Solitary fibrous tumor of the orbit. Case report and review of the literature

A giant orbital solitary fibrous tumor treated by surgical excision: a case report and literature review

BACKGROUND

Spindle cell tumors, called solitary fibrous tumors (SFTs), are of mesenchymal origin, and can develop in the orbit. As 'intermediate malignancy' tumors, only a small percentage show malignant behavior, such as invasion of surrounding tissue.

CASE PRESENTATION

A 57-year-old woman presented with a 19-year history of a giant right orbital mass. Orbital computed tomography (CT) revealed an inhomogeneously-enhancing mass compressing and engulfing the eyeball and optic nerve. She underwent lid-sparing orbital exenteration. Microscopic characteristics and immunohistochemistry (IHC) tests were indicative of a benign SFT. No recurrence was observed at the 4-year follow-up.

CONCLUSION

Early and complete tumor resection is recommended.

Solitary Fibrous Tumor of the Orbit: A Case Series With Clinicopathologic Correlation and Evaluation of STAT6 as a Diagnostic Marker

PURPOSE

To retrospectively describe the clinical characteristics, management, and outcomes of a series of patients with solitary fibrous tumor (SFT) of the orbit and to evaluate signal transducer and activator of transcription 6 (STAT6) as a diagnostic marker.

METHODS

Review of a retrospective, noncomparative, consecutive series of patients treated at a single institution with a histopathologic diagnosis of SFT. Demographic, clinical, and imaging data were collected, and paraffin-embedded tissue sections were stained to evaluate for the presence of STAT6 and other pertinent markers.

RESULTS

Twenty-one patients were identified. Most presented with painless progressive proptosis or eyelid swelling for less than 6 months. Imaging revealed well-circumscribed, firm, variably vascular contrast-enhancing lesions with low to medium reflectivity on ultrasound. Four tumors were histopathologically malignant. All tumors were primarily excised, and 1 patient required exenteration. Two patients were treated with adjuvant radiation therapy. Six patients had recurrent disease of which 3 underwent repeat excision, and 2 were observed. No metastatic disease or attributable deaths were observed. All lesions with available tissue stained positively for both CD34 and STAT6.

CONCLUSION

This is the largest single institution case series of orbital SFT with clinicopathologic correlation and the largest series to confirm the presence of STAT6 in orbital lesions. The management of SFT remains challenging due to unpredictable tumor behavior, and complete excision is the generally recommended treatment. It remains unclear whether a subset of asymptomatic patients with histopathologically benign disease can be durably observed without negative sequelae.

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 painless mass after a dacryochystorhinostomy

The solitary fibrous tumor (STF) is a rare spindle cell tumor that most often occurs in the pleura, mediastinum and other serosal sites, but it can be found anywhere. The authors present a case report of a 35-year-old male who was submitted to an eventless left external dacryocystorhinostomy (DCR) due to epiphora. During the surgery no tumors or anomalous tissues were visualized. Five months later the patient presented a painless mass at the lower medial quadrant of the left orbit, near the lacrimal fossa. A computed tomography, a magnetic resonance imaging and an orbital ultrasound were performed. A round, very vascularized and highly contrast enhanced mass was found. An anterior orbitotomy was done. Histological aspects and immunohistochemical markers were consistent with STF. The tumor was not visualized during the DCR. The authors think that the growth of the tumor and the weakening of the tissues in the medial canthus after the DCR allowed the tumor to move anteriorly within the orbit.

Solitary fibrous tumour of lacrimal gland: a rare entity

Solitary fibrous tumour (SFT) is a rare spindle cell tumour of mesenchymal origin most commonly encountered in pleura. It can affect the orbital region but SFT of lacrimal gland is rare. We hereby report of a SFT of lacrimal gland in a 50-year-old male presenting with slow growing swelling in left superolateral orbital region. The preliminary fine needle aspiration cytology (FNAC) could not reveal any definite diagnosis. Excision biopsy and immunohistochemistry (IHC) confirmed the diagnosis. Therefore, clinician and pathologist should be aware of this entity and biopsy along with IHC is required to rule out other entities which can mimic it clinically and histopathologically.

Ocular adnexal (orbital) solitary fibrous tumor: nuclear STAT6 expression and literature review

PURPOSE

To report the clinico-pathological features of solitary fibrous tumor occurring in the ocular adnexa (OA) in a single center. To assess the presence of NAB2-STAT6 genes fusion in OA solitary fibrous tumor detected by nuclear overexpression of STAT6.

METHODS

Retrospective study including orbital and OA solitary fibrous tumors treated between 2006 and 2014 in our center. The clinical, radiological, and histopathological findings were evaluated. STAT6 expression was assessed by immunohistochemistry.

