Pericardial malignant solitary fibrous tumour with right atrial invasion - a case report and literature review

Cardiac solitary fibrous tumor - an extremely rare but potentially fatal diagnosis

The background of this review is a description of the case of a 28-year-old man with an extremely rare cardiac solitary fibrous tumor (SFT). Although this tumor was removed surgically and in the 6-month follow-up examination no relapse was noted, recurrence was observed and confirmed in the magnetic resonance imaging 4 months later. SFT prevalence, symptoms and signs, treatment options and prognosis are reviewed.

Diagnostics and Treatment of Extrameningeal Solitary Fibrous Tumors

Solitary fibrous tumors (SFT) are rare mesenchymal neoplasms that account for less than 2% of all soft tissue masses. In the latest WHO 2020 Classification of Soft Tissue Tumors, extrameningeal SFT was listed as intermediate (rarely metastasizing) or malignant neoplasms. Due to the lack of characteristic clinical features, their diagnosis and treatment remain challenging. The pathogenesis of SFT is often associated with the presence of fusions of the NAB2-STAT6 gene on the 12q13 chromosome. Cytoplasmic CD34 positive staining is considerably characteristic for most SFTs; less frequently, factor XII, vimentin, bcl-2, and CD99 are present. A key factor in the diagnosis is the prevalent nuclear location of STAT6 expression. Radical resection is the mainstay of localized SFTs. In the case of unresectable disease, only radiotherapy or radio-chemotherapy may significantly ensure long-term local control of primary and metastatic lesions. To date, no practical guidelines have been published for the treatment of advanced or metastatic disease. Classical anthracycline-based chemotherapy is applicable. The latest studies suggest that antiangiogenic therapies should be considered after first-line treatment. Other drugs, such as imatinib, figitumumab, axitinib, and eribulin, are also being tested. Definitive radiotherapy appears to be a promising therapeutic modality. Since standards for the treatment of advanced and metastatic diseases are not available, further investigation of novel agents is necessary.

An unusual location of solitary fibrous tumor in heart-A case report and review of literature

BACKGROUND

Solitary fibrous tumor (SFT) are rare spindle cell tumors originating from the mesenchymal cells mostly from the visceral pleura. SFT was first described as a distinct entity in 1931 by Klemperer et al. Until now, we have limited data regarding the manifestation and behavior of extra pleural forms such as cardiac SFT. Here we present a case of SFT involving the pericardium where the diagnosis was made by imaging followed by biopsy findings. We also review the literature of SFT involving the heart and the management approaches.

CASE PRESENTATION

An 81-year-old male presented with progressive dyspnea. Computed tomography (CT) of the chest showed a 6.2 × 5.3 cm soft tissue mass in the anterior mediastinum. Further imaging with CT angiogram showed a stalk-like connection to the pericardium. A biopsy of the mass showed spindle cells positive for BCL-2, CD34, and STAT 6, indicative of a solitary fibrous tumor. A surveillance approach was adopted for the patient.

CONCLUSION

Primary pericardial tumors are exceedingly rare, with a prevalence rate of 0.001%-0.007%. Diagnosing a SFT requires a positive CD34 and BCL-2 marker. The current recommendation is resection of localized disease which has been documented to be curative in cases of benign disease however our patient was put on surveillance.

A Clinico-Pathologic Approach to the Differential Diagnosis of Pericardial Tumors

PURPOSE OF REVIEW

Tumors of the pericardium are rare, but a wide variety of congenital, infectious, inflammatory, and neoplastic processes have been reported. Pericardial tumors can be categorized as non-neoplastic or neoplastic. Neoplastic lesions can be further divided into benign or malignant, with malignancies being either primary or secondary (metastatic). Clinical, radiographic, and pathologic features of the most common entities are discussed.

RECENT FINDINGS

Metastatic neoplasms involving the heart and pericardium are far more common than primary pericardial neoplasms. Of primary pericardial malignancies, mesothelioma is the most common; notably, cytology of effusion fluid is relatively insensitive to the diagnosis. The prognosis for most malignancies of the pericardium, primary or secondary, is poor. Increasingly, clinically recognized diseases that involve the pericardium include Erdheim-Chester and IgG4-related disease. This article provides a comprehensive review of the most recent literature to develop a structured framework to the differential diagnosis of pericardial tumors.

Fat-forming solitary fibrous tumor of the sacrum: A case report and literature review

Fat-forming variant of solitary fibrous tumor (SFT) is a rare mesenchymal neoplasm. Here we report the case of a 33-year-old woman who developed pain and muscle weakness from the posterior aspect of the right hip to lower extremity. Imaging examinations revealed a mass with fatty components and hypervascular solid components filling the sacral spinal canal and sacral foramen. The sacral mass was resected and histological examination of the specimens revealed patternless proliferation of short spindle-shaped cells with staghorn blood vessels. A number of mature adipocyte-like cells were also observed. The tumor cells were positive for STAT6 and the nuclei of the adipocytes were also positive, which was diagnostic for fat-forming SFT.

Intrapericardial solitary fibrous tumor: A case report and review of literature

Solitary fibrous tumor (SFT) is a mesenchymal neoplasm mostly originates from pleura, but rarely from other parts of the body including pericardium. We report a case of a 44-year-old woman with dyspnea and intermittent edema in whom a large intrapericardial mass was discovered by echocardiography. Computed tomography (CT) revealed a focal pericardial calcification in right AV grove with pressure on right ventricle and right atrial, with no connection to cardiac chambers. Histopathological findings after complete resection of the mass revealed fibroconnective tissue with heavy calcification and no evidence of inflammation or malignancy. We reviewed the literature on pericardial solitary fibrous tumors up to 2020.

Primary solitary fibrous tumour in the pulmonary artery: a case report

This report presents a very rare case of fibrous tumour in the pulmonary artery. A 32-year-old male patient presented at the First Hospital of Jilin University with the chief complaint of chest pain accompanied by cough and haemoptysis. Laboratory test results showed a D-dimer level of 60 ng/ml, and protein S activity of 51.0%. Echocardiography and enhanced computed tomography (CT) of the lung revealed a thrombus-like mass in the main pulmonary artery trunk, and the left pulmonary artery and its branches. The patient was initially diagnosed with pulmonary embolism, but after performing arterial endarterectomy, the presence of a tumour in the corresponding areas was confirmed. Histopathology and immunohistochemistry indicated the presence of a malignant solitary fibrous tumour. Chemotherapeutic agents were administered following surgery. The patient was prescribed ongoing oral Apatinib (250 mg, once daily) as a tumour-targeting therapy. The patient refused permission for postoperative CT. The patient was still alive at the 2-year follow-up.