Solitary fibrous tumor of the genitourinary tract

Solitary fibrous tumor of the adrenal gland: a case report and review of the literature

Solitary fibrous tumor (SFT) is a rare mesenchymal tumor, probably of fibroblastic origin, mainly in the extremities and pleura. Primary SFT of the adrenal gland is clinically more rare. Here, we report the case of a 47-year-old woman who detected a left adrenal mass on physical examination, without any symptoms, and no laboratory abnormalities. A computed tomography (CT) examination of the adrenal gland suggested a round-like soft tissue density shadow in the left adrenal area. An unenhanced scan showed uneven density of the mass, with a scattered circular-like cystic low-density shadow inside, and an enhanced scan showed obvious uneven enhancement. We considered it to be adrenal pheochromocytoma. Ultimately, the patient was treated with laparoscopic left adrenalectomy. A pathological examination suggested an adrenal SFT. We reviewed previous case reports of adrenal SFTs and summarized the clinical characteristics of adrenal SFT combined with the relevant literature. For adrenal tumors with uneven low-density shadow and uneven CT enhancement features, we should consider the differential diagnosis of adrenal SFT.

Solitary Fibrous Tumor of the Kidney With Pure Round Cell Features: A Case Report With Review of Literature

Solitary fibrous tumor (SFT) is a rare mesenchymal neoplasm known to occur at various soft tissue and visceral locations. Kidney is a rarely reported site for these tumors. Most of the SFTs described in the kidney exhibit a classical CD34-positive patternless spindle cell histology. Focal round cell morphology is seldom reported. Herein, we describe a 48-year-old male patient with renal SFT. This tumor had pure round cell morphology with a CD34-/STAT6+ immunophenotype. Fluorescent in situ hybridization and a multiplexed sequencing assay performed on an Illumina® HiSeq 4000 platform revealed NAB2 and STAT6 gene rearrangement. Renal tumors with round cell morphology are diagnostically challenging and SFT is not often considered in the differential diagnosis of a round cell tumor of the kidney. Moreover, a CD34-negative profile can be rather confounding while diagnosing such lesions. In such scenarios, a strong nuclear STAT6 immunostaining is extremely helpful in clinching the diagnosis. SFT should always be considered in the differential diagnosis of round cell tumors of the kidney due to significant diagnostic and therapeutic implications.

Adrenal Solitary Fibrous Tumor: A Case Report

Solitary fibrous tumor is a mesenchymal neoplasm that first appeared in the literature as a pleural lesion, but over the last decades, it has been reported in many extrathoracic sites. Primary solitary fibrous tumor in the adrenal gland is very uncommon. Its biological behavior is variable but mostly benign. We report here a case of an apparently healthy woman who, in the context of the study of limb paresthesias, was diagnosed with an adrenal incidentaloma. Laboratory tests were performed, and no hormone hyperfunction was detected. Subsequently, a right adrenalectomy was performed, and the pathological study confirmed a solitary fibrous tumor. To the best of our knowledge, this is the 19th case reported in the literature of a primary solitary fibrous tumor originating from the adrenal gland and, notably, the first documented instance in Spain.

A case report and literature review on primary solitary fibrous tumor of the bladder

RATIONALE

Solitary fibrous tumors (SFT) is a rare mesenchymal tumor originating from a CD34-positive dendritic mesenchymal cell, most of which is benign, the most common sites is pleura and mediastinum, and rarely in the bladder. The clinical manifestations are mainly related to the tumor volume. When the tumor volume is large, it will compress the surrounding tissues or organs and cause corresponding symptoms. Laparoscopic Incision biopsy is effective means for diagnosing SFT.

PATIENT CONCERNS

A 70-year-old female patient was admitted to the hospital with a bladder neoplasm detected by computed tomography scan after experiencing intestinal obstruction 3 days following esophageal cancer surgery. She denied any history of tumor disease.

DIAGNOSES

No abnormality was found in the physical examination and laboratory testing after admission. Ultrasound imaging showed a large solid mass with low echogenicity in the bladder. Urological computed tomography with 3D reconstruction revealed a large cystic-solid mass located on the right wall of the bladder, measuring approximately 6.8 cm × 7.1 cm × 6.5 cm, with uneven density and mild inhomogeneous enhancement after contrast administration. Cystoscopy revealed a large mucosal bulge on the right wall of the bladder and laparoscopic exploration revealed a smooth-surfaced round mass, approximately 7 cm in size.

