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Ströse L, Sparn M, Klein M, Benigno L, Bischofberger S, Brunner W. Solitary fibrous tumor within the mesorectum: literature review based on a case report of resection by transanal minimally invasive surgery (TAMIS). Int J Colorectal Dis 2024; 39:87. [PMID: 38847931 PMCID: PMC11161540 DOI: 10.1007/s00384-024-04658-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2024] [Indexed: 06/10/2024]
Abstract
PURPOSE Solitary fibrous tumors (SFT) are a rare entity of in majority benign neoplasms. Nevertheless, up to 20% of cases show a malignant tendency with local infiltration or metastasis. Commonly arising in the thoracic cavity, only few cases of SFT of the mesorectal tissue have been reported in the literature. Complete surgical resection, classically by posterior approach, is the treatment of choice. The purpose of this review is to demonstrate the safety and suitability of transanal minimally invasive surgery (TAMIS) as a surgical approach for the resection of benign pararectal solid tumors. METHODS We report the case of a 52-year-old man who was diagnosed incidentally with SFT of the distal mesorectum. Resection by TAMIS was performed. Based on this case, we describe the steps and potential benefits of this procedure and provide a comprehensive review of the literature. RESULTS Histopathology confirms the completely resected SFT. After uneventful postoperative course and discharge on day four, follow-up was recommended by a multidisciplinary board by clinical examination and MRI, which showed a well-healed scar and no recurrence up to 3 years after resection. CONCLUSION SFT of the mesorectum is a very rare entity. To our knowledge, this is the first report on a TAMIS resection for SFT, demonstrated as a safe approach for complete resection of benign pararectal solid tumors.
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Affiliation(s)
- Lennard Ströse
- Department of General, Visceral, Endocrine and Transplant Surgery, Kantonsspital St. Gallen, 9007, St Gallen, Switzerland.
| | - Moritz Sparn
- Department of General, Visceral, Endocrine and Transplant Surgery, Kantonsspital St. Gallen, 9007, St Gallen, Switzerland
| | - Marie Klein
- Department of General, Visceral, Endocrine and Transplant Surgery, Kantonsspital St. Gallen, 9007, St Gallen, Switzerland
| | - Luca Benigno
- Department of Visceral Surgery, GZO Spital Wetzikon, 8620, Wetzikon, Switzerland
| | - Stephan Bischofberger
- Department of General, Visceral, Endocrine and Transplant Surgery, Kantonsspital St. Gallen, 9007, St Gallen, Switzerland
| | - Walter Brunner
- Department of General, Visceral, Endocrine and Transplant Surgery, Kantonsspital St. Gallen, 9007, St Gallen, Switzerland.
- Paracelsus Medical University, Salzburg, Austria.
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Gupta S, Vaidya AA, Nagireddy TV, Londhe M. Case Report of Rare Solitary Fibrous Tumour of Nape of Neck with Review of Literature. Indian J Otolaryngol Head Neck Surg 2024; 76:2026-2031. [PMID: 38566660 PMCID: PMC10982221 DOI: 10.1007/s12070-023-04383-z] [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: 10/05/2023] [Accepted: 11/19/2023] [Indexed: 04/04/2024] Open
Abstract
Solitary fibrous tumor (SFT) is a rare mesenchymal tumor with an indolent course but variable metastatic potential. Less than 50 cases of neck SFTs have been documented since 1991. We present a case report of rare presentations of SFT of nape of neck typifying the hypercellular variant of SFT (hemangiopericytoma) with challenges in treatment. Patient underwent excision and was subjected to adjuvant radiation. We concluded that SFT though a rare diagnosis should be considered while dealing with soft tissue tumors and multi-disciplinary pre-operative planning is must to avoid complications and recurrence. Surgical excision remains treatment of choice, but long follow-up is must.
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Affiliation(s)
- Samir Gupta
- Department of Surgical Oncology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, India
| | - Advait A. Vaidya
- Department of Surgical Oncology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, India
| | - Tejus V. Nagireddy
- Department of Surgical Oncology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, India
| | - Mangesh Londhe
- Department of Pathology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, India
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Piccardo AC, Gurdschinski S, Spieker S, Renner C, Czapiewski P, Wösle M, Ciernik IF. Repeated Radiation Therapy of Recurrent Solitary Fibrous Tumors of the Brain: A Medical Case History Over 20 Years. Adv Radiat Oncol 2024; 9:101426. [PMID: 38435964 PMCID: PMC10906171 DOI: 10.1016/j.adro.2023.101426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 11/20/2023] [Indexed: 03/05/2024] Open
Affiliation(s)
| | | | | | | | | | - Markus Wösle
- Radiotherapy and Radiation Oncology, Städtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane, Dessau, Germany
| | - I. Frank Ciernik
- University of Zurich (MeF), Zurich, Switzerland
- Radiotherapy and Radiation Oncology, Städtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane, Dessau, Germany
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4
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Piscopo AJ, Chowdhury AJ, Teferi N, Lee S, Challa M, Petronek M, Eschbacher K, Bathla G, Buatti JM, Hitchon P. Surgical Management of Craniospinal Axis Solitary Fibrous Tumors: A Single-Institution Case Series and Comprehensive Review of the Literature. Neurosurgery 2024; 94:358-368. [PMID: 37747216 DOI: 10.1227/neu.0000000000002692] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 08/16/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Meningeal solitary fibrous tumors (SFTs) comprise 0.4% of primary central nervous system neoplasms and carry metastatic potential. Disease course and optimal management are largely unknown, and there is currently no literature rigorously describing neurological outcomes in surgically managed SFTs. We present one of the largest craniospinal SFT series, analyze patient outcomes, and extensively review the associated literature. METHODS All surgically managed SFTs at our institution between January 2005 and March 2023 were retrospectively reviewed. Patient demographics, tumor and radiographic features, treatment, and clinical outcomes were collected. Neurological function was quantified using Frankel grade and Neurologic Assessment in Neuro-Oncology scores. Descriptive statistics, multivariate analysis, log-rank test, and Kaplan-Meier survival analysis were performed. RESULTS Twenty-one patients satisfied inclusion criteria. Tumor locations included 15 supratentorial, three infratentorial, and three spinal. All patients underwent surgical resection, and 16 (76.2%) underwent radiation. Six (28.6%) patients had tumor recurrence, and three (14.3%) developed metastasis. Younger age and higher postoperative Frankel grade were significantly associated with increased overall survival (OS) ( P = .011, P = .002, respectively). All patients symptomatically improved or stabilized after surgery, and Neurologic Assessment in Neuro-Oncology score ( P = .001) and functional status significantly improved postoperatively (Karnofsky Performance Status: 65.2 ± 25.2 vs 91.4 ± 13.5, P = .001). Sex, adjuvant radiation, and extent of resection were not significantly associated with OS. CONCLUSION SFT of the central nervous system is a rare entity with a variable clinical course. Surgical resection was associated with improved postoperative functional and neurological status. Higher postoperative neurological function was significantly associated with OS. Further studies are warranted to validate a standardized treatment algorithm and investigate the efficacy of adjuvant radiation in SFT.
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Affiliation(s)
- Anthony J Piscopo
- Department of Neurosurgery, University of Iowa Hospital and Clinics, Iowa City , Iowa , USA
| | - A J Chowdhury
- Department of Neurosurgery, University of Iowa Hospital and Clinics, Iowa City , Iowa , USA
| | - Nahom Teferi
- Department of Neurosurgery, University of Iowa Hospital and Clinics, Iowa City , Iowa , USA
| | - Sarah Lee
- Department of Neurosurgery, University of Iowa Hospital and Clinics, Iowa City , Iowa , USA
| | - Meron Challa
- University of Iowa, Carver College of Medicine, Iowa City , Iowa , USA
| | - Michael Petronek
- Department of Radiation Oncology, University of Iowa Hospital and Clinics, Iowa City , Iowa , USA
| | - Kathryn Eschbacher
- Department of Pathology, University of Iowa Hospital and Clinics, Iowa City , Iowa , USA
| | - Girish Bathla
- Department of Radiology, Mayo Clinic, Rochester , Minnesota , USA
| | - John M Buatti
- Department of Radiation Oncology, University of Iowa Hospital and Clinics, Iowa City , Iowa , USA
| | - Patrick Hitchon
- Department of Neurosurgery, University of Iowa Hospital and Clinics, Iowa City , Iowa , USA
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5
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Takehara M, Ashihara K, Fukunishi T, Ibuchi S, Mukai Y. Malignant retroperitoneal solitary fibrous tumor co-existing with Meigs' syndrome: A case report. Radiol Case Rep 2023; 18:4553-4557. [PMID: 37868006 PMCID: PMC10587666 DOI: 10.1016/j.radcr.2023.09.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/18/2023] [Accepted: 09/25/2023] [Indexed: 10/24/2023] Open
Abstract
Malignant solitary fibrous tumors in the retroperitoneum are rare, and their treatment strategies have not yet been established. A 61-year-old woman with dyspnea underwent laparotomy under a presumptive diagnosis of Meigs' syndrome. She underwent both adnexectomy and retroperitoneal tumor excision. The histologic diagnosis was of a fibrothecoma of both ovaries and a retroperitoneal solitary fibrous tumor that was considered malignant based on its mitotic activity. Local recurrence was observed 9 months postoperatively; re-excision was performed, and radiation therapy was administered. Four months later, metastasis to the left lung was detected, and a thoracoscopic resection was performed. Although pazopanib was administered subsequently, it was discontinued after 11 months because of proteinuria. She complained of dysphagia 3 weeks after the withdrawal of the drug, and a metastatic tumor was observed at the cranial base. Radiotherapy was initiated; however, she died of the disease 35 months after the primary surgery. Medical guidelines should be established for malignant solitary fibrous tumors to improve patient prognosis.
