[Intestinal calcifying fibrous tumor: case report]

Calcifying fibrous tumor (CFT) is a rare benign lesion of mesenchymal origin that may present similar characteristics to other more common tumors. We present the case of a 36-year-old woman with a tumor in the proximal jejunum, initially suspected to be a gastrointestinal stromal tumor (GIST). Surgical resection was performed, revealing a well-demarcated nodule at the anti-mesenteric border with microscopic features typical of a calcifying fibrous tumor. The tumor cells were positive for CD34 and negative for other markers, differentiating it from other neoplasms. Calcifying fibrous tumors can be confused with more common tumors because of its appearance, but an accurate diagnosis supported by immunohistochemistry is essential. Complete surgical excision is usually curative.

Large vulvar fibroepithelial polyp and review of differentials

Vulval fibroepithelial polyps (FEPs) are a rare type of vulval fibroblastic tumour commonly found in premenopausal women. It is important to obtain an accurate pathological diagnosis because, despite being benign, the condition shares some characteristics with malignant vulva lesions in its differential diagnosis. We present a case of young woman in her 20s with a giant FEP. After surgical excision, the patient did not manifest any signs of recurrence after 1-year follow-up. Our review focuses on the distinguishing characteristics of these rare neoplasms as we explore their differential diagnosis.

Fibroblastic and Myofibroblastic Soft-Tissue Tumors: Imaging Spectrum and Radiologic-Pathologic Correlation

Fibroblastic and myofibroblastic tumors are a variable group of neoplasms ranging from benign to malignant. These lesions may affect patients of any age group but are more frequently encountered in the pediatric population. Patient clinical presentation depends on the location, growth pattern, adjacent soft-tissue involvement, and pathologic behavior of these neoplasms. In the 2020 update to the World Health Organization (WHO) classification system, these tumors are classified on the basis of their distinct biologic behavior, histomorphologic characteristics, and molecular profiles into four tumor categories: (a) benign (eg, fibrous hamartoma of infancy, nodular fasciitis, proliferative fasciitis, fibroma of the tendon sheath, calcifying aponeurotic fibroma); (b) intermediate, locally aggressive (eg, desmoid fibromatosis); (c) intermediate, rarely metastasizing (eg, dermatofibrosarcoma protuberans, myxoinflammatory fibroblastic sarcoma, low-grade myofibroblastic sarcoma, infantile fibrosarcoma); and (d) malignant (eg, sclerosing epithelioid fibrosarcomas; low-grade fibromyxoid sarcoma; myxofibrosarcoma; fibrosarcoma, not otherwise specified). Detection of various components of solid tumors at imaging can help in prediction of the presence of corresponding histopathologic variations, thus influencing diagnosis, prognosis, and treatment planning. For example, lesions with a greater myxoid matrix or necrotic components tend to show higher signal intensity on T2-weighted MR images, whereas lesions with hypercellularity and dense internal collagen content display low signal intensity. In addition, understanding the radiologic-pathologic correlation of soft-tissue tumors can help to increase the accuracy of percutaneous biopsy and allow unnecessary interventions to be avoided. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.

Gastric calcifying fibrous tumors: Computed tomography findings and clinical manifestations

To retrospectively analyze the computed tomography (CT) findings and clinical manifestations of gastric calcifying fibrous tumor (CFTs).The features of 7 cases with pathologically proven gastric CFTs who had undergone CT were assessed, including tumor location, contour, growth, degree of enhancement, calcification and clinical data. In addition, the size and CT value of each lesion were measured. The mean values of these CT findings and clinical data were statistically analyzed only for continuous variables.Four patients were female and three were male (mean age: 33.3 years; range: 22 ∼ 47 years). Nonspecific clinical symptoms: abdominal pain and discomfort were observed in four cases and the CFTs were incidentally detected in the other three cases. Regarding tumor markers, lower ferritin levels were observed in three female patients. All of the gastric CFTs were solitary and mainly located inside the body; they were in round or oval shape and exhibited endophytic growth. Gastric CFTs are usually small sized and could contain confluent and coarse calcifications; cyst, necrosis, ulcer, bleeding and surrounding lymphadenopathy were not found in any of the cases. Unenhanced CT values of gastric CFTs were higher than those of same-transect soft tissue. Mild-to-moderate enhancement in the arterial phase and progressive enhancement in the portal venous phase were mainly noted.A gastric mass with a high unenhanced CT attenuation value, confluent and coarse calcifications and mild-to-moderate enhancement could prompt a diagnosis of gastric CFT. In addition, (1) being young- or middle-aged, (2) having relatively low ferritin levels, and (3) tumor located in the gastric body have critical reference value for diagnosis of gastric CFT.

Pedunculated atypical fibroxanthomas of the face

Atypical fibroxanthomas are rare, superficial dermal tumors. Most cases are benign and only locally destructive with a low rate of metastasis. Lesions are most commonly found on sun-exposed sites of elderly light-skinned patients and present as asymptomatic nodules with irregular borders; ulcerations and friability are other key characteristics. Pedunculated lesions, however, are rarely described in the literature. We present two cases of atypical fibroxanthoma manifesting as exophytic, pedunculated lesions on the face: one in a 74-year-old man and the other in an 82-year-old woman. These tumors are very effectively treated by excision with Mohs micrographic surgery.

Ultrasonographic imaging of calcifying fibrous tumor of cervical esophagus: A case report

RATIONALE

Calcifying fibrous tumor (CFT) is a rare benign mesenchymal tumor characterized by cytologically benign fibroblasts that produce abundant collagen with scattered lymphocytes, plasma cells, and psammomatous or dystrophic calcifications.

PATIENT CONCERNS

A 37 years old women was initially diagnosed thyroid nodule in local hospital. She was referred to receive microwave ablation of the nodule in our hospital. The patient was in good health with occasional foreign body sensation in the neck. Routine laboratory examination was normal.

