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Tariq MU, Asghari T, Armstrong SM, Ahmed A, Fritchie K, Din NU. Solitary fibrous tumor of head and neck region; A clinicopathological study of 67 cases emphasizing the diversity of histological features and utility of various risk stratification models. Pathol Res Pract 2023; 249:154777. [PMID: 37639955 DOI: 10.1016/j.prp.2023.154777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 08/17/2023] [Accepted: 08/20/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Head and neck SFT (HNSFT) exhibit diverse histological features and can mimic various neoplasms with different treatment and behavior. While risk stratification systems have been developed for this tumor at various anatomic sites, a specific scheme for head and neck tumors is lacking. Our aim was to describe the histologic patterns present in HNSFT cases as well as assess the utility of risk assessment models in this location. METHODS A retrospective review of pathology reports and microscopy glass slides of HNSFT cases diagnosed between January 2010 and August 2022 was performed.STAT6 was additionally performed on selected cases if needed. Follow up was obtained and various risk stratification models were applied. RESULTS Sixty seven cases of HNSFT were collected (age range from 11 to 87 years; median 42 years; M:F 1.6:1). Most common tumor sites were orbit (n = 21; 31.3 %), sinonasal tract (n = 18; 26.9 %), and oral cavity (n = 13; 19.4 %). Tumor size ranged from 1 to 16 cm (median 4cm). Apart from common histological features, tumor cells also showed focal epithelioid morphology, clear cell change and nuclear atypia in a subset of cases. Stromal findings included myxoid and lipomatous change, pseudoglandular spaces, pseudovascular spaces and multinucleated stromal giant cells. CD34 and STAT6 were expressed in 57/67 (85.1 %) and 56/56 (100 %) cases, respectively. Recurrence was observed in 4/26 (15.4 %) cases, while none (0/22) of the patients experienced distant metastasis (follow up 1-150 months; median 20.5 months). Clinical outcome was partially concordant with risk-categories of different risk stratification models. CONCLUSION Knowledge about histological diversity of HNSFT is essential for establishing correct diagnosis. Current risk stratification models do not perfectly predict outcome, and larger studies are needed to develop more accurate criteria for aggressive behavior.
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Affiliation(s)
- Muhammad Usman Tariq
- Department of Histopathology, Al Hada Armed Forces Hospital, Taif Region, Kingdom of Saudi Arabia.
| | - Tamana Asghari
- Section of Histopathology, Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan.
| | - Susan M Armstrong
- Department of Anatomic Pathology, Cleveland Clinic, Cleveland OH, USA.
| | - Arsalan Ahmed
- Section of Histopathology, Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan.
| | - Karen Fritchie
- Department of Anatomic Pathology, Cleveland Clinic, Cleveland OH, USA.
| | - Nasir Ud Din
- Section of Histopathology, Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan.
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Zhang J, Han S, Zhao Y, Song P, Zhang H, Zhang J, Ding D, Wu Y. A case report of solitary fibrous tumor of the thyroid gland and literature review. Medicine (Baltimore) 2023; 102:e34710. [PMID: 37653837 PMCID: PMC10470733 DOI: 10.1097/md.0000000000034710] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 09/02/2023] Open
Abstract
RATIONALE A solitary fibrous tumor (SFT) is an uncommon soft tissue tumor that was first discovered in the pleura. Although SFTs have been documented in other extra-pleural sites, an SFT in the thyroid gland is highly unusual. An SFT of the thyroid gland can be difficult to diagnose, and there is little information about their Underlying biological behavior. PATIENT CONCERNS We present a case of a 63-year-old man with a progressively growing left-neck mass detected 1 month ago, which was pathologically confirmed to be a benign SFT of the thyroid gland. DIAGNOSIS Postoperative pathological examination of the tumor revealed an SFT. Immunopathological examination was consistent with the diagnosis of an SFT. INTERVENTIONS The patient underwent surgical resection of the SFT. OUTCOMES The patient was recurrence-free during 1.5 years of follow-up. LESSONS Surgical excision is beneficial in SFTs that show no histological signs of malignancy, such as pleomorphism, enhanced mitotic activity, necrosis, bleeding, or capsular invasion. However, because the biologic activity remains unknown, meticulous long-term monitoring is required.