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Affiliation(s)
- Mikio Takehara
- Department of Obstetrics and Gynecology, Ikeda City Hospital, 3-1-18 Jyonan, Ikeda City, Osaka 563-8510, Japan
| | - Keisuke Ashihara
- Department of Obstetrics and Gynecology, Ikeda City Hospital, 3-1-18 Jyonan, Ikeda City, Osaka 563-8510, Japan
| | - Tomomi Fukunishi
- Department of Obstetrics and Gynecology, Ikeda City Hospital, 3-1-18 Jyonan, Ikeda City, Osaka 563-8510, Japan
| | - Seigo Ibuchi
- Department of Obstetrics and Gynecology, Ikeda City Hospital, 3-1-18 Jyonan, Ikeda City, Osaka 563-8510, Japan
| | - Yukari Mukai
- Department of Obstetrics and Gynecology, Ikeda City Hospital, 3-1-18 Jyonan, Ikeda City, Osaka 563-8510, Japan
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Ong K, Singh S, Swarbrick N, Hayne D. Solitary fibrous tumour of the urinary bladder - A rare and potentially malignant neoplasm. Urol Case Rep 2023; 50:102501. [PMID: 37529201 PMCID: PMC10387560 DOI: 10.1016/j.eucr.2023.102501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 07/10/2023] [Indexed: 08/03/2023] Open
Abstract
Solitary fibrous tumours (SFTs) of the urinary bladder are a rare mesenchymal neoplasm that occasionally has malignant potential. The tumour is characterised by haphazardly arranged spindle-shaped to ovoid cells, with a prominent, branching, thin-walled, dilated vasculature and NAB2-STAT6 gene rearrangement. While most SFTs are indolent in nature, difficulty arises predicting which SFTs are potentially malignant. There are now validated risk stratification tools to help identify which SFTs are likely to metastasize and help clinicians determine management. The mainstay of treatment for SFTs remains surgery, with emerging evidence in the combined use of surgery and radiotherapy.
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Affiliation(s)
- Katherine Ong
- Department of Urology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Shivani Singh
- Department of Anatomical Pathology, PathWest Laboratory Medicine WA, Western Australia, Australia
| | - Nicole Swarbrick
- Department of Anatomical Pathology, PathWest Laboratory Medicine WA, Western Australia, Australia
- Division of Pathology and Laboratory Medicine, UWA Medical School, University of Western Australia, Crawley, Western Australia, Australia
| | - Dickon Hayne
- Department of Urology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- UWA Medical School, University of Western Australia, Crawley, Western Australia, Australia
- Australia and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Sydney, New South Wales, Australia
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7
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Soumerai TE, Cote GM, Goiffon RJ, Yerevanian AI, Sy AL. Case 20-2023: A 52-Year-Old Man with a Solitary Fibrous Tumor and Hypoglycemia. N Engl J Med 2023; 388:2467-2477. [PMID: 37379139 DOI: 10.1056/nejmcpc2300899] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Affiliation(s)
- Tara E Soumerai
- From the Departments of Medicine (T.E.S., G.M.C., A.I.Y.), Radiology (R.J.G.), and Pathology (A.L.S.), Massachusetts General Hospital, and the Departments of Medicine (T.E.S., G.M.C., A.I.Y.), Radiology (R.J.G.), and Pathology (A.L.S.), Harvard Medical School - both in Boston
| | - Gregory M Cote
- From the Departments of Medicine (T.E.S., G.M.C., A.I.Y.), Radiology (R.J.G.), and Pathology (A.L.S.), Massachusetts General Hospital, and the Departments of Medicine (T.E.S., G.M.C., A.I.Y.), Radiology (R.J.G.), and Pathology (A.L.S.), Harvard Medical School - both in Boston
| | - Reece J Goiffon
- From the Departments of Medicine (T.E.S., G.M.C., A.I.Y.), Radiology (R.J.G.), and Pathology (A.L.S.), Massachusetts General Hospital, and the Departments of Medicine (T.E.S., G.M.C., A.I.Y.), Radiology (R.J.G.), and Pathology (A.L.S.), Harvard Medical School - both in Boston
| | - Armen I Yerevanian
- From the Departments of Medicine (T.E.S., G.M.C., A.I.Y.), Radiology (R.J.G.), and Pathology (A.L.S.), Massachusetts General Hospital, and the Departments of Medicine (T.E.S., G.M.C., A.I.Y.), Radiology (R.J.G.), and Pathology (A.L.S.), Harvard Medical School - both in Boston
| | - Albert L Sy
- From the Departments of Medicine (T.E.S., G.M.C., A.I.Y.), Radiology (R.J.G.), and Pathology (A.L.S.), Massachusetts General Hospital, and the Departments of Medicine (T.E.S., G.M.C., A.I.Y.), Radiology (R.J.G.), and Pathology (A.L.S.), Harvard Medical School - both in Boston
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8
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Lucas MF, Schlund M, Dapke S, Politis C, Aubert S, Wojcik T, Barry F, Mouawad F, Majoufre C, Leyman B, Testelin S, Nicot R. Surgical treatment outcomes of solitary fibrous tumors in the head and neck: A retrospective study. J Craniomaxillofac Surg 2023:S1010-5182(23)00094-X. [PMID: 37263831 DOI: 10.1016/j.jcms.2023.05.013] [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: 12/20/2022] [Revised: 02/14/2023] [Accepted: 05/23/2023] [Indexed: 06/03/2023] Open
Abstract
The aim of this study was to better characterize head and neck solitary fibrous tumors (SFTs) and to evaluate surgical treatment. This retrospective study included patients who presented with head and neck SFTs. Clinical, radiological, and histological information and data regarding the treatments performed were collected. The risk of locoregional and distant metastases was calculated, and for orbital SFTs a specific classification was used. Overall, 34 patients were included. The majority of the SFTs were found in the oral cavity (n = 10), followed by the neck region (n = 8). The mean time to recurrence was 67.4 months. All patients underwent primary surgical resection. Recurrence was observed in five patients with a low risk of locoregional recurrence and distant metastasis. The treatment of choice is complete resection. Recurrence seems to be highly correlated with positive surgical margins. The safety margin should be increased when removing the lesion, and long-term follow-up should be performed.
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Affiliation(s)
- Marti-Flich Lucas
- Univ. Angers, CHU Angers, Department of Oral and Maxillofacial Surgery, 49000, Angers, France.
| | - Matthias Schlund
- Univ. Bordeaux, CHU Bordeaux, Inserm, Department of Oral and Maxillofacial Surgery, U 1026 - Bioengineering of Tissues, F-33000, Bordeaux, France
| | - Stéphanie Dapke
- Maxillo-Facial Surgery Department, Amiens-Picardie University Hospital, 80000, Amiens, France
| | - Constantinus Politis
- Department OMFS, Department Imaging and Pathology, Faculty of Medicine, Leuven University Hospitals, Leuven, Belgium
| | - Sébastien Aubert
- Department of Pathology, Lille University Hospital, Lille, France; Inserm, CNRS, UMR9020, U1277 - CANTHER - Cancer Heterogeneity, Plasticity and Resistance to Therapies, University of Lille, Lille University Hospital, F-59000, Lille, France
| | - Thomas Wojcik
- Univ. Lille, CHU Lille, Inserm, Department of Oral and Maxillofacial Surgery, U 1008 - Controlled Drug Delivery Systems and Biomaterials, F-59000, Lille, France
| | - Florent Barry
- Univ. Angers, CHU Angers, Department of Oral and Maxillofacial Surgery, 49000, Angers, France
| | - François Mouawad
- ENT and Head and Neck Department, Lille, 59037, Cedex, France; University Lille, CNRS, Inserm, CHU Lille, UMR9020-U1277 - CANTHER - Cancer Heterogeneity Plasticity and Resistance to Therapies, Lille, F-59000, France
| | - Claire Majoufre
- Univ. Bordeaux, CHU Bordeaux, Department of Oral and Maxillofacial Surgery, F-33000, Bordeaux, France
| | - Bernard Leyman
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Sylvie Testelin
- Maxillo-Facial Surgery Department, Amiens-Picardie University Hospital, 80000, Amiens, France
| | - Romain Nicot
- Univ. Lille, CHU Lille, Inserm, Department of Oral and Maxillofacial Surgery, U 1008 - Controlled Drug Delivery Systems and Biomaterials, F-59000, Lille, France
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9
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Lee JS, Kelly CM, Bartlett EK. Management of pelvic sarcoma. Eur J Surg Oncol 2022; 48:2299-2307. [PMID: 36195471 DOI: 10.1016/j.ejso.2022.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 09/07/2022] [Accepted: 09/14/2022] [Indexed: 10/14/2022] Open
Abstract
Pelvic sarcomas are a rare and heterogenous group of tumors divided into two groups: soft tissue sarcomas and bone sarcomas. Soft tissue sarcomas of the pelvis include most commonly liposarcoma, leiomyosarcoma, gastrointestinal stromal tumors, malignant peripheral nerve sheath tumors, and solitary fibrous tumors. Bone sarcomas of the pelvis most commonly include osteosarcoma and chondrosarcoma. Multidisciplinary treatment at a center experienced in the treatment of sarcoma is essential. Management is dictated by histologic type and grade. Surgical resection with wide margins is the cornerstone of treatment for pelvic sarcomas, although this is often challenging due to anatomic constraints of the pelvis. Multimodal treatment is critical due to the high risk of local recurrence in the pelvis.
