1
|
Saraniti C, Burrascano D, Verro B, De Lisi G, Rodolico V. A solitary fibrous tumor of the parotid gland: Case report. Int J Surg Case Rep 2023; 111:108855. [PMID: 37742355 PMCID: PMC10520796 DOI: 10.1016/j.ijscr.2023.108855] [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: 08/22/2023] [Revised: 09/16/2023] [Accepted: 09/18/2023] [Indexed: 09/26/2023] Open
Abstract
INTRODUCTION Solitary fibrous tumor is a rare neoplasm that can affect any part of the body, also head and neck region. Etiology is unknown. The incidence is slightly higher in males, the age ranges from 11 to 79 years. PRESENTATION OF CASE It's the first case in our country of left parotid solitary fibrous tumor, removed by partial parotidectomy with facial nerve preservation. Histology examination showed diffuse spindle-shaped cells proliferation, moderate polymorphism, low mitotic index (<4 mitoses per 10 HPF), partially bordered by fibrous capsule. Immunohistochemistry showed STAT6, CD34, CD99 positivity. Six-months follow-up didn't show sign of recurrence. DISCUSSION Solitary fibrous tumor is a mesenchymal spindle cell neoplasm with fibroblastic differentiation ubiquitous in soft tissues, that involved the head and neck region in 6 % of cases. Etiology is unknown. The possible pathogenesis is NAB2-STAT6 gene fusion. It's asymptomatic or symptoms are related to space-occupying mass. Diagnostic work up involves imaging, immunohistochemistry, histology. Radiographic finding may lead to incorrect assessment of the mass: the same imaging features are present in pleomorphic adenoma, the most frequent tumor of salivary glands. CONCLUSION This case report aims to stress that, although rare, solitary fibrous tumor should be considered in differential diagnosis in case of indolent salivary gland mass, since it may require more invasive approach (e.g., total parotidectomy, adjuvant radiotherapy). It would like to highlight the role of multidisciplinary team to define the best therapy, tailored for the patient, as well as to give awareness to a rare but sometimes aggressive tumor.
Collapse
Affiliation(s)
- Carmelo Saraniti
- Division of Otolaryngology, Department of Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, 90127 Palermo, Italy.
| | - Davide Burrascano
- Division of Otolaryngology, Department of Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, 90127 Palermo, Italy
| | - Barbara Verro
- Division of Otolaryngology, Department of Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, 90127 Palermo, Italy
| | - Giovanni De Lisi
- Pathology Unit, Department of Health promotion Sciences maternal and Infantile Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy
| | - Vito Rodolico
- Pathology Unit, Department of Health promotion Sciences maternal and Infantile Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy
| |
Collapse
|
2
|
Suzuki K, Noda Y, Sakagami T, Yagi M, Kusafuka K, Iwai H. Head and Neck Solitary Fibrous Tumor Presenting as Salivary Gland Tumor: Two Case Reports and Review of the Literature. Case Rep Oncol 2023; 16:465-473. [PMID: 37485015 PMCID: PMC10359685 DOI: 10.1159/000531067] [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: 12/28/2022] [Accepted: 05/05/2023] [Indexed: 07/25/2023] Open
Abstract
Solitary fibrous tumors (SFTs) are soft tumors (mesenchymal origin) that most likely develop from adult mesenchymal stem cells. SFTs are not common in the head and neck region, and the characteristics of tumors in this location are unclear. The present study describes the clinicopathological findings of 2 cases of SFTs arising in the parotid gland and buccal space, presenting as salivary gland tumors. The first case is a 76-year-old man presenting with a painless tumor on the right parotid gland who subsequently underwent partial superficial parotidectomy. According to the results of histopathological analysis, the tumor consisted of stellate and spindle-shaped cells proliferating on a mucous-like substrate. Immunohistochemical staining revealed that neoplastic cells were positive for CD34, vimentin, Bcl2, and STAT6. The second case is of a 64-year-old man presenting with a painless lump on his right cheek. Based on the findings of fine needle aspiration cytology, a tumor derived from myoepithelial cells of the minor salivary gland or a nonepithelial tumor was suspected. The patient underwent surgical resection via an intraoral approach. Histopathologically, the tumor consisted of spindle-shaped cells with rod-shaped or irregular nuclei. Immunohistochemical staining revealed that the neoplastic cells were positive for CD34, CD99, Bcl2, and STAT6. Briefly, SFT should be considered in the differential diagnosis of a well-marginalized lesion in the salivary gland and oral cavity. STAT6 immunohistochemistry is the most specific and sensitive method of diagnosing SFT. A thorough understanding of the morphological changes associated with SFT and their correlation with clinical, immunohistochemical, and molecular characteristics is important to avoid misdiagnosis.
