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Maalouf H, Aby Hadeer R, Ghattas S, Tabbikha O, Numan H, Wakim R. Solitary fibrous tumor: A case report of this multifaceted tumor. World J Clin Cases 2024; 12:5791-5797. [DOI: 10.12998/wjcc.v12.i25.5791] [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: 04/08/2024] [Revised: 05/08/2024] [Accepted: 06/24/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND Solitary fibrous tumor (SFT) is a remarkably uncommon mesenchymal tumor. STAT6 level and a combination of clinical, pathological, and molecular features are required to arrive at a proper diagnosis.
CASE SUMMARY In this report, we present an intriguing case involving a 43-year-old woman who initially exhibited symptoms of a bleeding retroperitoneal tumor, initially resembling a gastrointestinal stromal tumor, but later confirmed as an SFT. However, a year later, what was initially believed to be a recurrence of her SFT was instead identified as a desmoid tumor.
CONCLUSION Distinguishing SFT from other tumors was pivotal. Correcting misdiagnoses of tumor type initially and of recurrence later was necessary for appropriate treatment of the correct desmoid type.
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Affiliation(s)
- Hani Maalouf
- Department of General Surgery, University of Balamand, Beirut 100, Lebanon
| | - Ribal Aby Hadeer
- Department of General Surgery, University of Balamand, Beirut 100, Lebanon
| | - Souad Ghattas
- Department of General Surgery, University of Balamand, Beirut 100, Lebanon
| | - Omar Tabbikha
- Department of General Surgery, University of Balamand, Beirut 100, Lebanon
| | - Hasan Numan
- Department of General Surgery, University of Balamand, Beirut 100, Lebanon
| | - Raja Wakim
- Department of General Surgery, Mount Lebanon Hospital University Medical Center, Beirut 7031, Lebanon
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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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Schöler F, Storz MA, Khavaran A, Hümmler N, Russe MF, Wielenberg C, Laubner K, Seufert J. Effective management of recurrent Doege-Potter syndrome with somatostatin-analogues: A case report. Cancer Rep (Hoboken) 2024; 7:e1992. [PMID: 38441351 PMCID: PMC10913086 DOI: 10.1002/cnr2.1992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 12/10/2023] [Accepted: 01/15/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Doege-Potter syndrome is defined as paraneoplastic hypoinsulinemic hypoglycemia associated with a benign or malignant solitary fibrous tumor frequently located in pleural, but also extrapleural sites. Hypoglycemia can be attributed to paraneoplastic secretion of "Big-IGF-II," a precursor of Insulin-like growth factor-II. This prohormone aberrantly binds to and activates insulin receptors, with consecutive initiation of common insulin actions such as inhibition of gluconeogenesis, activation of glycolysis and stimulation of cellular glucose uptake culminating in recurrent tumor-induced hypoglycemic episodes. Complete tumor resection or debulking surgery is considered the most promising treatment for DPS. CASE Here, we report a rare case of a recurrent Doege-Poter Syndrome with atypical gelatinous tumor lesions of the lung, pleura and pericardial fat tissue in an 87-year-old woman. Although previously described as ineffective, we propose that adjuvant treatment with Octreotide in conjunction with intravenous glucose helped to maintain tolerable blood glucose levels before tumor resection. The somatostatin-analogue Lanreotide was successfully used after tumor debulking surgery (R2-resection) to maintain adequate blood glucose control. CONCLUSION We conclude that somatostatin-analogues bear the potential of being effective in conjunction with limited surgical approaches for the treatment of hypoglycemia in recurrent or non-totally resectable SFT entities underlying DPS.
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Affiliation(s)
- Felix Schöler
- Division of Endocrinology and Diabetology, Department of Internal Medicine II, University Hospital of Freiburg, Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Maximilian Andreas Storz
- Division of Endocrinology and Diabetology, Department of Internal Medicine II, University Hospital of Freiburg, Faculty of MedicineUniversity of FreiburgFreiburgGermany
- Department of Internal Medicine II, Center for Complementary Medicine, University Hospital of Freiburg, Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Ashkan Khavaran
- Division of Endocrinology and Diabetology, Department of Internal Medicine II, University Hospital of Freiburg, Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Nicolas Hümmler
- Department of Thoracic Surgery, Medical CenterUniversity Hospital of FreiburgFreiburgGermany
| | - Maximilian Frederik Russe
- Department of Radiology, Clinic for Diagnostic and Interventional Radiology, University Hospital of Freiburg, Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | | | - Katharina Laubner
- Division of Endocrinology and Diabetology, Department of Internal Medicine II, University Hospital of Freiburg, Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Jochen Seufert
- Division of Endocrinology and Diabetology, Department of Internal Medicine II, University Hospital of Freiburg, Faculty of MedicineUniversity of FreiburgFreiburgGermany
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Chowdhury Z, Mishrikotkar S, Nehra P, Patne S, Tripathi M. Exploring Solitary Fibrous Tumors at a Tertiary Cancer Center: Clinicopathological and Immunomorphologic Profile. Cureus 2024; 16:e56899. [PMID: 38659562 PMCID: PMC11042756 DOI: 10.7759/cureus.56899] [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] [Accepted: 03/24/2024] [Indexed: 04/26/2024] Open
Abstract
Background Solitary fibrous tumor (SFT) is a distinct fibroblastic tumor that can occur at any anatomical site and can manifest a variety of histopathological features. NAB2-STAT6 gene fusion has recently emerged as a sensitive and specific molecular marker and its surrogate on immunohistochemistry, STAT6 has also displayed considerable efficacy. Nevertheless, its histologic diversity can result in diagnostic challenges, especially when classic features are not apparent. Methods A retrospective study was conducted at a tertiary cancer centre in North India over 3 years to document the clinicopathologic and immunomorphologic profile of SFTs. Immunohistochemical analysis of BCOR and p53 were gauged additionally and patients were stratified according to Modified Demicco and Salas criteria for risk of metastasis. Results Sixteen patients of SFT were identified, affecting middle-aged men and women equally. Though lung/pleura are known to be involved commonly, SFT affects other sites such as the kidney, brain, buccal mucosa, liver, and penis as well. The majority endured localized disease while a lesser number suffered locoregional/distant spread. Two patients revealed features of a malignant profile. Risk stratification according to the Modified Demicco and Salas criteria evinced comparable results. No discernible relationship however was highlighted between the immunohistochemical expression of BCOR, p53, and any significant SFT parameter. Conclusion Although SFTs are very rare substantially benign mesenchymal neoplasms, pathologists must be conversant with their histological diversity and be vigilant of their malignant attributes. The worth of STAT6 immunohistochemistry for precise diagnosis and long-term studies for delineating clinical behavior cannot be overemphasized.
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Affiliation(s)
- Zachariah Chowdhury
- Oncopathology, Mahamana Pandit Madan Mohan Malviya Cancer Centre (MPMMCC) and Homi Bhabha Cancer Hospital (HBCH) (Tata Memorial Hospital), Varanasi, IND
| | - Soumya Mishrikotkar
- Oncopathology, Mahamana Pandit Madan Mohan Malviya Cancer Centre (MPMMCC) and Homi Bhabha Cancer Hospital (HBCH) (Tata Memorial Hospital), Varanasi, IND
| | - Pritika Nehra
- Oncopathology, Mahamana Pandit Madan Mohan Malviya Cancer Centre (MPMMCC) and Homi Bhabha Cancer Hospital (HBCH) (Tata Memorial Hospital), Varanasi, IND
| | - Shashikant Patne
- Oncopathology, Mahamana Pandit Madan Mohan Malviya Cancer Centre (MPMMCC) and Homi Bhabha Cancer Hospital (HBCH) (Tata Memorial Hospital), Varanasi, IND
| | - Mayank Tripathi
- Surgical Oncology, Mahamana Pandit Madan Mohan Malviya Cancer Centre (MPMMCC) and Homi Bhabha Cancer Hospital (HBCH) (Tata Memorial Hospital), Varanasi, IND
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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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Bove M, Natale G, Messina G, Tiracorrendo M, Rendina EA, Fiorelli A, D'Andrili A. Solitary Fibrous Tumor of the Pleura: Surgical Treatment and Recurrence. Thorac Cardiovasc Surg 2023. [PMID: 38011860 DOI: 10.1055/s-0043-1777260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
BACKGROUND Solitary fibrous tumors of the pleura (SFTPs) are primary pleural tumors originating from the mesenchymal tissue. Surgical treatment was the first choice for management of SFTPs. There were no defined guidelines for the follow-up of these tumors and the postoperative therapy due to the rarity of these tumors. METHODS We conducted a retrospective, multicenter study from two high-volume centers in Italy. Data of patients diagnosed with pleural solitary fibrous tumors between January 2003 and October 2022 were prospectively recorded and retrospectively analyzed. The aim of this study was to identify predictive prognostic factors and the correlation between tumor characteristics and recurrence. RESULTS In all, 107 patients undergoing R0 surgical resection of pleural solitary fibrous tumor were included in the study. Patients were divided in two groups: benign and malignant. All the patients were treated with surgery with the aim to obtain R0 resection. Lung resection was necessary when the tumor adhered strongly to the lung parenchyma or infiltrated it. Twenty of the 107 patients had tumor recurrence. At a multivariate analysis, histological characteristics (high mitotic index) and maximum standardized uptake values (maxSUV) were related to recurrence. The mean disease-free survival (DFS) was 143.3 ± 6.1 months. CONCLUSION In our experience, histological features of malignancy and maxSUV are significantly related to recurrence, which can occur even years after the first diagnosis. Surgical excision with negative surgical margins results in good long-term outcomes. After surgery, a long-term and strict follow-up should be done, in order to detect recurrence early. R0 of the recurrence is associated with long-term survival.