INTERVENTIONS

Incision biopsy was performed to make a clear diagnosis, and appropriate tissue specimens were obtained for pathological testing.

OUTCOMES

The patient was diagnosed as SFT according to pathology. The patient was followed up for 6 months after surgery, and no recurrence was observed.

LESSONS

SFT occurring in the bladder are extremely rare, and the site is scarcely reported in the relevant literature; thus, it is easy to misdiagnose and laparoscopic incision biopsy may be a good choice.

Multicystic Solitary Fibrous Tumor of the Kidney: A Case Report With Review of Literature

Solitary fibrous tumor (SFT) is a rare mesenchymal neoplasm known to occur at various soft tissue and visceral locations. Kidney is one of the rare locations for these tumors with around 64 cases being available in the literature. Most of the renal SFTs are tan-white, solid, firm, unencapsulated, and lobulated masses. A predominantly cystic renal SFT has never been reported in the literature. Herein we describe a case of multicystic renal SFT in a 44-year-old male with the characteristic CD34 + /STAT6 + immunophenotype. A careful gross and microscopic examination is warranted while dealing with cystic spindle cell neoplasms of the kidney and SFT should always be considered in the differential diagnosis. STAT6 immunohistochemistry is quite specific for the diagnosis. Moreso, a detailed immunopanel is necessary to exclude other spindle cell neoplasms of the kidney because of significant therapeutic and prognostic implications.

Shapeshifters in Pathology: Paratesticular Solitary Fibrous Tumor Mimicking Leiomyoma

Solitary fibrous tumors are mesenchymal fibroblastic tumors that were originally described as intrathoracic lesions but have since been found to occur in many other locations. They may rarely occur as paratesticular masses. Here we present a peculiar case of a solitary fibrous tumor arising in the paratesticular region and exhibiting leiomyoma-like morphology. Confirmation of the tumor as a solitary fibrous tumor was achieved by RNA sequencing showing NAB2::STAT6 fusion. Possible explanations for the unusual tumor morphology include entrapment of normal smooth muscle elements and tumor differentiation into smooth muscle type cells.

Solitary Fibrous Tumor of Adrenal Gland and Review of the Literature

Solitary fibrous tumor (SFT) is a rare and still controversial entity. This type of tumor first appeared in the literature as a pleural lesion, but, over the last decades, it has been reported in many extrathoracic sites. As a tumor of the adrenal gland, SFT is still rare and very uncommon, thus extensive research among the English language literature has been performed. We present here a case report of an adrenal SFT which is compared to 11 other known cases. Our case report is from a patient with SFT on the left adrenal gland, followed by mild symptoms of abdominal discomfort and hypertension. Physical examination, laboratory, and radiological tests were performed. The patient underwent surgery and the material was sent for histopathologic analysis for a definite diagnosis. Regular follow up appointments were performed over the course of two years. No recurrence of the tumor has been detected. We explain the symptoms, diagnosis, treatment, and additionally we describe the results and implications of the findings reported in the literature. Correct diagnosis is mandatory for optimal management of solitary fibrous tumor patients.

Solitary Fibrous Tumors Arising from Bilateral Ovaries: A Case Report and Review of the literature

BACKGROUND

A solitary fibrous tumor (SFT) is a distinct mesenchymal neoplasm. It was originally described as a tumor localized to the pleura but was later reported in several other anatomic sites and exhibited a wide spectrum of histological features. Owing to its rarity, the diagnosis of extrapleural SFT is challenging and requires an integrated approach comprising specific clinical, imaging, histological, and immunohistochemical findings.

CASE PRESENTATION

Herein, we report the imaging findings of a rare case of SFT arising from bilateral ovaries confirmed by surgical excision and histological examination. No adjuvant radiotherapy or chemotherapy was given to the patient, and she was disease-free with no evidence of recurrence or metastasis at the 96-month postoperative follow-up. Although it mostly follows a favorable course, SFT is notoriously difficult for prognostication because of its propensity for late relapse or even metastases in 10-39% of cases.

CONCLUSION

Close follow-up is recommended because of the limited information on its long-term behavior.

