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Chung HR, Tam K, Han AY, Obeidin F, Nakasaki M, Chhetri DK, St John MA, Kita AE. Solitary Fibrous Tumors of the Head and Neck: A Single-Institution Study of 52 Patients. OTO Open 2022; 6:2473974X221098709. [PMID: 35845143 PMCID: PMC9280824 DOI: 10.1177/2473974x221098709] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 04/15/2022] [Indexed: 11/29/2022] Open
Abstract
Objective To evaluate the clinicopathologic characteristics of head and neck solitary fibrous tumors and features that may predict tumor recurrence. Study Design Retrospective review. Setting University of California–Los Angeles Medical Center. Methods A single-center retrospective study was conducted on pathologically confirmed cases of head and neck solitary fibrous tumors between 1996 and 2021. Patient demographics, clinical course, and histopathologic features were evaluated. Recurrence-free survival was estimated via Kaplan-Meier analysis. Results A total of 52 patients were reviewed. The average patient age was 54.7 years (range, 15-89). The most common subsite was the orbit (53.8%, n = 28), but other involved areas included the nasopharynx, paranasal sinuses, and scalp. The median tumor size was 2.95 cm (range, 1.3-11.2). Strong STAT6 (100%) and CD34 (97.9%) expression was observed on immunohistochemistry. Almost all patients were initially managed with wide local excision; 82% of patients (n = 14) had positive margins on pathologic review; and 15% (n = 4) had recurrence at a median 28.5 months (range, 10-113). White patient race was the only significant predictor of tumor recurrence. Patient age (≥55 years), tumor size (≥4), high mitotic rate, and disease subsite were not associated with recurrence. Conclusion Head and neck solitary fibrous tumors demonstrate a significantly larger local recurrence rate as compared with their rate of metastasis. They can recur many years following initial therapy, warranting long-term surveillance and follow-up to assess for tumor recurrence.
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Affiliation(s)
- Hye Rhyn Chung
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Kenric Tam
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Albert Y. Han
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Farres Obeidin
- Department of Pathology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Manando Nakasaki
- Department of Pathology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Dinesh K. Chhetri
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- UCLA Head and Neck Cancer Program, Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Maie A. St John
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- UCLA Head and Neck Cancer Program, Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Department of Biomedical Engineering, University of California–Los Angeles, Los Angeles, California, USA
| | - Ashley E. Kita
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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2
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Suh YJ, Park JH, Jeon JH, Bilegsaikhan SE. Extrapleural solitary fibrous tumor of the thyroid gland: A case report and review of literature. World J Clin Cases 2020; 8:782-789. [PMID: 32149061 PMCID: PMC7052546 DOI: 10.12998/wjcc.v8.i4.782] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/13/2020] [Accepted: 01/18/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Solitary fibrous tumor (SFT) is an uncommon mesenchymal neoplasm that arises from the pleura. A few SFTs have also been described in extrapleural sites. However, SFT of the thyroid gland is rare. Here, we report a case of extrapleural SFT on the thyroid gland, in addition to a literature review.
CASE SUMMARY A 59-year-old man visited our hospital in July 2017 complaining of a large mass in his neck. His thyroid function test results, including antibody levels, were within the normal limits. Ultrasonography showed a 4.7 cm × 4.0 cm × 3.2 cm solitary mass of intermediate suspicion in the left thyroid lobe. A fine-needle aspiration biopsy was subsequently performed. The pathologist reported a benign follicular lesion. However, the size of this nodule increased to 5.5 cm × 5.0 cm × 3.4 cm by April 2018. After a multidisciplinary discussion, a left lobectomy was performed in May 2018. The specimen showed a well-demarcated, partly encapsulated, soft nodule of whitish and tan/brown color on the cut surface. Light microscopy revealed high cellularity with moderate cytologic atypia. The mitotic count was 5/10 high-power fields. There was no tumor necrosis or lymphovascular invasion. The tumor was CD34-positive and signal transducer and activator of transcription 6-positive. Neither thyroid transcription factor-1 nor cytokeratin expression was detected. The Ki-67 showed intermediate proliferative activity. The final diagnosis was extrapleural SFT of the thyroid gland with a clear resection margin. The patient was discharged without complication three days after the surgery.
CONCLUSION In the literature, extrapleural SFT of the thyroid gland has been reported to behave indolently with the capacity for recurrence and rare metastasis, although surgical resection is the treatment of choice. Understanding this disease entity is important for accurate diagnosis and proper management.
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Affiliation(s)
- Yong Joon Suh
- Department of Breast and Endocrine Surgery, Hallym University Sacred Heart Hospital, Gyeonggi-do 14068, South Korea
| | - Jung Ho Park
- Department of Breast and Endocrine Surgery, Hallym University Sacred Heart Hospital, Gyeonggi-do 14068, South Korea
| | - Jae Hyeon Jeon
- Department of Biomedical Science, Hallym University, Chuncheon 24252, South Korea
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3
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Thompson LDR, Wei C, Rooper LM, Lau SK. Thyroid Gland Solitary Fibrous Tumor: Report of 3 Cases and a Comprehensive Review of the Literature. Head Neck Pathol 2019; 13:597-605. [PMID: 30758754 PMCID: PMC6854167 DOI: 10.1007/s12105-019-01012-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 01/14/2019] [Indexed: 02/07/2023]
Abstract
Solitary fibrous tumors of the thyroid gland are exceptionally rare. In order to further characterize the clinical and pathologic features of solitary fibrous tumor arising at this anatomic site, three cases of thyroid gland solitary fibrous tumor were analyzed in conjunction with 35 cases compiled from the English literature. Thyroid gland solitary fibrous tumors showed an equal sex distribution with a mean age at presentation of 54.4 years (range, 28-88 years). The patients typically presented with an asymptomatic, slow growing neck mass. Microscopically, the tumors were characterized by cytologically bland spindle cells with patternless growth, hypocellular and hypercellular areas, variable amounts of collagen, and ectatic, branching blood vessels. Two previous reported tumors were considered to be histologically malignant on the basis of increased mitotic activity, profound pleomorphism and tumor necrosis. Immunohistochemically, the tumor cells are variably positive with CD34, bcl-2, and CD99. STAT6 immunohistochemistry, performed on the current cases, demonstrated a strong, diffuse nuclear expression in all tumors. Among 26 patients with available follow up data (mean 47.3 months), one developed local recurrence and distant metastasis. Solitary fibrous tumors occurring in the thyroid gland are uncommon, but can be reliably diagnosed based on the presence of characteristic morphologic features as well as immunohistochemical expression of STAT6 and CD34. The majority of thyroid gland solitary fibrous tumors have exhibited an indolent clinical course, however experience is limited. The rare potential for aggressive clinical behavior requires clinical surveillance.