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Affiliation(s)
- Jay S Lee
- Department of Surgery, Duke University, Durham, NC, USA
| | - Ciara M Kelly
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Edmund K Bartlett
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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10
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Kazazian K, Demicco EG, de Perrot M, Strauss D, Swallow CJ. Toward Better Understanding and Management of Solitary Fibrous Tumor. Surg Oncol Clin N Am 2022; 31:459-483. [PMID: 35715145 DOI: 10.1016/j.soc.2022.03.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Solitary fibrous tumor (SFT) comprises a histologic spectrum of soft tissue neoplasms that are characterized by the unique NAB2-STAT6 gene fusion. Changes in diagnostic terminology and site-specific classification over the past few decades have resulted in a disjointed literature. Complete surgical excision with preservation of function remains the mainstay of treatment. New risk stratification systems including risk factors such as mitotic rate, age, tumor size, and presence of necrosis, among others, can be used to predict risk of recurrence or metastasis. Long-term follow-up after surgical resection is recommended. The clinical manifestations, diagnosis, management, and prognosis of SFT are reviewed here.
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Affiliation(s)
| | - Elizabeth G Demicco
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario M5G 1X5, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Marc de Perrot
- Department of Surgery, University of Toronto, Toronto, Canada; Division of Thoracic Surgery, Princess Margaret Cancer Centre/University Health Network, 200 Elizabeth Street, Toronto, Ontario M5G2C4, Canada
| | - Dirk Strauss
- Sarcoma Unit, Department of Academic Surgery, Royal Marsden Hospital, Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, England
| | - Carol J Swallow
- Department of Surgery, University of Toronto, Toronto, Canada; Department of Surgical Oncology, Princess Margaret Cancer Centre/Mount Sinai Hospital, Toronto, Canada.
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11
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Lin C, Yu X. Magnetic resonance imaging features of a solitary fibrous tumor of the vulva: a case report. J Int Med Res 2022; 50:3000605221112201. [PMID: 35899898 PMCID: PMC9340956 DOI: 10.1177/03000605221112201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Solitary fibrous tumors (SFTs) are commonly seen in the pleura. SFT involvement of the vulva is rare, and clinical diagnosis is mainly based on histopathological and immunohistochemical analyses. We herein describe the imaging features of a 69-year-old woman with an SFT of the vulva. The SFT was hypointense on T1-weighted images, similar to muscle; however, it showed inhomogeneous hyperintensity predominantly on fat-suppressed T2-weighted images. An area of low signal intensity was evident on T2-weighted images, and the tumor showed progressive enhancement in delayed phases. The tumor also displayed heterogeneous and prolonged, persistent enhancement, and serpentine vessels were present in the peritumoral area as signal voids. Pathological examination confirmed that the lesion was an atypical SFT originating from the vulva, and it was composed of spindle cells and perivascular and stromal hyalinization. This case reveals the characteristic imaging findings of vulvar SFT and their association with the relevant pathological findings, thus contributing to the primary diagnosis and preoperative evaluation of this potentially aggressive tumor.
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Affiliation(s)
- Chuxin Lin
- Department of Radiology, Zhuhai Hospital Affiliated with Jinan University (Zhuhai People's Hospital), Zhuhai, China
| | - Xiangrong Yu
- Department of Radiology, Zhuhai Hospital Affiliated with Jinan University (Zhuhai People's Hospital), Zhuhai, China
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12
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Ward C, Tsvetanova Z, O'Keane C, O'Mahony D. A case of multiple metastases from a primary renal solitary fibrous tumour; The uncertain long road. CURRENT PROBLEMS IN CANCER: CASE REPORTS 2022. [DOI: 10.1016/j.cpccr.2022.100163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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13
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Novel Therapeutic Options for Solitary Fibrous Tumor: Antiangiogenic Therapy and Beyond. Cancers (Basel) 2022; 14:cancers14041064. [PMID: 35205812 PMCID: PMC8870479 DOI: 10.3390/cancers14041064] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 01/10/2023] Open
Abstract
SFT is an ultrarare mesenchymal ubiquitous tumor, with an incidence rate <1 case/million people/year. The fifth WHO classification published in April 2020 subdivided SFT into three categories: benign (locally aggressive), NOS (rarely metastasizing), and malignant. Recurrence can occur in up to 10-40% of localized SFTs, and several risk stratification models have been proposed to predict the individual risk of metastatic relapse. The Demicco model is the most widely used and is based on age at presentation, tumor size, and mitotic count. Total en bloc resection is the standard treatment of patients with a localized SFT; in case of advanced disease, the clinical efficacy of conventional chemotherapy remains poor. In this review, we discuss new insights into the biology and the treatment of patients with SFT. NAB2-STAT6 oncogenic fusion, which is the pathognomonic hallmark of SFT, is supposedly involved in the overexpression of vascular endothelial growth factor (VEGF). These specific biological features encouraged the successful assessment of antiangiogenic drugs. Overall, antiangiogenic therapies showed a significant activity toward SFT in the advanced/metastatic setting. Nevertheless, these promising results warrant additional investigation to be validated, including randomized phase III trials and biological translational analysis, to understand and predict mechanisms of efficacy and resistance. While the therapeutic potential of immunotherapy remains elusive, the use of antiangiogenics as first-line treatment should be considered.
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14
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Zhang DY, Su L, Wang YW. Malignant solitary fibrous tumor in the central nervous system treated with surgery, radiotherapy and anlotinib: A case report. World J Clin Cases 2022; 10:631-642. [PMID: 35097089 PMCID: PMC8771389 DOI: 10.12998/wjcc.v10.i2.631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 11/01/2021] [Accepted: 12/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Solitary fibrous tumor (SFT) of the central nervous system is rare. It is predominantly benign and rarely malignant. There is no established standardized treatment regimen for malignant intracranial SFTs.
CASE SUMMARY We present a rare case of SFT in a 9-year-old girl with a space-occupying effect in the frontal-parietal lobes. She underwent craniotomy, and the mass was resected. Immunohistochemistry examination of the specimen showed that Ki-67 proliferation index staining was highly positive in 80% of tumor cells. Whole exome sequencing of the surgical tissue showed 38 somatic gene mutations and 1 gene amplification such as fibroblast growth factor receptor 4 or TP53. At 1.5 mo after surgery, head magnetic resonance imaging revealed that the tumor had recurred. The patient received 60 Gy and 30 fractions of intensity modulated radiotherapy. The patient then received anlotinib 8 mg po qd for 1-14 d of a 21 d cycle. Following this regimen, the patient achieved stable disease for > 17 mo. Magnetic resonance imaging at 1.5 year after surgery showed that the tumor had not progressed.
CONCLUSION This is the first reported case of SFT of the central nervous system treated with surgery, radiotherapy and anlotinib. This regimen may be an effective treatment option for malignant intracranial SFT patients.
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Affiliation(s)
- Dong-Yong Zhang
- Department of Neurosurgery, the First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Lan Su
- Department of Genetron Health, Genetron Health, Beijing 110024, China
| | - Yi-Wei Wang
- Department of Anatomy, Shenyang Medical College, Shenyang 110034, Liaoning Province, China
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15
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Recurrent Solitary Fibrous Tumor in Intradural Extramedullary Space: Case Report and Review of the Literature. Case Rep Oncol Med 2021; 2021:4559749. [PMID: 34845431 PMCID: PMC8627340 DOI: 10.1155/2021/4559749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 10/28/2021] [Indexed: 11/17/2022] Open
Abstract
Solitary fibrous tumor/hemangiopericytoma (SFT/HPC) is a rare neoplasm arising from spindle cells and most commonly arising from pleura. Spinal SFT/HPC is a rare entity; hence, it is not on the top of the differential diagnosis list when a clinician faces a spinal lesion. In the review of the literature, there exist less than 50 case reports of intradural extramedullary SFT/HPC. Here, we present a 54-year-old female patient who underwent subtotal surgical excision of an intradural extramedullary spinal mass pathologically reported to be SFT/HPC and had symptomatic recurrence in the 3rd year of follow-up. Surgical intervention was unachievable and the patient was given 45 Gy to the surgical cavity followed by a 5.4 Gy boost to visible tumor with external radiotherapy. Patient reported significant relief of her symptoms. We aim to contribute to the formation of a treatment algorithm for this rare entity.
