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Takada I, Amemiya R, Ono S, Kou K, Morishita Y, Ikeda N, Furukawa K. A Rare Case of Chest Wall Castleman's Disease with Calcification. Ann Thorac Cardiovasc Surg 2023; 29:319-322. [PMID: 35545524 PMCID: PMC10767661 DOI: 10.5761/atcs.cr.22-00026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 04/06/2022] [Indexed: 11/16/2022] Open
Abstract
Castleman's disease with calcification of the chest wall is very rare, and there have been few reports of such cases to date. A 57-year-old woman was referred to our hospital for a tumor with calcification on her left lateral chest wall, which was detected on chest computed tomography. Findings of her chest magnetic resonance imaging suggested schwannoma or a solitary fibrous tumor, and therefore, we performed surgery for diagnostic and therapeutic purposes. Pathologically, the tumor with calcification was diagnosed as Castleman's disease of the hyaline-vascular type. After the surgery, the patient has had no obvious symptoms and continues to undergo regular follow-up examinations.
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Affiliation(s)
- Ikki Takada
- Department of Thoracic Surgery, Tokyo Medical University Ibaraki Medical Center, Ami-machi, Ibaraki, Japan
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
| | - Ryosuke Amemiya
- Department of Thoracic Surgery, Tokyo Medical University Ibaraki Medical Center, Ami-machi, Ibaraki, Japan
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
| | - Shotaro Ono
- Department of Thoracic Surgery, Tokyo Medical University Ibaraki Medical Center, Ami-machi, Ibaraki, Japan
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
| | - Keni Kou
- Department of Diagnostic Pathology Division, Tokyo Medical University Ibaraki Medical Center, Ami-machi, Ibaraki, Japan
| | - Yukio Morishita
- Department of Diagnostic Pathology Division, Tokyo Medical University Ibaraki Medical Center, Ami-machi, Ibaraki, Japan
| | - Norihiko Ikeda
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
| | - Kinya Furukawa
- Department of Thoracic Surgery, Tokyo Medical University Ibaraki Medical Center, Ami-machi, Ibaraki, Japan
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2
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Mangal R, Hasso MF, Obri MS, Almajed MR, Entz A. A Case of a Large and Rare Incidental Pleural Tumor in an Elderly Female. Cureus 2023; 15:e42198. [PMID: 37601997 PMCID: PMC10439741 DOI: 10.7759/cureus.42198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2023] [Indexed: 08/22/2023] Open
Abstract
Solitary fibrous tumors are very rare in the pleura, and they are generally found incidentally. Even though they can potentially become malignant and metastasize, they have minimal clinical symptoms and can still be benign. Due to the low incidence of these tumors, there is no standard of therapy beyond surgical resection. We present an asymptomatic case of a large, rapidly expanding solitary fibrous tumor of the pleura in an elderly female.