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Affiliation(s)
- Lester D. R. Thompson
- Southern California Permanente Medical Group, Department of Pathology, Woodland Hills Medical Center, 5601 De Soto Avenue, Woodland Hills, Los Angeles, CA 91365 US
| | - Christina Wei
- Southern California Permanente Medical Group, Department of Pathology, Woodland Hills Medical Center, 5601 De Soto Avenue, Woodland Hills, Los Angeles, CA 91365 US
| | - Lisa M. Rooper
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD US
| | - Sean K. Lau
- Southern California Permanente Medical Group, Department of Pathology, Orange County-Anaheim Medical Center, Anaheim, CA US
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4
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Lee J, Kazmi S, VandenBussche CJ, Ali SZ. Mesenchymal neoplasms of the head and neck: a cytopathologic analysis on fine needle aspiration. J Am Soc Cytopathol 2017; 6:105-113. [PMID: 31043260 DOI: 10.1016/j.jasc.2017.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 03/12/2017] [Accepted: 03/13/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Fine-needle aspiration (FNA) is commonly used to diagnose mass lesions discovered in the head and neck (H&N). Soft tissue neoplasms (STNs) are less common than epithelial tumors in this anatomic zone and often cause diagnostic difficulty when encountered in routine practice. In this study, we examine the frequency of H&N STNs at our institution and describe their cytomorphologic characteristics and clinical correlates. METHODS 115 FNA specimens from 115 patients with STN of the H&N region were identified (2005-2015) from archives of The Johns Hopkins University Hospital. When available, slides from these cases were reviewed and any corresponding clinical and radiologic data was evaluated. RESULTS A total of 95 (83%) STNs were found to be primary to the H&N region and 20 (17%) were metastatic from distant sites. Of these 95 cases, 58 (61%) primary lesions were benign and 37 (39%) were malignant. The most common STNs were benign nerve sheath tumors, representing 40 (35%) cases: 30 schwannomas, 4 neurofibromas, and 6 were not further classified. The most aggressive neoplasms in terms of clinical outcome were leiomyosarcoma, Ewing sarcoma, synovial sarcoma, and chondrosarcoma. In 35 (60%) of the malignant cases and 25 (54%) of the benign cases a subsequent surgical resection was performed. CONCLUSIONS H&N can be involved by a wide range of primary and metastatic STNs. benign nerve sheath tumors are the most common STNs found on FNA in this region. Although not always definitively diagnostic, FNA of STNs can often provide a differential diagnosis that can help guide the need for an excision and/or further treatment.
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Affiliation(s)
- James Lee
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Samia Kazmi
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Syed Z Ali
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
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5
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Künzel J, Hainz M, Ziebart T, Pitz S, Ihler F, Strieth S, Matthias C. Head and neck solitary fibrous tumors: a rare and challenging entity. Eur Arch Otorhinolaryngol 2015; 273:1589-98. [PMID: 26026772 DOI: 10.1007/s00405-015-3670-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Accepted: 05/25/2015] [Indexed: 02/08/2023]
Abstract
The objective of this study is to analyze the outcome of treatment for solitary fibrous tumors (SFTs) in the head and neck area. SFTs present as slow-growing masses, often with local compressive symptoms that are difficult to distinguish from other soft-tissue tumors. SFTs are commonly treated using local excision without adjuvant therapy. To date, only heterogeneous small series have been published, documenting the treatment results and outcome with these tumors. Retrospective study of patients with histopathologically confirmed SFT treated at two tertiary referral hospitals between 2004 and 2014. Eight men and four women with histologically confirmed SFT were identified in the records. Their age range was 37-82 years (mean 57.8 years). The mean follow-up period for eight patients was 6.75 years (range 1-24 years). Four patients were lost to follow-up. Sublocalizations were neck (n = 3), orbit (n = 2), paranasal sinus (n = 2), cheek (n = 2), hard palate (n = 1), parotid gland (n = 1), and tongue (n = 1). The first-line treatment for all of the tumors identified was surgical excision. In four cases, the surgical margins were narrow or unclear due to piecemeal resection in the paranasal sinus and orbit (n = 3) or a tumor location deep in the parapharyngeal space (n = 1). Recurrences developed in two of these cases (in the orbit and parapharyngeal space), and the other two patients were lost to follow-up. Radiotherapy and chemotherapy were not administered as first-line treatments. Overall, the local recurrence rate (n = 2/8) was 25 %. The disease-specific survival rate was 100 %. These results are consistent with the literature data and show that safe surgical excision, without opening of the tumor capsule, reduces the risk of local recurrence and leads to a favorable outcome. Tumors in the head and neck often represent a surgical challenge, and wide surgical margins are rarely possible due to the complex three-dimensional anatomic compartments in the region. Head and neck surgeons should therefore be aware that there is an increased risk of recurrence in these patients; tightly scheduled follow-up visits are mandatory for at least 10 years, if not longer. Radiotherapy only appears to be an option in patients with unresectable tumors or when wide surgical excision would cause severe functional morbidity.
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Affiliation(s)
- Julian Künzel
- Department of Otorhinolaryngology and Head and Neck Surgery, Mainz University Hospital, Langenbeckstrasse 1, 55101, Mainz, Germany.
| | - Michael Hainz
- Department of Pathology, Mainz University Hospital, Mainz, Germany
| | - Thomas Ziebart
- Department of Maxillofacial Surgery, Mainz University Hospital, Mainz, Germany
| | - Susanne Pitz
- Department of Ophthalmology, Mainz University Hospital, Mainz, Germany
| | - Friedrich Ihler
- Department of Otorhinolaryngology, University of Göttingen Medical Center, Göttingen, Germany
| | - Sebastian Strieth
- Department of Otorhinolaryngology and Head and Neck Surgery, Mainz University Hospital, Langenbeckstrasse 1, 55101, Mainz, Germany
| | - Christoph Matthias
- Department of Otorhinolaryngology and Head and Neck Surgery, Mainz University Hospital, Langenbeckstrasse 1, 55101, Mainz, Germany
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6
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Alves Filho W, Mahmoud RRDGL, Ramos DM, Araujo-Filho VJFD, Lima PPD, Cernea CR, Brandão LG. Malignant solitary fibrous tumor of the thyroid: a case-report and review of the literature. ACTA ACUST UNITED AC 2015; 58:402-6. [PMID: 24936737 DOI: 10.1590/0004-2730000003230] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 02/27/2014] [Indexed: 12/22/2022]
Abstract
Solitary fibrous tumor (SFT) is an uncommon spindle-cell neoplasm that most often involves the pleura, rarely occurring in extra-thoracic locations. Twenty-six cases of SFT arising in the thyroid gland have been described. We report a case of a 60-year-old woman presenting an 8-month history of enlargement of the neck associated with dysphagia. The patient underwent a right hemithyroidectomy and SFT of the thyroid was diagnosed. Immunohistochemistry showed positivity for CD34 marker, and the high number of mitoses and the presence of cellular atypia suggested that the tumor was malignant. To our knowledge, this is the second case of malignant SFT of the thyroid gland ever reported. Due to the rarity of these tumors, the indication of adjuvant therapy and prognosis are uncertain. Long-term follow-up after surgical resection seems to be advisable.
