A case of orbital solitary fibrous tumor

Orbit Solitary Fibrous Tumor: A Proposed Risk Prediction Model Based on a Case Series and Comprehensive Literature Review

Solitary fibrous tumors (SFTs) of the orbit are rare. In order to further characterize the clinical and pathologic features of solitary fibrous tumor arising at this anatomic site, 12 cases of orbital SFTs were analyzed in conjunction with a review of 263 cases reported from the English literature in order to develop a risk prediction model. SFTs of the orbit were equally distributed between males (n = 5) and females (n = 7) with a mean patient age of 46.8 years (median 44.5 years; range 18-76 years) at initial diagnosis. The patients typically presented with swelling or mass around the orbit, with proptosis (n = 10), ptosis (n = 5), and visual changes (n = 6). Tumors were orbital (n = 10) or upper eyelid (n = 2). Mean tumor size was 2.5 cm (median 2.6 cm). Microscopically, the tumors were characterized by cytologically bland spindle cells with patternless growth, hypocellular and hypercellular areas, variable amounts of collagen, and ectatic, branching blood vessels. By immunohistochemistry, all cases had a strong nuclear STAT6 expression. All patients were initially managed with excision or biopsy, three with presurgical embolization. The two patients with biopsy only had persistent disease (mean 37.2 months), but a third patient developed distant bone metastasis at 86.9 months. Overall mean follow-up was 73.1 months: 9 patients are alive or dead without disease (mean 77.9 months), two patients with persistent disease, and one patient with metastatic disease at last follow-up (102 months). Incorporating cases sufficiently reported in the literature, a risk prediction model based on age > 45 years, tumor size > 3 cm, tumor necrosis, mitoses of > 4/2 mm², moderate to high cellularity, and moderate to severe pleomorphism allows for risk stratification for the development of local recurrence and distant metastasis. In conclusion, orbital SFTs are rare, but can be reliably diagnosed based on the presence of characteristic morphologic features and STAT6 immunohistochemistry. Orbital tumors tend to show a higher frequency of local recurrence than distant metastasis, which can be predicted by a risk stratification model unique to orbital tumors. With late disease common, long term clinical follow-up is recommended.

Orbital solitary fibrous tumor: a case series with review of the literature

PURPOSE

To report the clinical features, patient demographics, management, and outcomes of a series of patients with orbital solitary fibrous tumors (OSFTs) and provide a review of the English literature describing this rare entity.

DESIGN

A review of patient demographics, clinical presentations, imaging, histopathology, surgical management, and outcomes were analyzed.

METHODS

A non-comparative retrospective chart review of the demographics, clinical presentations, imaging, histopathological features, management, and disease outcomes of patients presenting to a tertiary orbital center with a tissue diagnosis of OSFT between 2007-2012 was performed along with a review of the English-language literature.

RESULTS

Our study included four male patients, with a mean age of 48 years at referral. The most common presentations included a slowly growing mass, globe displacement, diplopia on extreme gazes, and/or facial disfiguration. All tumors were analyzed with histopathology and immunohistochemistry. Treatment involved the complete surgical excision of the lesion, obtaining clear margins. All patients remain alive and well with no evidence of recurrence after a minimum follow-up of 15 months (range 15 months-5 years).

CONCLUSION

SFTs should be considered when confronting a painless slowly growing orbital mass that induces globe displacement and/or facial deformity. Imaging will show a well-defined lesion that enhances with contrast. A careful initial surgical excision with clear margins is required for adequate local control of the tumor, avoiding recurrence and potential malignant transformation.

[Solitary fibrous tumor of the orbit: report of two cases and review of literature]

Solitary fibrous tumor (SFT) is a rare mesenchymal neoplasm that most frequently arises in the pleura and uncommonly involves the orbit. There are 54 cases of SFT of the orbit available in the literature. The authors report tow cases of an orbital SFT and discuss the clinical, radiological, pathological features and differential diagnosis. Long-term follow-up of patients is necessary because SFT may recur many years after operation. Complete surgical resection is the most important prognosis factor of this tumor.

Hemangiopericytoma-solitary fibrous tumor of the eyelid

The authors report a rare case of hemangiopericytoma-solitary fibrous tumor of the eyelid. A 35-year-old male presented with approximately 1-year history of a painless and slow growing mass on his right lower eyelid, which rapidly grew in size over the last few months. The size of the lesion and the location resulted in secondary mechanical ectropion at presentation. The tumor was excised and was found to be a "hemangiopericytoma-solitary fibrous tumor" based on both histopathological and immunohistochemical examinations. Immunohistochemically, the tumor was positive for CD34 and Vimentin but negative for S100 protein and smooth muscle actin. Although initial tumor removal was complete, the patient required a subsequent operation for his residual ectropion. Despite the lesion being large at presentation, surgical intervention resulted in good functional and cosmetic outcome.