Solitary fibrous tumor of the urinary bladder: An unusual case report with literature review

Solitary fibrous tumor is neoplasm of mesenchymal origin commonly involving visceral pleura however we are presenting an unusual case with involvement of urinary bladder. It is generally indolent in nature therefore proper diagnosis is required for complete characterization to avoid unnecessary extensive surgical resection. Our patient was a 64-year-old female who presented with lower abdominal fullness with change in her bowel movement pattern. On imaging partially necrotic mass with heterogenous enhancement was found which was later biopsied and resected with clean surgical margin. Solitary fibrous tumor is overall a benign tumor with satisfactory outcome. Physicians should keep it in a differential of pelvic masses and with the risk recurrence, 6 monthly follow up imaging are usually required after resection.

Malignant solitary fibrous tumour of the kidney with an extensive thrombus: A case report and review of the literature

Solitary fibrous tumours (SFTs) are neoplasms originating from mesenchymal cells, usually found in lung pleura. Extrapleuritic lesions are extremely rare, with about 60 cases of SFTs of the kidney available in the English literature. We report here the first case of a malignant SFT of the kidney presenting with an extensive vascular thrombus extending to the right atrium with associated pulmonary emboli. We describe management, pathological assessment, as well as radiological and clinical evolution. Our report provides a first therapeutic approach to a critical presentation of a rare pathology, which should help guide management of such disease in future cases.

Solitary fibrous tumor mimicking adrenal tumor concomitant with contralateral adrenal pheochromocytoma: A case report of surgical resection after long-term observation

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The management of bilateral adrenal masses is sometimes challenging.

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Adrenal mass was enlarged after contralateral adrenalectomy for pheochromocytoma.

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SFT is a rare cause of adrenal mass and its long-term natural history remains unknown.

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Surgical resection of SFT with partial adrenalectomy is a preferred choice.

Introduction

Solitary fibrous tumors (SFT) usually originate from the pleura and rarely occur in the retroperitoneum. There were few reports of SFT around the adrenal gland and its long-term clinical behavior remains unknown.

Presentation of case

A 62-year-old woman with bilateral adrenal tumors was referred to our department in 2008. She had elevated urinary normetanephrine. Metaiodobenzylguanidine scintigraphy showed uptake in the right adrenal gland. The tumor in the right adrenal gland was 5 cm in diameter. The patient underwent right adrenalectomy and was diagnosed with pheochromocytoma. The left tumor was 3 cm in diameter and diagnosed as benign using imaging. However, its size gradually increased to 10 cm over 7 years after surgery. The catecholamine hormones were within normal range. The patient underwent the tumor resection and left partial adrenalectomy. A steroid cover was given temporarily after surgery for prophylactic purposes. The histological diagnosis was solitary fibrous tumor. There was no recurrence 2 years after surgery.

Discussion

There have been only nine case reports of SFTs that were diagnosed as adrenal tumor by clinical imaging in the English literature. Total adrenalectomy was performed in all patients with a unilateral tumor. One patient with bilateral tumors underwent partial adrenalectomy.

Conclusion

SFT in the periadrenal region is difficult to differentiate from adrenal tumor. However, tumor resection with partial adrenalectomy should be considered for enlarged tumor with less aggressive behavior in patients with a history of contralateral adrenalectomy.

Renal solitary fibrous tumor/hemangiopericytoma: computed tomography findings and clinicopathologic features

PURPOSE

To retrospectively characterize the clinical, pathological, and computed tomography (CT) findings of renal solitary fibrous tumor/hemangiopericytoma (rSFT/HPC).

METHODS

Twelve patients with rSFT/HPCs were enrolled. The CT findings and clinicopathological features were retrospectively reviewed.

RESULTS

This study included six male and six female patients (median age: 47; age range: 20-82 years). Eight benign (grade I) and four malignant (grade III) rSFT/HPCs were identified. Of the 12 lesions, 10 were in the renal sinus near the renal pelvis, while two replaced the whole kidney. Five lesions were well-defined, five were partially ill-defined, and two were ill-defined. Mild (5/12) and intermediate (1/12) hydronephrosis was observed. On the unenhanced CT images, ten tumors showed slightly higher density when compared to the normal renal parenchyma, and two masses were isodense to hypodense. After intravenous contrast medium injection, three enhancement patterns were observed, including "prolonged enhancement" (PE) (6/12), "gradual enhancement" (4/12), and "early washout" (2/12). A central fibrous scar was found in five patients. Compared to the grade I lesions, the grade III rSFT/HPC lesions tended to be larger (maximal diameter > 10 cm) and more heterogeneous with a higher incidence of the PE pattern.