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Affiliation(s)
- Wellington Alves Filho
- Department of Head and Neck Surgery, School of Medicine, University of Sao Paulo, Sao Paulo, SP, Brazil
| | | | - Daniel Marin Ramos
- Department of Head and Neck Surgery, School of Medicine, University of Sao Paulo, Sao Paulo, SP, Brazil
| | | | | | - Claudio Roberto Cernea
- Department of Head and Neck Surgery, School of Medicine, University of Sao Paulo, Sao Paulo, SP, Brazil
| | - Lenine Garcia Brandão
- Department of Head and Neck Surgery, School of Medicine, University of Sao Paulo, Sao Paulo, SP, Brazil
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7
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Solitary fibrous tumor of the thyroid gland. Med Mol Morphol 2013; 47:117-22. [PMID: 24013381 DOI: 10.1007/s00795-013-0056-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 08/20/2013] [Indexed: 12/19/2022]
Abstract
Solitary fibrous tumor is a spindle cell neoplasm rarely arising in the thyroid gland. We present a 78-year-old man with the diagnosis of solitary fibrous tumor of the thyroid gland resected by subtotal thyroidectomy. Fine needle aspiration cytology via ultrasound guidance demonstrated a hypocellular aspirate that revealed follicular epithelial cells with mild nuclear atypia and scattered spindle cells with bland nuclei. Histologically, the patternless proliferation of spindle cells was seen among collagenous bundles, accompanied by hemangiopericytomatous vessels, and variously dilated follicles with mild atypical cells having slightly enlarged nuclei, indicating adenomatous goiter. The neoplastic spindle cells showed diffuse immunoreactivity to CD34, bcl-2, CD99 and vimentin, but were negative for cytokeratins, calcitonin, TTF-1 and CD5. Although solitary fibrous tumor arising in thyroid gland is rare, this tumor should be included in the differential diagnosis of thyroid spindle cell tumors and also that of adenomatous.
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8
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Lin MW, Wu CT, Lee YH, Chang YL. Intrathoracic thyroid solitary fibrous tumor presenting with respiratory failure. Ann Thorac Cardiovasc Surg 2013; 20 Suppl:427-9. [PMID: 23445791 DOI: 10.5761/atcs.cr.12.02068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Solitary fibrous tumor (SFT) is an uncommon mesenchymal neoplasm that arises primarily from the pleura, but recognized also in other tissues. SFT in the thyroid gland is extremely rare. Here we presented the second reported SFT arising in an intrathoracic goiter. The88-year-old woman was referred with a huge goiter involving upper mediastinum accompanied by airway obstruction and tracheostomy. The patient underwent a left subtotal thyroidectomy, which revealed a SFT. No recurrence was noted during 3 years of follow-up.
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Affiliation(s)
- Mong-Wei Lin
- Department of Surgery, National Taiwan University Hospital Yun-Lin Branch, Yunlin, Taiwan
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9
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Verdi D, Pennelli G, Pelizzo MR, Toniato A. Solitary fibrous tumor of the thyroid gland: a report of two cases with an analysis of their clinical and pathological features. Endocr Pathol 2011; 22:165-9. [PMID: 21818669 DOI: 10.1007/s12022-011-9172-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Solitary fibrous tumors of the thyroid gland are rare soft-tissue neoplasms and only 24 cases have been reported in the literature to date. We describe two patients who underwent surgery for rapidly growing thyroid nodes of uncertain nature on cytology. At the final histological examination, they proved to be fibrous tumors of the thyroid gland that were CD-34, BCL2, CD-99, and Ki-67 positive, like other known cases. Neither of these two cases have recurred so far.
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Affiliation(s)
- Daunia Verdi
- Surgical Pathology Unit, Department of Medical and Surgical Sciences, University of Padua, Via Giustiniani 2, 35128 Padova, Italy.
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10
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Song Z, Yu C, Song X, Wei L, Liu A. Primary solitary fibrous tumor of the thyroid - report of a case and review of the literature. J Cancer 2011; 2:206-9. [PMID: 21509151 PMCID: PMC3079918 DOI: 10.7150/jca.2.206] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Accepted: 04/11/2011] [Indexed: 12/23/2022] Open
Abstract
Solitary fibrous tumor (SFT) is a rare spindle-cell neoplasm, especially in the thyroid. We report a case of primary solitary fibrous tumor of the thyroid gland in a 37 year-old Chinese man. The tumor was characterized by bland-looking spindle cells admixed with thin and thick collagen fibers. On immunohistochemistry study indicated that tumor cells were diffusely positive for CD34, Bcl-2 and CD99, and negative for Desmin, NSE, SMA, S-100, and CD68. The patient remains well 16 months after excision. The morphologic and immunohistochemical features of the thyroid SFTs are similar to their reported counterparts in other anatomic sites.
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Affiliation(s)
- Zhigang Song
- 1. Department of Pathology, the Chinese PLA General Hospital, Beijing, 100853, China
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11
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Ning S, Song X, Xiang L, Chen Y, Cheng Y, Chen H. Malignant solitary fibrous tumor of the thyroid gland: report of a case and review of the literature. Diagn Cytopathol 2010; 39:694-9. [PMID: 21837658 DOI: 10.1002/dc.21538] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Accepted: 08/05/2010] [Indexed: 12/20/2022]
Abstract
Solitary fibrous tumors of the thyroid gland (T-SFT) are rarely described, with only 21 cases being reported in the English literatures, all showing benign clinical characteristics. We herein present a 76-year-old woman presenting with a 3-month history of rapidly enlarging neck masses and the CT showed masses with partial calcification in the right thyroid lobe. We performed right hemithyroidectomy and isthmectomy with negative margin under general anesthesia. Histologically, the masses consisted of pleomorphic spindle cells with high mitoses and collagen bands. Immunohistochemically, the tumor cells showed positive reactions for CD34, vimentin and bcl-2, then a diagnosis of malignant solitary fibrous tumor of the right thyroid was made. Six months postoperatively, the CT showed the recurrence of the thyroid tumor and the presence of many nodules of varying sizes throughout bilateral pulmonary lobes. To our knowledge, this is the first case of malignant solitary fibrous tumor of the thyroid gland (T-SFT) with local recurrence and pulmonary metastasis and T-SFT must be considered in the differential diagnosis of spindle cells lesions in the thyroid gland. Correct diagnosis of the malignant T-SFT plays an important role in choosing appropriate therapeutic strategies and long-term follow-up is also extremely essential for these patients.
