1
|
Wang WW, Zhou SP, Wu X, Wang LL, Ruan Y, Lu J, Li HL, Ni XL, Qiu LL, Zhou XH. Imaging, pathology, and diagnosis of solitary fibrous tumor of the pancreas: A case report and review of literature. World J Clin Cases 2024; 12:995-1003. [PMID: 38414609 PMCID: PMC10895636 DOI: 10.12998/wjcc.v12.i5.995] [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: 10/13/2023] [Revised: 12/01/2023] [Accepted: 01/18/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND A solitary fibrous tumor (SFT) is often located in the pleura, while SFT of the pancreas is extremely rare. Here, we report a case of SFT of the pancreas and discuss imaging, histopathology, and immunohistochemistry for accurate diagnosis and treatment. CASE SUMMARY A 54-year-old man presented to our hospital with pancreatic occupancy for over a month. There were no previous complaints of discomfort. His blood pressure was normal. Blood glucose, tumor markers, and enhanced computed tomography (CT) suggested a malignant tumor. Because the CT appearance of pancreatic cancer varies, we could not confirm the diagnosis; therefore, we performed endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB). Pathology and immunohistochemistry were consistent with SFT of the pancreas. The postoperative pathology and immunohistochemistry were consistent with the puncture results. The patient presented for a follow-up examination one month after discharge with no adverse effects. CONCLUSION Other diseases must be excluded in patients with a pancreatic mass that cannot be diagnosed. CT and pathological histology have diagnostic value for pancreatic tumors. Endoscopic puncture biopsy under ultrasound can help diagnose pancreatic masses that cannot be diagnosed preoperatively. Surgery is an effective treatment for SFT of the pancreas; however, long-term follow-up is strongly recommended because of the possibility of malignant transformation of the tumor.
Collapse
Affiliation(s)
- Wen-Wen Wang
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Li Huili Hospital, Ningbo University School of Medicine, Ningbo 315000, Zhejiang Province, China
| | - Shu-Ping Zhou
- Ningbo College of Health Sciences, Ningbo College of Health Sciences, Ningbo 315000, Zhejiang Province, China
| | - Xiang Wu
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Li Huili Hospital, Ningbo University School of Medicine, Ningbo 315000, Zhejiang Province, China
- Health Science Center, Ningbo University, Ningbo 315000, Zhejiang Province, China
| | - Luo-Luo Wang
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Li Huili Hospital, Ningbo University School of Medicine, Ningbo 315000, Zhejiang Province, China
| | - Yi Ruan
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Li Huili Hospital, Ningbo University School of Medicine, Ningbo 315000, Zhejiang Province, China
| | - Jun Lu
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, Zhejiang Province, China
| | - Hai-Li Li
- Department of Diagnosis, Ningbo Diagnostic Pathology Center, Ningbo 315000, Zhejiang Province, China
| | - Xu-Ling Ni
- Department of Diagnosis, Ningbo Diagnostic Pathology Center, Ningbo 315000, Zhejiang Province, China
| | - Li-Li Qiu
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Li Huili Hospital, Ningbo University School of Medicine, Ningbo 315000, Zhejiang Province, China
| | - Xin-Hua Zhou
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Li Huili Hospital, Ningbo University School of Medicine, Ningbo 315000, Zhejiang Province, China
| |
Collapse
|
2
|
Yi K, Lee J, Kim DU. Metastatic pancreatic solitary fibrous tumor: A case report. World J Clin Cases 2023; 11:8416-8424. [PMID: 38130626 PMCID: PMC10731191 DOI: 10.12998/wjcc.v11.i35.8416] [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: 10/07/2023] [Revised: 11/27/2023] [Accepted: 12/04/2023] [Indexed: 12/14/2023] Open