CONCLUSIONS

We have shown that rSFT/HPCs usually arise from the renal sinus, and present as lobulated, slightly hyperdense, gradually enhancing soft tissue masses. CT findings, including large size, heterogeneity, and the PE pattern, may assist in the pre-operative identification of malignant grade III rSFT/HPCs.

Clinicopathological characteristics of renal solitary fibrous tumor: A single institution experience

To analyze the clinical characteristics, treatment modalities and outcomes of adult renal solitary fibrous tumors (SFT) treated at a single institution. Demographic, diagnostic, surgical, and pathological findings of patients who had undergone radical nephrectomy (RN) due to renal SFT were collected from the database of a single institution and were retrospectively reviewed. Ten patients (6 men and 4 women) were diagnosed with renal SFT in our institution between January 1, 2000 and December 31, 2016. The mean age was 50.9 ± 8.2 years (range, 38-63 years). Of the 10 patients, 6 were asymptomatic, 2 presented with flank pain, 1 presented with abdominal discomfort, and 1 presented with haematuria. Computed tomography scans were obtained for all patients. Open RN was performed on 6 patients, and laparoscopic RN was performed on 4 patients. The mean tumor size was 10.23 ± 4 cm (range, 5.3-19 cm). Pathological diagnosis revealed that the tumors in 8 patients were benign, while those in the other 2 patients were malignant renal SFT. No recurrence occurred during a mean follow-up period of 47.3 ± 21.5 months (range, 16-85 months). Renal SFT is extremely rare, and its diagnosis may be challenging because of a lack of typical imaging manifestations. RN is a safe treatment modality for benign or low-grade malignant renal SFT, ensuring favorable outcomes.

Malignant Solitary Fibrous Tumor of the Renal Vein Presenting as a Giant Renal Artery Aneurysm: A Case Report and Review of Literature

OBJECTIVES

To discuss an unusual presentation of solitary fibrous tumor (SFT) as well as the first description of SFT originating from the renal vein.

CASE REPORT

In this article, we report the case of a 56-year-old man who presented with nonspecific epigastric pain and was found on computed tomography to have a large 10-cm renal artery aneurysm with evidence of contained rupture, segmental ischemia of the kidney, and suggestion of renal vein thrombosis. This was treated by a multidisciplinary team of urologists, vascular surgeons, and interventional radiologists with both renal artery coil embolization and radical nephrectomy. The thrombosis was found on pathologic review to be a malignant SFT originating from the renal vein with likely erosion into the renal artery.

CONCLUSION

This report describes the first case of SFT originating from the renal vein and demonstrates the potential for mimicry as a giant renal artery aneurysm.

Clinical analysis of 47 cases of solitary fibrous tumor

The aim of the present study was to summarize the clinical manifestations, diagnosis, treatment, and prognosis of solitary fibrous tumor (SFT). In total, 47 cases of SFTs diagnosed by postoperative pathology between January 2002 and September 2014 were retrospectively reviewed, and the general information, clinical manifestations, imaging techniques, treatment, pathology and follow-up findings were analyzed. Of the 47 patients, clinical characteristics were collected in 37 cases (18 men and 19 women; mean age, 44.1 years; age range, 13-72 years). The maximum diameters of the tumors were 1.5-25 cm, with a mean diameter of 8.8 cm. The symptoms were various and non-specific. Imaging examinations following iodinated contrast administration showed the SFTs to be well-defined, cystic or solid mass and enhanced. On color Doppler ultrasound, SFTs were described as hypoechoic, clear, irregular masses. All patients underwent surgical resection, and SFT was diagnosed by postoperative pathological and immunohistochemical examination. Of the 47 patients, 25 received complete follow-up of 5-130 months, with a median follow-up period of 35.2 months, that included a color Doppler ultrasound or computed tomography (CT) scan every 6-12 months. At the end of the follow-up period all patients were alive and healthy, with the exception of one patient, who presented with recurrence 15 months after surgery. The findings of the present study showed SFT to be a rare systemic disease with no particular clinical manifestations. In the cases reviewed in the present study, CT, magnetic resonance imaging scans and color Doppler ultrasound were important for the diagnosis of SFT, while the definitive diagnosis relied on pathological and immunohistochemical examinations. Surgery, the primary treatment for SFT, was performed, and, following complete removal of the tumor, the prognosis was favorable.