Collapse
Affiliation(s)
- Kensuke Suzuki
- Department of Otolaryngology, Head and Neck Surgery, Kansai Medical University, Hirakata, Osaka, Japan
| | - Yuri Noda
- Department of Pathology, Kansai Medical University, Hirakata, Osaka, Japan
| | - Tomofumi Sakagami
- Department of Otolaryngology, Head and Neck Surgery, Kansai Medical University, Hirakata, Osaka, Japan
| | - Masao Yagi
- Department of Otolaryngology, Head and Neck Surgery, Kansai Medical University, Hirakata, Osaka, Japan
| | | | - Hiroshi Iwai
- Department of Otolaryngology, Head and Neck Surgery, Kansai Medical University, Hirakata, Osaka, Japan
| |
Collapse
|
3
|
Recurrent fibrous solitary tumor of the parotid gland with satellite location: imaging, clinical and histological findings of rare entity. Radiol Case Rep 2021; 16:2924-2928. [PMID: 34401027 PMCID: PMC8349757 DOI: 10.1016/j.radcr.2021.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/02/2021] [Accepted: 07/03/2021] [Indexed: 11/24/2022] Open
Abstract
Fibrous Solitary Tumors are infrequent neoplasms originating from mesenchymal tissues, most commonly arising from the visceral pleura and frequently exhibiting a benign behavior. Extra-pleural localization is unusual and the site of origin of these tumors from the parenchyma of the parotid gland is considered extremely rare. We report the case of a 66-years old woman with non-painful slow-growing left latero-cervical mass, who underwent a gadolinium-enhanced Magnetic Resonance Imaging showing a mass originating from the deep lobe of the parotid gland extending into the retro-pharyngeal space. After a total parotidectomy with tumor excision, a diagnosis of histologically proven fibrous solitary tumor of the parotid gland was made. Two years later, CT scan showed post-operative recurrence and further satellite localization in the neck, distant from the initial mass. We performed a literature review of the published similar cases, in order to clinicopathological and imaging features of this rare entity.
Collapse
|
4
|
Lim DWJ, Tan TSH, Tan JL, Venkateswaran K. Solitary fibrous tumour of the parotid gland: a case report and a 15-year literature review. AME Case Rep 2019; 3:14. [PMID: 31231715 DOI: 10.21037/acr.2019.04.05] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 04/12/2019] [Indexed: 11/06/2022]
Abstract
Solitary fibrous tumour (SFT) is uncommonly found in the salivary glands and is a rare group of spindle-cell tumours. A review of literature revealed only 40 reported cases of SFT of major salivary glands over a 15-year period from 2004 to 2018. SFTs of the salivary glands are usually benign, although rarely, can be aggressive and may sometimes recur after initial resection. Histology and Immunohistochemistry are the most important criteria to distinguish SFT from other head and neck tumours. SFTs strongly stain for CD34 and hence is the most frequently used stain for diagnosis. All reported SFT cases with available information on immunohistochemical stains were positive for CD34. Recently, immunohistochemistry for STAT6 has been introduced as a surrogate diagnostic marker for SFT that is highly sensitive and specific. We report a case of a 51-year-old Chinese gentleman who presents with a 3-month history of a left parotid tumour that required a subtotal parotidectomy for complete excision. It was diagnosed as SFT based on histology and immunohistochemical features. He was followed-up for 3 months post-operatively with no clinical evidence of recurrence. This case proposes that, although rare, SFT should be considered in the differential diagnosis of soft-tissue tumors in the major salivary glands. An awareness of this rare entity will help clinicians and pathologists better manage similar patients in the future.