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Affiliation(s)
- Mary Bove
- University of Campania Luigi Vanvitelli School of Medicine and Surgery, Napoli, Campania, Italy
| | - Giovanni Natale
- University of Campania Luigi Vanvitelli School of Medicine and Surgery, Napoli, Campania, Italy
| | - Gaetana Messina
- University of Campania Luigi Vanvitelli School of Medicine and Surgery, Napoli, Campania, Italy
| | | | | | - Alfonso Fiorelli
- University of Campania Luigi Vanvitelli School of Medicine and Surgery, Napoli, Campania, Italy
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Seito T, Kaneko T, Kawai T, Noda M, Tokura Y, Yoshimura I, Yasui M, Kikuchi Y, Sasajima Y, Nakagawa T. Solitary Fibrous Tumor in the Retroperitoneal Space Arising from the Diaphragm. In Vivo 2023; 37:2849-2853. [PMID: 37905637 PMCID: PMC10621437 DOI: 10.21873/invivo.13401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/07/2023] [Accepted: 08/10/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND/AIM We present a case of solitary fibrous tumor, arising from the diaphragm in the retroperitoneal space, that was resected with robotic assistance. CASE REPORT An 85-year-old female patient was referred to our hospital for evaluation of a suspected right renal tumor. Abdominal contrast-enhanced computed tomography revealed a tumor (maximum diameter, 36 mm) protruding from the superior pole of the right kidney. The patient was scheduled for robot-assisted, retroperitoneoscopic, partial nephrectomy based on a preoperative diagnosis of renal cell carcinoma. Intraoperative findings revealed that the tumor originated from the diaphragm and had no continuity with the renal parenchyma. Pathological examination revealed a solitary fibrous tumor. CONCLUSION Solitary fibrous tumors are rare soft-tissue neoplasms with a distinct molecular feature of the fusion of nerve growth factor-inducible A gene-binding protein 2 with signal transducer and activator of transcription 6 gene (NAB2::STAT6). We believe that this is the first reported case of a solitary fibrous tumor arising from the diaphragm in the retroperitoneal space.
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Affiliation(s)
- Toyoshi Seito
- Department of Urology, Teikyo University School of Medicine, Tokyo, Japan
| | - Tomoyuki Kaneko
- Department of Urology, Teikyo University School of Medicine, Tokyo, Japan;
| | - Taketo Kawai
- Department of Urology, Teikyo University School of Medicine, Tokyo, Japan
| | - Michio Noda
- Department of Urology, Teikyo University School of Medicine, Tokyo, Japan
| | - Yuumi Tokura
- Department of Urology, Teikyo University School of Medicine, Tokyo, Japan
| | - Itsuki Yoshimura
- Department of Urology, Teikyo University School of Medicine, Tokyo, Japan
| | - Mariko Yasui
- Department of Pathology, Teikyo University School of Medicine, Tokyo, Japan
| | - Yoshinao Kikuchi
- Department of Pathology, Teikyo University School of Medicine, Tokyo, Japan
| | - Yuko Sasajima
- Department of Pathology, Teikyo University School of Medicine, Tokyo, Japan
| | - Tohru Nakagawa
- Department of Urology, Teikyo University School of Medicine, Tokyo, Japan
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Talaat A, Mcguirt A. Recurrent Solitary Fibrous Tumor in a 73-Year-Old Male Presenting With Small Bowel Obstruction: A Case Report. Cureus 2023; 15:e44297. [PMID: 37779748 PMCID: PMC10533948 DOI: 10.7759/cureus.44297] [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: 05/05/2023] [Accepted: 08/28/2023] [Indexed: 10/03/2023] Open
Abstract
Solitary fibrous tumors (SFTs) are rare soft tissue tumors that can arise in the abdomen, pleura, and central nervous system, among other sites. Surgical resection is the mainstay of management, although recurrence rates remain substantial. This case describes a 73-year-old male treated surgically for both a recurrent SFT and small bowel obstruction (SBO) secondary to adhesions. The patient had undergone numerous intra-abdominal operations for malignant SFT since 1994, highlighting the importance of meticulous resection at the initial presentation of local disease.
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Affiliation(s)
- Adam Talaat
- Medicine, University of Central Florida College of Medicine, Orlando, USA
| | - Aron Mcguirt
- General Surgery, Bay Pines Veterans Affairs (VA) Health Care System, St. Petersburg, USA
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9
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Ahmed TM, Blanco A, Weisberg EM, Fishman EK. CT of retroperitoneal solitary fibrous tumor. Radiol Case Rep 2023; 18:2241-2244. [PMID: 37123044 PMCID: PMC10139852 DOI: 10.1016/j.radcr.2023.03.041] [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: 03/13/2023] [Accepted: 03/20/2023] [Indexed: 05/02/2023] Open
Abstract
Solitary fibrous tumors are rare tumors of pluripotent fibroblastic or myofibroblastic origin that generally arise among older individuals, with a mean age of onset ranging from 55 to 65 years. Though typically associated with pleural involvement, solitary fibrous tumors can emerge in virtually every anatomic location within the body. Although most solitary fibrous tumors are benign, approximately 20% may exhibit malignant features such as local invasion, recurrence, and metastases. In this article, we report the case of a 58-year-old male with a diagnosis of a retroperitoneal solitary fibrous tumor. We analyze computed tomography imaging findings and additionally correlate imaging features with the patient's unique pathological and genotypic findings to optimize diagnosis.
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Lai KKH, Wong TS, Li CK, Kuk A, Ko CKL. Solitary fibrous tumor of the lacrimal sac: A case report and review of the literature. J Fr Ophtalmol 2023; 46:e21-e24. [PMID: 36496292 DOI: 10.1016/j.jfo.2022.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 06/20/2022] [Indexed: 12/12/2022]
Affiliation(s)
- K K H Lai
- Department of Ophthalmology, Tung Wah Eastern Hospital, 19, Eastern Hospital Road, Causeway Bay, Hong Kong.
| | - T S Wong
- Department of Clinical Pathology, Pamela Youde Nethersole Eastern Hospital, 3, Lok Man Road, Chai Wan, Hong Kong
| | - C K Li
- Department of Radiology, Pamela Youde Nethersole Eastern Hospital, 3, Lok Man Road, Chai Wan, Hong Kong
| | - A Kuk
- Department of Ophthalmology, Tung Wah Eastern Hospital, 19, Eastern Hospital Road, Causeway Bay, Hong Kong
| | - C K L Ko
- Department of Ophthalmology, Tung Wah Eastern Hospital, 19, Eastern Hospital Road, Causeway Bay, Hong Kong
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Kumar P, Jindal A, Bhalgat B, Swain PK, Sharma RG. Malignant solitary fibrous tumor of maxilla presenting as proptosis: A case report. J Cancer Res Ther 2023; 19:S991-S993. [PMID: 38384099 DOI: 10.4103/jcrt.jcrt_2329_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 08/17/2022] [Indexed: 02/23/2024]
Abstract
ABSTRACT Solitary fibrous tumor (SFT) is a fibroblastic mesenchymal neoplasm that rarely metastasizes. SFTs was first described in relation to pleura. However, occurrence of this tumor type has been reported in other sites like peritoneum, liver, adrenal gland, meninges and oral cavity. In head and neck region, oral cavity is the most common site of involvement. Most of the solitary fibrous tumors are benign and present as an asymptomatic slow growing mass. Surgery remains the mainstay of treatment. Hereby, we describe a case of 71-year-old male with malignant solitary fibrous tumor arising from right maxilla invading the right orbit presenting as proptosis.
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Affiliation(s)
- Pravin Kumar
- Department of Surgical Oncology, SMS Medical College & Hospital, Jaipur, Rajasthan, India
| | - Arpita Jindal
- Department of Pathology, SMS Medical College & Hospital, Jaipur, Rajasthan, India
| | - Bhushan Bhalgat
- Department of Surgical Oncology, SMS Medical College & Hospital, Jaipur, Rajasthan, India
| | - Phanindra Kumar Swain
- Department of Surgical Oncology, SMS Medical College & Hospital, Jaipur, Rajasthan, India
| | - Raj Govind Sharma
- Department of Surgical Oncology, SMS Medical College & Hospital, Jaipur, Rajasthan, India
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Patel A, Palma D, Sangle N, Zayed S. Radiation management of a late thoracic metastasis from an intracranial solitary fibrous tumour. BMJ Case Rep 2022; 15:e250862. [PMID: 36357102 PMCID: PMC9660510 DOI: 10.1136/bcr-2022-250862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Solitary fibrous tumours (SFTs) are a rare soft tissue sarcoma. We present a case of a male patient with an SFT of the right posterior fossa, with a late metastasis to the right lung and chest wall identified 18 years later.A small number of late metastases of SFTs have previously been reported. Metastases are typically managed surgically, although there is limited evidence suggesting that radiotherapy may be effective for primary SFTs.In this case, the patient declined treatment for his metastasised cancer for 5 years. He then only agreed to radiation treatment without surgery, which uniquely resulted in excellent symptom relief and durable local control. This case illustrates the importance of further research on the role of radiation in managing SFTs, the value of long-term follow-up and the necessity of exploring barriers to care.This case also highlights issues regarding barriers to care related to late diagnoses of recurrence in rare tumours. In this case, at the time of recurrence the original tissue blocks were not available for review. The patient had moved to a different province where his former records were not easily accessible, and the original tissue blocks had been discarded. In that jurisdiction, laboratories must keep cytology slides for 5 years, histopathology slides for 10 years and paraffin blocks for 2 years. This contributed to a misdiagnosis of the recurrence as an Ewing sarcoma, resulting in the patient initially declining treatment at the time of disease recurrence, and leading to a long-standing mistrust of his physicians which impacted his decision-making.
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Affiliation(s)
- Arjun Patel
- Medicine, Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - David Palma
- Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Nikhil Sangle
- Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Sondos Zayed
- Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
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13
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Hanif M, Jaiswal V, Naz S, Patel N, Pokhrel NB, Vadiyala MR. Malignant fibroma presenting as a hypoglycemia and coma in a 45‐year‐old male patient: A case report. Clin Case Rep 2022; 10:e6627. [DOI: 10.1002/ccr3.6627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 10/19/2022] [Accepted: 11/08/2022] [Indexed: 11/22/2022] Open
Affiliation(s)
| | | | - Sidra Naz
- University of Health Science Lahore Pakistan
| | - Nirmit Patel
- GSC Medical College, Hospital and Research Center Ahmedabad India
| | - Nishan Babu Pokhrel
- Department of Internal Medicine Tribhuvan University Institute of Medicine Kathmandu Nepal
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14
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Georgiesh T, Aggerholm-Pedersen N, Schöffski P, Zhang Y, Napolitano A, Bovée JVMG, Hjelle Å, Tang G, Spalek M, Nannini M, Swanson D, Baad-Hansen T, Sciot R, Hesla AC, Huang P, Dorleijn D, Haugland HK, Lacambra M, Skoczylas J, Pantaleo MA, Haas RL, Meza-Zepeda LA, Haller F, Czarnecka AM, Loong H, Jebsen NL, van de Sande M, Jones RL, Haglund F, Timmermans I, Safwat A, Bjerkehagen B, Boye K. Validation of a novel risk score to predict early and late recurrence in solitary fibrous tumour. Br J Cancer 2022; 127:1793-1798. [PMID: 36030294 PMCID: PMC9643389 DOI: 10.1038/s41416-022-01959-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 08/08/2022] [Accepted: 08/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Current risk models in solitary fibrous tumour (SFT) were developed using cohorts with short follow-up and cannot reliably identify low-risk patients. We recently developed a novel risk model (G-score) to account for both early and late recurrences. Here, we aimed to validate the G-score in a large international cohort with long-term follow-up. METHODS Data were collected from nine sarcoma referral centres worldwide. Recurrence-free interval (RFi) was the primary endpoint. RESULTS The cohort comprised 318 patients with localised extrameningeal SFTs. Disease recurrence occurred in 96 patients (33%). The estimated 5-year RFi rate was 72%, and the 10-year RFi rate was 52%. G-score precisely predicted recurrence risk with estimated 10-year RFi rate of 84% in low risk, 54% in intermediate risk and 36% in high risk (p < 0.001; C-index 0.691). The mDemicco (p < 0.001; C-index 0.749) and SalasOS (p < 0.001; C-index 0.674) models also predicted RFi but identified low-risk patients less accurate with 10-year RFi rates of 72% and 70%, respectively. CONCLUSIONS G-score is a highly significant predictor of early and late recurrence in SFT and is superior to other models to predict patients at low risk of relapse. A less intensive follow-up schedule could be considered for patients at low recurrence risk according to G-score.