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16
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Wang W, Bao B, Hu A, Zhu X, Chen Q. Two case reports of rare diseases occurring in rare parts: splenic vein solitary fibrous tumor and liver solitary fibrous tumor. AME Case Rep 2021; 5:17. [PMID: 33912806 DOI: 10.21037/acr-20-142] [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: 09/15/2020] [Accepted: 02/06/2021] [Indexed: 11/06/2022]
Abstract
Solitary fibrous tumor (SFT) is a rare soft tissue tumor originating from mesenchymal cells. Here we report two new cases of SFT. One case was a 37-year-old female patient whose primary tumor site was located in the splenic vein and the primary tumor resulted in splenomegaly and hypersplenism; its recurred for many times after surgical resection and eventually transferred to the liver, 4 operations were performed during 10 years of follow-up, and the patient is in a good condition right now. The second case was a 54-year-old male patient whose primary tumor site was located in the liver, spleen and left side of the chest wall. We performed two operations to remove these tumors, totally. Six years later, SFT recurred in the liver, given that the tumor was too large to be surgical resected completely, we chose orthotopic liver transplantation (OLT), and no tumor recurred during 6 years' follow-up, he is also in a good condition right now. The reports of these two cases of SFT are exceedingly rare, especially the splenic vein SFT is the first report case, which helps expand the understanding of SFT. Although the current mainstream treatment of SFT is surgical resection, liver transplantation may be a new option treatment for the huge liver SFT.
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Affiliation(s)
- Wenjing Wang
- Department of Pediatric Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Banghe Bao
- Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Anbin Hu
- Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiaofeng Zhu
- Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qing Chen
- Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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17
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Tariq MU, Din NU, Abdul-Ghafar J, Park YK. The many faces of solitary fibrous tumor; diversity of histological features, differential diagnosis and role of molecular studies and surrogate markers in avoiding misdiagnosis and predicting the behavior. Diagn Pathol 2021; 16:32. [PMID: 33879215 PMCID: PMC8059036 DOI: 10.1186/s13000-021-01095-2] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/12/2021] [Indexed: 12/17/2022] Open
Abstract
Background Solitary Fibrous Tumor (SFT) is a distinct soft tissue neoplasm associated with NAB2-STAT6 gene fusion. It can involve a number of anatomic sites and exhibits a wide spectrum of histological features. Main body Apart from diversity in morphological features seen even in conventional SFT, two histologic variants (fat-forming and giant cell-rich) are also recognized. In addition, a malignant form and dedifferentiation are well recognized. Owing to diverse histological features and involvement of diverse anatomic locations, SFT can mimic other soft tissue neoplasms of different lineages including schwannoma, spindle cell lipoma, dermatofibrosarcoma protuberans, liposarcoma, gastrointestinal stromal tumor (GIST), malignant peripheral nerve sheath tumor (MPNST), and synovial sarcoma. SFT is classified as an intermediate (rarely metastasizing) tumor according to World Health Organization Classification of Tumors of Soft tissue and Bone, 5th edition. The management and prognosis of SFT differs from its malignant mimics and correct diagnosis is therefore important. Although SFT expresses a distinct immunohistochemical (IHC) profile, the classic histomorphological and IHC profile is not seen in all cases and diagnosis can be challenging. NAB2-STAT6 gene fusion has recently emerged as a sensitive and specific molecular marker and its IHC surrogate marker signal transducer and activator of transcription 6 (STAT6) has also shown significant sensitivity and specificity. However, few recent studies have reported STAT6 expression in other soft tissue neoplasms. Conclusion This review will focus on describing the diversity of histological features of SFT, differential diagnoses and discussing the features helpful in distinguishing SFT from its histological mimics.
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Affiliation(s)
- Muhammad Usman Tariq
- Section of Histopathology, Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Nasir Ud Din
- Section of Histopathology, Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Jamshid Abdul-Ghafar
- Department of Pathology and Clinical Laboratory, French Medical Institute for Mothers and Children (FMIC), Kabul, Afghanistan.
| | - Yong-Koo Park
- Emeritus Professor, Kyung Hee University, School of Medicine Vice President of Asia, International Academy of Pathology, U2Labs, Jangwon Medical Foundation 68 Geoma-ro, Songpa-gu, Seoul, 05755, South Korea
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18
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Hassani M, Jung S, Garzia L, Ghodsi E, Alcindor T, Turcotte RE. Aggressive Behavior Predictors in Solitary Fibrous Tumor: Demographic, Clinical, and Histopathologic Characteristics of 81 Cases. Ann Surg Oncol 2021; 28:6861-6867. [PMID: 33512676 DOI: 10.1245/s10434-021-09592-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 01/02/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Solitary fibrous tumor (SFT) is a rare mesenchymal tumor with an intermediate tendency to metastasize. Meningeal hemangiopericytoma (HPC), arising in the meningeal membranes, also is considered an SFT. Although SFT is assumed to show an unpredictable behavior, the authors defined some factors associated with its aggressive behavior. METHODS This retrospective study was based on the medical records of 81 SFT patients treated surgically, with the median follow-up period of 59 months. The patients were assigned to three histopathologic groups based on the 2016 WHO classification: group 1 (SFT, 29 patients), group 2 (cellular SFT/hemangiopericytoma [HPC], 27 patients), and group 3 (malignant SFT/anaplastic HPC, 25 patients). RESULTS The SFT histopathologic classification was associated with distant metastasis (DM) (p = 0.007). The multivariate analysis showed that cellular SFT had an independent impact on DM (odds ratio [OR] = 25.42; p = 0.006). Tumor diameter larger than 7.25 cm was correlated with DM (p = 0.010) and the patient's disease-specific death (DSD) (p = 0.007). A 1-cm increase in tumor diameter enhanced the likelihood of metastasis by 1.26 (OR = 1.26; 95% confidence interval [CI], 1.05-1.53). Tumors originating from the central nervous system (CNS) showed a greater tendency toward local recurrence (LR) (p = 0.039) and DM (p = 0.05). Radiotherapy had no association with LR, DM, or DSD. The 10-year disease-specific survival rate was 82.7%. CONCLUSIONS Tumor size and histopathologic diagnosis are the predictors of SFT's aggressive behavior. Cellular SFTs behave as aggressively as the malignant form of the tumor. A SFT grading based on SFT cellularity would contribute to anticipation of its aggressive behavior.
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Affiliation(s)
- Mohammad Hassani
- Division of Orthopedic Surgery, McGill University Health Center, Montreal, Quebec, Canada.,Division of Orthopedic Surgery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sungmi Jung
- Department of Pathology, McGill University Health Center, Montreal, Quebec, Canada
| | - Livia Garzia
- Division of Orthopedic Surgery, McGill University, Montreal, Quebec, Canada
| | | | - Thierry Alcindor
- Department of Oncology, McGill University Health Center, Montreal, Quebec, Canada
| | - Robert E Turcotte
- Division of Orthopedic Surgery, McGill University Health Center, Montreal, Quebec, Canada.
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19
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Gonzalez JA, Sanchez E, Messa Botero O, Cervera-Bonilla S. Solitary Fibrous Tumor in the Perianal Region: Report of Two Cases With an Atypical Location. Cureus 2021; 13:e12887. [PMID: 33643733 PMCID: PMC7901715 DOI: 10.7759/cureus.12887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
A solitary fibrous tumor (SFT) is a mesenchymal neoplasm of spindle cells, initially described in the pleura. The World Health Organization (WHO) classifies the solitary fibrous tumor as a neoplasm with intermediate biological potential. Diagnostic images are essential for the diagnostic and therapeutic approach in this entity. The standard of treatment for this type of lesion is surgical resection with oncological margins larger than 1 cm. The solitary fibrous tumors located in the perianal, perineal, and pelvic regions are infrequent and represent a challenge in the clinical approach, mainly because the manifestations are nonspecific. Given the low incidence of this type of neoplasm, we present two cases of SFT in the perianal region managed in a high-complexity hospital.