Solitary Fibrous Tumor of the Kidney: A Case Report and Literature Review

Solitary fibrous tumors are neoplasms of mesenchymal origin that may occur virtually in any body part, most commonly arising from the pleura. Solitary fibrous tumor of the kidney is exceptionally rare, and limited clinical knowledge regarding its behavior makes prognosis of the neoplasm difficult. We report a case of solitary fibrous tumor of the left kidney and describe its clinical, imaging, and pathological features.

Massive malignant solitary fibrous tumor arising from the bladder serosa: a case report

Introduction

Solitary fibrous tumors are rare neoplasms of mesenchymal origin. They are often of low malignant potential and rarely metastasize. While they frequently arise from the pleura, they can occur at any soft tissue site in the body. We present a case of a large (28 × 21cm) malignant solitary fibrous tumor arising from the bladder serosa. In addition, the clinicopathologic features, differential diagnosis, cytogenetics and management of this rare disease are discussed, along with a review of the existing literature on this topic.

Case presentation

An otherwise healthy 41-year-old Caucasian man presented with weight loss and progressive abdominal bloating. A subsequent computed tomography scan of his chest, abdomen and pelvis revealed a 26.8 × 21cm intra-abdominal mass occupying most of his abdominal cavity. The inferior vena cava was compressed, and the mass extended inferiorly to his upper pelvis abutting the superior dome of his bladder. He underwent operative resection and the resected mass measured 28 × 21 × 18cm and weighed 4.8kg. The cut surface revealed a gray-white mass with an ill-defined whorled-like pattern, with randomly assorted tan fleshy nodules. A histologic evaluation revealed variable, alternating hypercellular and hypocellular areas, with areas of necrosis. The tumor cells varied from spindle to epithelioid within a hyalinized stroma. In the hypercellular areas, the tumor cells showed moderate atypia with high mitotic activity. The histological features combined with immunophenotyping were suggestive of a malignant solitary fibrous tumor that grossly appeared to be growing from the bladder serosa, specifically the intraperitoneal superior dome of the bladder. Our patient is currently eight months post-surgery without evidence of recurrence.

Conclusions

Extrapleural occurrences of solitary fibrosis tumors are being increasingly observed. Malignant solitary fibrosis tumors of the urinary bladder, however, are very rare. As there are no pathognomonic features of malignancy, surgical resection is often both diagnostic and therapeutic, as was the case in our report.

A rare case of solitary fibrous tumor of the adrenal gland detected by (18)F-FDG PET/CT

A 33-year old man underwent an F-FDG PET/CT searching for the cause of a fever of unknown origin. F-FDG PET/CT incidentally detected a focal area of markedly increased radiopharmaceutical uptake corresponding to a 2.5-cm nodule in the right adrenal gland. Laboratory data ruled out the presence of a functioning adrenal lesion. All these findings were suggestive of adrenal malignancy. After right adrenalectomy, histology showed a benign solitary fibrous tumor of the adrenal gland. This case highlights that benign solitary fibrous tumor should be considered as possible false-positive F-FDG PET/CT finding for malignancy in evaluating adrenal incidentalomas.

Solitary fibrous tumour of the kidney: case report with review of the literature

Solitary Fibrous Tumour (SFT) is an unusual spindle cell tumour that usually occurs in the pleura, but has recently also been reported to be extra-pleural in origin. A renal presentation is very rare. Upto 90% of the tumours have benign characteristics. It is difficult to differentiate it from renal cell carcinoma by using imaging techniques. A definitive diagnosis can be made by doing a detailed pathological examination, which includes immunohistochemistry. We are reporting a case of a large solitary fibrous tumour of the kidney which here occurred in a 70-years-old male. Histological examination of the resected specimen confirmed the diagnosis, by revealing strongly positive reactions of the neoplastic cells for CD34, bcl-2, vimentin and negativity for Epithelial Membrane Antigen (EMA), Smooth Muscle Actin (SMA), S-100 protein and Ki-67. The patient suffered a cardiac arrest and died on the seventh day after his surgery.