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Affiliation(s)
- Tatiana Georgiesh
- Department of Pathology, Oslo University Hospital, Oslo, Norway
- Department of Tumour Biology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
| | | | - Patrick Schöffski
- Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Yifan Zhang
- Department of Oncology-Pathology, Karolinska Institutet and Clinical Pathology and Cancer Diagnostics, Karolinska University Hospital, Stockholm, Sweden
| | - Andrea Napolitano
- Sarcoma Unit, The Royal Marsden Hospital and The Institute of Cancer Research, London, UK
| | - Judith V M G Bovée
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Åse Hjelle
- Department of Oncology, Haukeland University Hospital, Bergen, Norway
| | - Gordon Tang
- Department of Clinical Oncology, Prince of Wales Hospital, Hong Kong SAR, China
| | - Mateusz Spalek
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Margherita Nannini
- Division of Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - David Swanson
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Thomas Baad-Hansen
- Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Raf Sciot
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Asle C Hesla
- Department of Molecular Medicine and Surgery, Karolinska Institutet and Clinical Orthopaedics, Karolinska University Hospital, Stockholm, Sweden
| | - Paul Huang
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - Desiree Dorleijn
- Department of Orthopedic Surgery, Bone and Soft Tissue Tumor Unit, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Maribel Lacambra
- Department of Clinical Oncology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jacek Skoczylas
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Maria A Pantaleo
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Rick L Haas
- Department of Radiotherapy, the Netherlands Cancer Institute, Amsterdam, The Netherlands and Department of Radiotherapy, the Leiden University Medical Center, Leiden, The Netherlands
| | - Leonardo A Meza-Zepeda
- Department of Tumour Biology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
- Department of Core Facilities, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
| | - Florian Haller
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Anna M Czarnecka
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Herbert Loong
- Department of Clinical Oncology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Nina L Jebsen
- Department of Oncology, Haukeland University Hospital, Bergen, Norway
| | - Michiel van de Sande
- Department of Orthopedic Surgery, Bone and Soft Tissue Tumor Unit, Leiden University Medical Center, Leiden, The Netherlands
| | - Robin L Jones
- Sarcoma Unit, The Royal Marsden Hospital and The Institute of Cancer Research, London, UK
| | - Felix Haglund
- Department of Oncology-Pathology, Karolinska Institutet and Clinical Pathology and Cancer Diagnostics, Karolinska University Hospital, Stockholm, Sweden
| | - Iris Timmermans
- Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Akmal Safwat
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Bodil Bjerkehagen
- Department of Pathology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kjetil Boye
- Department of Tumour Biology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway.
- Department of Oncology, Oslo University Hospital, Oslo, Norway.
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15
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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: 14] [Impact Index Per Article: 7.0] [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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16
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Van Venetien F, Luca C, Mercieca D, Farrugia P, Fsadni P. Rare case of a synchronous pleural solitary fibrous tumour and a thymic cyst. BMJ Case Rep 2022; 15:e247687. [PMID: 35232741 PMCID: PMC8889358 DOI: 10.1136/bcr-2021-247687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2021] [Indexed: 11/03/2022] Open
Abstract
We present a unique case of a 41-year-old man with an anterior mediastinal mass and a pulmonary nodule, found incidentally on a thoracic CT. Further evaluation with an MRI revealed a thymic cyst which was multiloculated with several septations. Biopsy of the pulmonary nodule was performed and histology was consistent with a solitary fibrous tumour (SFT), on the benign spectrum. Both lesions were successfully resected simultaneously via a median sternotomy approach. Final full histological diagnoses confirmed a multiloculated thymic cyst and a completely excised SFT.
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Affiliation(s)
| | - Conti Luca
- Medicine, Mater Dei Hospital, Msida, Malta
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17
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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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18
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Negură I, Ianole V, Dănilă R, Ungureanu MC, Apostol DGC. Primary solitary fibrous tumor of the thyroid gland: A review starting from a case report. Arch Clin Cases 2022; 8:97-105. [PMID: 34984233 PMCID: PMC8717007 DOI: 10.22551/2021.33.0804.10193] [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: 11/26/2022] Open
Abstract
Primary solitary fibrous tumor (SFT) of the thyroid gland is a rare mesenchymal tumor with fibroblastic differentiation, ramified, thin-walled, enlarged (staghorn) vessels and specific NAB2-STAT6 gene fusion, which is more commonly found in pleura and peritoneum. This neoplasm can be located in a variety of anatomical sites outside pleura and peritoneum including bone, visceral organs and soft tissues, head and neck examples representing only 10-15% of the extra-pleural and extra-peritoneal tumors. Diagnosing this entity can be difficult, especially in thyroid gland, mainly because of the rarity of this neoplasm, but presence of characteristic microscopic features together with positivity for STAT6 and CD34 can confirm the diagnosis and exclude other differential diagnosis. Information about the diagnosis and treatment options of thyroid SFTs is limited but almost all primary thyroid SFTs have a good prognosis and indolent clinical course. Clinical surveillance is still necessary because some SFTs can be aggressive. Raising awareness regarding extra-pleural and extra-peritoneal location of this tumor in endocrine organs can help to better manage these patients. We report the case of a 34-year-old female with primary SFT of the thyroid gland. Additionally, we review the literature for the main clinical, paraclinical and pathological features of this neoplasm.
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Affiliation(s)
- Ion Negură
- Pathology Department, "Sf. Spiridon" Emergency County Clinical Hospital, Iasi, Romania.,Pathology Department, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Victor Ianole
- Pathology Department, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Radu Dănilă
- Department of Surgery, III-rd Surgical Unit, "Sf. Spiridon" Emergency County Clinical Hospital, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Maria-Christina Ungureanu
- Endocrinology Department, "Sf. Spiridon" Emergency County Clinical Hospital, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Delia Gabriela Ciobanu Apostol
- Pathology Department, "Sf. Spiridon" Emergency County Clinical Hospital, Iasi, Romania.,Pathology Department, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
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19
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Badawy M, Nada A, Crim J, Kabeel K, Layfield L, Shaaban A, Elsayes KM, Gaballah AH. Solitary fibrous tumors: Clinical and imaging features from head to toe. Eur J Radiol 2021; 146:110053. [PMID: 34856518 DOI: 10.1016/j.ejrad.2021.110053] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 09/03/2021] [Accepted: 11/15/2021] [Indexed: 12/12/2022]
Abstract
Solitary fibrous tumors (SFTs) are rare fibroblastic mesenchymal tumors that are usually benign with variable malignant potential. They can develop in any organ due to their spindle cell origin. The exact etiology of solitary fibrous tumors is unknown. The majority of SFTs are benign with 10-30% of them exhibiting aggressive and malignant features. The aggressiveness of this type of tumor is not associated with its histological features, which makes surgical resection the treatment of choice. We will review the clinical and radiological features and possible differential diagnoses of SFTs according to their anatomical sites following the World Health Organization 2020 classification.
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Affiliation(s)
- Mohamed Badawy
- Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, United States.
| | - Ayman Nada
- Department of Radiology, University of Missouri Health Care, Columbia, MO, United States.
| | - Julia Crim
- Department of Radiology, University of Missouri Health Care, Columbia, MO, United States.
| | - Khalid Kabeel
- Department of Radiology, University of Missouri Health Care, Columbia, MO, United States.
| | - Lester Layfield
- Department of Pathology, University of Missouri Health Care, Columbia, MO, United States.
| | - Akram Shaaban
- Department of Diagnostic Imaging, University of Utah, Salt Lake City, UT, United States.
| | - Khaled M Elsayes
- Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, United States.
| | - Ayman H Gaballah
- Department of Radiology, University of Missouri Health Care, Columbia, MO, United States.
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20
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A Case Report of a Solitary Fibrous Tumor of the Maxillary Sinus. REPORTS 2021. [DOI: 10.3390/reports4040033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A solitary fibrous tumor (SFT) is a benign neoplasm, firstly described as a mesenchymal tumor of the pleura. Its incidence range in the head and neck region is about 5–27%, but only rarely does it affect paranasal sinuses. The differential diagnosis is challenging, owing to its erosive growth pattern and immuno-histochemical features. SFTs have an aggressive behavior and an important recurrence potential. Therefore, a radical surgical excision is the gold standard therapeutic procedure. A rare SFT originating from the right maxillary sinus is reported here. The 37-year-old patient presented to the outpatient clinic with a painful expansive lesion in the whole right maxillary region. The overlying skin was inflamed and the patient had no epistaxis episodes. The 1.5 dentary element tested negative for vitality; however, a puncture of the lesion led to a hematic spill and no purulent discharge. An endoscopic-guided biopsy was suggestive either of SFT or hemangioperictoma, excluding a malignant neoplasm. A multi-equipe surgical team was activated. The lesion was embolized in order to achieve a good hemostatic control and, after 48 h, the neoplasm was radically excised with a combined open and endoscopic approach. The patient was disease-free at 12-month radiological and clinical follow-up. Given the rarity of this lesion and the delicacy required in addressing head and neck neoplasms, we believe that the present case report might be of help in further understanding how to approach cranio-facial SFTs.