Abstract
BACKGROUND Solitary fibrous tumor (SFT) is a rare mesenchymal tumor that is most commonly found in the pleura but can also originate from non-pleural sites. Among the non-pleural localizations, the pancreas is extremely rare. In particular, metastasis to the pancreas from the central nervous system (CNS) is extremely rare, with only two cases reported so far. We report a case of recurrence in the pancreas 14 years after the initial complete surgical removal of a tumor in the CNS. CASE SUMMARY A 68-year-old man with a past medical history of recurrent meningeal hemangiopericytoma, currently referred to as SFT, presented to the hospital with jaundice. The patient was first diagnosed with an 8cm-sized meningeal hemangiopericytoma fourteen years ago and underwent osteoplastic craniotomy. After 16 mo, imaging showed recurrence and he underwent gamma knife radiosurgery (GKRS). 2 years later, imaging showed recurrence again leading to a second GKRS. 5 years later, recurrence was again suspected leading to a second craniotomy. Since then 3 years had passed, and imaging showed a 3.5cm-sized mass lesion on the pancreatic head with obstruction of the pancreatic and bile ducts. Endosonography with fine-needle aspiration biopsy was done preoperatively and aided in the diagnosis of SFT. The patient underwent pylorus-preserving pancreaticoduodenectomy. Pathologic findings of the resected pancreatic specimen, consistent with the previously resected brain specimen, confirmed the diagnosis of SFT. CONCLUSION The rarity and lack of knowledge about SFTs make suspecting and diagnosing this disease challenging. We believe that a report of metastatic pancreatic SFT from the CNS will contribute to a better understanding of this rare disease.
Collapse
Affiliation(s)
- Kiyoun Yi
- Division of Gastroenterology, Department of Internal Medicine, Pusan National University Hospital, Busan 49241, South Korea
| | - Jonghyun Lee
- Division of Gastroenterology, Department of Internal Medicine, Pusan National University Hospital, Busan 49241, South Korea
| | - Dong Uk Kim
- Division of Gastroenterology, Department of Internal Medicine, Pusan National University Hospital, Busan 49241, South Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
| |
Collapse
|
3
|
Lin C, Yu X. Magnetic resonance imaging features of a solitary fibrous tumor of the vulva: a case report. J Int Med Res 2022; 50:3000605221112201. [PMID: 35899898 PMCID: PMC9340956 DOI: 10.1177/03000605221112201] [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: 11/17/2022] Open
Abstract
Solitary fibrous tumors (SFTs) are commonly seen in the pleura. SFT involvement of the vulva is rare, and clinical diagnosis is mainly based on histopathological and immunohistochemical analyses. We herein describe the imaging features of a 69-year-old woman with an SFT of the vulva. The SFT was hypointense on T1-weighted images, similar to muscle; however, it showed inhomogeneous hyperintensity predominantly on fat-suppressed T2-weighted images. An area of low signal intensity was evident on T2-weighted images, and the tumor showed progressive enhancement in delayed phases. The tumor also displayed heterogeneous and prolonged, persistent enhancement, and serpentine vessels were present in the peritumoral area as signal voids. Pathological examination confirmed that the lesion was an atypical SFT originating from the vulva, and it was composed of spindle cells and perivascular and stromal hyalinization. This case reveals the characteristic imaging findings of vulvar SFT and their association with the relevant pathological findings, thus contributing to the primary diagnosis and preoperative evaluation of this potentially aggressive tumor.