Pediatric Renal Solitary Fibrous Tumor

Solitary fibrous tumors (SFTs) are unusual spindle cell neoplasms initially described in the pleura but have since been discovered in many extrapleural locations. SFT of the kidney is extremely rare, the majority occurring in middle-aged adults. To date, only two pediatric cases of renal SFT have been reported. We report a case of large SFT in the kidney of a 3-year-old boy that was clinically and radiologically thought to be a nephroblastoma. This case is the first pediatric renal SFT to be reported with detailed histopathologic and cytogenetic analyses. SFT should be included in the differential diagnosis of pediatric renal tumors.

A case of concomitant occurrence of solitary fibrous tumor and urothelial high-grade invasive carcinoma of the urinary bladder

Solitary fibrous tumor (SFT) is a rare mesenchymal neoplasm, most commonly arising from the pleura. It has also been recently described to occur in extrapleural sites. To our knowledge, only 16 cases of SFT have been reported in the urinary bladder to date. We report the clinicopathological features of a vesical SFT occurring in a 60-year-old man who presented a concomitant invasive high-grade urothelial cell carcinoma. No similar association has been found in the accessible literature. The morphologic and immunohistochemical clues leading to the correct diagnosis of SFT have been correlated with the data of the literature, and the differential diagnosis is briefly discussed.

Malignant solitary fibrous tumor of the kidney: report of the first case managed with interferon

Solitary fibrous tumors of the kidney are extremely rare tumors with unpredictable behavior. We describe a case of a patient with a solitary fibrous tumor of kidney with malignant findings with distant metastasis and nephrectomy managed with subcutaneous interferon achieving 23 months of progression-free survival. To date there is no prospective evaluation of any specific modality of treatment, but the surgical management and long-term followup are the only ones so far recommended strategies in the management of these patients. Studies are awaited with more patients to evaluate the different strategies of systemic therapy reported so far to allow adding survival benefit.

Beyond renal cell carcinoma: rare and unusual renal masses

The vast majority of primary renal masses represent clear cell or papillary renal cell carcinomas, angiomyolipomas, or transitional cell carcinomas. However, a number of more rare masses can also be encountered, many of which can be very difficult to differentiate from these more common entities based on their imaging features. These uncommon entities include metanephric adenoma, epithelioid angiomyolipoma, medullary renal cell carcinomas, multilocular cystic nephroma, hemangiopericytoma, hemangioma, leiomyoma, leiomyosarcoma, solitary fibrous tumor, renal plasmacytomas, and mixed epithelial and stromal tumors. In some cases, certain clinical and imaging features can allow one of these unusual entities to be placed in the differential diagnosis, including patient age, degree of tumor enhancement, presence of underlying sickle cell trait or sickle cell disease, the presence of a cystic component to the tumor, and tumor morphology. Even if a radiologist is unable to make a specific diagnosis, knowledge of these entities is important, as it allows radiologists to guide post-surgical follow-up, as well to understand the most common sites of metastatic disease.

[Solitary fibrous tumor of the adrenal gland with renal cell carcinoma and angiomyolipoma at the same time; a case report]

Solitary fibrous tumor (SFT) is a neoplasm of pleura and its occurrence in the retroperitoneal space is rare. We report a case of SFT of the adrenal gland associated with ipsilateral renal cell carcinoma (RCC) and angiomyolipoma (AML). A 48-year-old woman was referred to our hospital for a left renal AML. Computed tomography (CT) in our hospital showed a left adrenal mass (25 x 20 mm). Because the adrenal tumor was nonfunctioning, she was followed at outpatient clinic. Four years later, CT showed an increase in the left adrenal tumor size (42 x 30 mm) and a left RCC. Left adrenectomy and partial nephrectomy for RCC and AML were simultaneously performed. Histological examination revealed adrenal SFT and clear cell carcinoma and AML of the kidney. We present a brief review on histological characteristics of retroperitoneal SFT and its occurrence in the adrenal grand region.