DIAGNOSIS

The lesion was suspected benign and originating from the esophagus rather than the thyroid gland by conventional ultrasound and contrast-enhanced ultrasound in our hospital and was finally proved to be CFT by pathology.

INTERVENTIONS

The lesion was surgically removed.

OUTCOMES

The patient recovered well and was followed up for 2 years without recurrence.

LESSONS

Although imaging diagnosis of CFT is difficult, the findings of clear border, coarse calcification on conventional ultrasound and peripheral hypoenhancement without central enhancement on contrast-enhanced ultrasound (CEUS), together with real-time evaluation of the relationship between the tumor and esophagus help to distinguish CFT of cervical esophagus from other lesions in the neck.

Calcifying fibrous tumor of the terminal ileum mesentery: Case report

RATIONALE

Calcifying fibrous tumors ("CFT") are recognized as extremely rare mesenchymal tumors with benign biological behavior and low rates of recurrence are seen after removal. The first case of a CFT was reported in 1988 as a possibly inflammatory triggered pseudotumor in deep soft tissue of children. Histologically, the tumor is typically composed of dense hyalinized collagen with paucicellular infiltration of lymphocytes and fibroblasts as well as psammomatous or dystrophic calcifications. It can affect soft tissue in very different anatomical locations, also intrathoracic and intra-abdominal, mimicking various different diagnoses. The etiology is understood to be unclear. Asymptomatic CFTs can be found incidentally on medical images.

PATIENT CONCERNS

We present the case of a calcifying tumorous lesion found incidentally in the mesentery of the terminal ileum of a 34-year-old male patient in February 2016 undergoing a computed tomography for a urinary tract infection.

DIAGNOSIS

Histopathological and immunhistochemical examination after surgery revealed a CFT.

INTERVENTIONS

Our patient underwent lower abdominal median laparotomy for tumorectomy.

OUTCOMES

Two years after surgery the patient is free of a recurrence.

LESSIONS

We add another case of intra-abdominal CFT to medical literature to provide more information about this very seldom tumor. While the etiology of CFT should be further investigated, diagnosis and therapy seem clarified. CFT should be kept in mind as a rare differential diagnosis of calcifying tumors also in the abdominal cavity. Immunohistological work-up is important for finding the diagnosis and may also help solving pathogenetical questions.

[Lipofibromatosis: a clinicopathological analysis of eight cases]

Objective: To investigate the clinicopathological characteristics and differential diagnosis of lipofibromatosis. Methods: The clinicopathological features and immunohistochemical profiles in 8 cases of lipofibromatosis diagnosed at Fudan University Shanghai Cancer Center from January 2008 to June 2017 were studied. Molecular analysis of β-catenin mutation by Sanger sequencing, NTKR1 and ETV6 rearrangements by FISH were performed. The follow up information was evaluated and the literature was reviewed. Results: There were 4 males and 4 females with a median age of 1.5 years at presentation (range, 3 months-9 years). Tumor arose in the hand (4 cases), foot (2 cases) and trunk (2 cases), manifesting as a painless subcutaneous mass. Two cases were congenital, one with tumor noted at birth and the others shortly after birth. Grossly, the tumors were poorly defined and irregularly shaped, composed predominantly of fatty tissue which was mingled with fibrous element. They ranged from 1 to 5 cm in size (mean, 2.6 cm). Microscopically, they were characterized by variably sized lobules of adipose tissue traversed by fascicles, bundles or trabeculae of proliferative fibroblasts and myofibroblasts, resembling desmoid tumor. In 2 cases, the tumor infiltrated adjacent skeletal muscles. On high power, the spindled fibroblasts and myofibroblasts had a bland appearance with very low mitotic activity (<1/10 HPF). By immunohistochemistry, they showed variable staining of α-SMA, MSA, CD34 and CD99, with negativity for β-catenin, desmin, h-CALD, EMA, ALK, and S-100 protein. Ki-67 index was low (<2%). Molecular analysis showed no mutation of β-catenin gene (0/3), no NTRK1 gene rearrangement (0/3) and no ETV6 gene rearrangement (0/2). Follow up information was available in 6 patients, revealed local recurrence in two and persistent disease in one. Conclusions: Lipofibromatosis is a special variant of infantile fibromatosis, which has a predilection for the distal portion of the extremities of neonates and infants and characterized by lobules of adipose tissue traversed by demoid tumor-like fibroblasts and myofibroblasts. However, it differs from desmoid tumor by harboring no mutation of β-catenin gene. Familarity with its clinicopathological characteristics helps the distinction from its morphological mimics.

Ultrasonographyand Magnetic Resonance Imaging Findings of Solitary Fibrous Tumor of the Liver

Solitary fibrous tumor of the liver is a rare neoplasm which has been reported in only 27 patients in the English literature. A limited number of reports have described the radiological findings of this tumor. We report the radiological and pathological findings in a patient with solitary fibrous tumor located in the liver.

Fluorescence microscopy for the evaluation of elastic tissue patterns within fibrous proliferations of the skin on hematoxylin-eosin-stained slides

BACKGROUND

Diagnosis of fibrous tumors can be challenging and expensive due to the use of special stains.

OBJECTIVE

Determine the usefulness of fluorescence microscopy in the evaluation of elastic tissue patterns on hematoxylin-eosin-stained slides.

METHODS

In total, 228 slides representing different fibrous tumors were evaluated for their elastic tissue patterns by fluorescence microscopy, and sensitivity and specificity were determined for relevant comparisons.

RESULTS

Fluorescence microscopy was found to be useful, especially for distinguishing dermatofibroma from dermatofibrosarcoma protuberans and dermatomyofibroma from other fibrous tumors.

LIMITATIONS

In some cases, excessive background staining made patterns difficult to interpret.

CONCLUSION

Evaluation of elastic tissue patterns by fluorescence microscopy in fibrous tumors is a cheap and efficient means to further delineate these often challenging tumors.

