Solitary fibrous tumor of the oral mucosa--morphological and immunohistochemical profile in the differential diagnosis with hemangiopericytoma

Oral and Extraoral Intermediate Tumors: Are MMP-9 and Ki-67 Biomarkers Correlated to Their High Recurrence Rates?

Intermediate tumors of the head and neck fall in the borderline category. They are clinically aggressive tumors with no malignant phenotyping. They are locally infiltrative and have high recurrence rate with less chances to metastasize. The standard care is surgical excision with wide margins. However, surgeons are challenged with the anatomic complexity of the head and neck, increasing the susceptibly of satellite cells being left behind. Ki-67 and MMP-9 are proliferative index and extracellular matrix degradation biomarkers, respectively. They are directly correlated to malignant tumors, whereas less associated with the benign ones. Our main objective was to correlate between Ki-67 and MMP-9 expressions and the recurrence rates in these borderline tumors. We performed a retrospective immunohistochemical study comparing the immunoexpression of Ki-67 and MMP-9. Tumors of interest were aggressive fibromatosis (AF, n=70), epithelioid hemangioendothelioma (EHE, n=25), hemangiopericytoma (HP, n=25), benign fibrous histiocytoma (BFH, n=80) and juvenile ossifying fibroma (JOF, n= 40). Our results revealed that AF followed by HP showed significant high levels of MMP-9 expression, with an average positive area percentage of 40% and 37.4% respectively, compared with other tumors (P<0.05). Ki-67 immunoreaction was significantly the lowest in AF (2.3%, P<0.05) and the highest in JOF (24.7%). To conclude, MMP-9 can be used as a possible target in these tumors as an adjuvant therapy to minimize recurrence rates.

Clinicopathological Features of Solitary Fibrous Tumours in the Extremities: Four Case Reports and a Literature Review

This paper reports on the clinicopathological features of four patients with solitary fibrous tumours arising from the extremities and presents a review of the relevant literature. The patients consisted of three women and one man, with a mean age of 47.8 years. Standard pre-operative work-up data were examined, including: history, clinical examination, plain radiography, computed tomography scans of the lesion and chest, magnetic resonance imaging, angiography, technetium-99m bone scan, thallium-201 scintigraphy and routine laboratory tests. Immunohisto chemical staining was performed for CD34, Bcl-2 protein, vimentin, S-100 protein, desmin and smooth muscle actin, and pathological material was reviewed for the presence of histologically malignant components. Immunohistochemically, all of the tumours were diffusely positive for CD34. Clinical and radiological findings of solitary fibrous tumours affecting the extremities are reminiscent of those of aggressive or malignant soft tissue tumours. Pathological and immunohistochemical studies are important in making the correct diagnosis.

Solitary fibrous tumor of soft tissue: a case report and immunohistochemical study

A case of solitary fibrous tumor (SFT) arising in the soft tissue of the left inguinal region is reported. A 57-year-old Japanese woman presented with a nonadherent, well-defined, oval mass that was 2 x 3 cm in diameter and located in the inguinal soft tissue. Microscopic evaluation showed proliferation of spindle-shaped, fibroblast-like cells by the coexistence of hypo- and hypercellular areas with mast cell infiltration separated by hemangiopericytoma-like blood vessels. Immunohistochemistry revealed strong expression of CD34 and CD99 in the fibroblast-like cells, supporting the diagnosis of SFT. Although the patient was free of symptoms such as hypoglycemia, immunoreactive insulin-like growth factor (IGF)-II was localized in the socalled Golgi area of the spindle-shaped cells. In conclusion, immunoreactive IGF-II was detected in SFT that was not associated with hypoglycemia.

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.

Diagnostic Dilemma: Solitary Fibrous Tumor or Hemangiopericytoma of the Submandibular Region in a Patient with Multiple Odontogenic Keratocysts

Solitary fibrous tumors (SFTs) are rare spindle cell neoplasms that originate from mesothelial-lined surfaces, mainly the pleura and peritoneum. SFT is a distinctive mesenchymal neoplasm of the pleura but can be found in extrapleural sites. The treatment of SFT is simple excision or wide local resection. This is the case study of a 14-year-old girl who presented with a large diffuse swelling in the left submandibular region, ultimately diagnosed with SFT and surgically excised.

A rare case of malignant solitary fibrous tumor of the spinal cord

STUDY DESIGN

Case report.

OBJECTIVE

We present a case of an ambulatory patient with a solitary fibrous tumor of the spinal cord.

SUMMARY OF BACKGROUND DATA

Solitary fibrous tumor (SFT) is an uncommon mesenchymal tumor of the pleural cavity, increasingly recognized at numerous extrathoracic sites, including, among others, prostate, kidney, and thyroid. The spinal cord is an extremely rare localization of SFTs with only 17 cases reported in the literature since 1996. Although SFTs are usually indolent neoplasms that are cured with complete surgical resection, malignant transformation has been described within histologically benign SFTs. However, no cases of malignant dissemination have been described in this localization.

METHODS

Discussion of the patient's clinical and radiologic history with a review of the relevant background literature.

RESULTS

We report the first case of spinal cord SFT with visceral dissemination years after the primary diagnosis, despite benign histologic features of the primary tumor.

CONCLUSION

This finding may indicate that long-term follow-up might be necessary in these patients. In addition, metastatic radical surgery of SFTs should be considered to achieve long-term survival since there are no currently available effective systemic therapies.

Solitary Fibrous Tumor of the Parapharyngeal Space

Solitary fibrous tumors are benign neoplasms of mesenchymal origin. They usually arise from the visceral or parietal pleura and peritoneum, although they have been found in many areas throughout the body. We report a case of solitary fibrous tumor of the parapharyngeal space. Microscopically, the tumor contained spindle cells with areas of marked hypercellularity without a definite pattern. Consistent with a benign lesion, there were few mitoses and no necrosis. The tumor cells stained strongly positive for CD34 and vimentin. At the 2-year follow-up, the patient was well and free of local and/or distant disease.

