Pathology
- Bone and soft tissue study group; Taiwan Society of Pathology
| | - Po-Chun Lin
- Department of Orthopedics; Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine; Kaohsiung
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Ichiyanagi O, Ito H, Takai S, Naito S, Kato T, Nagaoka A, Yamakawa M. A GRIA2 and PAX8-positive renal solitary fibrous tumor with NAB2-STAT6 gene fusion. Diagn Pathol 2015; 10:155. [PMID: 26337721 PMCID: PMC4559176 DOI: 10.1186/s13000-015-0386-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 08/25/2015] [Indexed: 01/20/2023] Open
Abstract
Solitary fibrous tumor (SFT) is a rare neoplasm composed of mesenchymal-derived spindle cells. Although SFT occurs anywhere in the body, they most frequently affects the thoracic region. Here, we reported an extremely rare case of an extrathoracic SFT occurring primarily in the kidney. To our knowledge, little information has been described on the immunohistochemistry (IHC) and genetics of renal SFT. A 41-year old Japanese female came to our hospital for further examination of a left kidney mass detected incidentally with ultrasound. Extensive investigation of the tumor, including physical, laboratory, and image examinations led to a clinical diagnosis of renal cancer (cT1aN0M0), which were in most parts imbedded in the lower polar parenchyma. The patient underwent laparoscopic radical nephrectomy. The mass was diagnosed pathologically as SFT originating from the kidney, but not as renal carcinoma. Microscopically, the tumor was composed of spindle-shape cells distributed variably in dense collagenous stroma and had a focal hemangiopericytomatous staghorn-like vascular pattern. Mitotic figures, atypical structures, necrosis and hemorrhage were not identified. No adjuvant therapies were given postoperatively. The patient has been free of tumor recurrence for 25 months since the surgery. IHC revealed that the tumor diffusely expressed CD34, CD99, Bcl2, PAX8, NAB2, STAT6, and GRIA2. The tumor stained negatively for desmin, S-100, c-Kit, CK-AE1/AE3, CDK4 and MDM2. A NAB2-SATA6 gene fusion was detected in tumor cells by reverse transcription-polymerase chain reaction, direct sequencing, and an in situ proximity ligation brightfield assay. The gene fusion occurred as an 831 bp truncation of exon 2 in NAB2 connected to the beginning of exon 3 in STAT6. We have reported a case of GRIA2 and PAX8-positive SFT occurring primarily in the kidney with such NAB2-STAT6 gene fusion for the first time. Diffuse expression of PAX8 in the tumor might present with a renal origin. Reportedly, benign histology of SFT cannot necessarily predict favorable clinical prognosis. Genetic alterations recently identified in SFT could possibly refer to risk stratification for tumor recurrence. However, malignant preponderance of extrathoracic SFT over thoracic SFT remains unexplained so far. Long-term follow-up after surgery should be performed in the present case.
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Affiliation(s)
- Osamu Ichiyanagi
- Department of Urology, Yamagata University Faculty of Medicine, 2-2-2, Iida-Nishi, Yamagata City, Yamagata prefecture, 990-9585, Japan.
| | - Hiromi Ito
- Department of Urology, Yamagata University Faculty of Medicine, 2-2-2, Iida-Nishi, Yamagata City, Yamagata prefecture, 990-9585, Japan.
| | - Satoshi Takai
- Department of Urology, Yamagata University Faculty of Medicine, 2-2-2, Iida-Nishi, Yamagata City, Yamagata prefecture, 990-9585, Japan.
| | - Sei Naito
- Department of Urology, Yamagata University Faculty of Medicine, 2-2-2, Iida-Nishi, Yamagata City, Yamagata prefecture, 990-9585, Japan.
| | - Tomoyuki Kato
- Department of Urology, Yamagata University Faculty of Medicine, 2-2-2, Iida-Nishi, Yamagata City, Yamagata prefecture, 990-9585, Japan.
| | - Akira Nagaoka
- Department of Urology, Yamagata University Faculty of Medicine, 2-2-2, Iida-Nishi, Yamagata City, Yamagata prefecture, 990-9585, Japan.
| | - Mitsunori Yamakawa
- Department of Pathological Diagnostics, Yamagata University Faculty of Medicine, 2-2-2, Iida-Nishi, Yamagata City, Yamagata prefecture, 990-9585, Japan.
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