Impact of (18)F-FDG PET/CT imaging in therapeutic decisions for malignant solitary fibrous tumor of the pelvis

Transcatheter arterial embolization of malignant pelvic solitary fibrous tumor: case report and literature review

Pelvic malignant solitary fibrous tumor (SFT) is a relatively rare disease, and literature on radical resection with transcatheter arterial embolization of pelvic SFT is lacking. In this work, we report on a 55-year-old man with a presacral mass who was hospitalized at our department. Computed tomography and magnetic resonance imaging indicated pelvic space-occupying lesions that were 12 cm × 10 cm in size and pelvic lesions that were not clearly demarcated from the right posterior wall of the bladder and the right ureter. This result suggested severe secondary hydronephrosis of the right renal pelvis. The patient underwent transcatheter iliac arterial embolization. Radical tumor resection was performed, and the results of pathological examination confirmed the diagnosis of malignant pelvic SFT. There was no SFT recurrence in this patient at 1-year follow-up. Herein, we report on the treatment of a patient with malignant pelvic SFT, a rare condition, who underwent successful radical resection after transcatheter arterial embolization. Transcatheter arterial embolization can block the blood supply of the SFT as much as possible and improve the possibility of tumor resection. In the future, pelvic SFTs can be considered improving the resection rate by transcatheter arterial embolization before surgery.

A Rare Case of Metastatic Solitary Fibrous Tumor (Hemangiopericytoma) of the Dura on 18F-FDG PET/CT

ABSTRACT

Solitary fibrous tumor is a rare neoplasm of mesenchymal origin. It can arise in various locations, most commonly in the pleura. It encompasses a heterogeneous group of histological patterns with different biological behavior. In some cases, metastases occur, sometimes years after the initial diagnosis. We report a case of metastatic meningeal hemangiopericytoma, also called solitary fibrous tumor of the dura, exhibiting liver metastases and muscle metastases 5 years after resection and adjuvant radiotherapy of the primary tumor.

Solitary fibrous tumor: molecular hallmarks and treatment for a rare sarcoma

Solitary fibrous tumor (SFT) is a rare soft tissue sarcoma subtype which mainly affects adults in the fifth and sixth decades of life. Originally part of a spectrum of tumors called hemangiopericytomas, classification has been refined such that SFTs now represent a distinct subtype. The identification of NAB2-STAT6 fusion in virtually all SFTs has further aided to define this rare subgroup. SFTs have a spectrum of behavior from benign to malignant, with evidence suggesting risk of metastases related to age at diagnosis, extent of necrosis, mitotic rate and tumor size. The standard treatment for localized disease is surgical excision with or without radiotherapy. Retrospective and prospective evidence suggests antiangiogenic treatment is effective for unresectable disease. Further translational work is required to understand the biology driving the differential behavior and identify more effective treatments for patients with metastatic disease.

Solitary fibrous tumor with atypical features of the paravesical space: benign clinical course at the 10-years follow-up. Report of a case and review of the literature

Extra-pleural solitary fibrous tumor (SFT) is a relatively rare soft tissue neoplasm, with only rare cases reported in the pelvic cavity. Most SFTs are histologically benign, with only a few malignant cases reported in the literature so far. We report a rare case of SFT arising in the paravesical space of a 79-year-old man. Histologically the tumor corresponds to an “intermediate risk tumor” according to a risk stratification scheme for metastatic potential, which incorporates patient age, tumor size, mitotic activity and necrosis. Notably tumor showed a benign clinical course without evidence of local recurrence after a 10-years follow-up. Tumor was composed of both spindle and epithelioid cells variably set in a fibro-myxoid stroma, with focal pleomorphic, necrotic and highly mitotic (> 4 mitoses/10HPF) areas. Immunohistochemistry, showing a diffuse CD34 and STAT6 immunoreactivity, supported the diagnosis of SFT. The present case emphasizes that the clinical course of the pelvic SFTs with atypical morphological features is unpredictable on the basis of morphology alone, and thus the term “SFT with atypical features, including the risk stratification class” should be preferred to “malignant SFT”.

Salvage preoperative embolization of an infratemporal solitary fibrous tumor: A case report with review of the literature

RATIONALE

Head and Neck Solitary fibrous tumors (SFT) are very rare. They could be misdiagnosed as hemangiopericytomas (HPC).

PATIENT CONCERNS

We report a 60 y o lady presenting with sinonasal mass, causing recurrent profuse bleeding.

DIAGNOSES

Hemangioperocytomas versus SFT were among the differentials, according to Radiological studies. Upon Biopsy, the diagnosis of SFT has been adopted.

INTERVENTIONS

Salvage pre-operative embolization resulted in bleeding control, bridging the patient to surgery.

OUTCOMES

Post-operative course was uneventful, and patient symptoms resolved.

LESSONS

This is the first case report of a sinonasal SFT, where pre-operative embolization has been employed as a salvage procedure. This treatment modality is promising, since it controls bleeding, bridges patient to surgery and decreases blood loss during the surgical procedure.

Primary intrapulmonary solitary fibrous tumours

Due to the extreme rarity of primary intrapulmonary solitary fibrous tumours (SFTs), their clinical course, imaging characteristics, diagnosis, treatment and prognosis are poorly understood. The present study therefore assessed the diagnosis and management of primary intrapulmonary SFTs and systematically reviewed previously reported cases in the literature. A total of 5 patients who underwent resection for primary intrapulmonary SFTs were enrolled in the present study and their clinical course, tumour characteristics, management and survival were assessed in this retrospective study. Relevant studies regarding primary intrapulmonary SFTs were searched using PubMed and tumour characteristics, clinicopathologic features, therapeutic strategy and survival outcomes were reviewed. Of the 5 cases, all were males, with a mean age of 57.6 years (range, 37-68 years). All patients were asymptomatic and were identified incidentally on routine computed tomography examination. A total of 3 patients underwent thoracotomy and 2 patients underwent video-assisted thoracoscopic surgery. All tumours were completely resected. Postoperative haemorrhage occurred in 1 patient and he received surgical intervention for haemostasis. The average hospital stay was 15 (4-22) days, and no mortality occurred. The mean length of the postoperative follow-up was 37.6 (1-67) months. One patient was lost to follow-up, and 4 patients were asymptomatic. A total of 19 studies were identified from database searches. They included a total of 45 patients: Twenty-three males and 22 females (mean age, 59.4 years; range, 7-81 years). A total of 12 patients were asymptomatic, and pain and coughing were the major symptoms. Five, one, two, four, and 17 tumours occurred in the right upper lobe, right middle lobe, right lower lobe, left upper lobe and left lower lobe, respectively. A total of 39 patients underwent surgery, 1 patient underwent radiotherapy, and 1 patient underwent radiofrequency ablation. A total of 22 patients were followed up and the mean length of the postoperative follow-up was 48 (1-168) months. One patient was diagnosed with chest wall metastases, and 5 patients succumbed to mortality. To conclude, primary intrapulmonary SFTs are extremely rare and typically identified incidentally. The present findings indicated that the left lower lobe was the most common site location and complete surgical resection is a safe and effective treatment.