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Affiliation(s)
- Shanglei Ning
- Department of General Surgery, Qilu Hospital, Shandong University, Ji'nan, China
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12
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Abstract
BACKGROUND Solitary fibrous tumor (SFT) is a rare spindle cell tumor most often found in the mediastinal pleura. Nineteen cases of SFT arising in the thyroid gland have been reported. We report a case of SFT of the thyroid gland with immunohistochemical and cytogenetic investigation. SUMMARY A 58-year-old man had pulmonary symptoms, thought to be asthma. Computed tomographic scan revealed a large goiter with a solid hyperechoic nodule. The results of thyroid function tests were normal. Microscopically, the lesion was composed of fibroblast-like spindle cells in a patternless growth. Cellular atypia or necrosis was not seen, and mitotic activity was low. Immunohistochemistry showed positive reaction for CD34, vimentin, bcl-2, and CD99. Fluorescence in situ hybridization analysis of more than 100 cells exhibited no trisomy 21. Complete surgical removal of tumor is the treatment of choice. CONCLUSION The histological appearance and immunohistochemical reaction pattern of SFT is characteristic. The entity should be considered when dealing with a spindle cell lesion in the thyroid gland. All cases of this site of origin reported have had a benign clinical course. As only a small number of cases have been described, we recommend long-term follow-up.
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13
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Abstract
We report a case of solitary fibrous tumor of the thyroid gland in a 51-year-old man with pre-existing right recurrent laryngeal nerve paralysis from a congenital tracheoesophageal fistula repair as an infant. The left thyroid lobe was enlarged and soft. Fine needle aspiration biopsy via ultrasound guidance demonstrated a hypercellular aspirate composed of spindle cells with bland nuclear morphology. Given this histomorphology and immunohistochemical profile, the diagnosis of solitary fibrous tumor was considered and confirmed following left thyroid lobectomy.
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Affiliation(s)
- Tarik Y Farrag
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland 21287-0910, USA
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14
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Cranshaw IM, Gikas PD, Fisher C, Thway K, Thomas JM, Hayes AJ. Clinical outcomes of extra-thoracic solitary fibrous tumours. Eur J Surg Oncol 2009; 35:994-8. [PMID: 19345055 DOI: 10.1016/j.ejso.2009.02.015] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2007] [Revised: 02/23/2009] [Accepted: 02/24/2009] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Extra-thoracic solitary fibrous tumours (ESFTs) have traditionally been regarded as indolent neoplasms similar to their intra-thoracic counterparts. However there has been some evidence that a subset of more aggressively malignant tumours exist. We examined our experience with these rare tumours in an effort to clarify their clinico-pathological behaviour and relate this to their histopathological findings. PATIENTS/METHODS All patients with a histopathological diagnosis of solitary fibrous tumour (SFT) who presented to the Royal Marsden Hospital between 1998 and 2006 were reviewed. Clinico-pathological data were recorded for all cases and subset analysis performed to compare rates of locoregional recurrence, distant metastases and death. RESULTS There were 33 cases included in the study. 18 cases had malignant features on histological examination. Locoregional recurrent disease was more common in those with malignant histopathological findings compared to those with benign histopathology (6/18 vs 0/15 p 0.021). Distant metastatic disease was more common in those with malignant histopathological findings (7/18 vs 1/15 p 0.046) and these patients were at increased risk of death (10/18 vs 0/15 p<0.01). The presence of malignant histopathology was the only factor to affect survival with no benign cases dying of disease and malignant cases having a median survival of 59 months (p 0.003). CONCLUSION In our experience ESFTs have a higher rate of malignant behaviour than that classically described. Those tumours with atypical or malignant features on histological examination have poor prognosis and should be managed and followed up in the same manner as other high-grade soft tissue tumours.
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Affiliation(s)
- I M Cranshaw
- Sarcoma and Melanoma Unit, Royal Marsden Hospital, London SW3 6JJ, UK
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15
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Santeusanio G, Schiaroli S, Ortenzi A, Mulè A, Perrone G, Fadda G. Solitary fibrous tumour of thyroid: report of two cases with immunohistochemical features and literature review. Head Neck Pathol 2008; 2:231-5. [PMID: 20614321 PMCID: PMC2807559 DOI: 10.1007/s12105-008-0070-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2008] [Accepted: 07/10/2008] [Indexed: 12/16/2022]
Abstract
Solitary fibrous tumour (SFT) is a rare tumour principally found in adults in the pleural cavity. Extrapleural occurrences are rare. Two cases of SFT of the thyroid gland are described in this paper showing their distinctive microscopical architecture, namely "patternless growth pattern". It is characterized by a bland spindle-cell proliferation alternating hyper- and hypo-cellular areas, keloid-like hyalinization and a focal hemangiopericytoma-like vascular pattern. Tumour cells revealed a diffuse strong positivity for CD34, CD99, bcl-2 and Vimentin, but negativity for Desmin, EMA, AE1/AE3, SMA, S-100 and CD31 antibodies. The differential diagnosis of thyroid SFT includes different types of spindle cell proliferation, benign and malignant mesenchymal tumours, medullary thyroid carcinoma, fasciitis-like papillary carcinoma, and undifferentiated (anaplastic) carcinoma. However, the morphologic and immunohistochemical findings of SFT are so characteristic that this diagnosis seldom represent a difficulty.
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Affiliation(s)
- Giuseppe Santeusanio
- Dipartimento di Biopatologia e Diagnostica per Immagini, Sezione di Anatomia Patologica and UOC Anatomia Patologica, Università degli Studi di Roma “Tor Vergata”, Ospedale S. Eugenio - Azienda USL Roma C - Piazzale dell’Umanesimo n.10, 00144 Rome, Italy
| | - Stefania Schiaroli
- Dipartimento di Biopatologia e Diagnostica per Immagini, Sezione di Anatomia Patologica and UOC Anatomia Patologica, Università degli Studi di Roma “Tor Vergata”, Ospedale S. Eugenio - Azienda USL Roma C - Piazzale dell’Umanesimo n.10, 00144 Rome, Italy
| | - Angela Ortenzi
- Dipartimento di Biopatologia e Diagnostica per Immagini, Sezione di Anatomia Patologica and UOC Anatomia Patologica, Università degli Studi di Roma “Tor Vergata”, Ospedale S. Eugenio - Azienda USL Roma C - Piazzale dell’Umanesimo n.10, 00144 Rome, Italy
| | - Antonino Mulè
- Istituto di Anatomia e Istologia Patologica, Università Cattolica del Sacro Cuore, Largo Francesco Vito n.1, 00168 Rome, Italy
| | - Giuseppe Perrone
- Anatomia Patologica, Università Campus Bio-Medico, Via Emilio Longoni n.47, 00155 Rome, Italy
| | - Guido Fadda
- Istituto di Anatomia e Istologia Patologica, Università Cattolica del Sacro Cuore, Largo Francesco Vito n.1, 00168 Rome, Italy
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16
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Abstract
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.
