Lipomatous Hemangiopericytoma of the Skull Base and Parapharyngeal Space:

The Natural History of Parapharyngeal Solitary Fibrous Tumor/Hemangiopericytoma: A Case Report

Solitary fibrous tumor/hemangiopericytoma (SFT/HPC) is extremely rare, and most of them are immediately treated for radical resection. However, the information concerning its natural history remains unclear. In this report, we presented a patient with parapharyngeal SFT/HPC, who was not immediately treated with surgical resection at first diagnosis. After approximately 3 years, the tumor volume doubling time (TVDT) and specific growth rate (SGR) could be measured through 3 serial magnetic resonance imagings. The TVDTs in the early and late pretreatment stages were 350 and 180 days, respectively, while the SGRs were 0.002 and 0.003, respectively. The growth rate of this disease entity is generally slow and may accelerate in the disease process.

[Fat-forming solitary fibrous tumor with NAB2/ STAT6 gene fusion. Case report of genial location and literature review]

The lipomatous variety solitary fibrous tumor is a soft tissue neoplasm composed of mature adipose tissue and hemangiopericytoma areas. A 53-year-old man consulted for facial asymmetry and maxillofacial magnetic resonance imaging showed a cystic lesion, 3 x 2 cm in size, in front of the anterior wall of the maxillary sinus. Histologically, there were dense spindle cells expressing CD34, CD99, Bcl-2, and STAT6, myxoid zones, hemangiopericytomatous blood vessels, and S100 positive adipocytes. NAB2/STAT6 gene fusion was revealed by RT-PCR. The main differential diagnosis was raised with the spindle cell lipoma and malignant variant of the lipomatous solitary fibrous tumor. STAT6 overexpression and NAB2/STAT6 gene fusion are specific for lipomatous solitary fibrous tumor and the presence of lipoblasts and atypical lipomatous tumor areas suggests malignancy. These tumors located in the head and neck region have a benign biological behavior.

Anaplastic Hemangiopericytoma of the Jugular Foramen: Case Report and Systematic Review

BACKGROUND

Hemangiopericytomas (HPCs) and solitary fibrous tumors (SFTs) are rare tumors of mesenchymal origin. Here, the authors present a rare case of anaplastic HPC in the jugular foramen (JF). The authors also conduct a systematic review of the literature to examine the current fund of knowledge on JF HPC/SFTs.

METHODS

A systematic MEDLINE search was conducted using key words "hemangiopericytoma" OR "solitary fibrous tumor" AND "jugular foramen" OR "extracranial" OR "skull base." Clinicopathologic characteristics and outcomes of the present case were reviewed and compared with those in the literature.

RESULTS

A 41-year-old male, who had undergone stereotactic radiation therapy 6 years ago for a presumed glomus jugulare tumor, presented to our institution with worsening dysphagia, hoarseness, persistent tongue weakness, and radiographic evidence of tumor progression. The patient underwent uncomplicated gross total resection with sacrifice of the infiltrated hypoglossal nerve. Histopathologic evaluation revealed anaplastic HPC/SFT (World Health Organization grade III). Review of the literature yielded 9 additional cases of JF HPC/SFT in 5 males (56%) and 4 females (44%), with a mean age of 49.6 years old. Patients commonly presented with pain (37.5%) and lower cranial nerve deficits (100%). Preoperative diagnoses included glomus jugulare (n = 2) or JF schwannomas (n = 3). All patients underwent microsurgical resection of the lesion, except for 1 who refused all treatment after diagnostic biopsy.

CONCLUSION

The authors present the only reported case of anaplastic HPC of the JF. The illustrative case and those found on systematic review of the literature highlight the importance of tissue diagnosis and appropriate management.