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Affiliation(s)
| | - Elio Sanchez
- Surgical Oncology, Instituto Nacional de Cancerología, Bogota, COL
| | | | - Sergio Cervera-Bonilla
- Breast and Soft Tissue Surgery, Hospital Universitario San Ignacio, Bogota, COL.,Breast and Soft Tissue Surgery, Instituto Nacional de Cancerología, Bogota, COL
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20
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Usuda D, Yamada S, Izumida T, Sangen R, Higashikawa T, Nakagawa K, Iguchi M, Kasamaki Y. Intracranial malignant solitary fibrous tumor metastasized to the chest wall: A case report and review of literature. World J Clin Cases 2020; 8:4844-4852. [PMID: 33195652 PMCID: PMC7642533 DOI: 10.12998/wjcc.v8.i20.4844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/23/2020] [Accepted: 09/10/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Solitary fibrous tumor (SFT) is a rare fibroblastic mesenchymal neoplasm that affects spindle cell soft tissues with broad-spectrum biological behavior; it is predominantly benign, and rarely metastasizes. SFT occurs mainly in the tissue structure of the serosa in the pleura and the thorax, and can be found throughout the body, though extra-thoracic localization, including the cephalic region, is un-common. We reported the first case of intracranial malignant SFT metastasized to the chest wall.
CASE SUMMARY An 81-year-old Japanese man was referred to our hospital due to progressive gait disturbance and appetite loss. His medical history included partial resection due to brain tumor, four times, and 50-Gray radiation therapy at another hospital, starting when he was 74 years old. An unenhanced head computed tomography (CT) scan revealed an 8 cm × 5.1 cm × 6.5 cm mixed-density mass at the left frontal lobe, accompanying a midline shift, and an unenhanced chest-abdomen CT scan revealed a 6 cm × 4.1 cm × 6.5 cm low-density mass in the left chest wall. A CT-guided percutaneous lung biopsy was performed, and the pathological findings were SFT corresponding to brain tumor. Finally, the correct diagnosis of his brain tumor in history of past illness revealed to be SFT, and the unremovable tumor, namely present brain lesions enlarged and metastasized to the chest wall. We established a definitive diagnosis of intracranial malignant SFT metastasized to the chest wall. We notified him and his family of the disease, and offered palliative care. He passed away on the 29th hospital day.
CONCLUSION This case suggests the need for careful, detailed examination, and careful follow-up when encountering patients presenting with a mass.
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Affiliation(s)
- Daisuke Usuda
- Department of General Medicine, Kanazawa Medical University Himi Municipal Hospital, Himi-shi 935-8531, Toyama-ken, Japan
- Department of Infectious Diseases, Kanazawa Medical University, Uchinada-machi 920-0293, Ishikawa-ken, Japan
| | - Shinya Yamada
- Department of Respiratory Medicine, Kanazawa Medical University Himi Municipal Hospital, Himi-shi 935-8531, Toyama-ken, Japan
| | - Toshihide Izumida
- Department of General Medicine, Kanazawa Medical University Himi Municipal Hospital, Himi-shi 935-8531, Toyama-ken, Japan
| | - Ryusho Sangen
- Department of General Medicine, Kanazawa Medical University Himi Municipal Hospital, Himi-shi 935-8531, Toyama-ken, Japan
| | - Toshihiro Higashikawa
- Department of Geriatric Medicine, Kanazawa Medical University Himi Municipal Hospital, Himi-shi 935-8531, Toyama-ken, Japan
| | - Ken Nakagawa
- Department of Respiratory Medicine, Kanazawa Medical University Himi Municipal Hospital, Himi-shi 935-8531, Toyama-ken, Japan
| | - Masaharu Iguchi
- Department of Respiratory Medicine, Kanazawa Medical University Himi Municipal Hospital, Himi-shi 935-8531, Toyama-ken, Japan
| | - Yuji Kasamaki
- Department of General Medicine, Kanazawa Medical University Himi Municipal Hospital, Himi-shi 935-8531, Toyama-ken, Japan
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21
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Fernández-Trujillo L, Bolaños JE, Álvarez C, Giraldo J, Velásquez M, Zúñiga-Restrepo V, Pérez B, Sua LF. Doege-Potter Syndrome and Hypoglycemia associated with Solitary Fibrous Tumor of the Pleura: Two Case Reports. CLINICAL MEDICINE INSIGHTS-CIRCULATORY RESPIRATORY AND PULMONARY MEDICINE 2020; 14:1179548420964759. [PMID: 33110350 PMCID: PMC7566176 DOI: 10.1177/1179548420964759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 09/17/2020] [Indexed: 11/28/2022]
Abstract
Solitary fibrous tumors of the pleura (SFTP) are rare mesenchymal neoplasms that
originate from mesenchymal growth in the pleura, tend to be single tumors,
usually have an indolent course and show nonspecific symptoms. SFTP can be often
diagnosed from an incidental finding of a single mass in the thorax and should
be confirmed by biopsy and immunohistochemistry. A minority of cases may present
Doege–Potter syndrome (DPS, episodes of refractory hypoglycemia) associated with
production of insulin-like growth factor 2 (IGF-2). Both SFTP and DPS are rare
occurrences with less than 2000 cases reported worldwide. The curative treatment
is tumor resection. Two cases of patients with DPS caused by SFTP are presented
below.
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Affiliation(s)
- Liliana Fernández-Trujillo
- Department of Internal Medicine, Pulmonology Service, Interventional Pulmonology, Fundación Valle del Lili, Cali, Colombia.,Faculty of Health Sciences, Universidad Icesi, Cali, Colombia
| | - Jhon E Bolaños
- Faculty of Health Sciences, Universidad Icesi, Cali, Colombia
| | | | - Julián Giraldo
- Faculty of Health Sciences, Universidad Icesi, Cali, Colombia
| | - Mauricio Velásquez
- Faculty of Health Sciences, Universidad Icesi, Cali, Colombia.,Department of Surgery, Thoracic Surgery Service, Fundación Valle del Lili, Cali, Colombia
| | | | - Bladimir Pérez
- Faculty of Health Sciences, Universidad Icesi, Cali, Colombia.,Department of Pathology and Laboratory Medicine, Fundación Valle del Lili. Cali, Colombia
| | - Luz F Sua
- Faculty of Health Sciences, Universidad Icesi, Cali, Colombia.,Department of Pathology and Laboratory Medicine, Fundación Valle del Lili. Cali, Colombia
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22
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Haas RL, Walraven I, Lecointe-Artzner E, van Houdt WJ, Strauss D, Schrage Y, Hayes AJ, Raut CP, Fairweather M, Baldini EH, Gronchi A, De Rosa L, Griffin AM, Ferguson PC, Wunder J, van de Sande MAJ, Krol ADG, Skoczylas J, Sangalli C, Stacchiotti S. Extrameningeal solitary fibrous tumors-surgery alone or surgery plus perioperative radiotherapy: A retrospective study from the global solitary fibrous tumor initiative in collaboration with the Sarcoma Patients EuroNet. Cancer 2020; 126:3002-3012. [PMID: 32315454 PMCID: PMC7318349 DOI: 10.1002/cncr.32911] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 03/26/2020] [Accepted: 03/30/2020] [Indexed: 12/19/2022]
Abstract
Background Solitary fibrous tumor (SFT) is a rare mesenchymal malignancy. Although surgery is potentially curative, the local relapse risk is high after marginal resections. Given the lack of prospective clinical trial data, the objective of the current study was to better define the role of perioperative radiotherapy (RT) in various SFT presentations by location. Methods This was retrospective study performed across 7 sarcoma centers. Clinical information was retrieved from all adult patients with extrameningeal, primary, localized SFT who were treated between 1990 and 2018 with surgery alone (S) compared with those who also received perioperative RT (S+RT). Differences in treatment characteristics between subgroups were tested using analysis of variance statistics and propensity score matching. Local control and overall survival rates were calculated from the start of treatment until progression or death from any cause. Results Of all 549 patients, 428 (78%) underwent S, and 121 (22%) underwent S+RT. The median follow‐up was 52 months. After correction for mitotic count and surgical margins, S+RT was significantly associated with a lower risk of local progression (hazard ratio, 0.19: P = .029), an observation further confirmed by propensity score matching (P = .012); however, this association did not translate into an overall survival benefit. Conclusions The results from this retrospective study investigating perioperative RT in patients with primary extrameningeal SFT suggest that combining RT with surgery in the management of this patient population is significantly associated with a reduced risk of local failures, especially in patients who have less favorable resection margins and in those who have tumors with a high mitotic count. This retrospective study of perioperative radiotherapy in patients with primary extrameningeal solitary fibrous tumors suggests that combining radiotherapy with surgery in the management of this population significantly reduces the risk of local failures, especially in patients who have less favorable resection margins or tumors with a high mitotic count.
