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Suzuki K, Noda Y, Sakagami T, Yagi M, Kusafuka K, Iwai H. Head and Neck Solitary Fibrous Tumor Presenting as Salivary Gland Tumor: Two Case Reports and Review of the Literature. Case Rep Oncol 2023; 16:465-473. [PMID: 37485015 PMCID: PMC10359685 DOI: 10.1159/000531067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 05/05/2023] [Indexed: 07/25/2023] Open
Abstract
Solitary fibrous tumors (SFTs) are soft tumors (mesenchymal origin) that most likely develop from adult mesenchymal stem cells. SFTs are not common in the head and neck region, and the characteristics of tumors in this location are unclear. The present study describes the clinicopathological findings of 2 cases of SFTs arising in the parotid gland and buccal space, presenting as salivary gland tumors. The first case is a 76-year-old man presenting with a painless tumor on the right parotid gland who subsequently underwent partial superficial parotidectomy. According to the results of histopathological analysis, the tumor consisted of stellate and spindle-shaped cells proliferating on a mucous-like substrate. Immunohistochemical staining revealed that neoplastic cells were positive for CD34, vimentin, Bcl2, and STAT6. The second case is of a 64-year-old man presenting with a painless lump on his right cheek. Based on the findings of fine needle aspiration cytology, a tumor derived from myoepithelial cells of the minor salivary gland or a nonepithelial tumor was suspected. The patient underwent surgical resection via an intraoral approach. Histopathologically, the tumor consisted of spindle-shaped cells with rod-shaped or irregular nuclei. Immunohistochemical staining revealed that the neoplastic cells were positive for CD34, CD99, Bcl2, and STAT6. Briefly, SFT should be considered in the differential diagnosis of a well-marginalized lesion in the salivary gland and oral cavity. STAT6 immunohistochemistry is the most specific and sensitive method of diagnosing SFT. A thorough understanding of the morphological changes associated with SFT and their correlation with clinical, immunohistochemical, and molecular characteristics is important to avoid misdiagnosis.
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Affiliation(s)
- Kensuke Suzuki
- Department of Otolaryngology, Head and Neck Surgery, Kansai Medical University, Hirakata, Osaka, Japan
| | - Yuri Noda
- Department of Pathology, Kansai Medical University, Hirakata, Osaka, Japan
| | - Tomofumi Sakagami
- Department of Otolaryngology, Head and Neck Surgery, Kansai Medical University, Hirakata, Osaka, Japan
| | - Masao Yagi
- Department of Otolaryngology, Head and Neck Surgery, Kansai Medical University, Hirakata, Osaka, Japan
| | | | - Hiroshi Iwai
- Department of Otolaryngology, Head and Neck Surgery, Kansai Medical University, Hirakata, Osaka, Japan
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Shirakura T, Yamada Y, Nakata S, Asayama B, Seo Y, Tanikawa S, Kato T, Komoribayashi N, Kubo N, Monma N, Okura N, Tanaka S, Oda Y, Hirato J, Yokoo H, Nobusawa S. Analysis of clinicopathological features and NAB2-STAT6 fusion variants of meningeal solitary fibrous tumor with ectopic salivary gland components in the cerebellopontine angle. Virchows Arch 2022; 481:913-923. [PMID: 36056239 DOI: 10.1007/s00428-022-03403-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 08/24/2022] [Accepted: 08/25/2022] [Indexed: 12/14/2022]
Abstract
Solitary fibrous tumors (SFTs) are rare mesenchymal tumors that can occur at any location. Since the identification of specific NAB2-STAT6 fusion in SFTs, the fusion gene variants, NAB2 exon 4-STAT6 exon 2/3 and NAB2 exon 5/6/7-STAT6 exon 16/17/18, have been reported to be associated with clinicopathological features, and the latter variant is predominant in meningeal SFTs. SFTs developing in the salivary glands are rare, and more rarely, those involving ectopic salivary glands (ESGs) have been reported in the cerebellopontine angle (CPA); however, their characteristics remain not well understood. In this study, we performed a clinicopathological and molecular analysis of 3 cases of meningeal SFT with ESGs. All cases presented with an extra-axial mass in the CPA, which is a rarer location for intracranial ESGs compared to the sellar region. Histologically, except for the presence of ESGs, there was no significant difference between current cases and ordinary SFTs. The ESGs demonstrated no cellular atypia, and although the spindle tumor cells were immunopositive for STAT6, the ESGs were negative in all cases, supporting that the ESGs are non-neoplastic components. In 1 case, ESGs were found only in the primary tumor and disappeared in recurrence/dissemination. Of note, molecular analysis identified NAB2 exon 4-STAT6 exon 2 in all cases. In conclusion, our results suggest that ESGs particularly in the CPA may be associated with SFTs and that meningeal SFTs with ESGs may be associated with the minor fusion variant of NAB2-STAT6 in the intracranial lesions.