Calcifying fibrous tumor of stomach: A case report

RATIONALE

Calcifying fibrous tumor (CFT) is a rare benign soft tissue mesenchymal neoplasm. Although the gastrointestinal (GI) tract is the most common predilection site of CFT, the clinicians, even including pathologist, generally consider it as GI stromal tumor (GIST) or other submucosal tumors such as schwannoma and leiomyoma.

PATIENT CONCERNS

A 55-year-old man presented with complaints of epigastric discomfort and abdominal distention for more than 1 year.

DIAGNOSES

On the basis of endoscopic and computed tomography examination, preliminary diagnosis was GIST.

INTERVENTIONS

Endoscopic submucosal dissection (ESD) surgery was performed to remove the gastric mass.

OUTCOMES

The histopathological examination revealed a gastric CFT.

LESSONS

We present a case of gastric CFT, which was misdiagnosed as GIST based on endoscopic and radiologic findings.

Calcifying Fibrous Tumor: Review of 157 Patients Reported in International Literature

Calcifying fibrous tumor (CFT) is a benign lesion characterized by its specific histological findings and is found as solitary or multiple lesions in several locations of the human body. The aim of the present systematic review is to give a detailed account of all reported cases of CFT in the literature and to analyze the available data, to completely characterize the entity from epidemiological, medical, and surgical aspects.A bibliographic research was performed from 1988 until 2015. A database with the patients' characteristics was made, including sex, age, location of the tumor, symptoms, symptoms duration, size of the tumor, diagnostic methods, treatment, metastasis, and follow-up.A total of 104 articles were identified, reporting 157 cases of CFT. Mean age of patients was 33.58 years and the ratio between men and women was 1:1.27. The most common locations of CFT were stomach (18%), small intestine (8.7%), pleura (9.9%), mesentery (5%), and peritoneum (6.8%). Mean diameter of the tumor was estimated 4.6 cm. The correlations proceeded showed that as age increases, size decreases (P = 0.001) and that the tumor is larger in females (P = 0.027). Kruskal-Wallis test showed that the larger tumors appear in the neck and adrenal gland (P = 0.001). The percentage of asymptomatic patients was 30.57%. Computed tomography and biopsy were the most common tests for the diagnosis of CFT. Open surgical procedure was performed in the majority of cases. The median hospitalization was 6.06 days and the mean follow-up period was 29.97 months. Recurrences were mentioned in 10 of 96 patients with available data. No deaths owing to CFT were mentioned in the literature.CFT should be included in the differential diagnosis of enlarging mass revealed by clinical or imaging examination either incidentally or after specific acute or chronic symptomatology.

Submucosal calcifying fibrous tumor of the stomach: A case report

The calcifying fibrous tumor is a rare benign fibrous tumor which occurs in subcutaneous or deep soft tissues in children and young adults, but also is frequently seen in pleural and intraabdominal locations in older people. Gastric involvement has been only sporadically reported in the literature. We present here our experience with this unusual lesion discovered in a 68-year-old woman. Clinically, the tumor was described as a pendulating, submucosally located mass, in the body of the stomach on a lesser curvature. The calcifying fibrous tumor is a histologically distinct lesion composed of dense hyalinized collagen fibers, inconspicuous scattered fibroblasts, a varying amount of psammoma bodies or dystrophic calcifications and foci of lymphoplasmacytic infiltration. In this report we will focus on a brief review and differential diagnosis of this tumor and other more common or not widely known gastric spindle cell lesions.

Acute life-threatening portal venous dilatation induced by a huge solitary fibrous tumor of the omentum

An 85-year-old woman was referred to the medical oncology department because of a hypogastric mass. Contrast-enhanced CT showed a large hypervascular mass in the lower abdomen. CT angiography with volume rendering imaging revealed a vascular pedicle with an arborizing pattern of vessels. Many thick, early draining veins shunting into the portal vein were detected. Before surgery, the maximum size of the portal vein was 22 mm in diameter. Laparotomy revealed a huge, encapsulated, well-defined, hard tumor with hypervascularization, which was appended to the omentum. The mass with the omentum was curatively resected; it was 19 cm x 17 cm x 13 cm in size and 1915 g in weight. Histological features were consistent with a benign solitary fibrous tumor of the omentum, despite the tumor size and necrotic area found in the specimen. q Ultrasonography and CT performed at a 28-month follow-up revealed no evidence of tumor recurrence. Venous dilatation including that of the portal veins had diminished.

Subcutaneous Solitary Fibrous Tumor

We describe a unique case of subcutaneous solitary fibrous tumor (SFT) in a 56-year-old female patient. The patient had been aware of a painless soft mass in her back for ten years. The lesion was surgically excised. Histological examination revealed that the well-defined mass was composed of a proliferation of spindle-shaped fibroblastic cells and polygonal cells embedded in a fibrous matrix corresponding to the so-called "patternless pattern". A prominent pericytomatous pattern (hemangiopericytoma-like structures), focal myxoid changes, and thick hyalinized collagen fibers were also observed. Immunohistochemical stainings for CD34 and bcl-2 were positive in the tumor cells. These features are compatible with SFT. We suggest that SFT should be included in the differential diagnosis of subcutaneous spindle cell tumors.

[A case of calcifying fibrous tumor in the abdominal wall, morphologically resembling a gastric submucosal tumor]

We report an extremely rare case of a calcifying fibrous tumor (CFT) occurring in the abdominal wall. A 43-year-old woman was referred to our hospital because of a gastric submucosal tumor. Imaging findings revealed a gastric submucosal tumor with calcification. Endoscopic ultrasound-guided fine-needle aspiration was attempted to obtain a tissue specimen; however, the tumor was not adequately visualized because of calcification. Local excision was performed because of the tumor growth and the risk of progression to gastrointestinal stromal tumor. The tumor was histologically diagnosed as a CFT. We describe the imaging and pathological findings, and discuss the differential diagnosis and histogenesis of CFT.