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Affiliation(s)
- Ruchi Mangal
- Internal Medicine, Henry Ford Health System, Detroit, USA
| | - Muneer F Hasso
- Internal Medicine, Henry Ford Health System, Detroit, USA
| | - Mark S Obri
- Internal Medicine, Henry Ford Health System, Detroit, USA
| | | | - Abigail Entz
- Internal Medicine, Henry Ford Health System, Detroit, USA
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3
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Zhang A, Meng X, Zhou X, Wang S, Zhang Y, Li N. The 68 Ga-DOTA-FAPI-04 PET/CT for the differential diagnosis of solitary fibroma of pleura from other chest disease with low uptake of 18 F-FDG. Nucl Med Commun 2022; 43:908-915. [PMID: 35551166 DOI: 10.1097/mnm.0000000000001579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We conducted a prospective study using 68 Ga-DOTA-FAPI-04 PET/computed tomography (CT) to differentiate solitary fibromas of pleura (SFP) from other chest similar masses showing low uptake of 18 F-FDG. METHODS A prospective study including 13 patients was divided into two groups: five cases of SFP and eight of thoracic lesions resembling SFP on general imaging examination. Except for CT and MRI, all patients underwent both 18 F-FDG and 68 Ga-DOTA-FAPI-04 PET/CT examinations. Compare the differences of lesions in CT net enhancement value and the uptake of 18 F-FDG and 68 Ga-DOTA-FAPI-04 between the two groups. The values of CT and PET/CT for differential diagnosis were calculated by receiver operating characteristic (ROC) curves. RESULTS The uptake of 68 Ga-DOTA-FAPI-04 in SFP was significantly higher than the others in chest, SUVmean (8.10 ± 5.57) versus (1.11 ± 0.38); and SUVmax (15.46 ± 8.16) versus (3.96 ± 2.43), and the difference was statistically significant ( P < 0.05). The 68 Ga-DOTA-FAPI-04 could effectively distinguish SFP from other lesions, and the accuracies of SUVmax and SUVmean for differential diagnosis were 92.31 and 100%, the corresponding cutoff value being 7.19 and 2.26. The uptake of 18 F-FDG in SFP was slightly lower than other lesions, SUVmean (1.63 ± 0.30) versus (1.88 ± 1.02); and SUVmax (2.51 ± 0.54) versus (3.60 ± 1.57), and the difference was not statistically significant ( P > 0.05). The SFP showed significant enhancement in the venous phase, but the difference was not statistically significant ( P > 0.05). CONCLUSION The 68 Ga-DOTA-FAPI-04 has potential application value in differentiating SFP from lesions with low 18 F-FDG uptake, in addition, 68 Ga-DOTA-FAPI-04 may specifically target SFP.
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Affiliation(s)
- Annan Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Nuclear Medicine, Peking University Cancer Hospital & Institute, Beijing, China
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4
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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.
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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
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5
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Zhao L, Wang H, Shi J. 18F-FDG PET/CT characteristics of solitary fibrous tumour of the pleura: single institution experience. Ann Nucl Med 2022; 36:429-438. [PMID: 35137364 DOI: 10.1007/s12149-022-01723-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 01/21/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND To date, published studies have shown that 18F-FDG PET/CT and CT have limited value in differentiating benign and malignant solitary fibrous tumours of the pleura (SFTP). This study aimed to determine whether the metabolic and morphological characteristics of 18F-FDG PET/CT can be a valuable addition to diagnostic tools for SFTPs. METHODS From January 2016 to November 2021, we performed a retrospective review in 32 SFTPs patients who underwent 18F-FDG PET/CT scan. All the SFTP diagnoses were confirmed by surgical resection or biopsy samples. The metabolic parameters (including SUVmax, SUVmean, MTV, TLG, and SULmax) were obtained from 18F-FDG PET/CT images. RESULTS Thirty-two patients with SFTP were consecutively identified. The malignant SFTPs have higher Ki-67 expression (P = 0.005). The study observed that tumour heterogeneity without contrast injection (P = 0.001) and intratumor blood vessels (P = 0.047) were morphological features associated with malignant SFTP. Malignant SFTP was more frequently observed with higher SUVmax values (P = 0.001), higher SUVmean values (P = 0.001), higher TLG values (P = 0.006), and higher SULmax values (P < 0.001). For predicting malignant SFTP, the AUC values of SUVmax, SUVmean, TLG, and SULmax obtained by the area under curve analysis were 0.970 (95% CI 0.907-1.000; P = 0.001), 0.874 (95% CI 0.675-1.000; P = 0.009), 0.807 (95% CI 0.654-0.961; P = 0.031), and 0.911 (95% CI 0.747-1.000; P = 0.004), respectively. CONCLUSION The study showed that metabolic and morphological features were useful for distinguishing malignant from benign SFTPs.
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Affiliation(s)
- Long Zhao
- Department of Nuclear Medicine, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - HuoQiang Wang
- Department of Nuclear Medicine, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200092, China.
| | - Jingyun Shi
- Department of Radiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200092, China.
