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Zhang X, Chen J, Du J, Ying J. Case report: Solitary fibrous tumor of the paracervical uterus combined with vaginal wall adenocarcinoma. Front Med (Lausanne) 2024; 11:1456221. [PMID: 39206171 PMCID: PMC11349547 DOI: 10.3389/fmed.2024.1456221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Accepted: 07/30/2024] [Indexed: 09/04/2024] Open
Abstract
Background Solitary fibrous tumors are rare mesenchymal tumors that typically occur in the pleura. Solitary fibrous tumors of the uterine cervix are uncommon. We report the first case of a patient who underwent total hysterectomy for vaginal wall adenocarcinoma and was found to have a concurrent solitary fibrous tumor in the paracervical-uterus. Case presentation A 51-year-old woman was admitted to our hospital due to contact bleeding. A gynecological examination revealed nodules of 3.0 × 1.0 cm on the vaginal wall, and a colposcopy with biopsy revealed adenocarcinoma of the vaginal wall. After the recommended staging examinations, the patient underwent total hysterectomy, double adnexectomy, pelvic lymph node dissection, and vaginal wall resection. During surgery, a nodule measuring approximately 2 × 2 cm was found in the middle of the mass in the left paracervical region. Subsequent postoperative histopathological examination confirmed an solitary fibrous tumor of the uterine cervix with adenocarcinoma of the vaginal wall. The patient was followed up for 46 months after hospitalization, and no recurrence or distant metastases were observed. Conclusion In rare cases, solitary fibrous tumors may form large masses in the cervical or vaginal wall. They can easily be misdiagnosed as benign or malignant cervical tumors before and during surgery. Postoperative pathology and immunohistochemistry are helpful for diagnosis. Most solitary fibrous cervical tumors are benign, occasionally with low malignant potential, and surgical treatment is feasible and effective.
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Affiliation(s)
- Xiaowei Zhang
- Department of Pathology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang, China
| | - Jun Chen
- Department of Medical Imaging, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang, China
| | - Junqiang Du
- Department of Gynaecology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang, China
| | - Jiajia Ying
- Department of Surgical Center, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang, China
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Nkanyane N, Ngene NC. Surgical excision of benign spindle cell neoplasm of the cervix predating miscarriage due to cervical insufficiency: A case report. Case Rep Womens Health 2022; 35:e00425. [PMID: 35769945 PMCID: PMC9234196 DOI: 10.1016/j.crwh.2022.e00425] [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: 05/20/2022] [Revised: 06/10/2022] [Accepted: 06/13/2022] [Indexed: 12/02/2022] Open
Abstract
This case report is on cervical spindle cell neoplasm and complications of its excision. A 34-year-old multiparous woman presented with a one-year history of mild to moderate non-radiating lower abdominal pain and a sensation of a mass in the vagina when urinating. These symptoms were associated with a recurrent foul-smelling yellow vaginal discharge which was unresponsive to antibiotic therapy prescribed at a primary healthcare clinic. Vaginal examination at a gynaecological clinic revealed a firm circular cervical mass. Excision biopsy of the mass (attached between the 1 and 3 o'clock positions on the cervix) showed a benign spindle cell neoplasm. The patient became pregnant six months after the surgical excision and had a miscarriage at 18 weeks of gestation due to cervical insufficiency. The report highlights the importance of antenatal surveillance for women following surgical excision of a cervical lesion such as spindle cell neoplasm as they may be predisposed to cervical insufficiency. Cervical insufficiency results from a defect in the mechanical properties of the cervix. Cervical surgery predisposes to cervical insufficiency. Spindle cell tumour of the cervix is rare and its excision weakens the cervix. Surveillance of the cervix is required in pregnancy after cervical surgery. Cerclage is recommended after cervical surgery for women with a history of preterm delivery.