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21
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Sierra-Poyatos R, Cárdenas-Salas J, Ortega-Juaristi M, Vázquez-Martínez C. About a rare case of hypoglycemia: Non-islet cell tumor hypoglycemia (NICTH). ENDOCRINOL DIAB NUTR 2021; 68:589-591. [PMID: 34872643 DOI: 10.1016/j.endien.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 07/17/2020] [Indexed: 06/13/2023]
Affiliation(s)
- Roberto Sierra-Poyatos
- Servicio de Endocrinología y Nutrición. Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.
| | - Jersy Cárdenas-Salas
- Servicio de Endocrinología y Nutrición. Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Maite Ortega-Juaristi
- Servicio de Endocrinología y Nutrición. Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Clotilde Vázquez-Martínez
- Servicio de Endocrinología y Nutrición. Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
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22
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Smrke A, Thway K, H Huang P, Jones RL, Hayes AJ. Solitary fibrous tumor: molecular hallmarks and treatment for a rare sarcoma. Future Oncol 2021; 17:3627-3636. [PMID: 34409859 DOI: 10.2217/fon-2021-0030] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Solitary fibrous tumor (SFT) is a rare soft tissue sarcoma subtype which mainly affects adults in the fifth and sixth decades of life. Originally part of a spectrum of tumors called hemangiopericytomas, classification has been refined such that SFTs now represent a distinct subtype. The identification of NAB2-STAT6 fusion in virtually all SFTs has further aided to define this rare subgroup. SFTs have a spectrum of behavior from benign to malignant, with evidence suggesting risk of metastases related to age at diagnosis, extent of necrosis, mitotic rate and tumor size. The standard treatment for localized disease is surgical excision with or without radiotherapy. Retrospective and prospective evidence suggests antiangiogenic treatment is effective for unresectable disease. Further translational work is required to understand the biology driving the differential behavior and identify more effective treatments for patients with metastatic disease.
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Affiliation(s)
- Alannah Smrke
- Sarcoma Unit, Royal Marsden Hospital, 203 Fulham Road, London, SW3 6JJ, UK
| | - Khin Thway
- Sarcoma Unit, Royal Marsden Hospital, 203 Fulham Road, London, SW3 6JJ, UK.,The Institute of Cancer Research, 237 Fulham Road, London, SW3 6JB, UK
| | - Paul H Huang
- The Institute of Cancer Research, 237 Fulham Road, London, SW3 6JB, UK
| | - Robin L Jones
- Sarcoma Unit, Royal Marsden Hospital, 203 Fulham Road, London, SW3 6JJ, UK.,The Institute of Cancer Research, 237 Fulham Road, London, SW3 6JB, UK
| | - Andrew J Hayes
- Sarcoma Unit, Royal Marsden Hospital, 203 Fulham Road, London, SW3 6JJ, UK.,The Institute of Cancer Research, 237 Fulham Road, London, SW3 6JB, UK
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23
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Martin-Broto J, Mondaza-Hernandez JL, Moura DS, Hindi N. A Comprehensive Review on Solitary Fibrous Tumor: New Insights for New Horizons. Cancers (Basel) 2021; 13:cancers13122913. [PMID: 34200924 PMCID: PMC8230482 DOI: 10.3390/cancers13122913] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/01/2021] [Accepted: 06/04/2021] [Indexed: 12/16/2022] Open
Abstract
Simple Summary Solitary fibrous tumor (SFT) is a malignant condition that exhibits different clinical behaviors ranging from low to high aggressive SFT, with dedifferentiated SFT (DD-SFT) being the fastest-growing subtype. Even when surgery alone provides curation rates above 60%, recurrences do occur in a fraction of patients where surgery is unable to provide disease control. Among the systemic therapeutic options, antiangiogenic compounds have shown higher efficacy than chemotherapy by indirect comparisons. Furthermore, rotating different antiangiogenics, at the progression time, has been shown to be effective. The exception is DD-SFT since it is resistant to antiangiogenics but can respond to chemotherapy. This comprehensive review also analyzes the underlying molecular components that play a key role in SFT origin and aggressiveness. The discovery in 2013 of anomalous fusion genes between NAB2 and STAT6 was determinant to increase the knowledge on the molecular drivers in SFT that could be potential targets for future therapies. Abstract Solitary fibrous tumor (SFT) is a rare mesenchymal, ubiquitous tumor, with an incidence of 1 new case/million people/year. In the 2020 WHO classification, risk stratification models were recommended as a better tool to determine prognosis in SFT, to the detriment of “typical” or “malignant” classic terms. The risk for metastasis is up to 35–45%, or even greater, in series with a longer follow-up. Over the last few decades, advances in immunohistochemistry and molecular diagnostics identified STAT6 nuclear protein expression and the NAB2–STAT6 fusion gene as more precise tools for SFT diagnosis. Recent evidence taken from retrospective series and from two prospective phase II clinical trials showed that antiangiogenics are active and their sequential use from first line should be considered, except for dedifferentiated SFT for which chemotherapy is the best option. Since the fusion transcript driver’s first description in 2013, new insights have been brought on key molecular events in SFT. This comprehensive review mainly focuses on the superior efficacy of antiangiogenics over chemotherapeutic agents in SFT, provides the current knowledge of key molecules that could co-drive the SFT behavior, and suggests new target candidates that deserve to be explored in preclinical and clinical research in SFT.
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Affiliation(s)
- Javier Martin-Broto
- Fundacion Jimenez Díaz University Hospital, 28040 Madrid, Spain;
- General de Villalba University Hospital, Collado Villalba, 28400 Madrid, Spain
- Fundación Jiménez Díaz Institute for Medical Research (IIS/FJD), 28040 Madrid, Spain
- Correspondence:
| | - Jose L. Mondaza-Hernandez
- Institute of Biomedicine of Seville (IBiS, CSIC, US and HUVR), 41013 Sevilla, Spain; (J.L.M.-H.); (D.S.M.)
| | - David S. Moura
- Institute of Biomedicine of Seville (IBiS, CSIC, US and HUVR), 41013 Sevilla, Spain; (J.L.M.-H.); (D.S.M.)
| | - Nadia Hindi
- Fundacion Jimenez Díaz University Hospital, 28040 Madrid, Spain;
- General de Villalba University Hospital, Collado Villalba, 28400 Madrid, Spain
- Fundación Jiménez Díaz Institute for Medical Research (IIS/FJD), 28040 Madrid, Spain
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24
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Matsuishi K, Eto K, Morito A, Hamasaki H, Morita K, Ikeshima S, Horino K, Shimada S, Baba H. Retroperitoneal fibrous tumor recurring as lung metastases after 10 years: a case report. Surg Case Rep 2021; 7:127. [PMID: 34023959 PMCID: PMC8140954 DOI: 10.1186/s40792-021-01209-4] [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: 03/15/2021] [Accepted: 05/12/2021] [Indexed: 11/29/2022] Open
Abstract
Background Solitary fibrous tumor (SFT) is a relatively rare mesenchymal tumor that mainly affects adults. Its prognosis is good after curative resection, but distant recurrences after 10 years or longer have been reported. Recurrent SFT usually arises as a local lesion; distant metastasis is rarely reported. Here, we report lung metastases that recurred a decade after excising a retroperitoneal primary SFT. Case presentation A 44-year-old woman had an SFT resected from her right retroperitoneum at our hospital. Ten years later, at age 54, she underwent a lung resection after CT showed three suspected metastases in her left lung. All three were histologically diagnosed as lung metastases from the retroperitoneal SFT. However, whereas the primary SFT had 1–2 mitotic cells/10 high power fields (HPF), the metastatic lesion increased malignancy, at 50/10 HPF. Conclusion Patients who have had resected SFTs should be carefully followed up, as malignancy may change in distant metastasis, as in this case.
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Affiliation(s)
- Kozue Matsuishi
- Department of Surgery, Japan Community Health Care Organization Kumamoto General Hospital, 10-10 Toricho, Yatsushiro, Kumamoto, 866-8660, Japan
| | - Kojiro Eto
- Department of Surgery, Japan Community Health Care Organization Kumamoto General Hospital, 10-10 Toricho, Yatsushiro, Kumamoto, 866-8660, Japan
| | - Atsushi Morito
- Department of Surgery, Japan Community Health Care Organization Kumamoto General Hospital, 10-10 Toricho, Yatsushiro, Kumamoto, 866-8660, Japan
| | - Hirokazu Hamasaki
- Department of Surgery, Japan Community Health Care Organization Kumamoto General Hospital, 10-10 Toricho, Yatsushiro, Kumamoto, 866-8660, Japan
| | - Keisuke Morita
- Department of Surgery, Japan Community Health Care Organization Kumamoto General Hospital, 10-10 Toricho, Yatsushiro, Kumamoto, 866-8660, Japan
| | - Satoshi Ikeshima
- Department of Surgery, Japan Community Health Care Organization Kumamoto General Hospital, 10-10 Toricho, Yatsushiro, Kumamoto, 866-8660, Japan
| | - Kei Horino
- Department of Surgery, Japan Community Health Care Organization Kumamoto General Hospital, 10-10 Toricho, Yatsushiro, Kumamoto, 866-8660, Japan
| | - Shinya Shimada
- Department of Surgery, Japan Community Health Care Organization Kumamoto General Hospital, 10-10 Toricho, Yatsushiro, Kumamoto, 866-8660, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
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25
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Georgiesh T, Boye K, Bjerkehagen B. A novel risk score to predict early and late recurrence in solitary fibrous tumour. Histopathology 2021; 77:123-132. [PMID: 31991494 DOI: 10.1111/his.14078] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/03/2020] [Accepted: 01/24/2020] [Indexed: 12/13/2022]
Abstract
AIMS Solitary fibrous tumours (SFTs) are rare mesenchymal neoplasms with recurrence rates of 10-30%. Current risk stratification systems for extrameningeal SFTs are based on cohorts with limited follow-up and are not suitable for prediction of late recurrences. In this study we aimed to develop a prognostic model accounting for both early and late recurrences using a relatively large patient cohort with long-term follow-up. METHODS AND RESULTS Clinicopathological factors were analysed in a cohort of 100 extrameningeal, STAT6-positive SFTs. Median follow-up for overall survival (OS) and recurrence-free interval (RFi) were 121 and 84 months, respectively. Disease relapse occurred in 31% of patients and median time to recurrence was 63 months. In univariate analysis mitotic count, necrosis, male gender and presence of severe atypia and pleomorphism were associated with inferior RFi. Mitotic count, necrosis and male gender were independent predictors of recurrence in multivariate analysis. Previously published risk models were also statistically associated with RFi in our cohort, but failed to reliably identify low-risk patients due to poor prediction of late recurrences. A novel risk score based on mitotic count, necrosis and gender was able to stratify patients into low-, intermediate- and high-risk groups for both early and late recurrences. CONCLUSIONS In this cohort of patients with extrameningeal SFT and long-term follow-up mitotic count, necrosis and gender were independent prognostic markers of recurrence. We propose a novel risk score based on these factors and accounting for late recurrences, which should be validated in external cohorts with sufficient follow-up time.