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6
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Uterine Sarcomas: Are There MRI Signs Predictive of Histopathological Diagnosis? A 50-Patient Case Series with Pathological Correlation. Sarcoma 2021; 2021:8880080. [PMID: 34305438 PMCID: PMC8266466 DOI: 10.1155/2021/8880080] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 04/18/2021] [Accepted: 05/25/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose To make clear distinction between two radiological types of uterine sarcomas. Methods 50 preoperative MRI were analyzed retrospectively, blinded to histopathology: 11 endometrial stromal sarcomas (ESS), 19 leiomyosarcomas (LMS), 18 carcinosarcomas/malignant mixed Mullerian tumors (MMMT), and 2 smooth muscle tumors of uncertain malignant potential (STUMP). Results According to their locations, two radiological types of sarcomas were identified: type 1: intracavitary (ESS, MMMT) and type 2: intramyometrial (LMS, STUMP). In both types, all tumors displayed intermediate T2-weighted signal (p < 0.001) and high diffusion-weighted imaging (DWI) b1000 signal (p < 0.001). Dynamic contrast-enhanced (DCE) MRI showed intratumoral pathologic vessels (98%) and heterogeneity at venous phase (p < 0.001). In the type 1 subgroup, all tumors displayed local spread: invasion of junctional zone on T2-weighted imaging (T2WI), irregular margins on DWI, and disruption of arcuate arteries subendometrial ring on DCE-MRI. In the type 2 subgroup, all tumors displayed irregular margins on T2WI, DWI, and DCE-MRI. Tumor heterogeneity was due to necrosis (p < 0.001). Most commonly the tumor was single (61%). In both types, apparent diffusion coefficient (ADC) lesser than or equal to 0.86 × 10-3 mm2/s (sensitivity = 73%, specificity = 92%) was suggestive of malignancy. Conclusion It may be feasible to get close to histological type of a uterine sarcoma based on our topographic classification into two radiological subgroups, corresponding to two kinds of diagnostic difficulties. Advances in knowledge. MRI signs suggestive of histopathological malignancy are identifiable, considering the triad T2WI/DWI/DCE-MRI, easily for type 1 but less easily for type 2; the threshold value for ADC is 0.86 × 10-3 mm2/s.
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Martin-Broto J, Mondaza-Hernandez JL, Moura DS, Hindi N. A Comprehensive Review on Solitary Fibrous Tumor: New Insights for New Horizons. Cancers (Basel) 2021; 13:cancers13122913. [PMID: 34200924 PMCID: PMC8230482 DOI: 10.3390/cancers13122913] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/01/2021] [Accepted: 06/04/2021] [Indexed: 12/16/2022] Open
Abstract
Simple Summary Solitary fibrous tumor (SFT) is a malignant condition that exhibits different clinical behaviors ranging from low to high aggressive SFT, with dedifferentiated SFT (DD-SFT) being the fastest-growing subtype. Even when surgery alone provides curation rates above 60%, recurrences do occur in a fraction of patients where surgery is unable to provide disease control. Among the systemic therapeutic options, antiangiogenic compounds have shown higher efficacy than chemotherapy by indirect comparisons. Furthermore, rotating different antiangiogenics, at the progression time, has been shown to be effective. The exception is DD-SFT since it is resistant to antiangiogenics but can respond to chemotherapy. This comprehensive review also analyzes the underlying molecular components that play a key role in SFT origin and aggressiveness. The discovery in 2013 of anomalous fusion genes between NAB2 and STAT6 was determinant to increase the knowledge on the molecular drivers in SFT that could be potential targets for future therapies. Abstract Solitary fibrous tumor (SFT) is a rare mesenchymal, ubiquitous tumor, with an incidence of 1 new case/million people/year. In the 2020 WHO classification, risk stratification models were recommended as a better tool to determine prognosis in SFT, to the detriment of “typical” or “malignant” classic terms. The risk for metastasis is up to 35–45%, or even greater, in series with a longer follow-up. Over the last few decades, advances in immunohistochemistry and molecular diagnostics identified STAT6 nuclear protein expression and the NAB2–STAT6 fusion gene as more precise tools for SFT diagnosis. Recent evidence taken from retrospective series and from two prospective phase II clinical trials showed that antiangiogenics are active and their sequential use from first line should be considered, except for dedifferentiated SFT for which chemotherapy is the best option. Since the fusion transcript driver’s first description in 2013, new insights have been brought on key molecular events in SFT. This comprehensive review mainly focuses on the superior efficacy of antiangiogenics over chemotherapeutic agents in SFT, provides the current knowledge of key molecules that could co-drive the SFT behavior, and suggests new target candidates that deserve to be explored in preclinical and clinical research in SFT.