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Affiliation(s)
- Takahiro Shirakura
- Department of Human Pathology, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Yuichi Yamada
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoshi Nakata
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bunsho Asayama
- Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Japan
| | - Yoshinobu Seo
- Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Japan
| | - Satoshi Tanikawa
- Department of Cancer Pathology, Faculty of Medicine, Hokkaido University, Sapporo, Japan
- Institute for Chemical Reaction Design and Discovery (WPI-ICReDD), Hokkaido University, Sapporo, Japan
| | - Takayuki Kato
- Department of Neurosurgery, Daiyukai General Hospital, Ichinomiya, Japan
| | - Nobukazu Komoribayashi
- Iwate Prefectural Advanced Critical Care and Emergency Center, Iwate Medical University, Yahaba, Japan
- Department of Neurosurgery, Japanese Red Cross Morioka Hospital, Morioka, Japan
| | - Naohiko Kubo
- Department of Neurosurgery, Japanese Red Cross Morioka Hospital, Morioka, Japan
| | - Nobuhiro Monma
- Department of Pathology, Japanese Red Cross Morioka Hospital, Morioka, Japan
| | - Naoki Okura
- Department of Radiology, School of Medicine, International University of Health and Welfare, Narita, Japan
| | - Shinya Tanaka
- Department of Cancer Pathology, Faculty of Medicine, Hokkaido University, Sapporo, Japan
- Institute for Chemical Reaction Design and Discovery (WPI-ICReDD), Hokkaido University, Sapporo, Japan
| | - Yoshinao Oda
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Junko Hirato
- Department of Human Pathology, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan
- Department of Pathology, Public Tomioka General Hospital, Tomioka, Japan
| | - Hideaki Yokoo
- Department of Human Pathology, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Sumihito Nobusawa
- Department of Human Pathology, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan.
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Patil VS, Vidya K, Paul SA, Tirkey AJ. Solitary fibrous tumor of the masticator space - Report of a rare case. Natl J Maxillofac Surg 2022; 13:S159-S161. [PMID: 36393946 PMCID: PMC9651244 DOI: 10.4103/njms.njms_117_20] [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: 06/18/2020] [Revised: 06/25/2020] [Accepted: 03/23/2021] [Indexed: 06/16/2023] Open
Abstract
The solitary fibrous tumor (SFT) is a potentially malignant spindle cell neoplasm of the mesenchymal origin that was originally described as a thoracic lesion originating from the pleural tissue. Recently, numerous extrapleural sites of origin have been described, also affecting the head and neck region. SFTs are benign in most cases, but 10%-15% of extrapleural SFTs show malignant behavior in the form of recurrent or metastatic disease. We present the case of a 25-year-old female who presented with an asymptomatic left-sided facial swelling of over three years. She had a diffuse swelling in the left preauricular region, extending to the temporal region deep to the zygomatic arch. On magnetic resonance imaging, the vascular lobulated mass occupied the masticator space, infratemporal fossa, and parapharyngeal space, eroding the mandible. An ultrasound-guided fine-needle aspiration cytology was suggestive of SFT, positive for signal transducer and activator of transcription 6 and negative for TLE1. After preoperative embolization, the tumor was excised through a midline lip split approach with posterior segmental mandibulectomy and reconstruction with a titanium plate. Histopathological report was consistent with SFT. Due to high-risk features, she was advised adjuvant radiation therapy. SFTs of the head and neck are exceedingly rare and those with aggressive behavior even more so. To our knowledge, this is the only case of SFT arising in the masticator space. Diagnosis is often difficult and not definitive without immunohistochemistry. In most cases, complete surgical excision is the only treatment necessary. Regardless, all patients require close clinical follow-up for several years.