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Affiliation(s)
- Rick L Haas
- Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Radiation Oncology, The Leiden University Medical Center, Leiden, The Netherlands
| | - Iris Walraven
- Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Winan J van Houdt
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Dirk Strauss
- Sarcoma Unit, Department of Surgery, The Royal Marsden Hospital, London, United Kingdom
| | - Yvonne Schrage
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Sarcoma Unit, Department of Surgery, The Royal Marsden Hospital, London, United Kingdom.,Department of Surgical Oncology, The Leiden University Medical Center, Leiden, The Netherlands
| | - Andrew J Hayes
- Sarcoma Unit, Department of Surgery, The Royal Marsden Hospital, London, United Kingdom
| | - Chandrajit P Raut
- Division of Surgical Oncology, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.,Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Mark Fairweather
- Division of Surgical Oncology, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.,Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Elizabeth H Baldini
- Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Alessandro Gronchi
- Department of Surgical Oncology, IRCCS Foundation, National Cancer Institute, Milan, Italy
| | - Laura De Rosa
- Department of Surgical Oncology, IRCCS Foundation, National Cancer Institute, Milan, Italy
| | - Anthony M Griffin
- Department of Orthopedic Surgery, Sarcoma Unit, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Peter C Ferguson
- Department of Orthopedic Surgery, Sarcoma Unit, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Jay Wunder
- Department of Orthopedic Surgery, Sarcoma Unit, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Michiel A J van de Sande
- Department of Orthopedic Oncology, The Leiden University Medical Center, Leiden, The Netherlands
| | - Augustinus D G Krol
- Department of Radiation Oncology, The Leiden University Medical Center, Leiden, The Netherlands
| | - Jacus Skoczylas
- Department of Surgical Oncology, The Maria Sklodowska-Curie Institute Oncology Center, Warsaw, Poland
| | - Claudia Sangalli
- Radiation Oncology, IRCCS Foundation, National Cancer Institute, Milan, Italy
| | - Silvia Stacchiotti
- Adult Mesenchymal and Rare Tumor Unit, Medical Oncology, IRCCS Foundation, National Cancer Institute, Milan, Italy
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23
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Kaya EA, Carlson JD, Thomas CJ, Wagner AE, Fairbanks RK, Lamoreaux WT, Lee CM. Single Solitary Fibrous Tumor Brain Metastasis in a Patient with Simultaneous Adenocarcinoma of the Lung: Case Report and Review of the Literature. Case Rep Med 2020; 2020:3938270. [PMID: 32318112 PMCID: PMC7166291 DOI: 10.1155/2020/3938270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/24/2020] [Accepted: 02/27/2020] [Indexed: 11/29/2022] Open
Abstract
We present a unique case of a patient simultaneously diagnosed with solitary fibrous tumor (SFT) and unrelated adenocarcinoma of the lung, both proven with separate pathology. It was subsequently found that the SFT had metastasized to the brain by additional pathology, and not the predicted adenocarcinoma. SFTs are a rare mesenchymal neoplasm that accounts for less than 2% of all reported soft tissue tumors. SFTs most commonly arise in the thoracic cavity, but are frequently found in various locations throughout the body, and rarely metastasize to the brain. This case highlights that rare neoplasms, such as SFT, should not be ruled out as a potential cause of metastasis. Due to the rarity of this clinical situation, we also provide a review and discussion of previously reported SFT cases and the use of postoperative radiation therapy. The optimal treatment for individual patients remains unclear in this unique situation. Surgical resection followed by adjuvant Gamma Knife radiation therapy to the surgical bed appears to be a safe option for local treatment of SFT in select patients. Further studies are needed of this rare clinical situation in order to better understand and optimize future treatments for patients with SFT and metastasis to the brain.
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Affiliation(s)
- Erin A Kaya
- Department of Radiation Oncology, Cancer Care Northwest and Gamma Knife of Spokane, Spokane, WA, USA
- Washington State University (WSU) Elson S. Floyd College of Medicine (ESFCOM), Spokane, WA, USA
| | | | | | - Aaron E Wagner
- Department of Radiation Oncology, Cancer Care Northwest and Gamma Knife of Spokane, Spokane, WA, USA
| | - Robert K Fairbanks
- Department of Radiation Oncology, Cancer Care Northwest and Gamma Knife of Spokane, Spokane, WA, USA
| | - Wayne T Lamoreaux
- Department of Radiation Oncology, Cancer Care Northwest and Gamma Knife of Spokane, Spokane, WA, USA
| | - Christopher M Lee
- Department of Radiation Oncology, Cancer Care Northwest and Gamma Knife of Spokane, Spokane, WA, USA
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24
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Demicco EG, Griffin AM, Gladdy RA, Dickson BC, Ferguson PC, Swallow CJ, Wunder JS, Wang WL. Comparison of published risk models for prediction of outcome in patients with extrameningeal solitary fibrous tumour. Histopathology 2019; 75:723-737. [PMID: 31206727 DOI: 10.1111/his.13940] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 06/11/2019] [Indexed: 12/12/2022]
Abstract
AIMS Solitary fibrous tumours (SFTs) are fibroblastic mesenchymal tumours with a 10-30% metastatic rate. Several risk models have been proposed for extrameningeal SFT, but they have not been evaluated in direct comparison with each other. The aim of this study is to compare the utility of published risk models in a multi-institutional SFT cohort. METHODS AND RESULTS Clinicopathological data were evaluated for a cohort of extrameningeal SFTs, and used to stratify tumours by the use of five proposed risk models designed for soft tissue and/or pleural SFT [modified Demicco, Pasquali, Salas overall survival (OS), Salas metastasis, and Salas local recurrence (LR)]. Kaplan-Meier and Cox proportional hazards models were used to assess OS, time to first metastasis, time to first LR, and recurrence-free survival (RFS). The study included 303 patients (109 from a referral cancer treatment centre; previously described in the original Demicco model) and an independent cohort from two large hospitals (n = 194). The median patient age was 54 years, and the median clinical follow-up (available for 220 patients) was 37 months. The independent cohort had a 13% risk of metastasis at 5 years and a 16% risk of metastasis at 10 years. In this cohort, the modified Demicco, Salas OS, and Salas metastasis models predicted metastasis and RFS, whereas the Pasquali model had the best correlation with OS. CONCLUSIONS Multivariate risk models that include mitotic rate and patient age can more accurately predict aggressive behaviour in SFTs, with the modified Demicco and Salas OS risk models showing the best correlation with metastasis and RFS.
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Affiliation(s)
- Elizabeth G Demicco
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Anthony M Griffin
- Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, ON, Canada.,Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Rebecca A Gladdy
- Division of General Surgery, Mount Sinai Hospital, Toronto, ON, Canada.,Sarcoma Site Group, Princess Margaret Cancer Centre, Toronto, ON, Canada.,Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Brendan C Dickson
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Peter C Ferguson
- Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, ON, Canada.,Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Carol J Swallow
- Division of General Surgery, Mount Sinai Hospital, Toronto, ON, Canada.,Sarcoma Site Group, Princess Margaret Cancer Centre, Toronto, ON, Canada.,Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Jay S Wunder
- Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, ON, Canada.,Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Wei-Lien Wang
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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25
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Histological and molecular features of solitary fibrous tumor of the extremities: clinical correlation. Virchows Arch 2019; 476:445-454. [PMID: 31463729 DOI: 10.1007/s00428-019-02650-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 08/13/2019] [Accepted: 08/13/2019] [Indexed: 12/21/2022]
Abstract
Solitary fibrous tumor is a rare mesenchymal neoplasm that exhibits a broad spectrum of biological behaviors. Few studies relative to clinical-pathologic features and predictive factors have been reported, all involving a mixed population of tumors occurring at different anatomic sites. In this study, we described a cohort of 41 patients with solitary fibrous tumor of the extremities and evaluated the prognostic role of clinical and histological features, presence of C228T and C250T mutations at the TERT promoter region, and NAB2-STAT6 fusion variants. Patients were stratified according to the latest risk stratification model proposed by Demicco. The two patients with metastasis at presentation were in the high-risk group; the one with metastasis after surgery was classified in the intermediate-risk group. TERT promoter mutations were detected in 9 out of 38 DNA available. All patients with metastasis were characterized by a TERT promoter mutation. TERT promoter mutation was associated with mitoses > 4 per high-power field (p = 0.001), necrosis (p = 0.049), and size > 10 cm (p = 0.031). NAB2-STAT6 fusion variants were detected in 27 out of 41 cases without any prognostic value. In conclusion, we confirmed that the patients with solitary fibrous tumor of the limbs have a better prognosis than other solitary fibrous tumors, with a very low percentage of metastatic events. Besides, our data support an association between TERT promoter mutations and histologically malignant features, suggesting a possible molecular role in stratifying patients into intermediate- to high-risk tumor.