Solitary fibrous tumor of the orbit: a clinicopathologic entity that warrants both a heightened awareness and an atraumatic surgical removal technique

PURPOSE

To describe the first confirmed case of solitary fibrous tumor in Saudi Arabia and in the Middle East, and to illustrate a surgical technique for atraumatic complete removal.

METHODS

A retrospective interventional case report that describes the first confirmed case of solitary fibrous tumor in the King Khaled Eye Specialist Hospital in Riyadh, Saudi Arabia.

RESULTS

The clinical presentation, computed tomography (CT) findings, and histopathological, immunohistochemical and electron microscopic findings to confirm the diagnosis, as well as the cryodissection surgical technique for atraumatic removal of solitary fibrous tumor used, are described.

CONCLUSIONS

Solitary fibrous tumor should be considered in the differential diagnosis when a patient presents with unilateral proptosis and a well-circumscribed, intensely enhancing mass on CT imaging. Because of the risk of malignant transformation, surgical en bloc removal with minimal tissue damage is the treatment of choice. This may be achieved by means of cryo-extraction via a minimally invasive orbitotomy.

Tumeur fibreuse solitaire de l’orbite : une cause inhabituelle d’exophtalmie unilatérale

BACKGROUND

The solitary fibrous tumor (SFT) is a spindle-cell tumor that very rarely involves the orbit. We report a new case that we compare to reports in the literature.

CASE

A 72-year-old woman presented a conjunctival inflammation of the right eye developing over 5 months with progressive proptosis. Magnetic resonance imaging revealed an extraconal and homogeneous mass, which showed hypointensity on T1-weighted images and hyperintensity on T2-weighted images, without specificity. Histological examination of the lesion removed by anterior orbitotomy confirmed the diagnosis of the SFT of the orbit. The patient was doing well without recurrence after 9 months.

DISCUSSION

The diagnosis of SFT is histological. It is a mesenchymal tumor. Immunohistochemically, the tumor cells are strongly positive for CD34 and vimentin.

CONCLUSION

The SFT of the orbit is a very rare and generally benign tumor. It must be immunohistochemically differentiated from other spindle-cell tumors of the orbit. The treatment is a complete surgical excision, and long-term follow-up is necessary because recurrence may appear long after treatment.

Solitary fibrous tumor of the orbit--two cases and a review of the literature

Solitary fibrous tumors of the orbit (SFT) are mesenchymal lesions that can develop either as malignant or benign neoplasias. We describe the histological features leading to the diagnosis in two females and review the current literature. Diagnosis of SFT only can be performed by histological examination, since clinical signs and radiological features are not specific enough. Even a malignant or benign course cannot be predicted, since clinical and radiological features do not correlate with histological signs of malignancy and vice versa. Radical resection is the treatment of choice, since no other treatment option has been proven to be efficient.

Solitary fibrous tumor of the orbit: a clinicopathologic study of six cases with review of the literature

Solitary fibrous tumor of the orbit is a rare spindle cell neoplasm. There are 42 cases of solitary fibrous tumor of the orbit available in the literature. We present six more cases of orbital solitary fibrous tumors, which presented to our institute between 1999 and 2001. We highlight the need for clinical recognition of these tumors as a distinct entity and inclusion of this tumor in the etiological differential diagnosis of well-circumscribed orbital lesions presenting as unilateral proptosis in both children and in adults. The diagnosis may be suspected based on radiological features supported by histopathologic and immunohistochemical study. The strong CD34 immunoreactivity of this tumor supports its diagnosis. Complete surgical resection is the most important prognostic factor of this tumor.

Solitary fibrous tumor of the orbit

Painless unilateral proptosis is a frequent manifestation of numerous orbital neoplastic and non-neoplastic processes. Various mesenchymal tumors of both fibrohistiocytic and vascular origin are well-described causes. Solitary fibrous tumors (SFTs) are rare spindle-cell neoplasms usually found associated with serosal surfaces, especially the pleura, but they have recently been described in a number of extrapleural sites including the orbit. The authors describe the case of an 18-year-old man who presented with a 6-month history of painless proptosis in the right eye. A visible nontender mass in the right supermedial orbit producing ptosis of the upper lid was present. Magnetic resonance imaging (MRI) showed a well-circumscribed soft tissue mass located above the right globe with no obvious invasion of adjacent orbital structures. Uneventful surgical excision through a right frontal-orbitotomy approach was performed. Histological evaluation showed a solid, highly vascular tumor mass composed of spindle cells arranged in short ill-defined fascicles. Intense immunohistochemistry staining for CD34 and B-cell lymphoma 2 (BCL-2) differentiated the lesion from the more common hemangiopericytoma. Though considered benign, local recurrence and extraorbital extension of orbital SFTs have been described. Malignant behavior, including distant metastases, has been documented in as many as 20% of pleural cases with mortality rates as high as 50%. The natural history of this tumor in the orbit is unclear. The authors report the 35th case of orbital solitary fibrous tumor and discuss the differential diagnosis, histopathology, radiological features, and clinical course.