Subscapular elastofibrolipoma: a new variant type among elastofibromas or lipomas? A case report

Elastofibroma is a rare soft tissue benign fibrous proliferation that characteristically occurs in periscapular soft tissues of the elderly, particularly in females, with typical morphological features consisting of an admixture of excessive collagen and abnormal elastic fibers displaying a beaded or globular appearance. Here we report an unusual, recently described histological variant with unclear origin, showing the presence of abundant mature fat tissue, named 'elastofibrolipoma', which could lead to confusion with other adipose and mesenchymal cell tumour proliferations. The issue as to whether elastofibrolipoma is reactive or neoplastic, variant of elastofibroma or lipoma, remains controversial. Differential diagnostic problems and histogenetic considerations are provided.

Ovarian fibromatous tumours of uncertain biological potential: study of three cases

BACKGROUND

The classification of ovarian fibromatous tumours with high mitotic activity is controversial.

CASES REPORT

The first case was an 18 x 17 x 10 cm left ovarian fibromatous tumour with 17 mitoses/10 HPF detected in a 44-year-old woman. The second case consisted of a 4 x 2.5 x 2 and a 2.5 x 2.5 x 2 cm fibrmatous tumours found, respectively, in the left and right ovaries of a 67-year-old woman. The mitotic count varied from 4 to 6/10 HPF.

CONCLUSIONS

Prat & Scully reported that mitotic activity was the most important factor in diagnosing fibrosarcomas, and that cellular pleomorphism was not reliable. Irving et al. suggested that cellular fibromatous neoplasms with bland nuclear features and mitotic count of > or = 4 MFs/10 HPFs should be considered mitotically-active cellular fibromas rather than fibrosarcomas. We propose the term 'fibromatous tumours of uncertain biological potential' when an average mitotic count of 4 or more per 10 HPFs are found and nuclear atypia and necrosis are absent.

[Doege-Potter syndrome. about one new case]

Syndrome Doege-Potter is a paraneoplastic syndrome in which hypoglycemia is the result of tumors producing insulin growth factor-like (IGF-II) it is most often solitary fibrous tumor of the pleura (TFSP). These are rare and may be discovered incidentally, during non-specific respiratory symptoms or during hypoglycemia. Hypoglycemia occurs in tumors of large volume and it disappears after surgery, which is the treatment of choice for a permanent cure in most cases. We present a case of Doege-Potter syndrome whose interest is to consider the TFSP as a cause of hypoglycemia in patients with pleural tumors.

Ovarian tumours, their characterisation and origins and ovarian screening

Ultrasound assessment of ovarian tumours cannot accurately predict pathology. Recent reviews suggest that the source of many epithelial ovarian carcinomas may be the distal fallopian tube. Further study of the natural history of these tubal lesions is required before resuming ovarian screening.

Paratesticular fibrous hamartoma in an infant

Fibrous hamartoma of infancy is a rare benign tumour with local infiltration. The lesion is usually found in the upper torso and rarely occurs in the genital region. Diagnosis before surgery is rare, and complete excision is essential to prevent recurrence. We present a case in which fibrous hamartoma of infancy involving the spermatic cord was found. A pre-operative clinical diagnosis could not be made. On inguinal exploration, the tumour could not be dissected away from the testicular vessels, which necessitated an orchidectomy for complete removal. The case is presented due to its rarity and successful management.

[Clinicopathologic features of calcifying fibrous tumor with reappraisal of its histogenesis]

OBJECTIVE

To study the clinicopathologic features and histogenesis of calcifying fibrous tumor (CFT).

METHODS

The clinical manifestations, histopathologic characteristics and immunophenotype were analyzed in 11 cases of CFT.

RESULTS

The male-to-female ratio was 5:6, with a mean age of 38 years and age range of 25 to 52 years. The sites of involvement included abdominopelvic cavity (n=6), soft tissue (n=4) and scrotum (n=1). Most patients presented with a gradually enlarging and painless mass. Nearly half of the cases were associated with other diseases or history of inflammation, trauma or surgical intervention. One third of the tumors represented incidental findings and showed no recurrence after resection. Imaging revealed a solitary solid soft tissue mass or multiple nodules with clear borders and associated high-density calcifications. Macroscopically, the tumors were well-circumscribed but non-encapsulated. They ranged from 0.5 to 20.0 cm in diameter and were tan-greyish, round to oval, lobulated or irregular and solid with rubbery consistency. The cut surface was whitish to tan-yellowish, gritty and showed scattered spotty yellowish discoloration corresponding to the foci of dystrophic calcifications. Histologically, CFT was composed of hyalinized fibrous tissue and thickened vessel walls with interspersed bland spindly fibroblastic cells, scattered psammomatous calcifications, dystrophic calcification and lymphoplasmacytic infiltration. In addition, focal cloak-like polymorph infiltration at the tumor periphery and entrapment of adipocytes and nerves were demonstrated in some cases. Foci resembling solitary fibrous tumor, fibromatosis, keloid or inflammatory myofibroblastic tumor were observed. Immunohistochemical study showed that the tumor cells were diffusely positive for vimentin and focally positive for CD34, factor VIII-related antigen and beta-catenin. The admixed plasma cells were notably IgG positive, with more than 50% being IgG4 positive.

CONCLUSIONS

CFT has characteristic histopathologic manifestations and shows morphologic and immunohistochemical overlaps with known IgG4-related sclerosing diseases. It is possible that CFT may represent another example of IgG4-related diseases. It often runs a benign clinical course, with rare recurrence after surgical resection. Previous inflammation and trauma may be the precipitating factors of CFT.