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Naso JR, Chiu CG, Goecke ME, Chang D, Shiau CJ. Benign spindle cell lesions of the breast: a diagnostic approach to solitary fibrous tumour, nodular pseudoangiomatous stromal hyperplasia and nodular fasciitis. J Clin Pathol 2019; 72:438-442. [PMID: 30739079 DOI: 10.1136/jclinpath-2018-205561] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 01/12/2019] [Accepted: 01/19/2019] [Indexed: 01/20/2023]
Abstract
Benign spindle cell lesions of the breast include neoplastic and reactive entities that are diagnostically challenging given their rarity and similar histomorphology. Accurate diagnosis on percutaneous core biopsy within this category is essential as some lesions require excision and surveillance, whereas others may be observed. We present three cases of rare benign spindle cell lesions of the breast that reflect the diversity of this group: solitary fibrous tumour, nodular pseudoangiomatous stromal hyperplasia and nodular fasciitis. Through these cases, we discuss the associated differential diagnosis and demonstrate how emerging ancillary studies can be integrated into a diagnostic approach. We highlight distinctive clinical and histopathological features and summarise recent updates to the clinical management of these lesions. An organised approach to the broad differential of spindle cell lesions is essential for appropriate diagnosis and treatment.
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Affiliation(s)
- Julia R Naso
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Connie G Chiu
- Department of Surgery, Royal Columbian Hospital, New Westminster, BC, Canada
| | - Michelle E Goecke
- Department of Surgery, Royal Columbian Hospital, New Westminster, BC, Canada
| | - Debra Chang
- Department of Radiology, Royal Columbian Hospital, New Westminster, BC, Canada
| | - Carolyn J Shiau
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada .,Department of Pathology, Royal Columbian Hospital, New Westminster, BC, Canada
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Wang J, Zhao K, Han L, Jiao L, Liu W, Xu Y, Niu H, Ke C, Shu K, Lei T. Solitary Fibrous Tumor/Hemangiopericytoma of Spinal Cord: A Retrospective Single-Center Study of 16 Cases. World Neurosurg 2018; 123:e629-e638. [PMID: 30554000 DOI: 10.1016/j.wneu.2018.12.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 11/30/2018] [Accepted: 12/03/2018] [Indexed: 01/17/2023]
Abstract
OBJECTIVE In this study, we retrospectively reviewed our experience in the surgical management of solitary fibrous tumor (SFT)/hemangiopericytomas (HPCs) of the spinal cord. METHODS Sixteen patients with SFT/HPCs of the spinal cord were enrolled in this study. Data on clinical presentation, radiologic findings, histopathologic features, surgical treatment, adjuvant therapy, and prognosis were retrospectively reviewed. Kaplan-Meier curves and log-rank tests were used to identify the prognostic factors for recurrence and overall survival (OS). RESULTS Our series included 6 men and 10 women, with a male/female ratio of 1:1.7. Magnetic resonance imaging (MRI) showed slightly hyperintense lesions on T2-weighted images for all 16 patients. All tumors showed positive immunohistochemical staining for signal transducer and activator of transcription 6. Statistical analysis of clinical data showed that age, gender, tumor location, tumor size, medullary compartment location, and Ki-67 index were not associated with recurrence and OS (P > 0.05). However, World Health Organization grade III was significantly associated with recurrence (P < 0.01). Gross total resection (GTR) and postoperative radiotherapy significantly reduced recurrence (P < 0.01 and P < 0.05), but only GTR showed remarkable benefits to improve OS (P < 0.05). CONCLUSIONS SFT/HPCs of spinal cord are rare neoplasms with a propensity to recur. Hyperintensity on T2-weighted magnetic resonance imaging combined with positive immunohistochemical staining for signal transducer and activator of transcription 6 are important clues for classification and differentiation of these tumors. The extent of resection, World Health Organization grade, and postoperative radiotherapy might be predictive factors for recurrence. Complete tumor resection should be sought whenever possible, and adjuvant radiotherapy is recommended after surgical resection. Moreover, regular and long-term follow-up is mandatory to monitor recurrence.
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Affiliation(s)
- Junwen Wang
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kai Zhao
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lin Han
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liwu Jiao
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weihua Liu
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yu Xu
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongquan Niu
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Changshu Ke
- Department of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kai Shu
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Ting Lei
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Friis RB, Safwat A, Baad-Hansen T, Aggerholm-Pedersen N. Solitary Fibrous Tumour: A Single Institution Retrospective Study and Further Validation of a Prognostic Risk Assessment System. Clin Oncol (R Coll Radiol) 2018; 30:798-804. [PMID: 30206022 DOI: 10.1016/j.clon.2018.08.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 07/23/2018] [Accepted: 07/25/2018] [Indexed: 12/30/2022]
Abstract
AIMS Solitary fibrous tumour (SFT) is a rare mesenchymal-derived neoplasm that can arise in any anatomical location in the body. SFT rarely metastasises, but aggressive behaviour is seen in a minority of cases, and relapses can occur several years after treatment. It would be a clinical advantage if high-risk patients could be identified before treatment. MATERIALS AND METHODS We retrospectively analysed a population-based cohort of SFT to describe treatment, outcome, prognostic factors and to further validate a previously published risk assessment tool (D-score) based on age, tumour size and mitotic index. Seventy-two patients diagnosed with SFT in the Central, North and Southern Denmark regions between 1979 and 2013 were included in the study. RESULTS For patients with localised disease at the time of diagnosis (n = 64) the 5 and 10 year overall survival was 86% (95% confidence interval 74-92) and 65% (95% confidence interval 50-78), respectively. Seventeen of 62 patients (27%) who were in remission after radical treatment developed recurrence with either local or distant disease. The 5 year recurrence-free survival was 83% (95% confidence interval 70-90) and the 10 year was 69% (95% confidence interval 53-81). The 5 year local recurrence-free survival was 96% (95% confidence interval 86-99) and the 10 year was 92% (95% confidence interval 76-96). The median time to both overall recurrence and local recurrence was 4.3 years. Metastatic or inoperable SFT had a poor prognosis with a median overall survival of 8.4 months (range 3.6-26.4) and a 5 year overall survival of 11% (95% confidence interval 2-30). A further validation of a risk assessment tool (D-score) confirmed that patients classified as high-risk had a significantly decreased overall survival, with a hazard ratio of 3.7 (95% confidence interval 1.1-12.3). CONCLUSIONS This study showed that our management and outcome were comparable with other published studies describing SFT and confirmed the value of the D-score as a risk assessment tool. Because of late recurrences, long-term (e.g. 10 years) follow-up for moderate- and high-risk patients is recommended.
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Affiliation(s)
- R B Friis
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark.
| | - A Safwat
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - T Baad-Hansen
- Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus, Denmark
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Song Z, Yang F, Zhang Y, Fan P, Liu G, Li C, Ding W, Zhang Y, Xu X, Ye Y. Surgical therapy and next-generation sequencing-based genetic alteration analysis of malignant solitary fibrous tumor of the pleura. Onco Targets Ther 2018; 11:5227-5238. [PMID: 30214228 PMCID: PMC6118252 DOI: 10.2147/ott.s168045] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Solitary fibrous tumor of the pleura (SFTP) is a rare pleural neoplasm arising from mesenchymal cells, accounting for <5% of pleural neoplasms. Approximately 10% of cases of SFTP demonstrate malignant potential, leading to local recurrence after radical surgery and subsequent metastasis. Methods A large malignant-like mass was found in the left thoracic cavity of a 61-year-old woman. Following radical resection of the mass, the patient was diagnosed with malignant SFTP by histologic and immunohistochemical analyses. In addition, a next-generation sequencing-based mutation test was used to reveal the mutational profile of the tumor. The genetic alteration panel was analyzed with reference to public data on the ClinVar and COSMIC databases, after which the public SFTP data were analyzed for frequency of altered genes. Finally, through overlay of the abovementioned two sets, the genetic alteration accounting for SFTP initiation was anticipated to be identified. Results In the mutation panel of our malignant SFTP group, kinase insert domain receptor (KDR) and fms-related tyrosine kinase 1 (FLT1) scored high in pathogenesis but had only a medium frequency; the NAB2–STAT6 fusion appeared to be the dominant genetic alteration in public SFTP samples. Conclusion The high frequency of NAB2–STAT6 fusion indicates its prominent role in SFTP, while somatic mutations such as FLT1-R593W and KDR-V297I may also contribute to the malignant angiogenic phenotype. The present study affirmed the heterogeneity of SFTP, and more sophisticated classification methods will be needed to explore its underlying mechanisms. Summary We believe that improvement in the prognosis of SFTP relies on early diagnosis, margin-free resection, and long-term follow-up. Through genetic analysis, it appears that both NAB2–STAT6 fusion and somatic mutations such as FLT1-R593W and KDR-V297I contribute to SFTP development.