Collapse
Affiliation(s)
- Chuxin Lin
- Department of Radiology, Zhuhai Hospital Affiliated with Jinan University (Zhuhai People's Hospital), Zhuhai, China
| | - Xiangrong Yu
- Department of Radiology, Zhuhai Hospital Affiliated with Jinan University (Zhuhai People's Hospital), Zhuhai, China
| |
Collapse
|
4
|
Jones VM, Wangsiricharoen S, Cornea V, Bocklage TJ, Ali SZ, Allison DB. Cytopathological characteristics of solitary fibrous tumour involving the pancreas by fine needle aspiration: Making an accurate preoperative diagnosis in an uncommon location. Cytopathology 2021; 33:222-229. [PMID: 34551176 DOI: 10.1111/cyt.13061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/05/2021] [Accepted: 09/18/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Solitary fibrous tumour (SFT) is a unique mesenchymal neoplasm with classic features on histology and is characterised by the NAB2-STAT6 gene fusion. There are rare reports of SFTs with pancreatic involvement and only two cases in the literature reporting its features by preoperative fine needle aspiration (FNA). Herein, we characterise the cytomorphological features of four SFTs involving the pancreas by FNA to establish a preoperative diagnostic approach. METHODS The anatomic pathology archives of two academic medical centres were searched to identify patients with a pancreatic FNA cytology specimen and a confirmed diagnosis of SFT by surgical resection. The clinical history, pathological diagnosis, cytomorphological findings, and results of immunohistochemistry (IHC) were reviewed. RESULTS Four SFTs were identified from four patients with a median age of 59 years. The morphological features were variable but most frequently showed a bland spindled-to-epithelioid proliferation in fragments and single cells with small, oval, elongated, and hypochromatic nuclei in a haphazard arrangement with or without dense collagen. One tumour presented with a concurrent metastasis and showed a pure epithelioid component with necrosis and enlarged, hyperchromatic nuclei with conspicuous nucleoli and scattered mitoses. IHC was necessary for all diagnoses which were confirmed by surgical resection. CONCLUSIONS SFTs with pancreatic involvement are rare, and non-specific features and tumour heterogeneity can pose a diagnostic challenge on FNA; however, IHC can be used to make a definitive diagnosis. As a result, FNA is a simple, safe, cost-effective, and accurate approach that can be used to diagnose SFT in the pancreas.
Collapse
Affiliation(s)
- Victoria M Jones
- Department of Pathology & Laboratory Medicine, University of Kentucky College of Medicine, Lexington, KY, USA
| | | | - Virgilius Cornea
- Department of Pathology & Laboratory Medicine, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Therese J Bocklage
- Department of Pathology & Laboratory Medicine, University of Kentucky College of Medicine, Lexington, KY, USA.,Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - Syed Z Ali
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Derek B Allison
- Department of Pathology & Laboratory Medicine, University of Kentucky College of Medicine, Lexington, KY, USA.,Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| |
Collapse
|
5
|
Ramos N, Ramos R, Marialva C, Silva E. An urological cause of hypoglycaemia: A case report of the Doege-Potter syndrome. Arch Ital Urol Androl 2020; 92. [DOI: 10.4081/aiua.2020.4.392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 07/24/2020] [Indexed: 11/23/2022] Open
Abstract
The Doege-Potter syndrome is a rare paraneoplastic syndrome presenting with hypoglycaemia due to ectopic secretion of insulin-like growth factor II (IGF-II) from a solitary fibrous tumor. The underlying tumor can be benign or malignant and rarely present in extrapleural sites. We describe the case of a 83-year-old male diagnosed with a Doege-Potter syndrome due to a kidney tumor.
Collapse
|
6
|
Taguchi Y, Hara T, Tamura H, Ogiku M, Watahiki M, Takagi T, Harada T, Miyazaki S, Hayashi T, Kanai T, Mori H, Ozawa T, Nishiwaki Y. Malignant solitary fibrous tumor of the pancreas: a case report. Surg Case Rep 2020; 6:287. [PMID: 33188464 PMCID: PMC7666235 DOI: 10.1186/s40792-020-01067-6] [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: 07/31/2020] [Accepted: 11/05/2020] [Indexed: 12/21/2022] Open
Abstract
Background Solitary fibrous tumors (SFTs) are rare tumors, mostly derived from connective tissue mesenchymal cells that arise from the pleura. There are very few reports of primary pancreatic SFT. Preoperative diagnosis is difficult owing to the lack of distinctive radiological findings. We report a case of pancreatic SFT with particularly rare malignant findings. Case presentation A 60-year-old man was referred to the hospital because of a right upper quadrant mass and abnormal liver function test results. Contrast-enhanced computed tomography (CT) showed a well-defined enhanced tumor measuring approximately 8 cm in the pancreatic head. Magnetic resonance imaging (MRI) showed T1WI hypointensity, T2WI hyperintensity, and DWI hyperintensity. The main pancreatic duct and common bile duct were dilated owing to obstruction by the tumor. The following tumor markers were mildly elevated: carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), SPan-1, and DUPAN-2. The histological diagnosis obtained by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) was negative for pancreatic ductal carcinoma, malignant lymphoma and neuroendocrine tumor, suggesting the possibility of mesenchymal tumor, but the diagnosis was not confirmed. The patient was judged suitable for surgery and underwent subtotal stomach-preserving pancreatoduodenectomy with D2 lymph node dissection. On histopathological examination of the resected specimen, infiltrating spindle-shaped cells had proliferated, containing numerous mitotic figures, with necrotic findings inside the tumor. Immunostaining was positive for cluster of differentiation-34 (CD34), B cell CLL/lymphoma-2 (Bcl-2), and signal transducer and activator of transcription (STAT6). On the basis of these findings, a diagnosis of malignant pancreatic SFT was made. The patient remains free of recurrent disease after 12 months of follow-up without adjuvant therapy and he is being carefully followed up as an outpatient. Conclusions We experienced a case of malignant pancreatic head SFT. Immunohistochemical staining of the extracted specimens was useful for diagnosis.