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Devins KM, Young RH, Croce S, Burandt E, Bennett JA, Pesci A, Zannoni GF, Ip PPC, Nielsen GP, Oliva E. Solitary Fibrous Tumors of the Female Genital Tract: A Study of 27 Cases Emphasizing Nonvulvar Locations, Variant Histology, and Prognostic Factors. Am J Surg Pathol 2022; 46:363-375. [PMID: 34739418 DOI: 10.1097/pas.0000000000001829] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We report 27 solitary fibrous tumors of the female genital tract emphasizing nonvulvar locations, variant histology, and prognostic factors. The patients ranged from 25 to 78 years (most were over 40), and tumors occurred in the vulva (7), vagina (2), cervix (2), corpus (6), fallopian tube/paratubal soft tissue (5), and ovary (5). They ranged from 1.5 to 39 (mean=10.5) cm and were typically solid, but 4 were predominantly cystic. All had a haphazard arrangement of spindled to ovoid cells, with most demonstrating alternating cellular and hypocellular areas and prominent vessels, but 13 lacked hypocellular areas, and 7 had focal diffuse growth with inconspicuous vasculature. Other patterns included corded (8), fascicular (5), trabecular (1), and nested (1). Microcysts (6), myxoid background (8), hyalinization (8), lipomatous differentiation (2), and multinucleated cells (6) were also present, and 10 tumors had necrosis. Vasculature included thin-walled branching "staghorn" (27), thick-walled (7), and hyalinized vessels (5) or dilated anastomosing vascular channels (3). Nuclear atypia ranged from mild (19), moderate (7), to severe (1), and mitoses from 0 to 24/10 HPF (mean=4). STAT6 was positive in all 25 tumors tested. One tumor showed dedifferentiation; the remainder were classified as benign (19) or malignant (7) based on mitotic rate (univariate stratification model) and as low risk (14), intermediate risk (8), or high risk (4) based on the Demicco multivariate risk stratification score. Follow-up (median=23 mo) was available for 16 patients. Six tumors recurred (2 intermediate risk, 3 high risk, and the dedifferentiated tumor), 5 in the abdomen; the dedifferentiated tumor metastasized to the lung. Multivariate risk stratification was superior to univariate classification, as 5 "benign" tumors were reclassified as intermediate risk using the multivariate model; of these, 2 recurred, and 1 patient died of disease. Upper female genital tract tumors occurred in older patients, were larger, and more frequently classified as high risk compared with those of the lower tract. A trend toward increased cellularity was also seen in the upper tract tumors. Only size (P=0.04), necrosis (P=0.04), and Demicco score (P=0.01) independently correlated with recurrence. Female genital tract solitary fibrous tumors demonstrate a wide range of variant morphologies and occur in diverse sites in addition to the vulva. Tumors were often misdiagnosed as other neoplasms; thus, awareness of solitary fibrous tumors occurring at these sites is crucial in prompting staining for STAT6 to establish this diagnosis. The Demicco risk stratification system effectively predicts behavior.
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Affiliation(s)
- Kyle M Devins
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Robert H Young
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Sabrina Croce
- Department of Pathology, Bergonié Institute, Bordeaux, France
| | - Eike Burandt
- Department of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Anna Pesci
- Department of Pathology, IRCCS Sacred Heart Hospital, Negrar-Verona
| | - Gian F Zannoni
- Department of Pathology, Catholic University of the Sacred Heart, Rome, Italy
| | - Philip P C Ip
- Department of Pathology, University of Hong Kong, Pokfulam, Hong Kong
| | - G Petur Nielsen
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Esther Oliva
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Yan X, Zheng C, Wang J, Li D, Lu J, He L, Wang C. Transcatheter arterial embolization of malignant pelvic solitary fibrous tumor: case report and literature review. Transl Cancer Res 2022; 10:4979-4987. [PMID: 35116348 PMCID: PMC8797669 DOI: 10.21037/tcr-21-887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 10/20/2021] [Indexed: 12/15/2022]
Abstract
Pelvic malignant solitary fibrous tumor (SFT) is a relatively rare disease, and literature on radical resection with transcatheter arterial embolization of pelvic SFT is lacking. In this work, we report on a 55-year-old man with a presacral mass who was hospitalized at our department. Computed tomography and magnetic resonance imaging indicated pelvic space-occupying lesions that were 12 cm × 10 cm in size and pelvic lesions that were not clearly demarcated from the right posterior wall of the bladder and the right ureter. This result suggested severe secondary hydronephrosis of the right renal pelvis. The patient underwent transcatheter iliac arterial embolization. Radical tumor resection was performed, and the results of pathological examination confirmed the diagnosis of malignant pelvic SFT. There was no SFT recurrence in this patient at 1-year follow-up. Herein, we report on the treatment of a patient with malignant pelvic SFT, a rare condition, who underwent successful radical resection after transcatheter arterial embolization. Transcatheter arterial embolization can block the blood supply of the SFT as much as possible and improve the possibility of tumor resection. In the future, pelvic SFTs can be considered improving the resection rate by transcatheter arterial embolization before surgery.