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Affiliation(s)
- Zuoqing Song
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Fan Yang
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Yingguo Zhang
- Wuwei Tumour Hospital, Gansu Province 733000, China,
| | - Ping Fan
- Wuwei Tumour Hospital, Gansu Province 733000, China,
| | - Guowei Liu
- Wuwei Tumour Hospital, Gansu Province 733000, China,
| | - Chao Li
- Wuwei Tumour Hospital, Gansu Province 733000, China,
| | - Wansheng Ding
- Wuwei Tumour Hospital, Gansu Province 733000, China,
| | - Yulong Zhang
- Wuwei Tumour Hospital, Gansu Province 733000, China,
| | - Xiaohong Xu
- College of Nursing, Tianjin Medical University, Tianjin 300070, China,
| | - Yancheng Ye
- Wuwei Tumour Hospital, Gansu Province 733000, China,
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Ronchi A, Cozzolino I, Zito Marino F, Accardo M, Montella M, Panarese I, Roccuzzo G, Toni G, Franco R, De Chiara A. Extrapleural solitary fibrous tumor: A distinct entity from pleural solitary fibrous tumor. An update on clinical, molecular and diagnostic features. Ann Diagn Pathol 2018; 34:142-150. [PMID: 29660566 DOI: 10.1016/j.anndiagpath.2018.01.004] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 01/04/2018] [Accepted: 01/08/2018] [Indexed: 02/08/2023]
Abstract
Solitary fibrous tumor (SFT) is a mesenchymal neoplasm that was originally described to be localized in the pleura, but thereafter, this has been reported in several anatomic sites. Although the etiology of the neoplasm remains largely unknown, the pathogenesis seems to be related to an NAB2-STAT6 fusion gene due to paracentric inversion on chromosome 12q13. The diagnosis of extrapleural SFT is challenging, owing to its rarity, and requires an integrated approach that includes specific clinical, histological, immunohistochemical, and even molecular findings. Histologically, extrapleural SFT shares morphological features same as those of the pleural SFT because it is characterized by a patternless distribution of both oval- and spindle-shaped cells in a variable collagen stroma. In addition, morphological variants of mixoid, fat-forming, and giant cell-rich tumors are described. A correct diagnosis is mandatory for a proper therapy and management of the patients with extrapleural SFT, as extrapleural SFT is usually more aggressive than pleural form, particularly cases occurring in the mediastinum, retroperitoneum, pelvis, and meninges. Although SFT is usually considered as a clinically indolent neoplasm, the prognosis is substantially unpredictable and only partially related to morphological features. In this context, cellularity, neoplastic borders, cellular atypias, and mitotic activity can show a wide range of variability. We review extrapleural SFT by discussing diagnostic clues, differential diagnosis, recent molecular findings, and prognostic factors.
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Affiliation(s)
- Andrea Ronchi
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania "Luigi Vanvitelli", via Luciano Armanni 20, 80100 Naples, Italy
| | - Immacolata Cozzolino
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania "Luigi Vanvitelli", via Luciano Armanni 20, 80100 Naples, Italy
| | - Federica Zito Marino
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania "Luigi Vanvitelli", via Luciano Armanni 20, 80100 Naples, Italy
| | - Marina Accardo
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania "Luigi Vanvitelli", via Luciano Armanni 20, 80100 Naples, Italy
| | - Marco Montella
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania "Luigi Vanvitelli", via Luciano Armanni 20, 80100 Naples, Italy
| | - Iacopo Panarese
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania "Luigi Vanvitelli", via Luciano Armanni 20, 80100 Naples, Italy
| | - Giuseppe Roccuzzo
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania "Luigi Vanvitelli", via Luciano Armanni 20, 80100 Naples, Italy
| | - Giorgio Toni
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania "Luigi Vanvitelli", via Luciano Armanni 20, 80100 Naples, Italy
| | - Renato Franco
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania "Luigi Vanvitelli", via Luciano Armanni 20, 80100 Naples, Italy.
| | - Annarosaria De Chiara
- Pathology Unit, Department in Support of Oncology Paths, Diagnostic Area, Istituto Nazionale dei Tumori I.R.C.C.S. Fondazione "Pascale", via Mariano Semmola 52, 80131 Naples, Italy
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Intrathoracic solitary fibrous tumor - an international multicenter study on clinical outcome and novel circulating biomarkers. Sci Rep 2017; 7:12557. [PMID: 28970578 PMCID: PMC5624895 DOI: 10.1038/s41598-017-12914-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 09/12/2017] [Indexed: 02/07/2023] Open
Abstract
Intrathoracic solitary fibrous tumor (SFT) is a rare disease. Radical resection is the standard of care. However, estimating prognosis and planning follow-up and treatment strategies remains challenging. Data were retrospectively collected by five international centers to explore outcome and biomarkers for predicting event-free-survival (EFS). 125 histological proven SFT patients (74 female; 59.2%; 104 benign; 83.2%) were analyzed. The one-, three-, five- and ten-year EFS after curative-intent surgery was 98%, 90%, 77% and 67%, respectively. Patients age (≥59 vs. <59 years hazard ratio (HR) 4.23, 95 confidence interval (CI) 1.56–11.47, p = 0.005), tumor-dignity (malignant vs. benign HR 6.98, CI 3.01–16.20, p <0.001), tumor-size (>10 cm vs. ≤10 cm HR 2.53, CI 1.10–5.83, p = 0.030), de Perrot staging (late vs. early HR 3.85, CI 1.65–8.98, p = 0.002) and resection margins (positive vs. negative HR 4.17, CI 1.15–15.17, p = 0,030) were associated with EFS. Furthermore, fibrinogen (elevated vs. normal HR 4.00, CI 1.49–10.72, p = 0.006) and the neutrophil–to-lymphocyte-ratio (NLR > 5 vs. < 5 HR 3.91, CI 1.40–10.89, p = 0.009) were prognostic after univariate analyses. After multivariate analyses tumor-dignity and fibrinogen remained as independent prognosticators. Besides validating the role of age, tumor-dignity, tumor-size, stage and resection margins, we identified for the first time inflammatory markers as prognosticators in SFT.
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Ali JM, Ali A, Van Leuven M, Bartosik WR. Giant solitary fibrous tumour of the pleura an unpredictable entity: case series and literature review. Ann R Coll Surg Engl 2017; 99:e165-e171. [PMID: 28660826 DOI: 10.1308/rcsann.2017.0067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
A small proportion of tumours can undergo malignant transformation. We report a case series of five patients diagnosed with giant solitary fibrous tumours of the pleura. These cases highlight the unpredictable nature of this disease process, with significant variability in clinical course observed, from indolence to aggressive progression. Three patients were found to have malignant disease on explant, with two of these having preoperative imaging and histology suggesting benign pathology. This finding emphasises that accurately differentiating between benign and malignant disease on imaging and/or biopsy has low specificity and sensitivity and cannot be relied upon in guiding the management of these tumours. Patients with solitary fibrous tumours of the pleura should be managed cautiously, owing to the unpredictable and potentially aggressive clinical course. We would advocate the position that all patients with solitary fibrous tumours of the pleura should be managed as if they have malignant disease. Prolonged follow-up is required due to the risk of disease recurrence, even in patients with benign disease.
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Affiliation(s)
- J M Ali
- Department of Thoracic Surgery, Norfolk and Norwich University Hospitals NHS Trust , Norwich , UK
| | - A Ali
- Department of Histopathology, Norfolk and Norwich University Hospitals NHS Trust , Norwich , UK
| | - M Van Leuven
- Department of Thoracic Surgery, Norfolk and Norwich University Hospitals NHS Trust , Norwich , UK
| | - W R Bartosik
- Department of Thoracic Surgery, Norfolk and Norwich University Hospitals NHS Trust , Norwich , UK
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Thway K, Ng W, Noujaim J, Jones RL, Fisher C. The Current Status of Solitary Fibrous Tumor: Diagnostic Features, Variants, and Genetics. Int J Surg Pathol 2016; 24:281-92. [PMID: 26811389 DOI: 10.1177/1066896915627485] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Solitary fibrous tumor (SFT) is a fibroblastic mesenchymal tumor originally described in the pleura but now shown at almost every anatomic site. Histopathologically, SFT is characteristically a circumscribed neoplasm composed of variably cellular and patternless distributions of bland spindle and ovoid cells within prominent collagenous stroma and shows diffuse expression of CD34, but it has a broad spectrum of both morphology and of biologic behavior. Many different names (particularly hemangiopericytoma) were previously used in the course of our understanding of this neoplasm but are now subsumed under the term "SFT," and the putative cell of origin was debated. However, it is now recognized that SFT is a translocation-associated neoplasm, consistently associated with NAB2-STAT6 gene fusions arising from recurrent intrachromosomal rearrangements on chromosome 12q, and this translocation is a likely major contributor to its pathogenesis. While most SFT with classical morphologic features behave in an indolent manner and those with overtly malignant histologic features tend to be aggressive neoplasms that behave as high-grade sarcomas, the behavior of SFT is unpredictable, and it is important to be aware of the propensity for aggressive behavior in a minority of histologically classical SFT and to ensure adequate clinical follow-up. Surgical excision remains the treatment gold standard; while radiotherapy and conventional chemotherapeutic agents have only shown limited efficacy, further understanding of the molecular events underlying tumorigenesis may allow the development of novel targeted treatments. We review SFT, discussing the morphologic spectrum and variants, including malignant and dedifferentiated subtypes, clinicopathological aspects, recent molecular genetic findings, and the differential diagnosis.
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Affiliation(s)
| | - Wen Ng
- Royal Marsden Hospital, London, UK
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