Collapse
Affiliation(s)
- Yuka Taguchi
- Department of Gastroenterological Surgery, Hamamatsu Medical Center, 328 Tomitsukacho, Naka-ku, Hamamatsu city, Shizuoka, 432-8580, Japan
| | - Takanobu Hara
- Department of Gastroenterological Surgery, Hamamatsu Medical Center, 328 Tomitsukacho, Naka-ku, Hamamatsu city, Shizuoka, 432-8580, Japan. .,Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan.
| | - Hiroaki Tamura
- Department of Gastroenterological Surgery, Hamamatsu Medical Center, 328 Tomitsukacho, Naka-ku, Hamamatsu city, Shizuoka, 432-8580, Japan
| | - Masahito Ogiku
- Department of Gastroenterological Surgery, Hamamatsu Medical Center, 328 Tomitsukacho, Naka-ku, Hamamatsu city, Shizuoka, 432-8580, Japan
| | - Mana Watahiki
- Department of Gastroenterological Surgery, Hamamatsu Medical Center, 328 Tomitsukacho, Naka-ku, Hamamatsu city, Shizuoka, 432-8580, Japan
| | - Toru Takagi
- Department of Gastroenterological Surgery, Hamamatsu Medical Center, 328 Tomitsukacho, Naka-ku, Hamamatsu city, Shizuoka, 432-8580, Japan
| | - Takashi Harada
- Department of Gastroenterological Surgery, Hamamatsu Medical Center, 328 Tomitsukacho, Naka-ku, Hamamatsu city, Shizuoka, 432-8580, Japan
| | - Shinichiro Miyazaki
- Department of Gastroenterological Surgery, Hamamatsu Medical Center, 328 Tomitsukacho, Naka-ku, Hamamatsu city, Shizuoka, 432-8580, Japan
| | - Tadataka Hayashi
- Department of Gastroenterological Surgery, Hamamatsu Medical Center, 328 Tomitsukacho, Naka-ku, Hamamatsu city, Shizuoka, 432-8580, Japan
| | - Toshikazu Kanai
- Department of Gastroenterological Surgery, Hamamatsu Medical Center, 328 Tomitsukacho, Naka-ku, Hamamatsu city, Shizuoka, 432-8580, Japan
| | - Hiroki Mori
- Department of Pathology, Hamamatsu Medical Center, 328 Tomitsuka-cho, Naka-ku, Hamamatsu city, Shizuoka, 432-8580, Japan
| | - Takachika Ozawa
- Department of Pathology, Hamamatsu Medical Center, 328 Tomitsuka-cho, Naka-ku, Hamamatsu city, Shizuoka, 432-8580, Japan
| | - Yoshiro Nishiwaki
- Department of Gastroenterological Surgery, Hamamatsu Medical Center, 328 Tomitsukacho, Naka-ku, Hamamatsu city, Shizuoka, 432-8580, Japan
| |
Collapse
|