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Affiliation(s)
- Javier Martin-Broto
- Fundacion Jimenez Díaz University Hospital, 28040 Madrid, Spain;
- General de Villalba University Hospital, Collado Villalba, 28400 Madrid, Spain
- Fundación Jiménez Díaz Institute for Medical Research (IIS/FJD), 28040 Madrid, Spain
- Correspondence:
| | - Jose L. Mondaza-Hernandez
- Institute of Biomedicine of Seville (IBiS, CSIC, US and HUVR), 41013 Sevilla, Spain; (J.L.M.-H.); (D.S.M.)
| | - David S. Moura
- Institute of Biomedicine of Seville (IBiS, CSIC, US and HUVR), 41013 Sevilla, Spain; (J.L.M.-H.); (D.S.M.)
| | - Nadia Hindi
- Fundacion Jimenez Díaz University Hospital, 28040 Madrid, Spain;
- General de Villalba University Hospital, Collado Villalba, 28400 Madrid, Spain
- Fundación Jiménez Díaz Institute for Medical Research (IIS/FJD), 28040 Madrid, Spain
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8
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Mercer RM, Wigston C, Banka R, Cardillo G, Benamore R, Nicholson AG, Asciak R, Hassan M, Hallifax RJ, Wing L, Bedawi EO, Maskell NA, Harriss EK, Miller RF, Rahman NM. Management of solitary fibrous tumours of the pleura: a systematic review and meta-analysis. ERJ Open Res 2020; 6:00055-2020. [PMID: 32832532 PMCID: PMC7430150 DOI: 10.1183/23120541.00055-2020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 05/26/2020] [Indexed: 12/24/2022] Open
Abstract
Background Solitary fibrous tumours of the pleura (SFTP), or pleural fibromas, are rare tumours that generally, but not universally, follow a benign course. Surgical resection is the standard treatment, but there are no evidence-based guidelines regarding the management of these tumours. Methods Five databases were searched from inception to April 1, 2019 for studies reporting on SFTP management. Results Twenty-seven studies met the inclusion criteria (1542 patients, all non-comparative case series); 98% of these patients underwent resection and all SFTP included were pathologically diagnosed. 394 out of 1299 cases (30.5%, 95% CI 27.8–32.8%) were malignant with recurrence rates of between 0% and 42.9%. A pleural effusion was always associated with a negative outcome, but no other features were consistently reported to have negative associations. Preoperative biopsies incorrectly reported malignant histology in two studies. Over 25% of cases of recurrence occurred when a complete (R0) resection had been achieved. The first recurrence occurred >5 years after the initial resection in at least 23% of cases. Conclusions There is strong evidence to support long-term surveillance after surgical resection of SFTP, even where a complete (R0) resection has been achieved; however, there is no clear evidence to inform clinicians regarding the selection of patients who should undergo resection. The rates of malignant SFTP and SFTP recurrence are higher than previously reported. Only those that were pathologically diagnosed or resected were included, which may bias the data towards more aggressive tumours. Data collection on radiologically diagnosed SFTP is required to draw conclusions regarding the timing and need for intervention. Long-term surveillance should be undertaken after a resection of solitary fibrous tumours of the pleura but further work is needed to determine which patients are likely to follow a malignant clinical course to decide timing and necessity of a resectionhttps://bit.ly/2U10SaA
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Affiliation(s)
- Rachel M Mercer
- University of Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, UK.,Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Charlotte Wigston
- University of Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, UK
| | - Radhika Banka
- University of Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, UK
| | | | - Rachel Benamore
- University of Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, UK
| | - Andrew G Nicholson
- Dept of Histopathology, Royal Brompton and Harefield NHS Foundation Trust, and National Heart and Lung Institute, Imperial College, London, UK
| | - Rachelle Asciak
- University of Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, UK.,Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Maged Hassan
- University of Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, UK.,Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK.,Chest Diseases Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Robert J Hallifax
- University of Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, UK.,Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Louise Wing