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Affiliation(s)
- Tatiana Georgiesh
- Department of Pathology, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway.,Department of Tumour Biology, Institute for Cancer Research, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Kjetil Boye
- Department of Tumour Biology, Institute for Cancer Research, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway.,Department of Oncology, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Bodil Bjerkehagen
- Department of Pathology, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine and Institute of Oral Biology, University of Oslo, Oslo, Norway
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26
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Georgiesh T, Namløs HM, Sharma N, Lorenz S, Myklebost O, Bjerkehagen B, Meza-Zepeda LA, Boye K. Clinical and molecular implications of NAB2-STAT6 fusion variants in solitary fibrous tumour. Pathology 2021; 53:713-719. [PMID: 33745702 DOI: 10.1016/j.pathol.2020.11.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 11/20/2020] [Indexed: 02/06/2023]
Abstract
Solitary fibrous tumour (SFT) is a mesenchymal neoplasm characterised by pathognomonic NAB2-STAT6 gene fusions. The clinical implications and prognostic value of different fusion variants has not been clarified. In the current study, we explore the clinicopathological, prognostic and molecular differences between tumours with different fusions. Thirty-nine patients with localised, extrameningeal SFT were included, of whom 20 developed distant recurrence and 19 were without recurrence after long term follow-up. Capture-based RNA sequencing identified 12 breakpoint variants, which were categorised into two groups based on the STAT6 domain composition in the predicted chimeric proteins. Twenty-one of 34 (62%) sequenced tumours had fusions with most of the STAT6 domains intact and were classified as STAT6-Full. Thirteen tumours (38%) contained only the transactivation domain of STAT6 and were classified as STAT6-TAD. Tumours with STAT6-TAD fusions had a higher mitotic count (p=0.016) and were associated with inferior recurrence-free interval (p=0.004) and overall survival (p=0.012). Estimated 10-year recurrence-free survival was 25% for patients with STAT6-TAD tumours compared to 78% for the STAT6-Full group. Distinct transcriptional signatures between the fusion groups were identified, including higher expression of FGF2 in the STAT6-TAD group and IGF2, EGR2, PDGFRB, STAT6 and several extracellular matrix genes in STAT6-Full tumours. In summary, we demonstrate that NAB2-STAT6 fusion variants are associated with distinct clinicopathological and molecular characteristics and have prognostic significance in extrameningeal SFT.
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Affiliation(s)
- Tatiana Georgiesh
- Department of Pathology, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway; Department of Tumour Biology, Institute for Cancer Research, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Heidi Maria Namløs
- Department of Tumour Biology, Institute for Cancer Research, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Nitin Sharma
- Department of Tumour Biology, Institute for Cancer Research, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Susanne Lorenz
- Department of Tumour Biology, Institute for Cancer Research, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Ola Myklebost
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Bodil Bjerkehagen
- Department of Pathology, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine and Institute of Oral Biology, University of Oslo, Oslo, Norway
| | - Leonardo A Meza-Zepeda
- Department of Tumour Biology, Institute for Cancer Research, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Kjetil Boye
- Department of Tumour Biology, Institute for Cancer Research, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway; Department of Oncology, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway.
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Masmoudi M, Hasnaoui M, Dgani I, Thabet W, Ben Abdeljalil N, Ch C, Mighri K, Driss N. Solitary Fibrous Tumor of the External Auditory Canal. EAR, NOSE & THROAT JOURNAL 2021; 102:NP145-NP148. [PMID: 33683977 DOI: 10.1177/0145561321997539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Solitary fibrous tumors (SFTs) originating from the external auditory canal are uncommon; only few cases have been reported in the literature. In this article, we report a case of a 35-year-old man who presented with a 6-month history of a gradual swelling in the entrance of the left external auditory meatus associated with hearing loss. The tumor was surgically removed, and histological examination showed spindle-cell proliferation with a collagenous stroma. Immunohistochemically, the tumor cells were positive for CD34 confirming the diagnosis of an SFT. Although SFTs are benign, complications such as relapses and metastasis after excision were reported. Thus, a careful and long follow-up is recommended.
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Affiliation(s)
- Mohamed Masmoudi
- ENT department of Tahar Sfar University Hospital, Mahdia, Tunisia
| | - Mehdi Hasnaoui
- ENT department of Tahar Sfar University Hospital, Mahdia, Tunisia
| | - I Dgani
- ENT department of Tahar Sfar University Hospital, Mahdia, Tunisia
| | - W Thabet
- ENT department of Tahar Sfar University Hospital, Mahdia, Tunisia
| | - N Ben Abdeljalil
- Cytopathology department of Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Chébaane Ch
- Cytopathology department of Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Khalifa Mighri
- ENT department of Tahar Sfar University Hospital, Mahdia, Tunisia
| | - Nabil Driss
- ENT department of Tahar Sfar University Hospital, Mahdia, Tunisia
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28
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Haas RL, Walraven I, Lecointe-Artzner E, van Houdt WJ, Scholten AN, 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, Brandsma D, Doglietto F, Sangalli C, Stacchiotti S. Management of meningeal solitary fibrous tumors/hemangiopericytoma; surgery alone or surgery plus postoperative radiotherapy? Acta Oncol 2021; 60:35-41. [PMID: 32988268 DOI: 10.1080/0284186x.2020.1826574] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION A meningeal solitary fibrous tumor (SFT), also called hemangiopericytoma, is a rare mesenchymal malignancy. Due to anatomic constrains, even after macroscopic complete surgery with curative intent, the local relapse risk is still relatively high, thus increasing the risk of dedifferentiation and metastatic spread. This study aims to better define the role of postoperative radiotherapy (RT) in meningeal SFTs. PATIENTS AND METHODS A retrospective study was performed across seven sarcoma centers. Clinical information was retrieved from all adult patients with meningeal primary localized SFT treated between 1990 and 2018 with surgery alone (S) compared to those that also received postoperative RT (S + RT). Differences in treatment characteristics between subgroups were tested using independent samples t-test for continuous variables and chi-square tests for proportions. Local control (LC) and overall survival (OS) rates were calculated as time from start of treatment until progression or death from any cause. LC and OS in groups receiving S or S + RT were compared using Kaplan-Meier survival curves. RESULTS Among a total of 48 patients, 7 (15%) underwent S and 41 (85%) underwent S + RT. Median FU was 65 months. LC was significantly associated with treatment. LC after S at 60 months was 60% versus 90% after S + RT (p = 0.052). Furthermore, R1 resection status was significantly associated with worse LC (HR 4.08, p = 0.038). OS was predominantly associated with the mitotic count (HR 3.10, p = 0.011). CONCLUSION This retrospective study, investigating postoperative RT in primary localized meningeal SFT patients, suggests that combining RT to surgery in the management of this patient population may reduce the risk for local failures.
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Affiliation(s)
- R. L. Haas
- Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Radiation Oncology, The Leiden University Medical Center, Leiden, The Netherlands
| | - I. Walraven
- Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - W. J. van Houdt
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - A. N. Scholten
- Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - D. Strauss
- Sarcoma Unit, Department of Surgery, The Royal Marsden Hospital, London, UK
| | - Y. Schrage
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Sarcoma Unit, Department of Surgery, The Royal Marsden Hospital, London, UK
- Department of Surgical Oncology, The Leiden University Medical Center, Leiden, The Netherlands
| | - A. J. Hayes
- Sarcoma Unit, Department of Surgery, The Royal Marsden Hospital, London, UK
| | - C. P. Raut
- Division of Surgical Oncology, Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - M. Fairweather
- Division of Surgical Oncology, Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - E. H. Baldini
- Department of Radiation Oncology, Brigham and Women’s Hospital, Boston, MA, USA
- Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - A. Gronchi
- Department of Surgical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - L. De Rosa
- Department of Surgical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - A. M. Griffin
- Department of Orthopedic Surgery, Sarcoma Unit, Mount Sinai Hospital, Toronto, ON, Canada
| | - P. C. Ferguson
- Department of Orthopedic Surgery, Sarcoma Unit, Mount Sinai Hospital, Toronto, ON, Canada
| | - J. Wunder
- Department of Orthopedic Surgery, Sarcoma Unit, Mount Sinai Hospital, Toronto, ON, Canada
| | - M. A. J. van de Sande
- Department of Orthopedic Oncology, The Leiden University Medical Center, Leiden, The Netherlands
| | - A. D. G. Krol
- Department of Radiation Oncology, The Leiden University Medical Center, Leiden, The Netherlands
| | - J. Skoczylas
- Department of Surgical Oncology, The Maria Sklodowska-Curie Institute – Oncology Center, Warsaw, Poland
| | - D. Brandsma
- Department of Neuro-Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - F. Doglietto
- Neurosurgery Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - C. Sangalli
- Department of Radiation Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - S. Stacchiotti
- Adult Mesenchymal and Rare Tumor Unit, Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Sierra-Poyatos R, Cárdenas-Salas J, Ortega-Juaristi M, Vázquez-Martínez C. About a rare case of hypoglycemia: Non-islet cell tumor hypoglycemia (NICTH). ENDOCRINOL DIAB NUTR 2020; 68:S2530-0164(20)30220-2. [PMID: 33309586 DOI: 10.1016/j.endinu.2020.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/12/2020] [Accepted: 07/17/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Roberto Sierra-Poyatos
- Servicio de Endocrinología y Nutrición. Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.
| | - Jersy Cárdenas-Salas
- Servicio de Endocrinología y Nutrición. Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Maite Ortega-Juaristi
- Servicio de Endocrinología y Nutrición. Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Clotilde Vázquez-Martínez
- Servicio de Endocrinología y Nutrición. Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
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30
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Magro G, Salvatorelli L, Piombino E, Vecchio GM, Broggi G, Castorina S. Solitary fibrous tumor with atypical features of the paravesical space: benign clinical course at the 10-years follow-up. Report of a case and review of the literature. Pathologica 2020; 112:200-209. [PMID: 33393523 PMCID: PMC8183344 DOI: 10.32074/1591-951x-126] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 05/18/2020] [Indexed: 12/13/2022] Open
Abstract
Extra-pleural solitary fibrous tumor (SFT) is a relatively rare soft tissue neoplasm, with only rare cases reported in the pelvic cavity. Most SFTs are histologically benign, with only a few malignant cases reported in the literature so far. We report a rare case of SFT arising in the paravesical space of a 79-year-old man. Histologically the tumor corresponds to an “intermediate risk tumor” according to a risk stratification scheme for metastatic potential, which incorporates patient age, tumor size, mitotic activity and necrosis. Notably tumor showed a benign clinical course without evidence of local recurrence after a 10-years follow-up. Tumor was composed of both spindle and epithelioid cells variably set in a fibro-myxoid stroma, with focal pleomorphic, necrotic and highly mitotic (> 4 mitoses/10HPF) areas. Immunohistochemistry, showing a diffuse CD34 and STAT6 immunoreactivity, supported the diagnosis of SFT. The present case emphasizes that the clinical course of the pelvic SFTs with atypical morphological features is unpredictable on the basis of morphology alone, and thus the term “SFT with atypical features, including the risk stratification class” should be preferred to “malignant SFT”.