Parapharyngeal Hemangiopericytoma: the Role for Mandibular Proximal Segment Replantation-Review of Literature

Pharyngeal hemangiopericytoma is a rare tumor .Surgical access to space has been selected based on the location of the tumor in this space, size, and type of pathology. Hemangiopericytoma requires extracapsular dissection. Hemorrhagic nature and tight attachment to adjacent tissues are the other reasons for choosing the surgical approach with the best access. The patient was a 55-year-old female with left-sided facial swelling and dumbbell-shaped lesion involving buccal and lateral pharyngeal space. Brisk hemorrhage happened during biopsy. Submandibular incision, osteotomy of mandibular angle, and temporary proximal segment removal were done. Extracapsular dissection of the lesion performed under direct vision. Proximal segment was returned to the original location and internally fixed with miniplate. Postoperative course was without complication. Mandibular proximal segment replantation technique should be used to treat parapharyngeal tumors with a hemorrhagic tendency.

Treatment outcome and prognostic factors of head and neck hemangiopericytoma: meta-analysis

BACKGROUND

Head and neck hemangiopericytoma (HNHPC) is rare. Treatment outcome and specific prognostic factors were unexplored.

METHODS

A case meta-analysis, in which treatment and outcome data were available, was performed.

RESULTS

A total of 116 primary HNHPC cases were analyzed. Poor pathologic differentiation was associated with increased risk of tumor recurrence (odds ratio [OR] = 2.378; p = .005), metastasis (OR = 3.634; p = .011), and mortality (OR = 4.563; p = .002), whereas surgery was associated with decreased risk of tumor recurrence (OR = 0.109; p = .004). The tumor size >5.0 cm in diameter (hazard ratio [HR] = 6.391; p = .002), nonsurgical treatment (HR = 7.648; p = .000), and poor pathologic differentiation (HR = 1.705; p = .012) were the independent unfavorable prognostic factors for disease-free survival. Moreover, nonsurgical treatment (HR = 8.097; p = .002) and deep tumor location (HR = 4.074; p = .013) were independent adverse prognostic factors for overall survival (OS).

CONCLUSION

These results suggest a management emphasizing the surgical removal of the tumor as first-line treatment. Tumor size >5.0 cm, poor pathologic differentiation, deep tumor location, and nonsurgical treatment were independent adverse prognostic factors.

Fat-forming variant of solitary fibrous tumour of the pleura: CT findings

The fat-forming variant of solitary fibrous tumour (SFT) was previously called lipomatous haemangiopericytoma and is a rare variant of solitary fibrous tumour. It predominantly occurs in the deep soft tissues of the retroperitoneum and thigh. Only a handful of cases involving the perineum, spine, thoracic wall and pelvic cavity have been reported in the radiological literature and the fat-forming variant of SFT involving the pleura has not been previously reported. Herein, we report the CT findings of a case of the fat-forming variant of SFT involving the pleura that was treated by excision. Chest CT showed a large lobulated heterogeneous fatty mass with a multifocal enhancing soft-tissue component in the left lower hemithorax. Although rare, the fat-forming variant of SFT of the pleura should be added to the differential diagnosis of fat-containing pleural soft-tissue tumours.

Fat-forming solitary fibrous tumour (lipomatous haemangiopericytoma) of the spine: case report and literature review

Solitary fibrous tumour (SFT) is a rare soft tissue tumour of uncertain histogenesis and unpredictable biological behaviour, which was first described in the pleura and subsequently in many extra-pleural locations. Fat-forming SFT is a sub-type of SFT and only a handful of cases have been reported in the literature. We present the clinical, radiological and histological features of a case of intraspinal fat-forming SFT, along with a literature review. This is the first known report of a fat-forming SFT in the spine.

Management of a retrorectal lipomatous hemangiopericytoma by preoperative vascular embolization and a multidisciplinary surgical team: report of a case

Large, highly vascular pelvic tumors can be challenging to manage, and bleeding is a major concern of the surgeon. Other concerns relate to the risk of injury to associated pelvic structures, difficulties in operative exposure, and complete tumor removal. We report an unusual case of a massive retrorectal lipomatous hemangiopericytoma managed successfully by preoperative vascular embolization and a multidisciplinary surgical team. The combined efforts of an interventional radiologist, vascular surgeon, orthophedic oncologist, and colorectal surgeon led to successful and safe complete removal of the tumor.