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Affiliation(s)
- Giampaolo Papi
- Department of Internal Medicine, Endocrinology Unit, University of Modena and Reggio Emilia, Modena, Italy
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17
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Tanahashi J, Kashima K, Daa T, Kondoh Y, Suzuki M, Kerakawauchi H, Yokoyama S. Solitary fibrous tumor of the thyroid gland: report of two cases and review of the literature. Pathol Int 2006; 56:471-7. [PMID: 16872444 DOI: 10.1111/j.1440-1827.2006.01992.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Presented herein are the first two Japanese cases of solitary fibrous tumor (SFT) of the thyroid gland. The patients were 64- and 41-year-old men, who underwent hemithyroidectomy for thyroid tumors. Histopathologically, the tumors were well circumscribed, and were composed of spindle cells, collagen bundles and entrapped thyroid follicles. Spindle cells and collagen bundles were mostly in a patternless arrangement with an admixture of hypo- and hypercellular areas. Proliferating spindle cells were bland, slender, and occasionally wavy without any atypia and increased mitotic figures. Immunohistochemically, they were strongly positive for CD34, CD99, and bcl-2, but negative for epithelial membrane antigen, keratin, thyroglobulin, calcitonin, thyroid transcription factor-1, alpha-smooth muscle actin, desmin, S-100 protein and CD117. Based on these findings, the two patients were diagnosed as having thyroid SFT. Neither local recurrence nor metastasis has been observed in 5 years in patient 1 or in 4 years in patient 2. Thyroid SFT is extremely rare, and only 20 cases have been reported in the English-language literature including hemangiopericytoma. Although recurrence or metastasis has not been described in any reported cases, the clinical behavior of SFT is still undetermined, therefore long-term follow up seems necessary at present.
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Affiliation(s)
- Jin Tanahashi
- Department of Pathology, Faculty of Medicine, Oita University, Yufu, and Department of Otolaryngology, Nankai Hospital, Saiki, Japan.
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18
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Shine N, nor nurul Khasri M, Fitzgibbon J, O'Leary G. Solitary Fibrous Tumor of the Floor of the Mouth: Case Report and Review of the Literature. EAR, NOSE & THROAT JOURNAL 2006. [DOI: 10.1177/014556130608500713] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Solitary fibrous tumor is an uncommon spindle cell neoplasm that is believed to be of mesenchymal origin. Rarely does it originate in the oral cavity, and only 1 case of this lesion in the floor of the mouth has been previously reported. We describe a new case of solitary fibrous tumor arising from the soft tissues of the floor of the mouth.
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Affiliation(s)
- Neville Shine
- From the Department of Otolaryngology–Head and Neck Surgery, South Infirmary–Victoria Hospital, Cork, Republic of Ireland
| | | | - Jim Fitzgibbon
- Department of Pathology, Mercy Hospital, Cork, Republic of Ireland
| | - Gerard O'Leary
- From the Department of Otolaryngology–Head and Neck Surgery, South Infirmary–Victoria Hospital, Cork, Republic of Ireland
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19
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Abstract
Solitary fibrous tumor (SFT) is commonly found on serosal surfaces, and is rarely localized in the liver. There are benign and malignant variants of hepatic SFT. We report a new case of benign SFT. Our patient, a 63-year old woman, who has been followed for 5 years for an asymptomatic liver mass, was admitted for abdominal pain. Ultrasonography (US), CT, MR Imaging and angiography showed the liver mass with typical imaging features, situated in the right hepatic lobe with blood supply from the hepatic artery. Histopathological examination demonstrated a highly vascularized tumor, composed of short spindle cells alternating with hypocellular collagenous regions, with a hemangiopericytoma-like vascular pattern. The immunohistochemical staining was positive for CD 34. Tumor resection was performed. Follow-up 8 years after the resection showed no tumor recurrence or metastasis, thus confirming the initial diagnosis of benign SFT.
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Affiliation(s)
- C Lehmann
- Service de Radiologie, Hôpital Saint-Antoine, 184 Rue du Faubourg Saint-Antoine, 75012 Paris
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20
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Josselin N, Valo I, Guyétant S, Saint-André JP. [An uncommon thyroid tumor]. Ann Pathol 2005; 25:251-2. [PMID: 16230956 DOI: 10.1016/s0242-6498(05)80121-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Nicolas Josselin
- Service d'Anatomie Pathologie, CHU d'Angers, rue Larrey, 49033 Angers Cedex 01
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21
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González-García R, Gil-Díez Usandizaga JL, Hyun Nam S, Rodríguez Campo FJ, Naval-Gías L. Solitary fibrous tumour of the oral cavity with histological features of aggressiveness. Br J Oral Maxillofac Surg 2005; 44:543-5. [PMID: 16203067 DOI: 10.1016/j.bjoms.2005.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2005] [Revised: 08/28/2005] [Accepted: 09/01/2005] [Indexed: 10/25/2022]
Abstract
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.
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Affiliation(s)
- Raúl González-García
- Department of Oral & Maxillofacial Surgery, University Hospital La Princesa-Madrid, c/ Diego de León, 62, 28006 Madrid, Spain.
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22
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Bohórquez CL, González-Cámpora R, Loscertales MC, Escudero AG, Mezquita JC. Solitary fibrous tumor of the thyroid with capsular invasion. Pathol Res Pract 2004; 199:687-90. [PMID: 14666971 DOI: 10.1078/0344-0338-00481] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
This report describes the clinical and pathologic findings of a peculiar case of solitary fibrous tumor of the thyroid gland that showed capsular invasion. After four and a half years of follow-up, neither local recurrence nor metastasis has developed.
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23
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Chithriki M, Jaibaji M, Vandermolen R. Solitary Fibrous Tumor of the Liver with Presenting Symptoms of Hypoglycemic Coma. Am Surg 2004. [DOI: 10.1177/000313480407000403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We report a patient with solitary fibrous tumor of the liver, a rare fibrous neoplasm which to our knowledge has been reported in only 21 patients in the English literature. Most frequently, solitary fibrous tumors arise in the thoracic cavity, particularly in the pleura. Hypoglycemia has rarely been associated with these mesenchymal tumors. The presentation of this patient with hypoglycemic coma without preceding symptomatology, to our knowledge, has never been reported.