- University of Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, UK
| | - Eihab O Bedawi
- University of Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, UK.,Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Nick A Maskell
- Academic Respiratory Unit, Bristol Medical School, Southmead Hospital, University of Bristol, Bristol, UK
| | - Elinor K Harriss
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - Robert F Miller
- Institute for Global Health, University College London, London, UK
| | - Najib M Rahman
- University of Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, UK.,Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK.,NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
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Essid MA, Bouzouita A, Blel A, Saadi A. Inguinal Solitary Fibrous Tumor: A Case Report. Perm J 2019; 23:18-236. [PMID: 31314717 DOI: 10.7812/tpp/18-236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION A solitary fibrous tumor (SFT) is a rare mesenchymal neoplasm that may occur in a wide range of sites, more commonly in the pleura. We report a well-documented case of an SFT with malignant histology arising in the inguinal region. CASE PRESENTATION A 59-year-old man, with an unremarkable medical history, presented with a slow-growing painless mass in the left side of the inguinal region, which he had ignored for 3 years. On clinical examination, there was an indurated, irreducible, mobile, and painless mass in the left side of the inguinal area. Magnetic resonance imaging and computed tomography results revealed a 15-cm mass made up of soft tissue and with nonspecific radiologic aspect. The tumor was totally excised, and the results of the pathologic examination concluded it was an SFT. DISCUSSION The aim of our case report is to present a rare extrapleural localization of an SFT. Although its radiologic features are not specific, SFT should be considered in the differential diagnosis of inguinal masses.
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Affiliation(s)
- Mohamed Ali Essid
- Department of Urology, Charles Nicolle University Hospital of Tunis, Tunisia
| | | | - Ahlem Blel
- Department of Pathology, Charles Nicolle University Hospital of Tunis, Tunisia
| | - Ahmed Saadi
- Department of Urology, Charles Nicolle University Hospital of Tunis, Tunisia
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Song Z, Yang F, Zhang Y, Fan P, Liu G, Li C, Ding W, Zhang Y, Xu X, Ye Y. Surgical therapy and next-generation sequencing-based genetic alteration analysis of malignant solitary fibrous tumor of the pleura. Onco Targets Ther 2018; 11:5227-5238. [PMID: 30214228 PMCID: PMC6118252 DOI: 10.2147/ott.s168045] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Solitary fibrous tumor of the pleura (SFTP) is a rare pleural neoplasm arising from mesenchymal cells, accounting for <5% of pleural neoplasms. Approximately 10% of cases of SFTP demonstrate malignant potential, leading to local recurrence after radical surgery and subsequent metastasis. Methods A large malignant-like mass was found in the left thoracic cavity of a 61-year-old woman. Following radical resection of the mass, the patient was diagnosed with malignant SFTP by histologic and immunohistochemical analyses. In addition, a next-generation sequencing-based mutation test was used to reveal the mutational profile of the tumor. The genetic alteration panel was analyzed with reference to public data on the ClinVar and COSMIC databases, after which the public SFTP data were analyzed for frequency of altered genes. Finally, through overlay of the abovementioned two sets, the genetic alteration accounting for SFTP initiation was anticipated to be identified. Results In the mutation panel of our malignant SFTP group, kinase insert domain receptor (KDR) and fms-related tyrosine kinase 1 (FLT1) scored high in pathogenesis but had only a medium frequency; the NAB2–STAT6 fusion appeared to be the dominant genetic alteration in public SFTP samples. Conclusion The high frequency of NAB2–STAT6 fusion indicates its prominent role in SFTP, while somatic mutations such as FLT1-R593W and KDR-V297I may also contribute to the malignant angiogenic phenotype. The present study affirmed the heterogeneity of SFTP, and more sophisticated classification methods will be needed to explore its underlying mechanisms. Summary We believe that improvement in the prognosis of SFTP relies on early diagnosis, margin-free resection, and long-term follow-up. Through genetic analysis, it appears that both NAB2–STAT6 fusion and somatic mutations such as FLT1-R593W and KDR-V297I contribute to SFTP development.
