Solitary fibrous tumour of the oral cavity: report of two cases

Reconstruction of Midface Defects after Radical Tumor Resection - a Rare Case Report of Solitary Fibrous Tumour of the Hard Palate

Introduction- Spindle cell neoplasm is a variant of squamous cell carcinoma. One of its subtypes is solitary fibrous tumor. Its occurrence in head and neck is very rare and rarer in hard palate. But if occurs, radical excision is the only choice as it has malignant potential but coverage of such large mid face defects imposes a challenge in front of a Plastic Surgeon as it demands both soft tissue coverage and skeletal support. Report of the case- A 33 year male presented to our department with swelling of left side face involving the anterior palate, maxilla, nose, and upper lip. With the help of the surgical oncology team, wide local excision of the neoplasm along with bilateral infrastructure maxillectomy, total rhinectomy, total upper lip resection and total hard palatectomy was done. This created large defect in the mid face which was covered with free anterolateral thigh flap. Biopsy was done which revealed the swelling as a solitary fibrous tumor of hard palate. All the margins were free of tumour. The flap settled well. Nostrils were secured with nasal stents. After 3 months, an expander was placed in forehead of the patient for future nasal reconstruction. After 3 months, nasal reconstruction was done using expanded forehead flap and costal cartilage. After 21 days flap detachment and insetting was done. White roll creation was also done. One more secondary procedure was done for flap thinning as patient had complain of nasal obstruction. After 6 months vascularised free fibula bone graft was introduced to reconstruct maxilla for future dental rehabilitation. The patient is in regular follow up and he is satisfied with the results. Discussion- Mid face defects involving perioral and nasomaxillar areas are very uncommon and require composite reconstruction. In such cases, microvascular free flap coverage is an irreplaceable option. Multiple stages might have to be done for further refinement. Conclusion- Reconstruction after oncological resection is always very demanding. With proper preoperative planning and skilled execution, the patient can be benefited functionally, aesthetically and psychosocially.

Solitary Fibrous Tumor of Hard Palate: A Case Report and Literature Review

Solitary fibrous tumor (SFT) is a mesenchymal tumor accounting for less than 2% of soft tissue tumors and has variable clinical behavior. It can arise in many anatomical locations of the body and in rare occasions in the oral cavity mostly in buccal mucosa and tongue. To date, a handful of such cases have been reported in the hard palate. We present a case of SFT in the hard palate of a 32-year-old man and describe the tissue morphology, immunohistochemistry workup, and follow-up together with literature review.

Clinicopathologic and immunohistochemical features of five new cases of solitary fibrous tumor of the oral cavity

OBJECTIVE

To describe the clinicopathologic and immunohistochemical features of five cases of oral solitary fibrous tumor.

STUDY DESIGN

Clinical data were collected from charts of two oral pathology laboratories of Latin America. All cases were evaluated by conventional hematoxylin and eosin staining and an extended immunohistochemical panel comprising vimentin, CD34, CD99, bcl-2, HHF-35, smooth muscle actin, calponin, S-100 protein, h-caldesmon, and Ki-67.

RESULTS

The study included 1 male (20%) and 4 female (80%) patients, with a median age of 43 years. The most common affected site was the buccal mucosa (40%). Tumors were characterized by proliferation of spindled and ovoid cells in a variably vascular and collagenized stroma. All tumors were positive for vimentin, CD34, bcl-2, and CD99. Recurrence was not observed after complete surgical enucleation.

CONCLUSIONS

Oral solitary fibrous tumors usually appear as well-delimited submucous nodules with a firm-rubbery consistency and covered by intact mucosa. Immunoreactivity for CD34, bcl-2, and CD-99 is helpful to confirm the diagnosis.

Solitary fibrous tumor of the soft palate: A report of two cases

Solitary fibrous tumors (SFTs) are a unique group of mesenchymal neoplasms of fibroblastic or myofibroblastic origin and are extremely rare in the oral cavity. The present study reported two additional cases of SFTs in the soft palate, along with the computed tomography characteristics, which demonstrated well-circumscribed soft tissue lesions with marked and homogenous enhancement. Following wide resection, one of the cases showed certain malignant pathological characteristics, including infiltration of mucinous gland, hypercellularity, nuclear atypia and weak positive staining for S-100. In our experience, SFTs should be considered as a differential diagnosis when a well-circumscribed and solid mass in the soft palate is identified.

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.

Solitary Fibrous Tumor of the Floor of the Mouth: Case Report and Review of the Literature

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.

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.

Solitary fibrous tumor arising in the sphenoethmoidal recess: a case report and review of the literature

Recently, solitary fibrous tumors (SFTs) have been reported in the head and neck area, such as the nasal cavity, thyroid, salivary gland, etc. We present a rare case of SFT which arose from the sphenoethmoidal recess of the nasal cavity, penetrating into the sphenoid sinus, and which showed different intensities on magnetic resonance imaging (MRI) according to the occupied locations. T2 weighted magnetic resonance (MR) images showed low intensity in the nasal cavity, and iso-intensity in the sphenoid sinus. Enhancement with gadolinium contrast on T1-weighted images was more remarkable in the sphenoid sinus than in the nasal cavity. While the tumor in the nasal cavity showed abundant collagen and high cellularity in microscopic examination, numerous small vessels and dilated vascular spaces were remarkable in the tumor of the sphenoid sinus. MRI findings corresponded to pathological findings. We review SFTs in the head and neck area in the English literature.

Metastatic malignant solitary fibrous tumour to the infra-temporal fossa

Malignant solitary fibrous tumours (MSFTs) are rare tumours of fibrous origin, which can occur at all anatomical sites and represent 20% of solitary fibrous tumours. Fine-needle aspiration cytology is not able to distinguish benign from malignant disease, and sufficient tissue has to be obtained for accurate histological diagnosis to be made. Lesions > 10 cm in diameter and incomplete resection or non-resectability are predictive factors for poor long-term survival. We present a 57-year-old patient with a presumably metastatic MSFT from the peritoneal cavity to the skull-base who is in a stable state 17 months after surgical debulking of the skull-base and removal of the peritoneal lesion, followed by post-operative chemotherapy. We suggest the terminology metastatic malignant solitary fibrous tumour for a description of this disease.