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Affiliation(s)
| | - Moneer Jaibaji
- From the St. Joseph Mercy Oakland Hospital, Pontiac, Michigan
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24
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Sawada N, Ishiwata T, Naito Z, Maeda S, Sugisaki Y, Asano G. Immunohistochemical localization of endothelial cell markers in solitary fibrous tumor. Pathol Int 2002; 52:769-76. [PMID: 12588446 DOI: 10.1046/j.1440-1827.2002.t01-1-01423.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Solitary fibrous tumor (SFT) is an uncommon tumor first reported in the pleura, but recently described in other tissues. CD34, which is expressed in hematopoietic stem cells, endothelial progenitor cells and vascular endothelial cells, is observed in most SFT and some investigators believe that its expression is a definitive marker of this tumor. In the present study, the expression of vascular endothelial cell markers, such as vascular endothelial growth factor receptor (VEGFR)-1 (flt-1), VEGFR-2 (flk-1/KDR), Tie-2 and c-Met, was examined in SFT to clarify the relationship between SFT and endothelial cells. By immunohistochemical staining of tumor cells from 26 patients, VEGFR-1 was detected in 24 (92%), VEGFR-2 in five (19%), Tie-2 in 14 (54%), and c-Met, a specific receptor of hepatocyte growth factor (HGF) in 23 patients (88%). Furthermore, VEGFR-3 (flt-4) immunoreactivity was detected in eight of 26 patients (31%). In contrast, VEGF, VEGF-C and HGF, which are ligands for the receptors, were not localized in the SFT cells. These findings indicate that most SFT may closely relate to vascular or lymphatic endothelial cells and the endothelial growth factors may contribute to the growth of SFT in a paracrine manner.
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Affiliation(s)
- Namie Sawada
- Department of Pathology, Nippon Medical School, Tokyo, Japan.
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25
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Kumagai M, Suzuki H, Takahashi E, Matsuura K, Furukawa M, Suzuki H, Tezuka F. A case of solitary fibrous tumor of the parotid gland: review of the literatures. TOHOKU J EXP MED 2002; 198:41-6. [PMID: 12498313 DOI: 10.1620/tjem.198.41] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We report a rare case of solitary fibrous tumor of the parotid gland. A 47-year-old woman presented with a 3-year-history of left-sided subauricular swelling. Computed tomographic scans and magnetic resonance images revealed a well-defined and dumbbell-shaped mass, measuring about 30 mm in its greatest dimension, in the left parotid gland. Because the tumor occupied both superficial and deep lobes of the gland, she underwent total parotidectomy with preservation of the facial nerve. The microscopic finding showed short-spindle and ovoid cells arranged in a haphazard pattern with interspersed thin collagen fibrils. Immunohistochemically, the tumor cells were strongly positive for CD34, bcl-2 and vimentin, whereas stains for S-100, cytokeratin, smooth muscle actin, collagen type IV and CD117 (KIT) were negative. On the basis of these findings, the tumor was diagnosed as solitary fibrous tumor. Her post-operative course was uneventful, and she is currently free from disease 14 months after surgery. Diagnosis, clinical behavior and treatment of solitary fibrous tumor are reviewed from perusal of the literature.
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Affiliation(s)
- Masaki Kumagai
- Department of Otolaryngology, Sendai National Hospital, Sendai 983-8520, Japan
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26
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Magro G, Cavallaro V, Torrisi A, Lopes M, Dell'Albani M, Lanzafame S. Intrarenal solitary fibrous tumor of the kidney report of a case with emphasis on the differential diagnosis in the wide spectrum of monomorphous spindle cell tumors of the kidney. Pathol Res Pract 2002; 198:37-43. [PMID: 11866209 DOI: 10.1078/0344-0338-00182] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Solitary fibrous tumor (SFT) is a neoplasm that can occur in the urogenital tract, and is also reported occurring in the spermatic cord, seminal vesicles, urinary bladder, prostate, and kidney. Furthermore, it is most important to consider its existence in the kidney, because it is usually diagnosed as renal cell carcinoma pre-operatively. To our knowledge, only 10 cases of SFT have been reported in the kidney to date. We report the clinico-pathological features of an intrarenal SFT occurring in a 31-year-old woman. The tumor, measuring 8.6 cm in its greatest diameter, completely replaced the cortex and the medulla of the middle region of the right kidney, compressing the pelvis. Radiological imaging was consistent with a renal cell carcinoma. Histologically, the tumor was composed of a proliferation of bland-looking vimentin+, CD34+, bcl2+ and CD99+ spindle cells exhibiting a haphazard to storiform growth pattern, pushing borders, and a low mitotic rate (2 mitoses x 10 HPF). We placed emphasis on the differential diagnostic problems, i.e., its differentiation from other primary monomorphous benign and malignant spindle cell tumors of the kidney, such as fibroma, benign fibrous histiocytoma, hemangiopericytoma, inflammatory myofibroblastic (pseudo-)tumor, leiomyoma, angiomyolipoma with predominant spindle cell smooth muscle component, benign peripheral nerve sheath tumors, renal mixed epithelial/stromal tumors, adult type mesoblastic nephroma, fibrous type monophasic synovial sarcoma, malignant peripheral nerve sheath tumors, fibrosarcoma, and low-grade fibromyxoid sarcoma.
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Affiliation(s)
- Gaetano Magro
- Institute of Anatomic Pathology, University of Catania, Italy.
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27
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Hayashi S, Kurihara H, Hirato J, Sasaki T. Solitary Fibrous Tumor of the Orbit with Extraorbital Extension: Case Report. Neurosurgery 2001. [DOI: 10.1227/00006123-200111000-00042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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28
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Hirano M, Tanuma J, Shimoda T, Sugihara K, Tsuneyoshi M, Kitano M. Solitary fibrous tumor in the mental region. Pathol Int 2001; 51:905-8. [PMID: 11844061 DOI: 10.1046/j.1440-1827.2001.01290.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Solitary fibrous tumor (SFT) is a rare, benign, soft tissue tumor that most commonly occurs in the pleura; however, it has recently been described in other sites of the body. To date, eight examples of oral SFT have been reported. This paper is a description of the first case of an SFT occurring as a soft tissue tumor in the mental region. Histologically, the tumor was composed predominantly of rather uniform spindle-shaped fibroblastic cells arranged in vague fascicles or in a haphazard fashion, intermingled with abundant collagen fibers. Immunohistochemically, the tumor cells were positive for CD34 and vimentin, and weakly positive for muscle actin and alpha-smooth muscle actin. The diagnosis of SFT may be difficult as this tumor shares a number of histological features with other soft tissue tumors. Awareness of its occurrence in the oral cavity is important so that confusion with other spindle cell neoplasms can be avoided.