Collapse
Affiliation(s)
| | | | - Jian Li Tan
- Department of Otolaryngology, Khoo Teck Puat Hospital, Singapore
| | | |
Collapse
|
5
|
Lee CK, Liu KL, Huang SK. A dedifferentiated solitary fibrous tumor of the parotid gland: a case report with Cytopathologic findings and review of the literature. Diagn Pathol 2019; 14:20. [PMID: 30777087 PMCID: PMC6379935 DOI: 10.1186/s13000-019-0792-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 02/01/2019] [Indexed: 12/19/2022] Open
Abstract
Background Solitary fibrous tumor (SFT) is a ubiquitous mesenchymal neoplasm but it rarely occurs in the parotid gland. The histological features are variable, with the majority having spindle cell morphology and non-specific branching (staghorn) ecstatic vascular pattern. SFT ranges from benign to overtly malignant. Dedifferentiation within SFTs represents an abrupt transition from a well-differentiated component to a high-grade area, the latter most often including poorly differentiated epithelioid/round cell or high-grade spindle cell morphology. To the best of our knowledge, dedifferentiated SFT in the parotid gland has not been previously reported. Case presentation A 33-year-old woman presented with a soft tissue tumor in the right parotid gland that had been present for 6 months. Fine needle aspiration (FNA) cytology indicated epithelioid morphology in the dedifferentiated component of the tumor, along with metachromatic myxoid matrix. The tumor was initially interpreted as a salivary gland neoplasm of uncertain malignant potential (SUMP).Right partial parotidectomy was performed, and microscopic examination of the resected specimen revealed a malignant spindle cell tumor with a central epithelioid/anaplastic component. The tumor cells were diffusely positive for CD34, STAT-6 and FLI-1, and negative for pan-cytokeratin, CAM5.2, p63, S100 protein, CD31, SMA, and calponin.ERG and Ki67 immunostaining showed an accentuated nuclear staining pattern in the central dedifferentiated area. There was no overexpression of p53 or p16. The patient is currently undergoing regular follow-up and is 11 months postresection with no evidence of recurrence or distant metastasis. Conclusions Unlike the typical spindle cell morphology of conventional SFTs, malignant SFTs can show areas of dedifferentiation mimicking an epithelial neoplasm. FNA of dedifferentiated SFTs of the parotid gland may show, a combination of atypical epithelioid cells and metachromatic myxoid/collagenous matrix, which is a less emphasized cytological feature of SFT and may lead to misdiagnosis as a more common parotid gland epithelial neoplasm.
Collapse
Affiliation(s)
- Chien-Kuan Lee
- Department of Pathology, Kung Tien General Hospital, Shalu, Taichung, Taiwan
| | - Ken-Liao Liu
- Department of Otorhinolaryngology, Kung Tien General Hospital, Shalu, Taichung, Taiwan.
| | - Sheng-Kai Huang
- Department of Otorhinolaryngology, Kung Tien General Hospital, Shalu, Taichung, Taiwan
| |
Collapse
|
6
|
A New Primary in Parotid Gland with History of Treated Mediastinal Solitary Fibrous Tumour. Case Rep Surg 2019; 2019:3234692. [PMID: 30723568 PMCID: PMC6339743 DOI: 10.1155/2019/3234692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 12/04/2018] [Indexed: 11/21/2022] Open
Abstract
Solitary fibrous tumours (SFTs) are rare tumours in the head and neck region. They have been reported in many anatomic sites but occurrence in the parotid gland is exceptional. We report a very rare finding of a benign SFT of the parotid gland in a patient with a past history of excision of a malignant type of mediastinal tumour. It is important that clinicians are aware of the possible existence of SFT in the parotid as a synchronous lesion or occurrence of the same disease later on elsewhere when SFT is diagnosed at one anatomical site. This case report illustrates that regular clinical and imaging follow-up is essential in SFTs to look for the appearance of new lesions in the other anatomic site.
Collapse
|
7
|
Rais M, Kessab A, Sayad Z, El Mourabit S, Zrarqi R, Benazzou S, Boulaadas M, Cherradi N. Solitary fibrous tumor occurring in the parotid gland: a case report. BMC Clin Pathol 2017; 17:22. [PMID: 29200960 PMCID: PMC5697096 DOI: 10.1186/s12907-017-0062-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 11/13/2017] [Indexed: 11/29/2022] Open
Abstract
Background Solitary fibrous tumor is an uncommon spindle cell neoplasm of unknown origin. It has been reported in many anatomic sites, with a rare occurrence in the head and neck region. Solitary fibrous tumors of the parotid gland are exceptional; their clinical and radiologic features are non specific, often mimicking more common salivary gland tumors. Pathologic examination and immunohistochemistry are required to make the correct diagnosis. The prognosis is favorable, with most tumors being benign, and complete surgical resection is the treatment of choice. Case presentation We report the case of a 42-year-old man who presented with a painless mass involving the parotid gland. A parotidectomy was performed, and follow up was unremarkable. Gross examination showed a well circumscribed, firm tumor measuring 3,4 cm. Histologically, the tumor was composed of a spindle cell proliferation of variable cellularity, with staghorn vessels. A panel of immunohistochemical stains was performed, and confirmed the diagnosis of parotid gland solitary fibrous tumor. Conclusion In this report we aim to increase awareness of this rare entity among clinicians and pathologists, and to emphasize the role of immunohistochemistry in confirming the diagnosis.