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Affiliation(s)
- Zuoqing Song
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Fan Yang
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Yingguo Zhang
- Wuwei Tumour Hospital, Gansu Province 733000, China,
| | - Ping Fan
- Wuwei Tumour Hospital, Gansu Province 733000, China,
| | - Guowei Liu
- Wuwei Tumour Hospital, Gansu Province 733000, China,
| | - Chao Li
- Wuwei Tumour Hospital, Gansu Province 733000, China,
| | - Wansheng Ding
- Wuwei Tumour Hospital, Gansu Province 733000, China,
| | - Yulong Zhang
- Wuwei Tumour Hospital, Gansu Province 733000, China,
| | - Xiaohong Xu
- College of Nursing, Tianjin Medical University, Tianjin 300070, China,
| | - Yancheng Ye
- Wuwei Tumour Hospital, Gansu Province 733000, China,
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11
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You X, Sun X, Yang C, Fang Y. CT diagnosis and differentiation of benign and malignant varieties of solitary fibrous tumor of the pleura. Medicine (Baltimore) 2017; 96:e9058. [PMID: 29245313 PMCID: PMC5728928 DOI: 10.1097/md.0000000000009058] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
To investigate computed tomography (CT) characteristics of benign and malignant solitary fibrous tumors of the pleura (SFTPs).Preoperative CTs for 60 SFTP cases (49 benign and 11 malignant) with subsequently confirmed diagnoses were retrospectively analyzed.Tumor morphologies included mounded or mushroom umbrella-shape (19 cases, 31.7%), quasi-circular or oval-shape (30 cases, 50%), and growth resembling a casting mould (12 cases, 20%). Maximum tumor diameters were 1.1 to 18.9 cm (average: 6.4 ± 4.8 cm). Fifty-seven cases had clear boundaries, and 3 had partially coarse boundaries. Twenty-seven cases showed homogeneous density; 33, "geographic"-patterned inhomogeneous density; 6, calcifications; 12, intratumor blood vessels; and 3, thick nourishing peritumoral blood vessels. Pleural thickening (regular and irregular) was found adjacent to tumors in 4, compression of adjacent ribs with absorption and cortical sclerosis in 2, and location adjacent to ribs with bony destruction in 1. Four cases had a small amount of lung tissue enfolded along the boundary, 2 had multiple peritumoral pulmonary bullae, and 9 had small ipsilateral pleural effusions. Compared with benign and malignant SFTPs were larger (P < .001), had inhomogeneous density, and were more commonly associated with intratumor blood vessels and pleural effusions (P < .01).CT revealed characteristic patterns in SFTPs, including casting mould-like growth, rich blood supply, and "geographic"-patterned enhancement. In addition, larger tumor size, inhomogeneous intensities, abundant intratumor blood vessels, and pleural effusions were more common with malignancy. Lastly, multislice CT angiography can reveal feeding arteries and help guide surgical management.