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Affiliation(s)
- Xingjian Yan
- Department of Urology, The First Hospital of Jilin University, Changchun, China
| | - Chao Zheng
- Department of Neurology and Neuroscience Center, First Hospital of Jilin University, Changchun, China
| | - Jin Wang
- Department of Urology, The First Hospital of Jilin University, Changchun, China
| | - Dawei Li
- Department of Urology, The First Hospital of Jilin University, Changchun, China
| | - Ji Lu
- Department of Urology, The First Hospital of Jilin University, Changchun, China
| | - Liang He
- Department of Urology, The First Hospital of Jilin University, Changchun, China
| | - Chunxi Wang
- Department of Urology, The First Hospital of Jilin University, Changchun, China
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Abstract
INTRODUCTION Solitary fibrous tumors (SFTs) are uncommon mesenchymal neoplasms and are particularly rare in the female genital tract. Doege-Potter syndrome is a paraneoplastic syndrome involving SFT-associated hypoglycemia. We report, for the first time, on a broad ligament SFT with Doege-Potter syndrome; additionally, we review 30 cases of women with SFTs reported in the literature. PATIENT CONCERNS A 37-year-old woman who presented with life-threatening hypoglycemia and a pelvic mass (16 × 15 × 15 cm). DIAGNOSES The patient was diagnosed with broad ligament SFT with Doege-Potter syndrome. INTERVENTIONS Tumor resection, sub-extensive hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymphadenectomy were performed, and 6 cycles of adjuvant chemotherapy were administered. OUTCOMES Serum glucose levels returned to normal as soon as the tumor was resected. Forty-3 months after operation, there was recurrence in the posterior peritoneal tissues. She underwent tumor resection and has remained tumor-free 28 months after this excision. CONCLUSION Even though it is extremely rare, SFT should be quickly identified to prevent undue treatment delay and avoid unnecessary examination; surgery and long-term follow-up are recommended. SFT can be considered a highly invasive cancer, and intraoperative bleeding may occur. Although no correlation between adjuvant therapy and improved prognosis was found, further studies are required because of the small number of cases reported to date.
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Affiliation(s)
- Sijing Chen
- Department of Gynecologic Oncology, West China Second Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, China
| | - Ying Zheng
- Department of Gynecologic Oncology, West China Second Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, China
| | - Lin Chen
- Department of Gynecologic Oncology, West China Second Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, China
| | - Qihua Yi
- Department of Gynecologic Oncology, West China Second Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, China
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Yang EJ, Howitt BE, Fletcher CDM, Nucci MR. Solitary fibrous tumour of the female genital tract: a clinicopathological analysis of 25 cases. Histopathology 2018; 72:749-759. [DOI: 10.1111/his.13430] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 10/31/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Eric J Yang
- Department of Pathology; Stanford University Medical Center; Stanford CA USA
| | - Brooke E Howitt
- Division of Women's & Perinatal Pathology; Department of Pathology; Harvard Medical School; Brigham and Women's Hospital; Boston MA USA
| | | | - Marisa R Nucci
- Division of Women's & Perinatal Pathology; Department of Pathology; Harvard Medical School; Brigham and Women's Hospital; Boston MA USA
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Nowakowski A, Kozłowski W, Włodarczyk D, Szajnik-Szczepański M, Baranowski W. A case of a large solitary fibrous tumour of the uterine cervix. BMC WOMENS HEALTH 2014; 14:3. [PMID: 24397838 PMCID: PMC3893460 DOI: 10.1186/1472-6874-14-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2013] [Accepted: 12/23/2013] [Indexed: 11/14/2022]
Abstract
Background Solitary fibrous tumour of the uterine cervix is an extremely rare phenomenon. We present a case of the largest cervical tumour of this type in this anatomical location reported so far. Case presentation A 45-year old white female presented with abdominal pain, abnormal uterine bleedings and a 15 cm mass of the uterine cervix/left parametrium. Histological examination with immunohistochemistry of the tumour biopsy revealed diagnosis of solitary fibrous tumour. The patient underwent radical abdominal hysterectomy with bilateral salpingo-oophorectomy and pelvic lymphadenectomy. No recurrence has been observed for 8 months of follow-up. Conclusions Solitary fibrous tumour can be occasionally found in patients with large cervical/parametrial masses. Immunohistochemistry was helpful in diagnosis and surgery was feasible and effective in treatment of our case of a large solitary fibrous tumour of the cervix.
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Affiliation(s)
- Andrzej Nowakowski
- Department of Gynaecology and Oncologic Gynaecology, Military Institute of Medicine, ul, Szaserów 128, 04-141 Warsaw 44, Poland.
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Taki M, Baba T, Mandai M, Suzuki A, Mikami Y, Matsumura N, Konishi I. Solitary fibrous tumor arising slowly in the vulva over 10 years: Case report and review. J Obstet Gynaecol Res 2012; 38:884-8. [DOI: 10.1111/j.1447-0756.2011.01792.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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