Collapse
Affiliation(s)
- Meryem Rais
- Department of Pathology, Hospital of Specialities, Rabat, Morocco.,Faculty of Medicine and Pharmacy of Rabat, Mohammed V University in Rabat, Rabat, Morocco
| | - Amine Kessab
- Department of Pathology, Hospital of Specialities, Rabat, Morocco.,Faculty of Medicine and Pharmacy of Rabat, Mohammed V University in Rabat, Rabat, Morocco
| | - Zahra Sayad
- Department of Plastic and Maxillofacial Surgery, Hospital of Specialities, Rabat, Morocco.,Faculty of Medicine and Pharmacy of Rabat, Mohammed V University in Rabat, Rabat, Morocco
| | - Sanae El Mourabit
- Department of Plastic and Maxillofacial Surgery, Hospital of Specialities, Rabat, Morocco.,Faculty of Medicine and Pharmacy of Rabat, Mohammed V University in Rabat, Rabat, Morocco
| | - Redallah Zrarqi
- Department of Plastic and Maxillofacial Surgery, Hospital of Specialities, Rabat, Morocco.,Faculty of Medicine and Pharmacy of Rabat, Mohammed V University in Rabat, Rabat, Morocco
| | - Salma Benazzou
- Department of Plastic and Maxillofacial Surgery, Hospital of Specialities, Rabat, Morocco.,Faculty of Medicine and Pharmacy of Rabat, Mohammed V University in Rabat, Rabat, Morocco
| | - Malik Boulaadas
- Department of Plastic and Maxillofacial Surgery, Hospital of Specialities, Rabat, Morocco.,Faculty of Medicine and Pharmacy of Rabat, Mohammed V University in Rabat, Rabat, Morocco
| | - Nadia Cherradi
- Department of Pathology, Hospital of Specialities, Rabat, Morocco.,Faculty of Medicine and Pharmacy of Rabat, Mohammed V University in Rabat, Rabat, Morocco
| |
Collapse
|
8
|
Ge W, Yu DC, Chen G, Ding YT. Clinical analysis of 47 cases of solitary fibrous tumor. Oncol Lett 2016; 12:2475-2480. [PMID: 27698815 PMCID: PMC5038456 DOI: 10.3892/ol.2016.4967] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 07/15/2016] [Indexed: 12/24/2022] Open
Abstract
The aim of the present study was to summarize the clinical manifestations, diagnosis, treatment, and prognosis of solitary fibrous tumor (SFT). In total, 47 cases of SFTs diagnosed by postoperative pathology between January 2002 and September 2014 were retrospectively reviewed, and the general information, clinical manifestations, imaging techniques, treatment, pathology and follow-up findings were analyzed. Of the 47 patients, clinical characteristics were collected in 37 cases (18 men and 19 women; mean age, 44.1 years; age range, 13-72 years). The maximum diameters of the tumors were 1.5-25 cm, with a mean diameter of 8.8 cm. The symptoms were various and non-specific. Imaging examinations following iodinated contrast administration showed the SFTs to be well-defined, cystic or solid mass and enhanced. On color Doppler ultrasound, SFTs were described as hypoechoic, clear, irregular masses. All patients underwent surgical resection, and SFT was diagnosed by postoperative pathological and immunohistochemical examination. Of the 47 patients, 25 received complete follow-up of 5-130 months, with a median follow-up period of 35.2 months, that included a color Doppler ultrasound or computed tomography (CT) scan every 6-12 months. At the end of the follow-up period all patients were alive and healthy, with the exception of one patient, who presented with recurrence 15 months after surgery. The findings of the present study showed SFT to be a rare systemic disease with no particular clinical manifestations. In the cases reviewed in the present study, CT, magnetic resonance imaging scans and color Doppler ultrasound were important for the diagnosis of SFT, while the definitive diagnosis relied on pathological and immunohistochemical examinations. Surgery, the primary treatment for SFT, was performed, and, following complete removal of the tumor, the prognosis was favorable.
Collapse
Affiliation(s)
- Wei Ge
- Department of General Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu 210008, P.R. China
| | - De-Cai Yu
- Department of General Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu 210008, P.R. China
| | - Gang Chen
- Department of General Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu 210008, P.R. China
- Correspondence to: Mr. Gang Chen, Department of General Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, Jiangsu 210008, P.R. China, E-mail:
| | - Yi-Tao Ding
- Department of General Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu 210008, P.R. China
| |
Collapse
|