Multifocal peritoneal calcifying fibrous tumour: incidental finding at cholecystectomy

Calcifying fibrous tumour (CFT) is a benign tumour of elusive aetiology and a potential for local recurrence. Despite its peculiar histological characteristics it can still be confused with interrelated differential diagnosis like inflammatory myofibroblastic tumour (IMT) or solitary fibrous tumours. The clinical differential diagnosis is however much wider. To date seven cases of multiple peritoneal CFTs are on record. The authors present a case discovered incidentally during laparoscopic cholecystectomy, with no previous history and no radiological diagnosis achieved despite having undergone magnetic resonance cholangiopancreatography (MRCP) and normal routine perioperative investigation. The patient is disease-free 12 months after diagnosis. The case report is followed by a detailed literature review.

June 2001: 61 year old woman with confusion and obtundation

The June COM. A 61 year old female presents with a three week history of increasing confusion, lethargy and headache. A neurological exam revealed disorientation, mild expressive aphasia, bilateral papilledema, and a right pronator drift. She had a craniotomy and resection of tumor. The tumor histologically was consistent with a solitary fibrous tumor displaying malignant features of hypercellularity, marked nuclear atypia, high mitotic activity, and a high proliferation index. This case is unique as the first malignant variant of solitary fibrous tumor to be reported intracranially.

The Spectrum of Pediatric Fibroblastic and Myofibroblastic Tumors

Fibroblastic and myofibroblastic tumors in neonates, infants, and children provide a diagnostic dilemma in surgical pathology due to their relative rarity and similarity in appearances. These tumors may be congenital or occur early during the first years of life or later during the first and second decades of life. The morphologic, immunocytochemical, ultrastructural, cytogenetic, and molecular features of the more "common" pediatric fibroblastic and myofibroblastic tumors are reviewed. In addition, the importance of a multimodal approach to tumor diagnosis is emphasized, with correlation with treatment and outcome differences among these unique fibroblastic and myofibroblastic tumors. The importance of providing an accurate diagnosis with pediatric fibroblastic and myofibroblastic tumors cannot be overstated, because treatment, prognosis, follow-up, and outcome are based on the initial assessment of these fascinating, but oftentimes, perplexing tumors.

Cervical intra-/extramedullary solitary fibrous tumour

A 53-year-old man presented with a 9-month history of symptoms of right-sided weakness, tingling and hypersentivity to clothes on both sides of the body. MRI revealed a large intraspinal intradural tumour at the level of C3-C4 in the cervical cord. The final histology was a solitary fibrous tumour (SFT) of the cervical spinal cord. The radiological diagnosis, surgical management and histology are reviewed.

[Fibrolamellar carcinoma of the liver]

The paper presents the data available in the literature and theauthors' own case of hepatic fibrolamellar carcinoma developing in a 49-year-old male patient. A complex morphological (histological and immunohistochemical) study has shown that the tumor is presented by trabecular, alveolar, and glandular structures separated by connective tissue interlayers. The tumor cells showed a positive reaction with cytokeratins 7, 8,18, 19, vimentin, synaptophysin, alpha-fetoprotein, carcinoembryonic antigen, and CA 19-9.

Fibromatous periorchitis

We report a case of diffuse fibrous pseudotumour/fibromatous periorchitis, in a 43 year old male, that completely encased the right testis and was adjacent to a hydrocoele cavity. Although fibrous pseudotumours of this region are uncommon, they are reported to be the second most common benign paratesticular lesion after adenomatoid tumours. These comprise approximately 6 percent of paratesticular lesions, and are accepted as reactive lesions secondary to trauma, hydrocoele, infections or inflammation. Fibrous pseudotumours have a peak incidence in the third decade of life but can occur at any age. Clinically these lesions mimic malignancy resulting in the treatment by radical orchidectomy. Fibrous pseudotumours should be considered in differential diagnosis when one encounters a predominantly fibrocollagenous lesion.

Solitary fibrous tumor arising from stomach: CT findings

Solitary fibrous tumors are spindle-cell neoplasms that usually develop in the pleura and peritoneum, and rarely arise in the stomach. To our knowledge, there is only one case reporting a solitary fibrous tumor arising from stomach in the English literature. Here we report the case of a 26-year-old man with a large solitary fibrous tumor arising from the stomach which involved the submucosa and muscular layer and resembled a gastrointestinal stromal tumor in the stomach, based on what was seen during abdominal computed tomography. A solitary fibrous tumor arising from the stomach, although rare, could be considered as a diagnostic possibility for gastric submucosal tumors.

Solitary fibrous tumor of the oral cavity: the need for an extensive sampling for a correct diagnosis

BACKGROUND

Solitary fibrous tumor (SFT) is an uncommon but well-characterized soft tissue tumor that was first described as a pleural lesion and now is considered ubiquitous, having been detected at many extra-pleural sites (abdominal cavity, orbit, upper respiratory tract, and oral cavity). Histologically, SFT may show wide morphological variability of both its cellular and stromal components, which may lead to incorrect diagnosis especially when dealing with small incisional biopsies.

MATERIALS

We report on the clinical, morphological and immunohistochemical features of eight SFT occurring in the oral cavity.

RESULTS

Microscopically all eight tumors showed widely variable morphological features in terms of cellular density and stromal architecture, thus simulating benign fibrous histiocytoma, schwannoma, hemangiopericytoma or low-grade sarcoma in distinct areas of the same lesion. Among these eight cases, five had been diagnosed as SFT, two as benign fibrous histiocytoma and one as low-grade sarcoma.

CONCLUSIONS

In consideration of the heterogeneous morphological appearance of SFT, inaccurate sampling of the mass may lead to misdiagnosis and inappropriate treatment. Therefore, an accurate histological examination of multiple tissue sections is advised, along with the use of appropriate immunostains.

Intracranial solitary fibrous tumors: imaging findings in 6 consecutive patients

BACKGROUND AND PURPOSE

Intracranial solitary fibrous tumors (ISFTs) are rare mesenchymal neoplasms originating in the meninges. The aim of this study was to describe the CT, MR imaging, and angiographic features of the solitary fibrous tumor and to identify imaging characteristics.

