Large solitary fibrous tumor of the seminal vesicle

Incidental solitary fibrous tumor involving the seminal vesicle: A case report

Solitary fibrous tumors are rare mesenchymal neoplasms that can range from slow-growing to aggressive tumors. This report presents a unique case of a young male patient with a solitary fibrous tumor involving the seminal vesicle, a rare location, and reinforces incidental discovery of these tumors on imaging and physical exams. Detection of these tumors is imperative to identify and treat malignancy. In our case, a 39-year-old previously healthy Asian male presents to the emergency department as a trauma admission post bicycle crash and is incidentally found to have a pelvic mass on computed tomography imaging of the pelvis. The patient underwent trans-anal biopsy which showed spindle epithelioid cells positive for CD34 and STAT6 markers, with a morphological and immunohistochemical profile consistent with a solitary fibrous tumor. The patient underwent surgery with a robotic-assisted laparoscopic pelvic mass resection and now follows up annually with imaging for observation.

Solitary Fibrous Tumor of the Seminal Vesicle: A Systematic Literature Review and Case Presentation

BACKGROUND/AIM

Solitary fibrous tumors (SFTs) are ubiquitous mesenchymal neoplasms that have an unpredictable biological behavior. Histological criteria for this type of malignancy are uncertain. Clinical characteristics, diagnostic and treatment options of SFTs originating in the seminal vesicle are presented in this review article.

MATERIALS AND METHODS

A systematic review including the following databases: Scopus, Embase and Medline from 1960 until the end of March 2021 was performed according to the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines.

RESULTS

We found seven patients affected with SFTs of seminal vesicle, in which we added our own case, making a total of 8 patients. Mean age at presentation was 55±7 years. Mean size of the SFTs was 9±2 cm and the right seminal vesicle was preferentially involved. The majority of patients were symptomatic and presenting symptoms were hematuria, dysuria, hematospermia, urinary increased frequency and urgency. Abdominal ultrasonography, computed tomography (CT) scan, and magnetic resonance (MRI) were the diagnostic tools. Trans-rectal ultrasound-guided core biopsy was also used. Seven (87%) patients had open surgery. Adjuvant radiotherapy after R0 resection was used in 1 patient.

CONCLUSION

The treatment of SFTs located in the seminal vesicle necessitates a radical surgical resection to obtain acceptable results in terms of local recurrence and distant metastases.

Localized giant solitary fibrous tumor of the scrotum: a rare case report and literature review

Background

A solitary fibrous tumor (SFT) is a fibroblastic mesenchymal tumor initially thought to originate from the pleura but that may arise at almost any anatomic site. It is mostly benign, and surgical resection is usually the best treatment option. An SFT involving the scrotum is extremely rare. Case presentation: We herein report an uncommon case of a 22-year-old man who presented with a huge asymptomatic scrotal mass that had begun growing 3 years before presentation. Contrast-enhanced computed tomography revealed a heterogeneous, well-circumscribed scrotal mass with soft tissue density. No invasion of the surrounding organs, distal metastasis, or lymph node swelling was present. Complete resection of the mass was successfully performed. The specimen was a 14.5 × 12.0 × 9.5 cm encapsulated tumor that weighed 970 g. After pathological analysis, we confirmed the diagnosis of SFT. This diagnosis was based on clinical findings, histological morphology, and immunohistochemistry. No recurrence or metastasis was observed during a 3-year follow-up.

Conclusion

SFTs have an unpredictable clinical course, and they are difficult to diagnose and easy to misdiagnose. A scrotal location is extremely rare. Complete resection of the mass is the treatment of choice and is associated with a high success rate and low recurrence rate.

Solitary fibrous tumor of the spermatic cord: A case report and literature review

A 31-year-old male patient with a six-year history of left inguinoscrotal swelling was admitted to the Second Xiangya Hospital (Changsha, China). The mass was not found to be associated with intraperitoneal pressure. Ultrasonography and computed tomography examinations demonstrated several solid, botryoidal masses involving the spermatic cord, with limited capacity of mobility. The demarcation between the masses and the left testicle was clear; thus, the masses were removed by a left spermatic cord tumor resection via a left inguinal approach, under epidural anesthesia. Positive staining of the tumor markers, CD34⁺, CD99⁺ and Bcl-2⁺, was confirmed by pathological examination following surgery, and a solitary fibrous tumor of the spermatic cord was diagnosed. No recurrence and metastasis were observed in the patient during the subsequent 25-month follow-up period.

Radiology-pathology conference: malignant solitary fibrous tumor of the seminal vesicle

Mesenchymal neoplasms are rarely encountered in the seminal vesicle. Only four cases of the seminal vesicle solitary fibrous tumor have been reported in English literature, all of which were benign in nature. We are describing the clinicoradiological and pathological features of a locally aggressive malignant solitary fibrous tumor arising from the seminal vesicle, which posed the therapeutic challenge for the surgical management in a 52-year-old male patient. To our knowledge, this is the first reported case of the malignant solitary fibrous tumor arising from the seminal vesicle.

Somatic and visceral solitary fibrous tumors in the abdomen and pelvis: cross-sectional imaging spectrum

Solitary fibrous tumors (SFTs) are a unique group of mesenchymal neoplasms of fibroblastic or myofibroblastic origin. These tumors were originally described as "benign fibrous mesotheliomas" of the pleural cavity and were erroneously thought to be confined to the serosal surfaces (due to a putative mesothelial or submesothelial origin). It is now established that SFTs are ubiquitous neoplasms with both pleural and extrapleural distribution. Extrapleural SFTs commonly occur in middle-aged adults and manifest as asymptomatic, slow-growing, large tumors. Fewer than 5% of patients with SFTs present with symptomatic hypoglycemia. SFTs are histopathologically diverse with a variable admixture of fibroblasts or myofibroblasts, numerous thin-walled vessels, and dense fibrosis. Tumors previously categorized as hemangiopericytomas are now considered cellular variants of SFTs. At imaging, SFTs demonstrate remarkable heterogeneity, with variable degrees of enhancement, necrosis, or hemorrhage. Although most extrapleural SFTs have a benign clinical course, 10%-15% of these tumors demonstrate aggressive behavior in the form of recurrence or malignancy.

Imaging appearance of solitary fibrous tumor of the abdominopelvic cavity

The computed tomographic or magnetic resonance imaging appearance of solitary fibrous tumors of the abdominopelvic cavity has previously only been presented in the English literature as individual case reports. In this article, we present the cross-sectional imaging appearance of 5 such cases, all of which exhibited highly similar imaging features, including well-circumscribed margins, lack of invasion of adjacent structures, and avid enhancement. In view of these shared imaging features, it may be possible to suggest the diagnosis preoperatively. Given their unpredictable biologic behavior with infrequent reports of recurrent or metastatic disease, complete surgical excision and long-term follow-up for these lesions is recommended.

Primary myxoid solitary fibrous tumor involving the seminal vesicle

Although focal myxoid change is a well-recognized feature of solitary fibrous tumor (SFT), predominantly myxoid SFT are exceedingly rare. Reported herein is the case of a 65-year-old man with SFT containing abundant myxoid matrix, arising from the capsule of the right seminal vesicle. To the authors' knowledge this is the first myxoid SFT involving the male genito-urinary system. Recognition of the myxoid variant of SFT is crucial, given possible confusion with a variety of myxoid spindle cell neoplasms with different biological potential in the pelvic cavity.