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Affiliation(s)
- V. Shruthi Patil
- Department of Head and Neck Surgery, Unit-2, Christian Medical College, Vellore, Tamil Nadu, India
| | - Konduru Vidya
- Department of Head and Neck Surgery, Unit-2, Christian Medical College, Vellore, Tamil Nadu, India
| | - S. Arun Paul
- Department of Dental Surgery, Unit-1, Christian Medical College, Vellore, Tamil Nadu, India
| | - Amit Jiwan Tirkey
- Department of Head and Neck Surgery, Unit-2, Christian Medical College, Vellore, Tamil Nadu, India
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Recurrent fibrous solitary tumor of the parotid gland with satellite location: imaging, clinical and histological findings of rare entity. Radiol Case Rep 2021; 16:2924-2928. [PMID: 34401027 PMCID: PMC8349757 DOI: 10.1016/j.radcr.2021.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/02/2021] [Accepted: 07/03/2021] [Indexed: 11/24/2022] Open
Abstract
Fibrous Solitary Tumors are infrequent neoplasms originating from mesenchymal tissues, most commonly arising from the visceral pleura and frequently exhibiting a benign behavior. Extra-pleural localization is unusual and the site of origin of these tumors from the parenchyma of the parotid gland is considered extremely rare. We report the case of a 66-years old woman with non-painful slow-growing left latero-cervical mass, who underwent a gadolinium-enhanced Magnetic Resonance Imaging showing a mass originating from the deep lobe of the parotid gland extending into the retro-pharyngeal space. After a total parotidectomy with tumor excision, a diagnosis of histologically proven fibrous solitary tumor of the parotid gland was made. Two years later, CT scan showed post-operative recurrence and further satellite localization in the neck, distant from the initial mass. We performed a literature review of the published similar cases, in order to clinicopathological and imaging features of this rare entity.
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Romano N, Ferrari A, Moroni M, Dessanti P, Bardine A, D'Amato M, Stefanini T. Solitary Fibrous Tumor of the Deep Parotid Gland. EAR, NOSE & THROAT JOURNAL 2020; 101:NP291-NP293. [PMID: 33258381 DOI: 10.1177/0145561320966068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Nicola Romano
- Department of Diagnostic and Interventional Neuroradiology, E.O. Ospedali Galliera, Genoa, Italy
| | - Alice Ferrari
- Department of Health Sciences (DISSAL), Radiology Section, 9302University of Genoa, Genoa, Italy
| | - Michele Moroni
- Department of Pathology, General 175049Hospital Sant'Andrea, La Spezia, Italy
| | - Paolo Dessanti
- Department of Pathology, General 175049Hospital Sant'Andrea, La Spezia, Italy
| | - Alex Bardine
- Department of Radiology, General 175049Hospital Sant'Andrea, La Spezia, Italy
| | - Massimo D'Amato
- Department of Radiology, General 175049Hospital Sant'Andrea, La Spezia, Italy
| | - Teseo Stefanini
- Department of Radiology, General 175049Hospital Sant'Andrea, La Spezia, Italy
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Jiang L, Hu C, Chen L, Chen L. Diagnosis of solitary fibrous tumor in the submandibular gland: Case report and literature review. JOURNAL OF CLINICAL ULTRASOUND : JCU 2019; 47:486-489. [PMID: 31364769 DOI: 10.1002/jcu.22760] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 07/03/2019] [Accepted: 07/09/2019] [Indexed: 06/10/2023]
Abstract
Solitary fibrous tumors (SFTs) rarely occur in the head and neck area. Imaging findings are nonspecific, and immunohistochemical (IHC) analysis is necessary for a definitive diagnosis. We report the case of a patient with a mass in the submandibular region that was initially diagnosed as basal cell adenoma. After excision and IHC examinations, a SFT was diagnosed.