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Affiliation(s)
- Gaetano Magro
- Department of Medical and Surgical Sciences and Advanced Technologies, G.F. Ingrassia, Azienda Ospedaliero-Universitaria "Policlinico Vittorio Emanuele", Anatomic Pathology, School of Medicine, University of Catania, Italy
| | - Lucia Salvatorelli
- Department of Medical and Surgical Sciences and Advanced Technologies, G.F. Ingrassia, Azienda Ospedaliero-Universitaria "Policlinico Vittorio Emanuele", Anatomic Pathology, School of Medicine, University of Catania, Italy
| | - Eliana Piombino
- Department of Medical and Surgical Sciences and Advanced Technologies, G.F. Ingrassia, Azienda Ospedaliero-Universitaria "Policlinico Vittorio Emanuele", Anatomic Pathology, School of Medicine, University of Catania, Italy
| | - Giada Maria Vecchio
- Department of Medical and Surgical Sciences and Advanced Technologies, G.F. Ingrassia, Azienda Ospedaliero-Universitaria "Policlinico Vittorio Emanuele", Anatomic Pathology, School of Medicine, University of Catania, Italy
| | - Giuseppe Broggi
- Department of Medical and Surgical Sciences and Advanced Technologies, G.F. Ingrassia, Azienda Ospedaliero-Universitaria "Policlinico Vittorio Emanuele", Anatomic Pathology, School of Medicine, University of Catania, Italy
| | - Sergio Castorina
- Department of Medical and Surgical Sciences and Advanced Technologies, G.F. Ingrassia, Azienda Ospedaliero-Universitaria "Policlinico Vittorio Emanuele", Anatomy, School of Medicine, University of Catania, Italy and "G.B. Morgagni" Mediterranean Foundation, Catania
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31
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Haas RLM, Trama A, Stacchiotti S. Reply to Incidence of extrameningeal solitary fibrous tumors and Novel therapeutic approaches in the treatment of solitary fibrous tumors: A call for a combination therapy. Cancer 2020; 126:4069-4070. [PMID: 32619051 DOI: 10.1002/cncr.33056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 05/20/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Rick L M Haas
- Department of Radiotherapy, Netherlands Cancer Institute, Amsterdam, the Netherlands.,Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Annalisa Trama
- Evaluative Epidemiology Unit, Research Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Silvia Stacchiotti
- Adult Mesenchymal and Rare Tumor Unit, Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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32
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Clinical Presentation, Natural History, and Therapeutic Approach in Patients with Solitary Fibrous Tumor: A Retrospective Analysis. Sarcoma 2020; 2020:1385978. [PMID: 32300277 PMCID: PMC7140119 DOI: 10.1155/2020/1385978] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 02/20/2020] [Accepted: 03/02/2020] [Indexed: 12/16/2022] Open
Abstract
Background Solitary fibrous tumor (SFT) is a rare variant of soft tissue sarcoma (STS). Materials and Methods. We reviewed SFT patients (pts) treated at our institution between 12/1990 and 09/2017. Results We identified 94 pts with a median follow-up (mFU) of 4.7 years (range: 0.1–21.53). Primary sites were the chest (33%), abdomen (21.3%), brain (12.8%), and extremities (9.6%); 6.4% of pts presented with synchronous metastasis. Median overall survival (mOS) from the first diagnosis was 56.0 months (m) (0.3–258.3). Doege–Potter syndrome was seen in 2.1% of pts. Primary resection was performed in 86 pts (91.5%). Median progression-free survival was 34.1 m (1.0–157.1), and 43% of pts stayed SFT-free during FU. Local recurrence occurred in 26.7% after a mFU of 35.5 m (1.0–153.8), associated with an OS of 45.1 m (4.7–118.2). Metachronous metastasis occurred in 30.2% after a mFU of 36.0 m (0.1–157.1). OS in metastatic pts was 19.0 m (0.3–149.0). Systemic therapy was given to 26 pts (27.7%) with inoperable/metastatic disease. The most common (57.7%) upfront therapy was doxorubicin, achieving responses in 13.3% of pts with a PFS of 4.8 m (0.4–23.8). In second line, pts were treated with ifosfamide or pazopanib, the latter achieving the highest response rates. Third-line treatment was heterogeneous. Conclusion SFT is an orphan malignancy with a highly variable clinical course and a considerable risk of local failure and metachronous metastasis. Surgery is the only curative option; palliative systemic therapy is used in inoperable/metastatic cases but achieves low response rates. The highest response rates are seen with pazopanib in second/third line.
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33
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Pazopanib for treatment of typical solitary fibrous tumours: a multicentre, single-arm, phase 2 trial. Lancet Oncol 2020; 21:456-466. [PMID: 32066540 DOI: 10.1016/s1470-2045(19)30826-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 11/22/2019] [Accepted: 12/10/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Solitary fibrous tumour is an ultra-rare sarcoma, which encompasses different clinicopathological subgroups. The dedifferentiated subgroup shows an aggressive course with resistance to pazopanib, whereas in the malignant subgroup, pazopanib shows higher activity than in previous studies with chemotherapy. We designed a trial to test pazopanib activity in two different cohorts of solitary fibrous tumour: the malignant-dedifferentiated cohort, which was previously published, and the typical cohort, which is presented here. METHODS In this single-arm, phase 2 trial, adult patients (aged ≥18 years) diagnosed with confirmed metastatic or unresectable typical solitary fibrous tumour of any location, who had progressed in the previous 6 months (by Choi criteria or Response Evaluation Criteria in Solid Tumors [RECIST]) and an Eastern Cooperative Oncology Group (ECOG) performance status of 0-2 were enrolled at 11 tertiary hospitals in Italy, France, and Spain. Patients received pazopanib 800 mg once daily, taken orally, until progression, unacceptable toxicity, withdrawal of consent, non-compliance, or a delay in pazopanib administration of longer than 3 weeks. The primary endpoint was proportion of patients achieving an overall response measured by Choi criteria in patients who received at least 1 month of treatment with at least one radiological assessment. All patients who received at least one dose of the study drug were included in the safety analyses. This study is registered in ClinicalTrials.gov, NCT02066285, and with the European Clinical Trials Database, EudraCT 2013-005456-15. FINDINGS From June 26, 2014, to Dec 13, 2018, of 40 patients who were assessed, 34 patients were enrolled and 31 patients were included in the response analysis. Median follow-up was 18 months (IQR 14-34), and 18 (58%) of 31 patients had a partial response, 12 (39%) had stable disease, and one (3%) showed progressive disease according to Choi criteria and central review. The proportion of overall response based on Choi criteria was 58% (95% CI 34-69). There were no deaths caused by toxicity, and the most frequent adverse events were diarrhoea (18 [53%] of 34 patients), fatigue (17 [50%]), and hypertension (17 [50%]). INTERPRETATION To our knowledge, this is the first prospective trial of pazopanib for advanced typical solitary fibrous tumour. The manageable toxicity and activity shown by pazopanib in this cohort suggest that this drug could be considered as first-line treatment for advanced typical solitary fibrous tumour. FUNDING Spanish Group for Research on Sarcomas (GEIS), Italian Sarcoma Group (ISG), French Sarcoma Group (FSG), GlaxoSmithKline, and Novartis.
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34
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Kovacs T, Waxman J. Recurrence of a malignant solitary fibrous tumor of the pleura 17 years after primary tumor resection - A case report. Respir Med Case Rep 2019; 28:100895. [PMID: 31334027 PMCID: PMC6624449 DOI: 10.1016/j.rmcr.2019.100895] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 07/01/2019] [Accepted: 07/01/2019] [Indexed: 11/10/2022] Open
Abstract
Most recurrences of solitary fibrous tumor of the pleura (SFTP) occur within 2 years. Here we report a rare case of bilateral recurrence in a 61 year old female, 17 years after the original surgery for a right sided malignant SFTP. On repeat CT scan a 10 cm right mass and two small left lower lobe nodules were found. Patient underwent staged reoperations. She was also found to have a secondary smaller right tumor intraoperatively. All four tumors were confirmed to be recurrent SFTP on pathologic examination with identical immunohistochemistry to the original tumor.
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Affiliation(s)
- Tamas Kovacs
- Florida Atlantic University, Charles E. Schmidt College of Medicine, Department of Surgery, Boca Raton Regional Hospital, Boca Raton, FL, USA
| | - Jonathan Waxman
- Florida Atlantic University, Charles E. Schmidt College of Medicine, Department of Surgery, Boca Raton Regional Hospital, Boca Raton, FL, USA
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35
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Retroperitoneal Pelvic Solitary Fibrous Tumor With High Tracer Uptake in 68Ga-DOTATOC PET/CT. Clin Nucl Med 2019; 44:e370-e371. [DOI: 10.1097/rlu.0000000000002540] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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36
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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.
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37
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Wang Y, Wei R, Ji T, Chen Z, Guo W. Surgical treatment of primary solitary fibrous tumors involving the pelvic ring. PLoS One 2018; 13:e0207581. [PMID: 30481195 PMCID: PMC6258478 DOI: 10.1371/journal.pone.0207581] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 11/03/2018] [Indexed: 12/02/2022] Open
Abstract
The surgical treatment of primary solitary fibrous tumors (SFT) involving the pelvic ring has not been reported previously. In this study, we aimed to evaluate the efficacy of surgical treatment for this disease. From 2009 to 2015, 13 patients underwent tumor resection at our hospital, with an average age of 49.5 years (27–68 years). Four patients underwent en bloc resection, and 9 patients underwent piecemeal resections. A Chi-square test was used to compare the postoperative recurrence rates between the en bloc resection and the piecemeal resection groups (p = 0.68), and no significant difference was found between the benign and malignant solitary fibrous tumor groups (p = 0.44). The 5-year survival rate of the patients in this study was 83.3%, and the 5-year progression-free survival rate was 63.5%. The progression-free survival rate was not significantly different between the en bloc resection and piecemeal resection groups (p = 0.97). Piecemeal resection can also achieve acceptable local control, particularly for patients with sacral tumors, as they may achieve even better postoperative function with sacral nerve preservation. Recurrence and metastasis occur relatively late in the course of this disease. Therefore, long-term follow-up is required.