MATERIALS AND METHODS

We retrospectively reviewed CT, MR, and angiographic findings in 6 cases of ISFT. We evaluated the size, shape, and location of the tumor; the internal content and margin of the lesion; the pattern of enhancement; and the change of the adjacent structures. Density on noncontrast CT scans, signal intensity on MR images, and angiographic features were also documented.

RESULTS

Each lesion appeared as a discrete extra-axial mass (size, 3-7 cm; mean, 5 cm). Five lesions were entirely solid, and 1 had peritumoral cyst. All 5 of the noncontrast CT scans showed hyperattenuated masses, and the tumors exhibited marked heterogeneous enhancement. No lesion contained calcification, and 2 cases showed bone invasions. On the MR images, 4 lesions showed mixed signal intensity on T2-weighted imaging. All of the lesions revealed marked heterogeneous enhancement. All of the tumors had thickening of the meninges adjacent to the tumor. Angiography showed delayed tumor blushing in all, and 3 of them had dysplastic dilation of the tumor vessels.

CONCLUSION

Although there are no pathognomonic imaging findings, some imaging features, such as the "black-and-white mixed" pattern on T2-weighted images and marked heterogeneous enhancement, might be helpful in the diagnosis of intracranial solitary fibrous tumor.

Solitary fibrous tumor of the pancreas: a case report

Solitary fibrous tumor (SFT) is an unusual mesenchymal neoplasm that most often arises in the pleura; however, it has recently been described in a number of extrapleural sites. This report describes an extremely rare case of a benign SFT arising in the pancreas. A 41-year-old woman presented in the clinic with right upper abdominal pain. Subsequent ultrasonographic studies revealed a 1.5x1.5x1.4 cm hypoechoic mass within the pancreatic body, which was later confirmed on both helical computerized tomography and magnetic resonance imaging studies. An endocrine tumor was clinically suspected. Laparoscopic enucleation of the mass was performed. Microscopically, the tumor was composed of bland uniform spindle cells arranged between collagen bundles. On immunohistochemical studies, these spindle cells were positive for CD34 and bcl-2 but negative for cytokeratin (AE1+AE3 and Cam5.2), smooth muscle actin, desmin, S-100, and c-kit. Based on the light microscopic morphology and immunohistochemical staining profile, the diagnosis of SFT was rendered.

Epithelioid fibrous papule - a new variant

Fibrous papules (FPs) are common benign lesions occurring most frequently on the nose. Multiple variants have been described, including classic, hypercellular, clear cell, pigmented, pleomorphic, inflammatory and granular FPs. We describe a group of FPs with characteristics that do not easily fit into any of the above categories, with diffuse sheets of distinctive epithelioid cells, causing potential diagnostic confusion. Immunoperoxidase stains show that the cells of this 'epithelioid fibrous papule' are reactive for procollagen, and are negative for NKI/C3, unlike previously described clear cell variants.

Malignant solitary fibrous tumor of the soft tissue: a cytogenetic study

We report on a case of a solitary fibrous tumor that developed in the thigh of an 82-year-old woman. The tumor was composed of areas of high-grade sarcoma and typical solitary fibrous tumor. Its karyotype was: 70,XXX,+X[4],+1[2],add(1)(p36)[4],add(1)[2],+2[4],-3[4],+6[4],add(6)(p11)x2[4],+7[4],+9[3],-11[4],-12[4],-13[4],add(13)(p11)x2[4],-14[4],+15[4],-16[3],-17[4],-19[4],+20,[4],+21[4],+22[2],+mar1x2[4][cp4].

Solitary fibrous tumor of the parapharyngeal space

Solitary fibrous tumors are benign neoplasms of mesenchymal origin. They usually arise from the visceral or parietal pleura and peritoneum, although they have been found in many areas throughout the body. We report a case of solitary fibrous tumor of the parapharyngeal space. Microscopically, the tumor contained spindle cells with areas of marked hypercellularity without a definitepattern. Consistent with a benign lesion, there were few mitoses and no necrosis. The tumor cells stained strongly positive for CD34 and vimentin. At the 2-year follow-up, the patient was well and free of local and/or distant disease.

A solitary fibrous tumor in the broad ligament of the uterus

Solitary fibrous tumor (SFT) is a rare mesenchymal tumor that occurs preferentially in the pleura. Although it has been described at some extrathoracic sites, its occurrence in the female genital tract is extremely rare. We are the first to report on an unusual case of a large (14cm in the largest diameter) SFT localized in the broad ligament of the uterus in a 50-year-old woman. The patient underwent surgical tumor extirpation and has remained well without any sign of local tumor recurrence after 6 years of follow-up. We discuss the clinical aspects, the gross macroscopic appearance, the histologic findings, and the differential diagnosis, and provide a review of the literature.

Large Solitary Fibrous Tumour of the Pleura: Analysis of Six Cases

BACKGROUND

A large solitary fibrous tumour of the pleura (SFTP) is a very rare occurrence. The aim of this study was to retrospectively review the clinical characteristics, surgical treatment and outcome of patients with a large SFTP operated on in our General Thoracic Surgery Unit.

METHODS

We conducted a retrospective analysis of the clinical records of six patients who underwent surgery for a huge SFTP between 1998 and 2004.

RESULTS

Six patients (four men and two women, mean age 73.3 years) with a large SFTP (mean diameter 20.3 and mean weight 1265 g) underwent surgery during this period with full excision of the tumour. Five tumours were excised together with the implantation basis, and in one case extended resection with pneumonectomy was performed. The presentation symptoms resolved in all cases after surgery.

CONCLUSIONS

Despite the huge size of these tumours (giant SFTP), surgical resection is an acceptable method of treatment in elderly patients with low morbidity and mortality rates.