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Affiliation(s)
- M Hirano
- Department of Oral Pathology, Kagoshima University Dental School, Sakuraoka, Japan
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29
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Rodriguez I, Ayala E, Caballero C, De Miguel C, Matias-Guiu X, Cubilla AL, Rosai J. Solitary fibrous tumor of the thyroid gland: report of seven cases. Am J Surg Pathol 2001; 25:1424-8. [PMID: 11684960 DOI: 10.1097/00000478-200111000-00011] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Solitary fibrous tumor is a soft tissue neoplasm initially described in the pleura but subsequently reported in a wide variety of locations. The clinical behavior is usually benign, but the existence of aggressive cases has been documented both in the pleura and in extrapleural sites. In this report clinical and pathologic features of seven solitary fibrous tumors of the thyroid gland are presented. Patients' ages ranged from 43 to 64 years (mean 52 years), and tumor sizes varied from 2 to 6 cm. Grossly, the tumors were white-tan and well circumscribed. Microscopically, there was a variegated, wavy, storiform, hemangiopericytic or desmoid-like arrangement of spindle cells. Trapped thyroid follicles within the tumor and peripheral jagged tumor infiltration among follicles were common. There was immunohistochemical reactivity for CD34, CD99, and bcl-2, and ultrastructural analysis of one tumor was consistent with a fibroblastic lineage. The differential diagnosis included other benign and malignant mesenchymal tumors of the thyroid, spindle cell follicular adenoma, Riedel's thyroiditis, the spindle cell, and paucicellular variants of anaplastic carcinoma, papillary thyroid carcinoma with exuberant nodular fasciitis-like stroma, and the spindle epithelial tumor with thymus-like differentiation. The cumulative data of 13 cases (comprised of the seven present cases and the six previously reported) suggest a benign clinical behavior for thyroid SFT.
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Affiliation(s)
- I Rodriguez
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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30
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Hayashi S, Kurihara H, Hirato J, Sasaki T. Solitary fibrous tumor of the orbit with extraorbital extension: case report. Neurosurgery 2001; 49:1241-5. [PMID: 11846919 DOI: 10.1097/00006123-200111000-00042] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2001] [Accepted: 06/28/2001] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE AND IMPORTANCE Solitary fibrous tumors (SFTs) are rare tumors of mesenchymal origin that typically arise in the pleura. Only 24 cases of SFTs in the orbit have been reported, all located within the orbit and generally with a benign course. We report the first case of an orbital SFT with extraorbital extension and short-term regrowth. CLINICAL PRESENTATION A 54-year-old man presented with proptosis and double vision that had persisted for 7 months. The tumor extended from the right extraconal inferolateral orbit to the extradural middle cranial fossa and cavernous sinus, via the superior orbital fissure, on magnetic resonance imaging scans. Positron emission tomography with [(18)F]fluorodeoxyglucose demonstrated faint uptake in the orbital portion. INTERVENTION Resection of the tumor was performed twice, because of short-term regrowth of the residual tumor in the orbit. The histological diagnosis was a SFT. The MIB-1 labeling index was 7% and the mitotic count was 5 mitotic figures/10 high-power fields at the time of the second operation. These findings indicate the malignant nature of the tumor. CONCLUSION The natural history of SFTs of the orbit remains unclear, and the importance of careful and continued follow-up monitoring of the tumor should be emphasized.
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Affiliation(s)
- S Hayashi
- Department of Neurosurgery, Gunma University School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan.
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31
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Alawi F, Stratton D, Freedman PD. Solitary fibrous tumor of the oral soft tissues: a clinicopathologic and immunohistochemical study of 16 cases. Am J Surg Pathol 2001; 25:900-10. [PMID: 11420461 DOI: 10.1097/00000478-200107000-00008] [Citation(s) in RCA: 108] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
We describe the clinicopathologic and immunohistochemical features of 16 solitary fibrous tumors (SFTs) originating within the oral soft tissues. There were 10 women and six men with a mean age at diagnosis of 56 years. In all cases the tumors were slow-growing, asymptomatic, submucosal growths of variable size and duration. The buccal mucosa was involved in 12 cases, and the tongue and lower lip were affected in two cases, respectively. Thirteen tumors developed on the left side of the mouth. Follow-up information was available in 10 cases and averaged 44.7 months, with no evidence of recurrence or metastasis. All 16 tumors were well circumscribed and demonstrated histologic features that were invariably benign. In all cases they were composed of an admixture of alternating hypercellular and hypocellular, collagenous zones; haphazardly arranged, cytologically bland spindle and ovoid cells that in areas were intimately intermixed with collagen; a prominent vasculature; and perivascular hyalinization. Immunohistochemically, the tumors were consistently positive for CD34, bcl-2, factor XIIIa, and vimentin, whereas 75% of the tumors were reactive for CD99. To further define the clinicopathologic profile of intraoral SFT, we include a review of the previously reported cases. We also include a comparison and brief review of the clinicopathologic and immunohistochemical features of other spindle cell tumors of the oral cavity, from which SFTs must be differentiated.
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Affiliation(s)
- F Alawi
- Department of Oral and Maxillofacial Pathology, New York Hospital Medical Center of Queens, Flushing, New York, USA
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32
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Talacko AA, Aldred MJ, Sheldon WR, Richard Hing N. Solitary fibrous tumour of the oral cavity: report of two cases. Pathology 2001. [DOI: 10.1080/00313020126298] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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33
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Fuksbrumer MS, Klimstra D, Panicek DM. Solitary fibrous tumor of the liver: imaging findings. AJR Am J Roentgenol 2000; 175:1683-7. [PMID: 11090404 DOI: 10.2214/ajr.175.6.1751683] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE This study describes the imaging features of solitary fibrous tumor of the liver in three patients. CONCLUSION A single large, well-circumscribed, heterogeneously enhancing hepatic mass was present in each patient. These imaging features are suggestive of, but not diagnostic for, solitary fibrous tumor of the liver. The two benign and one malignant solitary fibrous tumors of the liver in this series were indistinguishable from one another on imaging studies.
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Affiliation(s)
- M S Fuksbrumer
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10021, USA
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34
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35
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Abstract
The solitary fibrous tumor (SFT) is a rare tumor that most commonly arises in the pleura. Recent evidence has indicated that this tumor originates from mesenchymal, probably fibroblastic, cells and is not restricted to the pleura. However, its occurrence in the female genital tract is extremely rare. We report a case of primary SFT that originated from the vagina in a 34-year-old female. It was a pedunculated polypoid tumor and occurred at the site of scar tissue, caused by laceration during her last labor 7 years previously. Histologically, the tumor was predominantly composed of a random proliferation of spindle cells, intimately admixed with collagen. Immunohistochemically, the cells were strongly positive for CD34, vimentin and bcl-2, but were negative for S-100 protein, neuron-specific enolase, smooth muscle actin, desmin, CD68, cytokeratins and epithelial membrane antigen. To the best of our knowledge, this is the first reported case of a primary vaginal SFT in the English literature. Our report suggests to include SFT in the differential diagnosis of a spindle cell neoplasm originating from the vagina.