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Affiliation(s)
- Xiaofang You
- Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai
| | - Xiwen Sun
- Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai
| | - Chunyan Yang
- Department of Radiology, The People's Hospital of Shihezi City, Shihezi, Xinjiang
| | - Yong Fang
- Tuberculosis Center for Diagnosis and Treatment, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Yangpu, Shanghai, China
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Hohenforst-Schmidt W, Grapatsas K, Dahm M, Zarogoulidis P, Leivaditis V, Kotoulas C, Tomos P, Koletsis E, Tsilogianni Z, Benhassen N, Huang H, Kosmidis C, Kosan B. Solitary fibrous tumor: A center's experience and an overview of the symptomatology, the diagnostic and therapeutic procedures of this rare tumor. Respir Med Case Rep 2017; 21:99-104. [PMID: 28458994 PMCID: PMC5397016 DOI: 10.1016/j.rmcr.2017.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 04/09/2017] [Accepted: 04/10/2017] [Indexed: 01/30/2023] Open
Abstract
Solitary Fibrous Tumor of the Pleura (SFTP) is a rare tumor of the pleura. Worldwide about 800 patients diagnosed with this oncological entity have been described in the existing literature. We report our center's 13 year experience. During this time three patients suffering from this rare disease have been treated in our department. All patients were asymptomatic and their diagnosis was initially triggered by a random finding in a routine chest x-ray. The diagnosis was set preoperatively through a needle biopsy under computer tomography (CT) guidance. The tumors were resected surgically though video-assisted thoracoscopic surgery (VATS) or thoracotomy. Because of the lack of specific guidelines due to the rarity of the disease a long-term, systematic follow-up was recommended and performed. Parallel an overview of the diagnostic and therapeutic procedures of the rare tumor is made.
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Affiliation(s)
- Wolfgang Hohenforst-Schmidt
- Sana Clinic Group Franken, Department of Cardiology/Pulmonology/Intensive Care/Nephrology, "Hof" Clinics, University of Erlangen, Hof, Germany
| | - Konstantinos Grapatsas
- Department of Cardiothoracic and Vascular Surgery, Westpfalz Klinikum, Academic Educational Hospital, Heidelberg University and Mainz University, Kaiserslautern, Germany
| | - Manfred Dahm
- Department of Cardiothoracic and Vascular Surgery, Westpfalz Klinikum, Academic Educational Hospital, Heidelberg University and Mainz University, Kaiserslautern, Germany
| | - Paul Zarogoulidis
- Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasileios Leivaditis
- Department of Cardiothoracic and Vascular Surgery, Westpfalz Klinikum, Academic Educational Hospital, Heidelberg University and Mainz University, Kaiserslautern, Germany
| | | | - Periclis Tomos
- Department of Thoracic Surgery, "Attikon" University Hospital of Athens, Athens University Medical School, Athens, Greece
| | - Efstratios Koletsis
- Department of Cardiothoracic Surgery, Medical School, University of Patras, Patras, Greece
| | - Zoi Tsilogianni
- First Department of Internal Medicine, 401 General Military Hospital of Athens, Athens, Greece
| | - Naim Benhassen
- Medical Clinic I, "Fuerth" Hospital, University of Erlangen, Fuerth, Germany
| | - Haidong Huang
- Department of Respiratory and Critical Care Medicine, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | | | - Bora Kosan
- Sana Clinic Group Franken, Department of Cardiology/Pulmonology/Intensive Care/Nephrology, "Hof" Clinics, University of Erlangen, Hof, Germany