RESULTS

Five patients were identified and presented with a chronic OA mass. The tumors were radiologically well delimited, highly vascularized and without bone erosion. All the patients underwent complete surgical excision. Pathological examination confirmed solitary fibrous tumor in all cases. All tumors demonstrated a nuclear expression of STAT6. There were no recurrences, with a mean follow-up of 5 years after surgery. Our review demonstrated that proptosis was the most common presentation occurring in 60 % of the cases. In the ocular adnexa, adverse histological criteria were found in 19.7 % of the tumors, and recurrences were observed in 48 % of these cases. Thirty-six percent of patients presented at least one local recurrence, and metastastic spread was found in 2.4 % of the cases. Tumor-related death was described in two cases.

CONCLUSION

Ocular adnexal SFT are rare and usually present as a chronic orbital mass with proptosis. In the OA, solitary fibrous tumor demonstrates STAT6 nuclear expression, as documented in other locations. Recurrences are unusual and metastasis exceptional. Initial surgical resection should be complete in order to avoid recurrence.

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.

MRI study of solitary fibrous tumor in the orbit

OBJECTIVE

Solitary fibrous tumor (SFT) is a rare lesion of the orbit. The purpose of this study is to determine the MRI features of orbital SFTs.

MATERIALS AND METHODS

We retrospectively reviewed 15 patients with histopathologically proven orbital SFTs. All patients underwent orbital MRI. The location, size, shape, margin, and MRI signal of 15 lesions were reviewed. The time-intensity curve (TIC) of dynamic contrast-enhanced MRI in 14 patients and diffusion-weighted imaging in four patients were also analyzed.

RESULTS

Ten orbital SFTs were located in the extraconal space (seven at the superior aspect and three at the lateral aspect), three in the retrobulbar intraconal space, one in the superomedial aspect of the intraconal space, and one in the lacrimal sac region. All SFTs appeared ovoid in configuration and had well-defined margins. The mean maximum diameter was 30.2 mm (range, 15-56 mm). Fourteen SFTs appeared homogeneously isointense to gray matter on T1-weighted images. On T2-weighted images, the lesions showed heterogeneous isointensity in nine patients and hypointensity in five patients. The lesions showed heterogeneous marked enhancement on contrast-enhanced MRI. Streaky high-signal-intensity areas on T2-weighted images with marked enhancement were observed in nine patients. Flow-void signal was identified in six patients. The TICs of 14 patients showed a washout pattern. The contrast index was 1.61±0.42, the time to peak enhancement was 34.15±14.04 seconds, and the washout ratio was 37.32%±14.37%. The mean apparent diffusion coefficient value of four patients was 1.28±0.23×10(-3) mm2/s. Another case exhibited multicystic appearance.

CONCLUSION

Isointense or hypointense signal on T2-weighted images, marked enhancement, and a washout TIC pattern are the characteristic MRI features of orbital SFTs.

Cancer of the orbit and adnexa

The diagnosis and treatment of orbital and periorbital malignancies are challenging. These tumors can result in blindness, death, and significant cosmetic deformities. Herein, we present the most common ocular malignancies and a systematic approach to diagnosis. Further, we integrate the seventh edition American Joint Committee on Cancer staging system, biomarkers, and multidisciplinary approaches to treatment.

Tuberculosis: an extremely unusual cause of orbital wall erosion

We present the case report of a 10-year-old girl who presented to us with a painless swelling involving the left infraorbital region. The swelling was diagnosed to be tubercular in origin with erosion of the zygomatic, maxillary and frontal bones constituting the inferior and lateral walls of the left orbit. The patient responded well to antitubercular chemotherapy. A discussion of the case and a literature review of causes of orbital erosion is presented.

Orbital solitary fibrous tumor. Another rare case from Africa

Solitary fibrous tumor (SFT) of the orbit, initially thought to be rare, is being increasingly documented in the medical literature. We here present the case of a 37-year-old Nigerian man who presented with left sided painless, vision-sparing proptosis. Cranial computed tomography scan showed a globular, left medial, orbital extraconal mass. The mass was excised, en bloc, via a medial orbitotomy procedure aided by left ethmoidectomy. Surgery was uncomplicated and histology of the excised tissue was reported as compatible with SFT. There was also a strong and diffuse immunostaining with CD 34. At 6-month follow-up, the left-sided proptosis has completely regressed. To the best of our knowledge, this is the second case of orbital SFT to be reported in an African.