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Affiliation(s)
- Y Akiyama
- Department of Pathology, Miyazaki Medical College Hospital, Miyazaki, Japan
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36
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Kataoka H, Akiyama Y, Kubo S, Itoh H, Hamasuna R, Tajima N, Koono M. Solitary fibrous tumor of the spinal nerve rootlet: case report and literature survey. Pathol Int 1999; 49:826-30. [PMID: 10504556 DOI: 10.1046/j.1440-1827.1999.00946.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Solitary fibrous tumor (SFT) is a rare tumor that arises most commonly in the pleura. Recent evidence indicated that it is a tumor that originates from mesenchymal, probably fibroblastic, cells and is not restricted to the pleura. This report presents a case of primary SFT occurring as a dumbbell-shaped tumor of the cervical spine (C4/5) in a 46-year-old Japanese female, probably originating from the spinal rootlet. The tumor was predominantly extradural, loosely attached to the dura mater, with a small intradural extramedullary part attached to the C5 anterior and posterior rootlets. Histologically, the tumor was predominantly composed of a haphazard proliferation of spindle cells separated by abundant collagen. Immunohistochemically, the cells were strongly positive for CD34, bcl-2 and vimentin, but were negative for S-100 protein, neuron specific enolase, cytokeratin and epithelial membrane antigen. The present case and review of the literature strongly suggest that SFT is an entity that should be considered in the differential diagnosis of tumors of the cerebrospinal region.
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Affiliation(s)
- H Kataoka
- Second Department of Pathology, Miyazaki Medical College, Miyazaki, Japan
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37
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Kurihara K, Mizuseki K, Sonobe J, Yanagihara J. Solitary fibrous tumor of the oral cavity: report of a case. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1999; 87:223-6. [PMID: 10052379 DOI: 10.1016/s1079-2104(99)70276-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
A case of benign solitary fibrous tumor of the oral cavity is reported. The tumor occurred in the buccal mucosa of a 34-year-old woman. The surgically removed tumor was 1.5 x 1.2 x 1.0 cm in size and well circumscribed. Histologically, the tumor was composed of spindle-shaped cells that were predominantly arranged haphazardly. Hemangiopericytoma-like areas and collagenous areas were also noted. Immunohistochemically, the tumor cells were positive for CD34 and vimentin. To our knowledge, this is only the second report of solitary fibrous tumor involving the oral cavity.
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Affiliation(s)
- K Kurihara
- Department of Pathology, Uwajima City Hospital, Ehime, Japan
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38
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Vallat-Decouvelaere AV, Dry SM, Fletcher CD. Atypical and malignant solitary fibrous tumors in extrathoracic locations: evidence of their comparability to intra-thoracic tumors. Am J Surg Pathol 1998; 22:1501-11. [PMID: 9850176 DOI: 10.1097/00000478-199812000-00007] [Citation(s) in RCA: 436] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Solitary fibrous tumor (SFT), first described as a pleural lesion, has been reported at numerous extrathoracic sites over the past 10 years. About 10% to 15% of intrathoracic SFTs are histologically or clinically malignant, but such cases have very rarely been described at other locations. Among 92 cases of extrathoracic SFT in our files, we identified 10 that either had recurred (2 cases) or had a least one atypical histologic feature (8 cases). The ten tumors occurred in five men and five women, 32 to 81 years old (median 56), measured 1.9 cm to 20 cm (median 11.5 cm), and were located in the abdomen/pelvis (4 cases), retroperitoneum (3 cases), groin, trunk, and upper arm. Nuclear atypia (8 cases), markedly increased cellularity (6 cases), areas of necrosis (4 cases), and greater than 4 mitoses/10 HPFs (3 cases) were seen in addition to the typical histologic features of SFT. Six tumors had at least two of these atypical histologic features. Nine cases were positive for CD34, six were positive for O-13, and one was focally positive for smooth muscle actin. Eight were excised completely. Subsequent follow-up revealed tumor relapse in eight cases (follow up 6-180 months, median 24). Four patients had local recurrence at 12 to 168 months. Distant metastasis developed at 1 to 6 years in five cases with spread to lung (2 cases), liver (4 cases), and bone. Metastasis or local recurrence developed within 2 years in five patients. To date, no patient has died of their tumor. These findings demonstrate that nuclear atypia, hypercellularity, greater than 4 mitoses/10 HPFs, and necrosis may be seen in up to 10% of extrathoracic SFTs, and are associated with, but are not by themselves predictive of, aggressive clinical behavior. In addition, our findings confirm that the behavior of extrathoracic SFTs is unpredictable, entirely comparable to that of their better known pleural counterparts, and confirm that patients with SFTs in all locations require careful, long-term follow up. It is probably unwise to regard any such lesion as definitely benign.
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Moran CA, Ishak KG, Goodman ZD. Solitary fibrous tumor of the liver: a clinicopathologic and immunohistochemical study of nine cases. Ann Diagn Pathol 1998; 2:19-24. [PMID: 9845719 DOI: 10.1016/s1092-9134(98)80031-2] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Nine cases of primary solitary fibrous tumors of the liver are presented. The patients are 7 women and 2 men between the ages of 32 and 83 years (mean, 57.5 years). Clinically, palpable masses were detected during physical examination in five patients. Two patients presented with symptoms of cholecystitis, one with hematuria, one with periumbilical pain, and one with hypoglycemia. One patient was found to have an abdominal mass during follow-up evaluation for colonic carcinoma, whereas in one patient the tumor was an incidental finding at autopsy. Two patients were asymptomatic, and the tumor masses were detected during a routine physical examination. Grossly, the tumors varied in size from 2 to more than 20 cm in greatest dimension and were described as firm, white-to-gray, well or ill defined. Eight tumors were described as intraparenchymal lesions, two were grossly necrotic, and one tumor was attached by a pedicle to the liver capsule without infiltration into the liver parenchyma. Histologically, most of the tumors had a bland appearance with the classic short storiform (so-called patternless) pattern and absence of cellular atypia, mitoses and/or necrosis. However, in two cases, there was marked cellular atypia and mitotic figures varying from 2 to 4 mitoses per 10 high power field (hpf). Immunohistochemically, all the tumors showed a strong positive reaction against antibodies for CD-34 and vimentin. Follow-up information showed that two patients died within days of postsurgical resection of the tumor, whereas one was alive and well 1 year after initial diagnosis. No follow-up information was available for the other five patients. The cases herein presented highlight the ubiquitous distribution of this neoplasm and the similar clinical and histopathological features to those observed in serosal surfaces. Solitary fibrous tumors of the liver, although rare, need to be considered in the differential diagnosis of mesenchymal lesions of the liver.
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Affiliation(s)
- C A Moran
- Hepatic & Gastrointestinal Pathology, Armed Forces Institute of Pathology, Washington, DC, USA
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