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Affiliation(s)
- Yifei Wang
- Department of Musculoskeletal Tumors, Peking University People’s Hospital, Beijing, People’s Republic of China
| | - Ran Wei
- Department of Musculoskeletal Tumors, Peking University People’s Hospital, Beijing, People’s Republic of China
| | - Tao Ji
- Department of Musculoskeletal Tumors, Peking University People’s Hospital, Beijing, People’s Republic of China
| | - Zhongyan Chen
- Department of Musculoskeletal Tumors, Peking University People’s Hospital, Beijing, People’s Republic of China
| | - Wei Guo
- Department of Musculoskeletal Tumors, Peking University People’s Hospital, Beijing, People’s Republic of China
- * E-mail:
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38
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Santos MN, Tavares AB, Viveiros FA, Baldaia H. Solitary fibrous tumour of caecum wall: an unlikely cause of low gastrointestinal haemorrhage. BMJ Case Rep 2018; 2018:bcr-2018-227238. [PMID: 30366899 PMCID: PMC6203041 DOI: 10.1136/bcr-2018-227238] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2018] [Indexed: 01/23/2023] Open
Abstract
Solitary fibrous tumour (SFT), previously denominated as haemangiopericytoma, is a rare, spindle cell neoplasm that was first described in the thoracic pleura. It is now known that this tumour may develop from almost any anatomic location. We report a case of SFT, in a 65-year-old man, which was located in the muscularis propria layer of the caecum with involvement of the serosa and the ileocecal appendix, location never described in the literature, and with an uncommon clinical presentation of hematochezia. A radical right hemicolectomy was performed, and the patient was asymptomatic without evidence of metastasis or relapse after 6 months of follow-up.
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Affiliation(s)
- Mariana Nogueira Santos
- General Surgery, Centro Hospitalar de Vila Nova de Gaia Espinho EPE, Vila Nova de Gaia, Portugal
| | - Amelia Brandao Tavares
- General Surgery, Centro Hospitalar de Vila Nova de Gaia Espinho EPE, Vila Nova de Gaia, Portugal
| | - Fernando Arruda Viveiros
- General Surgery, Centro Hospitalar de Vila Nova de Gaia Espinho EPE, Vila Nova de Gaia, Portugal
| | - Helena Baldaia
- Anatomical Pathology, LAP-Laboratório Anatomia Patológica-Unilabs, Porto, Portugal
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Comparison of Risk Stratification Models to Predict Recurrence and Survival in Pleuropulmonary Solitary Fibrous Tumor. J Thorac Oncol 2018; 13:1349-1362. [DOI: 10.1016/j.jtho.2018.05.040] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 05/03/2018] [Accepted: 05/04/2018] [Indexed: 01/01/2023]
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41
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Kawai S, Ariyasu H, Uraki S, Takeshima K, Morita S, Inaba H, Iwakura H, Doi A, Ohashi T, Kawago M, Matsuoka N, Okamura S, Tsujii S, Akamizu T. Imbalanced Expression of IGF2 and PCSK4 Is Associated With Overproduction of Big IGF2 in SFT With NICTH: A Pilot Study. J Clin Endocrinol Metab 2018; 103:2728-2734. [PMID: 29897468 DOI: 10.1210/jc.2018-00593] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 04/17/2018] [Indexed: 02/12/2023]
Abstract
CONTEXT Nonislet cell tumor hypoglycemia (NICTH) is a rare but serious paraneoplastic syndrome associated with large tumors. The high molecular weight IGF2, known as "big" IGF2, is produced by culprit tumors and leads to severe hypoglycemia. The detailed mechanism of its production in NICTH, however, remains unclear. OBJECTIVE To clarify the mechanism of production of big IGF2 in light of the processing of pro-IGF2 in patients with solitary fibrous tumor (SFT) and NICTH. DESIGN We enrolled 14 patients with SFT and divided them based on the presence or absence of hypoglycemia. In light of the processing of pro-IGF2 in SFT with hypoglycemia, we, retrospectively, compared the production levels of big IGF2 and the expression levels of IGF2 and proprotein convertase subtilisin/kexin type 4 (PCSK4), a proteolytic enzyme of pro-IGF2. RESULTS In all patients with NICTH, big IGF2 was detected in serum by western immunoblotting analysis. Moreover, we showed that two patients without hypoglycemia also had a small amount of big IGF2 in their serum. By immunohistochemical analysis, the protein expression level of IGF2 was significantly higher in the NICTH group than in the non-NICTH group (P = 0.043). The IGF2/PCSK4 protein expression-level ratio in the NICTH group was significantly higher than that in the non-NICTH group (P = 0.021). CONCLUSION In patients with SFT and hypoglycemia, an imbalance of IGF2 and PCSK4 expression could lead to increased serum levels of big IGF2.
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Affiliation(s)
- Shintaro Kawai
- First Department of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Hiroyuki Ariyasu
- First Department of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Shinsuke Uraki
- First Department of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Ken Takeshima
- First Department of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Shuhei Morita
- First Department of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Hidefumi Inaba
- First Department of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Hiroshi Iwakura
- First Department of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Asako Doi
- First Department of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takuya Ohashi
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, Wakayama, Japan
| | - Mitsumasa Kawago
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, Wakayama, Japan
| | - Naoki Matsuoka
- Department of Endocrinology and Diabetes, Kobe City Medical Center General Hospital, Chuo-ku, Kobe, Japan
| | | | - Satoru Tsujii
- Department of Endocrinology, Tenri Hospital, Tenri, Nara, Japan
| | - Takashi Akamizu
- First Department of Medicine, Wakayama Medical University, Wakayama, Japan
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42
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Lin Y, Seger N, Tsagkozis P, Hesla AC, Ghaderi M, Chen Y, Ehnman M, Warsito D, Wejde J, Larsson O, Haglund F. Telomerase promoter mutations and copy number alterations in solitary fibrous tumours. J Clin Pathol 2018; 71:832-839. [PMID: 29703757 DOI: 10.1136/jclinpath-2018-205132] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 04/04/2018] [Accepted: 04/05/2018] [Indexed: 12/13/2022]
Abstract
AIMS Solitary fibrous tumour (SFT) is an infrequently metastasising mesenchymal tumour defined by the NAB2-STAT6 fusion gene. Activating mutations in the telomerase reverse transcriptase (hTERT) gene promoter has been reported to associate with adverse patient outcome in SFTs. METHODS We analysed the hTERT gene for promoter mutations and copy number alterations in 43 primary extrameningeal SFTs (9 malignant and 34 benign tumours according to WHO 2013 criteria), six local recurrences and three metastatic lesions. RESULTS Activating -124 C>T (n=12) or -148 C>T (n=2) mutations were found in 33% of the tumours and associated with older age (P=0.006), necrosis (P=0.009), higher mitotic rate (P=0.003), nuclear atypia (P=0.002), malignant histological diagnosis (P=0.04) and worse progression-free survival (P=0.023). We also observed frequent (24%) hTERT promoter mutations in histologically benign tumours without metastasis (mean follow-up >9 years), and in 14%-18% of low-risk SFTs as determined by three risk-stratification models. Mutations were seen in 2/6 metastatic tumours and metastatic lesions. hTERT copy number gain was seen in 11/28 hTERT promoter wild-type cases. CONCLUSIONS Activating hTERT promoter mutations associate with aggressive histopathological features, indicating a role in tumour progression. Given the comparatively high prevalence of hTERT promoter mutations in low-risk and non-metastasising lesions, further studies are required to clarify the prognostic value of hTERT promoter analysis before implementing the analysis in clinical diagnostics.
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Affiliation(s)
- Yingbo Lin
- Department of Oncology-Pathology, Cancer Center Karolinska, Karolinska Institutet, Stockholm, Sweden
| | - Nelly Seger
- Department of Oncology-Pathology, Cancer Center Karolinska, Karolinska Institutet, Stockholm, Sweden
| | - Panagiotis Tsagkozis
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Orthopedic Surgery, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Asle C Hesla
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Orthopedic Surgery, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Mehran Ghaderi
- Department of Oncology-Pathology, Cancer Center Karolinska, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Pathology and Cytology, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Yi Chen
- Department of Oncology-Pathology, Cancer Center Karolinska, Karolinska Institutet, Stockholm, Sweden
| | - Monika Ehnman
- Department of Oncology-Pathology, Cancer Center Karolinska, Karolinska Institutet, Stockholm, Sweden
| | - Dudi Warsito
- Department of Oncology-Pathology, Cancer Center Karolinska, Karolinska Institutet, Stockholm, Sweden
| | - Johan Wejde
- Department of Oncology-Pathology, Cancer Center Karolinska, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Pathology and Cytology, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Olle Larsson
- Department of Oncology-Pathology, Cancer Center Karolinska, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Pathology and Cytology, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Felix Haglund
- Department of Oncology-Pathology, Cancer Center Karolinska, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Pathology and Cytology, Karolinska University Hospital Solna, Stockholm, Sweden
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43
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Soft Tissue Solitary Fibrous Tumor: Combined Surgery and Radiation Therapy Results in Excellent Local Control. Am J Clin Oncol 2017; 41:81-85. [PMID: 26270446 DOI: 10.1097/coc.0000000000000218] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE To report survival outcomes and local control in patients with solitary fibrous tumors (SFT) treated using surgery and radiation therapy (RT). METHODS We reviewed the medical records of 31 consecutive patients definitively treated for SFT with surgery and RT between 1982 and 2012. The median age was 51 years (range, 23 to 88 y) and tumors were evenly distributed between the head and neck (n=9, 29%), trunk (n=10, 32%), and lower extremities (n=9, 29%). The majority of tumors were large (>5 cm) (n=23, 72%). Specimens had a median of 2 mitoses/10 HPF (range, 0 to 8). Nearly half the cases were treated with postoperative RT (n=14, 45%; median dose, 58 Gy) and the other 17 patients (55%) received preoperative RT (median dose, 50 Gy). RESULTS Median follow-up time was 59 months (range, 18 to 349 mo). The 5-year rates of local control, overall survival, and distant metastatic-free survival were 100%, 95%, and 92%, respectively. There were no local or nodal relapses and the 10-year complication rate was 6% (n=2). CONCLUSIONS Treatment of soft tissue SFT using combined surgery and RT results in excellent local control.
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44
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Rutkowski PL, Mullen JT. Management of the "Other" retroperitoneal sarcomas. J Surg Oncol 2017; 117:79-86. [PMID: 29127695 DOI: 10.1002/jso.24893] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 10/07/2017] [Indexed: 12/12/2022]
Abstract
The focus of this review is on the management of the less common sarcomas occurring in the retroperitoneal space, including solitary fibrous tumor (SFT), malignant peripheral nerve sheath tumor (MPNST), perivascular epithelioid cell tumor (PEComa), and undifferentiated pleomorphic sarcoma (UPS) of the psoas muscle. As for other retroperitoneal sarcomas, surgical resection is the mainstay of curative therapy, and multidisciplinary preoperative assessment, including percutaneous needle biopsy for histologic confirmation, is the basis for personalized management, as the surgical management, and the integration of systemic therapy and radiation therapy is unique to each histologic subtype.