Orbital solitary fibrous tumor : a case report and diagnostic clues

Orbital solitary fibrous tumor (SFT) is a rare tumor originating from the mesenchyme. We describe the clinical presentations, radiological and operative findings, and pathological features of a patient with orbital SFT. The patient was a 46-year-old female who presented with progressive proptosis advanced for 20 months. On ophthalmological examination, no visual impairment was detected, but left eye was found to be obviously protruded on exophthalmometry. Orbital magnetic resonance imaging showed a 2.5 x 2 x 2 cm, intensely enhanced mass in the left orbit, which compressed the eyeball forward and the optic nerve downward. The patient underwent frontal craniotomy with superior orbitotomy and gross total resection was performed for the tumor. The histopathological diagnosis including immunohistochemistry was a SFT. After the surgery, proptosis was markedly relieved without visual impairment. Although orbital SFT is extremely rare, it should be considered in the differential diagnosis of orbital tumors. Clinical presentations such as painless proptosis and CD34 immunoreactivity play a significant role in differentiating orbital SFT from other spindle-cell neoplasms of the orbit.

Solitary fibrous tumor of the orbit: a case series

PURPOSE

Solitary fibrous tumor (SFT) occurs rarely in the orbit. We present four such cases, representing one of the largest case series reported to date of this rare orbital tumor.

METHOD

The four patients ranged from ages 20 to 50, all of whom presented with lid swelling or bulging in the involved eye. All four patients underwent CT scan to confirm the diagnosis of an orbital mass, which was then excised.

RESULTS

The tumors of all four specimens contained spindle-shaped cells with bland nuclei and rare mitotic figures. They all stained positively with CD34 and vimentin. Resection margins were positive in two of the four cases. One of these cases demonstrated residual tumor on follow-up CT scan, which remained unchanged at one-year follow-up. No evidence of residual tumor was found in the other three cases, despite one having malignant pathology.

CONCLUSION

SFT is a rare and generally benign tumor of the orbit. Immunohistochemical testing with CD34 is necessary to confirm the diagnosis. Although en bloc tumor resection is the definitive treatment, residual tumor may remain stable for some time. However, this must be followed closely if complete resection is not carried out.

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.

Nasal solitary fibrous tumor arising from the anterior cranial fossa

The solitary fibrous tumor (SFT) is a mesenchymal, spindle cell neoplasm that was originally found in pleural tissue. Recently, however, numerous extrapleural sites have been discovered, including the nasal cavity. We present the 15th case of a nasal SFT, and the first such tumor to arise from the cribriform plate and extend into the anterior cranial fossa. In addition to highlighting the aggressive nature of this tumor, we review its clinical features and the diagnostic difficulties posed by SFT.

Solitary fibrous tumor arising in the sphenoethmoidal recess: a case report and review of the literature

Recently, solitary fibrous tumors (SFTs) have been reported in the head and neck area, such as the nasal cavity, thyroid, salivary gland, etc. We present a rare case of SFT which arose from the sphenoethmoidal recess of the nasal cavity, penetrating into the sphenoid sinus, and which showed different intensities on magnetic resonance imaging (MRI) according to the occupied locations. T2 weighted magnetic resonance (MR) images showed low intensity in the nasal cavity, and iso-intensity in the sphenoid sinus. Enhancement with gadolinium contrast on T1-weighted images was more remarkable in the sphenoid sinus than in the nasal cavity. While the tumor in the nasal cavity showed abundant collagen and high cellularity in microscopic examination, numerous small vessels and dilated vascular spaces were remarkable in the tumor of the sphenoid sinus. MRI findings corresponded to pathological findings. We review SFTs in the head and neck area in the English literature.

Autogenous orbital reconstruction in a child with congenital abnormalities of the orbital roof and vertical orbital dystopia

Congenital anomalies of the orbital roof are rare occurrences. The case of a 2-year-old child with vertical orbital dystopia and abnormalities of the right bony orbit is presented. The patient underwent right orbital reconstruction to restore facial symmetry. A coronal approach with a frontal craniotomy was used for intracranial exposure. The abnormal angulation of the roof was corrected, and the defect was reconstructed with a split-calvarial bone graft harvested from the parietal region. The bone graft was secured with resorbable plate fixation. To preserve vision, reconstruction of this type must be done at an early age, preferably before the age of 4 years. In this patient, there is good facial symmetry and normal globe positioning 5 years after surgery.

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.

Metastatic malignant solitary fibrous tumour to the infra-temporal fossa

Malignant solitary fibrous tumours (MSFTs) are rare tumours of fibrous origin, which can occur at all anatomical sites and represent 20% of solitary fibrous tumours. Fine-needle aspiration cytology is not able to distinguish benign from malignant disease, and sufficient tissue has to be obtained for accurate histological diagnosis to be made. Lesions > 10 cm in diameter and incomplete resection or non-resectability are predictive factors for poor long-term survival. We present a 57-year-old patient with a presumably metastatic MSFT from the peritoneal cavity to the skull-base who is in a stable state 17 months after surgical debulking of the skull-base and removal of the peritoneal lesion, followed by post-operative chemotherapy. We suggest the terminology metastatic malignant solitary fibrous tumour for a description of this disease.

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.