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Affiliation(s)
- Liping Jiang
- Department of Ultrasonography, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Cai Hu
- Department of Ultrasonography, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Li Chen
- Department of Ultrasonography, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Lu Chen
- Department of Ultrasonography, First Affiliated Hospital of Nanchang University, Nanchang, China
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Lim DWJ, Tan TSH, Tan JL, Venkateswaran K. Solitary fibrous tumour of the parotid gland: a case report and a 15-year literature review. AME Case Rep 2019; 3:14. [PMID: 31231715 DOI: 10.21037/acr.2019.04.05] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 04/12/2019] [Indexed: 11/06/2022]
Abstract
Solitary fibrous tumour (SFT) is uncommonly found in the salivary glands and is a rare group of spindle-cell tumours. A review of literature revealed only 40 reported cases of SFT of major salivary glands over a 15-year period from 2004 to 2018. SFTs of the salivary glands are usually benign, although rarely, can be aggressive and may sometimes recur after initial resection. Histology and Immunohistochemistry are the most important criteria to distinguish SFT from other head and neck tumours. SFTs strongly stain for CD34 and hence is the most frequently used stain for diagnosis. All reported SFT cases with available information on immunohistochemical stains were positive for CD34. Recently, immunohistochemistry for STAT6 has been introduced as a surrogate diagnostic marker for SFT that is highly sensitive and specific. We report a case of a 51-year-old Chinese gentleman who presents with a 3-month history of a left parotid tumour that required a subtotal parotidectomy for complete excision. It was diagnosed as SFT based on histology and immunohistochemical features. He was followed-up for 3 months post-operatively with no clinical evidence of recurrence. This case proposes that, although rare, SFT should be considered in the differential diagnosis of soft-tissue tumors in the major salivary glands. An awareness of this rare entity will help clinicians and pathologists better manage similar patients in the future.
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Affiliation(s)
| | | | - Jian Li Tan
- Department of Otolaryngology, Khoo Teck Puat Hospital, Singapore
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Lee CK, Liu KL, Huang SK. A dedifferentiated solitary fibrous tumor of the parotid gland: a case report with Cytopathologic findings and review of the literature. Diagn Pathol 2019; 14:20. [PMID: 30777087 PMCID: PMC6379935 DOI: 10.1186/s13000-019-0792-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 02/01/2019] [Indexed: 12/19/2022] Open
Abstract
Background Solitary fibrous tumor (SFT) is a ubiquitous mesenchymal neoplasm but it rarely occurs in the parotid gland. The histological features are variable, with the majority having spindle cell morphology and non-specific branching (staghorn) ecstatic vascular pattern. SFT ranges from benign to overtly malignant. Dedifferentiation within SFTs represents an abrupt transition from a well-differentiated component to a high-grade area, the latter most often including poorly differentiated epithelioid/round cell or high-grade spindle cell morphology. To the best of our knowledge, dedifferentiated SFT in the parotid gland has not been previously reported. Case presentation A 33-year-old woman presented with a soft tissue tumor in the right parotid gland that had been present for 6 months. Fine needle aspiration (FNA) cytology indicated epithelioid morphology in the dedifferentiated component of the tumor, along with metachromatic myxoid matrix. The tumor was initially interpreted as a salivary gland neoplasm of uncertain malignant potential (SUMP).Right partial parotidectomy was performed, and microscopic examination of the resected specimen revealed a malignant spindle cell tumor with a central epithelioid/anaplastic component. The tumor cells were diffusely positive for CD34, STAT-6 and FLI-1, and negative for pan-cytokeratin, CAM5.2, p63, S100 protein, CD31, SMA, and calponin.ERG and Ki67 immunostaining showed an accentuated nuclear staining pattern in the central dedifferentiated area. There was no overexpression of p53 or p16. The patient is currently undergoing regular follow-up and is 11 months postresection with no evidence of recurrence or distant metastasis. Conclusions Unlike the typical spindle cell morphology of conventional SFTs, malignant SFTs can show areas of dedifferentiation mimicking an epithelial neoplasm. FNA of dedifferentiated SFTs of the parotid gland may show, a combination of atypical epithelioid cells and metachromatic myxoid/collagenous matrix, which is a less emphasized cytological feature of SFT and may lead to misdiagnosis as a more common parotid gland epithelial neoplasm.
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Affiliation(s)
- Chien-Kuan Lee
- Department of Pathology, Kung Tien General Hospital, Shalu, Taichung, Taiwan
| | - Ken-Liao Liu
- Department of Otorhinolaryngology, Kung Tien General Hospital, Shalu, Taichung, Taiwan.
| | - Sheng-Kai Huang
- Department of Otorhinolaryngology, Kung Tien General Hospital, Shalu, Taichung, Taiwan
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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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