Case of retroperitoneal solitary fibrous tumor

Solitary fibrous tumor (SFT) of the retroperitoneal space is rare. We report a case of retroperitoneal tumor, diagnosed as SFT. A 69-year-old woman presented with right lower abdominal swelling, and was referred to our hospital with suspicion of right renal tumor. Abdominal ultrasound and computerized tomography (CT) showed a mass (about 15 x 14 x 10 cm) in the right abdomen. The tumor was thought to be right renal rumor, and right radical nephrectomy was performed. In the excised specimen the tumor was not connected to gastrointestinal tract, peritoneum, or right kidney. The histological and immunohistochemical examination of the specimen revealed SFT. The tumor has malignant potential with partially increased mitotic activity and cellularity in the histological examination. The patient is healthy and without evidence of recurrence or metastasis 26 months from surgery.

Solitary fibrous tumour: a diagnostic dilemma

Solitary fibrous tumour (SFT) is a rare spindle cell neoplasm arising at pleural and extrapleural sites. Five cases of SFT diagnosed at our institution over a five year period were reviewed. Haematoxylin and eosin stained histological sections, immuno-histochemical markers including CD34 and electron microscopy were the different methods used to study these tumours. Three histological features were consistently observed in all the tumours: the tumours were composed of short spindle cells separated by dense collagen bands and arranged in alternate hypocellular and hypercellular areas. CD34 positivity was seen in all the cases. SFT's have been reported to behave in an unpredictable fashion and hence prolonged follow up is essential. Histology, CD34 positivity and electron microscopy are useful tools in diagnosing SFT. While the pleural tumours can be diagnosed based on histology, this must be substantiated by ancillary techniques in case of extrapleural tumours.

Solitary Fibrous Tumor of the Female Genital Tract A Case Report and Review of the Literature

Originally thought to be limited to mesothelial-lined surfaces, solitary fibrous tumor (SFT) has now been reported in numerous extrathoracic sites. The female genital tract is among the rarest reported sites involving SFT, and only a handful of cases have been described. Although features pointing to a more malignant biological behavior have been described, these tumors remain unpredictable in their clinical course. We present a case of primary SFT originating in the vulva of a 45-year-old woman, only the fourth such case and only the ninth case of primary SFT of the female genital tract. The tumor presented as a 60-mm, well-circumscribed, painless lump and comprised bland spindle cells in a collagenized stroma with hypercellular and hypocellular foci. Immunohistochemically, the spindle cells were strongly positive for CD34, Bcl 2, and vimentin, with focal positivity for CD99. Immunohistochemical staining for MNF116, desmin, smooth muscle actin, ER, PR, and S100 was negative. There has been no recurrence after 6 months. We discuss the principal differential diagnoses of spindle cell mesenchymal tumors of the vulva and review the previously published cases of primary SFTs originating in the female genital tract. We also stress the importance of informing clinicians involved in these cases of the potential for an unpredictable clinical outcome.

[Solitary fibrous tumor of the nose and paranasal sinuses]

OBJECTIVE

The solitary fibrous tumor is an uncommon, benign lesion with a mesenchymal origin which arises most commonly from the pleura and, in extremely rare cases, from the mucosa of the nose and paranasal sinuses.

PATIENT AND METHODS

We describe a case of solitary fibrous tumor in the nasal cavity with an extension into both ethmoid sinuses and destruction of the nasal septum in a 64-year-old woman presenting with nasal obstruction and frontal headache. In the histopathologic examination and by immunohistochemistry, the tumor was composed of spindle cells and nodular collagen, and was confirmed as a solitary fibrous tumor. It was completely removed using an endonasal approach with the patient being free of any complaints and without evidence of disease 2 years after surgery.

CONCLUSIONS

Solitary fibrous tumor should be included in diagnostic considerations in patients with sinonasal masses, especially in cases with the appearance of spindle cells. Diagnostic procedures, clinicopathological features, therapeutic options and prognosis of the such tumors are discussed.

Solitary Fibrous Tumor on Needle Biopsy and Transurethral Resection of the Prostate

One of the least commonly encountered spindle cell tumors seen on prostatic needle biopsy or transurethral resection (TUR) of the prostate is solitary fibrous tumor (SFT). We studied 13 cases of SFTs identified on either prostate needle biopsy (n=9) or TUR of the prostate (n=4). Mean patient age at diagnosis was 63 years (range: 46 to 75 y; median: 65 y). Twelve men presented with urinary tract symptoms and 1 patient was biopsied during work-up of bone metastases. Ten cases were SFTs originating in the prostate, 2 cases arose between the prostate and rectum extending into the prostate (n=2), and 1 case was a pelvic mass without infiltration of the prostate. In 9 cases, a complete tumor resection was attempted by cystoprostatectomy (n=2), radical prostatectomy (n=4), pelvic exenteration (n=2), or pelvic tumor resection (n=1). Enucleation (n=1) and TUR (n=1) were performed in 2 other cases. Tumor sizes ranged from 8.5 to 15 cm in 7 radically resected cases. Mitotic rates were 3 to 5 per 10 high power fields in 5 cases, with the remaining cases having either rare (n=4) or no mitoses (n=4). Seven cases demonstrated areas of necrosis. Based on a combination of increased cellularity, mitotic activity, necrosis, nuclear pleomorphism, and infiltrativeness, 4 prostatic SFTs were malignant, 4 were benign, and 2 were borderline. Of the 3 non-prostatic SFTs, 1 was malignant and 2 were borderline. All tumors but 1 were immunoreactive for CD34 (n=12). Material for additional immunohistochemistry was available for the majority of cases with positive stains for Bcl-2 (11/11), CD99 (7/10), beta-catenin (5/10), and c-kit (0/11). Three SFTs demonstrated >or=10% p53 immunoreactivity including 1 tumor with 50% positivity; and 3 cases had Ki-67 rates of >or=20%. Although all SFTs were initially clinically considered to be of prostatic origin, some of the cases arose in the pelvis with secondary involvement of the prostate. Approximately 50% of prostatic SFTs were malignant. Even in the prostatic and nonprostatic SFTs with no overt malignant features, sometimes it was necessary to remove the prostate and in some instances the adjacent organs because of the large size of the tumors. SFTs must be differentiated from other spindle cell neoplasms of the prostate especially from gastrointestinal stromal tumors that may arise from the rectal wall with invasion of the prostate or from the region between the rectum and the prostate.