Myopericytoma of the oral cavity

BACKGROUND

Myopericytoma is a rare mesenchymal neoplasm of pericytic cells demonstrating myoid differentiation. The lesion typically arises within the subcutaneous tissue of the extremities. We report a case that, to the best of our knowledge, is the first case of myopericytoma involving the soft tissue of the oral cavity.

METHODS

A 36-year-old woman had a 5-mm sessile, whitish-pink, firm tongue nodule. The patient underwent excisional biopsy, and histopathologic examination as well as immunohistochemical analysis were performed.

RESULTS

The differential diagnosis by histologic analysis included solitary fibrous tumor, myofibroma, glomus tumor, and myopericytoma. The results of immunohistochemical analysis, when combined with the histologic features, led to a diagnosis of myopericytoma.

CONCLUSIONS

Applying strict morphologic criteria and appropriately selective immunohistochemical markers will help to distinguish myopericytoma in the oral cavity.

Solitary fibrous tumor of the orbit: Morphological, cytogenetic and molecular features

Solitary fibrous tumor (SFT), a benign neoplasm arising in mesenchymal structures, was initially described in the pleura but subsequently has also been documented in other locations. It is uncommon in the orbit, where it closely resembles other benign spindle-shaped mesenchymal tumors of this area such as schwannoma, meningioma or hemangiopericytoma. We present a case of orbital SFT in a 34-year-old woman. The radiological study showed the presence of an enhanced uptake lesion measuring 2 cm in major diameter. The histopathological evaluation revealed alternating cellular and hypocellular areas with spindle-shaped cells. The cellular organization displayed a broad variety of irregular morphological patterns. The neoplastic cells were intensely positive for CD34 and vimentin, while S100, epithelial membrane antigen (EMA), Caldesmon, Calretinin and WT-1 proved negative. The pericellular matrix exhibited strong positivity for CD44 and collagen IV. Scarce mitotic figures, a Ki-67 nuclear labeling index of <5%, and focal expression of p53 were also observed. Measurement of DNA content revealed a DNA index of 1, indicating a diploid peak in 95% of the tumor cells. A normal 46,XX karyotype was present. No TP53 (exons 5-8) mutations or MDM2 and CDK4 amplifications were observed. No p14(ARF), p15(INK4B) and p16(INK4A) deletions or hypermethylation were observed in this benign tumor. Following surgical resection and radiotherapy, the patient showed no tumor relapse after one year of follow-up.

Solitary fibrous tumor with pseudo-lipoblasts involving the sublingual gland: report of a case and review of the literature

Solitary fibrous tumors (SFTs) are mesenchymal neoplasms uncommonly occurring in the salivary glands. In rare instances, SFTs can contain mature fat, atrophic fat, or vacuolated cells previously termed 'pseudo-lipoblasts', which may be misinterpreted as a feature of malignancy. We report an unusual tumor with pseudo-lipoblasts occurring in the sublingual gland. The tumor exhibited a prominent hemangiopericytic pattern, bland cytology, and immunohistochemical and morphologic features consistent with that of an SFT. A review of 15 cases of SFTs of the salivary glands is presented. Emphasis is laid upon the histologic differential diagnosis and the clinical features of these tumors.

Solitary fibrous tumor of the retropharynx causing obstructive sleep apnea

Solitary fibrous tumors (SFTs) are rare, usually benign, spindle cell neoplasms that most often originate near mesothelium-lined surfaces of the pleural or peritoneal cavity. SFTs reported in the head and neck occur most commonly in the oral cavity, sinonasal tract, and orbit. We report a case of SFT of the retropharynx causing severe obstructive sleep apnea. The diagnostic and management strategies of SFTs are discussed.

Solitary fibrous tumour of the oral cavity with histological features of aggressiveness

We operated on a 65-year-old woman and removed a solitary fibrous tumour from her oral mucosa. Microscopically we found marked atypia, abundant necrosis, increased number of mitotic figures (>4 in 10 high-power fields) and hypercellularity. The tumour cells were strongly stained for CD34. There has been no recurrence after 18 months.

Haemangiopericytoma of the maxillary gingiva: report of a case

AIM

Haemangiopericytoma (HPC) represents approximately 3% of all tumours in the head and neck. This tumour is a soft tissue tumour derived from mesenchymal cells with pericytic differentiation. We present the clinicopathological findings of a case.

MATERIALS AND METHODS

A 69-year-old man was referred to our Department for a mass located on the right pre-molar maxillary gingiva; this mass caused problems during chewing, but was otherwise asymptomatic.

RESULTS

Clinical examination revealed a nodular, pink lesion, 3.5 cm in diameter, which was lined with normal mucosa. The lesion was mobile in relation to the deep and superficial tissues. Microscopic analysis of the neoplasm showed a vascular rich pattern, constituted by vessels covered with flat endothelium and surrounded by abundant spindly cells. On the basis of these histological and immunohistochemical findings, the final diagnosis was HPC.

CONCLUSIONS

HPC is an uncommon vascular tumour for which the biological behaviour is difficult to predict. In our patient, no recurrences or distant metastases were present at a 4 years follow-up.

Benign fibrous tumour of the parotid gland

The case of a 44-year-old man with left parotid enlargement that was initially diagnosed as cementifying fibroma is presented. The lesion was found in the deep lobe of the parotid gland and was successfully removed. Postoperatively, the patient recovered well with intact facial nerve function and remained asymptomatic after 1 year. Subsequent histology revealed the mass to be a benign fibrous tumour. The diagnosis and management of this rare entity are discussed.