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Saynak M, Veeramachaneni NK, Hubbs JL, Okumuş D, Marks LB. Solitary Fibrous Tumors of Chest: Another Look with the Oncologic Perspective. Balkan Med J 2017; 34:188-199. [PMID: 28443588 PMCID: PMC5450857 DOI: 10.4274/balkanmedj.2017.0350] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Solitary fibrous tumors are mesenchymal lesions that arise at a variety of sites, most commonly the pleura. Most patients are asymptomatic at diagnosis, with lesions being detected incidentally. Nevertheless, some patients present due to symptoms from local tumor compression (eg. of the airways and pulmonary parenchyma). Furthermore, radiological methods are not always conclusive in making a diagnosis, and thus, pathological analysis is often required. In the past three decades, immunohistochemical techniques have provided a gold standard in solitary fibrous tumor diagnosis. The signature marker of solitary fibrous tumor is the presence of the NAB2-STAT6 fusion that can be reliably detected with a STAT6 antibody. While solitary fibrous tumors are most often benign, they can be malignant in 10-20% of the cases. Unfortunately, histological parameters are not always predictive of benign vs malignant solitary fibrous tumors. As solitary fibrous tumors are generally regarded as relatively chemoresistant tumors; treatment is often limited to localized treatment modalities. The optimal treatment of solitary fibrous tumors appears to be complete surgical resection for both primary and local recurrent disease. However, in cases of suboptimal resection, large disease burden, or advanced recurrence, a multidisciplinary approach may be preferable. Specifically, radiotherapy for inoperable local disease can provide palliation/shrinkage. Given their sometimes -unpredictable and often- protracted clinical course, long-term follow-up post-resection is recommended.
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Affiliation(s)
- Mert Saynak
- Department of Radiation Oncology, Trakya University School of Medicine, Edirne, Turkey
| | | | - Jessica L Hubbs
- Department of Obstetrics and Gynecology, University of North Carolina, North Carolina, USA
| | - Dilruba Okumuş
- Department of Radiation Oncology, Trakya University School of Medicine, Edirne, Turkey
| | - Lawrence B Marks
- Department of Radiation Oncology, University of North Carolina, North Carolina, USA
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Abstract
OBJECTIVE The objective of our study was to evaluate the metastatic patterns and imaging features of solitary fibrous tumors (SFTs). MATERIALS AND METHODS This retrospective study included 139 patients with pathologically proven SFT, 49 of whom developed metastases. Electronic medical records and all available images were reviewed to record the pattern and imaging appearances of metastatic disease, and comparisons of thoracic SFTs and extrathoracic SFTs were also performed. Associations of metastatic spread were studied using univariate and multivariate Cox regression analyses. RESULTS A total of 49 (35%) patients developed metastases at a median of 124 months (interquartile range [IQR], 66-195 months) after SFT diagnosis; 11 patients (8%) had metastases at presentation. Of these 49 patients, 40 patients died at a mean of 183 months after diagnosis. The associations with metastatic disease on univariate analysis were tumor size ≥ 10 cm (p = 0.01) and malignant pathology or mitotic count ≥ 4 per 10 high-power fields (HPF) (p < 0.001). Malignant pathology and a mitotic count of ≥ 4 per 10 HPF were also associated with metastatic disease on multivariate analysis (p = 0.01; hazard ratio, 0.22; 95% CI, 0.05-0.73). The most common sites of metastasis were the lungs (30/49, 61%) followed by the pleura (24/49, 49%) and then the liver (20/49, 41%), bones (20/49, 41%), and peritoneum (20/49, 41%). A significantly higher proportion of patients with extrathoracic SFT had metastatic disease (37/139, 27%) compared with those with thoracic SFT (12/139, 9%) (p = 0.003). The overall metastasis-free survival was a median of 117 months (IQR, 33-169 months) in patients with extrathoracic SFT and a median of 120 months (IQR, 82-169 months) in patients with thoracic SFT (p = 0.01). CONCLUSION A mitotic count of ≥ 4 per 10 HPF or malignant pathology was significantly associated with metastatic disease on both univariate and multivariate analyses. The sites of metastatic disease differed depending on the site of the primary SFT but were most commonly the lung and pleura. Patients with extrathoracic SFT were statistically more likely to develop metastatic disease than those with thoracic SFT.
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