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Affiliation(s)
- Piotr L Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Institute-Oncology Center, Warsaw, Poland
| | - John T Mullen
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, Massacheusetts
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45
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Egashira A, Ikeda Y, Morita M, Taguchi KI, Kinjyo N, Tsujita E, Minami K, Yamamoto M, Toh Y. Ileum preserving expanded jejunectomy and pancreaticoduodenectomy with combined resection of the superior mesenteric artery for huge retroperitoneal solitary fibrous tumor. Clin Case Rep 2017; 5:1264-1268. [PMID: 28781839 PMCID: PMC5538048 DOI: 10.1002/ccr3.876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 12/21/2016] [Accepted: 01/30/2017] [Indexed: 11/09/2022] Open
Abstract
We encountered a patient with a large retroperitoneal solitary fibrous tumor, in whom we could preserve approximately 150 cm of the ileum even after pancreaticoduodenectomy combined with resection of the superior mesenteric artery, thus preventing short bowel syndrome.
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Affiliation(s)
- Akinori Egashira
- Department of Gastroenterological Surgery National Kyushu Cancer Center Fukuoka Japan.,Present address: Department of Gastroenterological Surgery National Hospital Organization Beppu Medical Center 1473 Uchikamado Beppu Oita 874-0011 Japan
| | - Yasuharu Ikeda
- Department of Gastroenterological Surgery National Kyushu Cancer Center Fukuoka Japan
| | - Masaru Morita
- Department of Gastroenterological Surgery National Kyushu Cancer Center Fukuoka Japan
| | - Ken-Ichi Taguchi
- Department of Cancer Pathology National Kyushu Cancer Center Fukuoka Japan
| | - Nao Kinjyo
- Department of Gastroenterological Surgery National Kyushu Cancer Center Fukuoka Japan
| | - Eiji Tsujita
- Department of Gastroenterological Surgery National Kyushu Cancer Center Fukuoka Japan
| | - Kazuhito Minami
- Department of Gastroenterological Surgery National Kyushu Cancer Center Fukuoka Japan
| | - Manabu Yamamoto
- Department of Gastroenterological Surgery National Kyushu Cancer Center Fukuoka Japan
| | - Yasushi Toh
- Department of Gastroenterological Surgery National Kyushu Cancer Center Fukuoka Japan
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46
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Ford S, Almond L, Gronchi A. An Update on Non-extremity Soft Tissue Sarcomas. Clin Oncol (R Coll Radiol) 2017; 29:516-527. [DOI: 10.1016/j.clon.2017.02.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 02/08/2017] [Indexed: 12/18/2022]
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47
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Yasukawa M, Ohbayashi C, Uchiyama T, Kawaguchi T, Kawai N, Tojo T, Taniguchi S. Rapid progression of solitary fibrous tumor after induction of hemodialysis. Oxf Med Case Reports 2017; 2017:omx037. [PMID: 28694973 PMCID: PMC5499212 DOI: 10.1093/omcr/omx037] [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: 03/22/2017] [Revised: 05/10/2017] [Accepted: 05/19/2017] [Indexed: 12/01/2022] Open
Abstract
A 42-year-old male patient presented in 2002 with a solitary fibrous tumor (SFT) arising from the visceral pleura of the right lung. Thoracic surgery was performed to remove the tumor. A second operation to remove a recurrent tumor on the parietal pleura of the right thorax was performed in 2010. A follow-up computed tomography (CT) scan revealed local recurrence in the chest wall. And then a third operation involving en bloc resection of chest wall was performed in 2012. Thereafter, a CT scan in 2015 revealed slow-growing local recurrence. In 2016, he was started on hemodialysis. Two months later he was hospitalized because of chest pain and dyspnea. Imaging showed bilateral massive pleural effusion and dissemination along with left pulmonary metastasis. We report a case of SFT recurrence, which rapidly worsened after induction of hemodialysis. Induction of hemodialysis is potentially challenging that may lead to be in a tumor-bearing condition.
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Affiliation(s)
- Motoaki Yasukawa
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University School of Medicine, Kashihara, Nara, Japan
| | - Chiho Ohbayashi
- Department of Diagnostic Pathology, Nara Medical University School of Medicine, Kashihara, Nara, Japan
| | - Tomoko Uchiyama
- Department of Diagnostic Pathology, Nara Medical University School of Medicine, Kashihara, Nara, Japan
| | - Takeshi Kawaguchi
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University School of Medicine, Kashihara, Nara, Japan
| | - Norikazu Kawai
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University School of Medicine, Kashihara, Nara, Japan
| | - Takashi Tojo
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University School of Medicine, Kashihara, Nara, Japan
| | - Shigeki Taniguchi
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University School of Medicine, Kashihara, Nara, Japan
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48
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Webb AJ, Yassin AS, Saeed A, Yadav H, Utz JP. Mediastinal Solitary Fibrous Tumor Diagnosed by Endobronchial Ultrasound-Directed Biopsy. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:549-552. [PMID: 28515414 PMCID: PMC5445977 DOI: 10.12659/ajcr.903680] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Solitary fibrous tumors of the middle mediastinal space are uncommon and often not discovered until symptoms secondary to compression of adjacent structures occur. Diagnosis requires surgical biopsy and histological tissue analysis. We describe the ECHO appearance of the solitary fibrous tumor and successful non-invasive EBUS diagnosis. This method of diagnosis allowed for surgical planning for resection and allowed us to exclude non-surgical diseases, such as small cell carcinoma. CASE REPORT A 32-year-old man presented to his primary care physician with worsening intermittent chronic chest pain with recent progressive dysphagia, cough, and dyspnea. Physical examination and routine laboratory work-up were unrevealing. Chest radiograph and computed tomography (CT) of the chest revealed a middle mediastinal mass. Flexible bronchoscopy confirmed extrinsic compression of right and left bronchial trees. Endobronchial ultrasound (EBUS) was used to biopsy the mass and the diagnosis of solitary fibrous tumor was confirmed. The patient underwent successful tumor resection and was discharged home after an uneventful postoperative period. CONCLUSIONS Endobronchial ultrasound-directed tissue biopsy is an appropriate modality for suspected solitary fibrous tumors of the mediastinum. To our knowledge, this is only the second reported case of SFT diagnosed by EBUS-TBNA. Our case uniquely demonstrates the advantages of pre-surgical diagnosis of mediastinal masses with EBUS-TBNA when the diagnosis SFT is suggested on CT and US imaging.
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Affiliation(s)
- Alaina J Webb
- Division of Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ahmed S Yassin
- Division of Pulmonary and Critical Care Medicine, Mayo clinic, Rochester, MN, USA
| | - Ali Saeed
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Hemang Yadav
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - James P Utz
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
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49
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Saynak M, Veeramachaneni NK, Hubbs JL, Okumuş D, Marks LB. Solitary Fibrous Tumors of Chest: Another Look with the Oncologic Perspective. Balkan Med J 2017; 34:188-199. [PMID: 28443588 PMCID: PMC5450857 DOI: 10.4274/balkanmedj.2017.0350] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Solitary fibrous tumors are mesenchymal lesions that arise at a variety of sites, most commonly the pleura. Most patients are asymptomatic at diagnosis, with lesions being detected incidentally. Nevertheless, some patients present due to symptoms from local tumor compression (eg. of the airways and pulmonary parenchyma). Furthermore, radiological methods are not always conclusive in making a diagnosis, and thus, pathological analysis is often required. In the past three decades, immunohistochemical techniques have provided a gold standard in solitary fibrous tumor diagnosis. The signature marker of solitary fibrous tumor is the presence of the NAB2-STAT6 fusion that can be reliably detected with a STAT6 antibody. While solitary fibrous tumors are most often benign, they can be malignant in 10-20% of the cases. Unfortunately, histological parameters are not always predictive of benign vs malignant solitary fibrous tumors. As solitary fibrous tumors are generally regarded as relatively chemoresistant tumors; treatment is often limited to localized treatment modalities. The optimal treatment of solitary fibrous tumors appears to be complete surgical resection for both primary and local recurrent disease. However, in cases of suboptimal resection, large disease burden, or advanced recurrence, a multidisciplinary approach may be preferable. Specifically, radiotherapy for inoperable local disease can provide palliation/shrinkage. Given their sometimes -unpredictable and often- protracted clinical course, long-term follow-up post-resection is recommended.
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Affiliation(s)
- Mert Saynak
- Department of Radiation Oncology, Trakya University School of Medicine, Edirne, Turkey
| | | | - Jessica L Hubbs
- Department of Obstetrics and Gynecology, University of North Carolina, North Carolina, USA
| | - Dilruba Okumuş
- Department of Radiation Oncology, Trakya University School of Medicine, Edirne, Turkey
| | - Lawrence B Marks
- Department of Radiation Oncology, University of North Carolina, North Carolina, USA
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50
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Inoue T, Owada Y, Watanabe Y, Muto S, Okabe N, Yonechi A, Kanno R, Suzuki H. Recurrent Intrapulmonary Solitary Fibrous Tumor With Malignant Transformation. Ann Thorac Surg 2017; 102:e43-5. [PMID: 27343529 DOI: 10.1016/j.athoracsur.2015.12.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 10/30/2015] [Accepted: 12/07/2015] [Indexed: 11/28/2022]
Abstract
Intrapulmonary solitary fibrous tumor (SFT) of the pleura; the so-called inverted pattern, which appears to grow into the lung parenchyma, is extremely rare. We experienced a 66-year-old woman with an intrapulmonary SFT that recurred locally with malignant transformation 2 years after wedge resection of the left upper lobe for the primary tumor. Subsequently, she underwent a lobectomy of the residual left upper lobe. Six years after the second operation she was well, without rerecurrence. Complete excision and long-term follow-up of intrapulmonary SFTs of the pleura are important, even when the primary tumor displays benign histopathologic features.
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Affiliation(s)
- Takuya Inoue
- Department of Thoracic Surgery, Fukushima Red Cross Hospital, Fukushima, Japan.
| | - Yuki Owada
- Department of Thoracic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yuzuru Watanabe
- Department of Thoracic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Satoshi Muto
- Department of Thoracic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Naoyuki Okabe
- Department of Thoracic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Atsushi Yonechi
- Department of Thoracic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Ryuzo Kanno
- Department of Thoracic Surgery, Fukushima Red Cross Hospital, Fukushima, Japan
| | - Hiroyuki Suzuki
- Department of Thoracic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
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