Giant pelvic solitary fibrous tumor obstructing intestinal and urinary tract: a case report and literature review

We are reporting a giant pelvic neoplasm, a rare solitary fibrous tumor that presented with a large bowel obstruction and bilateral ureteral obstruction because of its size and location. Preoperative diagnosis required complex pathological studies to exclude a high-grade sarcoma suspected clinically. Complete resection was required for resolution of obstructive symptoms. Prognosis for solitary fibrous tumors is usually good after complete resection. Recurrence and metastasis may be related to rare aggressive histological features, including nuclear atypia, hypercellularity, greater than four mitoses/10 high power fields, and necrosis. Because histology is not always a reliable predictor of prognosis, careful long-term follow-up is necessary for this tumor. Solitary fibrous tumors (SFTs) are rare spindle cell neoplasms most likely arising from mesenchymal cells. SFTs were originally described in the pleura, the most common site for this tumor; however, extrathoracic SFTs are seemingly diagnosed with increased frequency. We report a case of a giant pelvic SFT that required complicated clinical management.

Intrapulmonary Solitary Fibrous Tumor Diagnosed by Immunohistochemical and Genetic Approaches: Report of a Case

Although solitary fibrous tumors (SFTs) of the pleura are not uncommon, intrapulmonary SFTs are extremely rare. A 72-year-old woman was admitted to our hospital for an investigation of an enlarging intrapulmonary tumor. Because a definitive diagnosis could not be readily established, a pulmonary wedge resection under video-assisted thoracic surgery was performed. Grossly, the tumor was white, well circumscribed, and separate from the pleural surface. Histologically, it consisted of spindle cells proliferating in a vague fascicular pattern, with many dilated capillaries, and intermingled glandular components. These findings suggested a differential diagnosis that included SFT and nonchondromatous pulmonary hamartoma. On immunohistochemical analysis, the spindle cells showed a strong positive reaction to the CD34 antigen. Interphase fluorescent in situ hybridization revealed an absence of HMGA-1 and -2 translocations. These results supported a diagnosis of SFT. A genetic approach may therefore be useful in the differentiation of SFT from nonchondromatous hamartoma.

[The clinicopathological features and surgical treatment of solitary fibrous tumor of the pleura]

OBJECTIVE

To investigate the clinicopathological features and surgical treatment of solitary fibrous tumor of the pleura (SFTP).

METHODS

The clinical, radiological and pathological features of 11 cases of SFTP were analyzed. The detection of immunohistochemistry, surgical treatment and follow-up data were also reviewed.

RESULTS

The group consisted of 6 males and 5 females, age ranging from 35 to 73 years (mean 53.7 years). Clinical findings were mainly cough, chest pain and other local symptoms. Five cases had pleural effusion. Surgical excision was performed by thoracotomy in 6 patients, by video-assisted thoracoscopic surgery (VATS) in 3 patients, and by VATS plus a small thoracotomy in 2 patients. Eight cases received tumor resection by wedge resection of the lung, and the other 3 patients by middle and lower lobe resection, lower lobe resection and chest wall tumor resection, respectively. Nine tumors were located in the visceral pleura, 1 tumor below the visceral pleura, and 1 tumor in parietal pleura. Histopathologically, SFTP consisted mainly of spindle-shaped cells which were diffusely distributed. There were abundant gross collagenous fibers and thick-walled blood vessels around tumor cells. Malignant tumors displayed high cell density, nuclear atypia and patho-karyokinesis. The tumor cells were stained with vimentin (100%, 11/11), CD(34) (100%, 11/11), CD(99) (63.6%, 7/11), and bcl-2 (63.6%, 7/11), but no expression of CD(31). Of the 11 cases, 9 were histologically diagnosed as benign SFTP, 1 as cell-abundant type of SFTP, and another as malignant SFTP. One patient died of multiple organ failure after surgery. The mean duration of hospital stay after surgery was 11 days. Follow-up visit results were available for 10 cases. The follow-up time ranged from 12 to 48 months and all patients remained well without recurrence or metastasis.

CONCLUSIONS

SFTP should be considered when chest X-ray and CT showed single nodule or mass in the pleura. The diagnosis is based on examination of histopathology and immunohistochemistry. For a tumor with a diameter les than 5 cm, resection by VATS or VATS plus small thoracotomy is a good surgical procedure.

Advanced malignant solitary fibrous tumor in pelvis responding to radiation therapy

Solitary fibrous tumor (SFT) is a rare spindle cell neoplasm that is benign in most cases. Although SFT was first recognized to arise only in the pleura, recent reports indicate that SFT can involve a wide range of anatomical sites. To date, 17 cases of pelvic SFT have been reported. Herein is reported a case of a 74-year-old woman with a giant malignant SFT in the pelvis. Along with massive invasion to adjacent organs and multiple lung metastases detected on radiography, biopsy from the tumor through the vaginal wall showed malignant looking spindle-cell neoplasm with increased cellularity, areas of necrosis, and high mitotic activity (5/10 high-power fields). Immunohistochemically, the tumor cells were diffusely and strongly positive for CD34, CD99, and bcl-2. Based on pathological features and clinical presentation, diagnosis of malignant SFT was made. The patient received systemic and the intra-arterial chemotherapy followed by whole pelvic radiation therapy (50 Gy). Initial chemotherapies failed to control the tumor. Afterwards, improvement was observed radiologically and pathologically in the 12 months' follow up after the radiation therapy. This is the first report related to therapeutic remarks on advanced malignant SFT.