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Affiliation(s)
- Jin Zhang
- Clinical Medical College of Jining Medical University, Jining, People’s Republic of China
| | - Simin Han
- Clinical Medical College of Jining Medical University, Jining, People’s Republic of China
| | - Yufeng Zhao
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Hospital of Jining Medical University, Jining, People’s Republic of China
| | - Panpan Song
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Hospital of Jining Medical University, Jining, People’s Republic of China
| | - Hui Zhang
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Hospital of Jining Medical University, Jining, People’s Republic of China
| | - Jiafu Zhang
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Hospital of Jining Medical University, Jining, People’s Republic of China
| | - Detao Ding
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Hospital of Jining Medical University, Jining, People’s Republic of China
| | - Yungang Wu
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Hospital of Jining Medical University, Jining, People’s Republic of China
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Malignant solitary fibrous tumor of the infratemporal fossa. OTOLARYNGOLOGY CASE REPORTS 2022. [DOI: 10.1016/j.xocr.2022.100481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Solitary fibrous tumors of the head and neck region revisited: a single-institution study of 20 cases and review of the literature. Hum Pathol 2020; 99:1-12. [PMID: 32217090 DOI: 10.1016/j.humpath.2020.03.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 03/07/2020] [Accepted: 03/16/2020] [Indexed: 01/18/2023]
Abstract
A solitary fibrous tumor (SFT) is a rare, NAB2-STAT6 fusion gene-associated mesenchymal neoplasm. It most commonly arises in the pleural site, but it can occur at many other sites, and rarely also in the head and neck (H&N) region. STFs may show many growth patterns and therefore can be easily mistaken for other more common H&N spindle cell or epithelial lesions. In this study, we present our experience in the diagnosis of 20 cases of SFT in the H&N region and discuss their most notable mimickers. In all cases, STAT6 expression was found positive by immunohistochemistry, and the NAB2-STAT6 fusion was confirmed by next-generation sequencing. Three major fusion variants were detected: NAB2ex2-STAT6int1 (5/20, 25%), NAB2ex6-STAT6ex16 (4/20, 20%), and NAB2ex4-STAT6ex2 (3/20, 15%). Clinical follow-up was available for 16 patients (median follow-up time: 84 months). One patient with a morphologically malignant SFT experienced multiple local recurrences, followed by dissemination into the lungs and meninges. This malignant SFT also displayed an aberrant FLI1 expression, which was not previously reported in SFT cases. We also summarize findings from 200 cases of SFT of the H&N region, which included cases from our study, and from previous studies that reported on the fusion status of the STAT6 gene. The results suggest that metastatic disease developed only in cases with STAT6 variants that included the DNA-binding domain (STAT6-full variants), which contradicts expectations from previous reports and deserves further investigation.
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Suh YJ, Park JH, Jeon JH, Bilegsaikhan SE. Extrapleural solitary fibrous tumor of the thyroid gland: A case report and review of literature. World J Clin Cases 2020; 8:782-789. [PMID: 32149061 PMCID: PMC7052546 DOI: 10.12998/wjcc.v8.i4.782] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/13/2020] [Accepted: 01/18/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Solitary fibrous tumor (SFT) is an uncommon mesenchymal neoplasm that arises from the pleura. A few SFTs have also been described in extrapleural sites. However, SFT of the thyroid gland is rare. Here, we report a case of extrapleural SFT on the thyroid gland, in addition to a literature review.
CASE SUMMARY A 59-year-old man visited our hospital in July 2017 complaining of a large mass in his neck. His thyroid function test results, including antibody levels, were within the normal limits. Ultrasonography showed a 4.7 cm × 4.0 cm × 3.2 cm solitary mass of intermediate suspicion in the left thyroid lobe. A fine-needle aspiration biopsy was subsequently performed. The pathologist reported a benign follicular lesion. However, the size of this nodule increased to 5.5 cm × 5.0 cm × 3.4 cm by April 2018. After a multidisciplinary discussion, a left lobectomy was performed in May 2018. The specimen showed a well-demarcated, partly encapsulated, soft nodule of whitish and tan/brown color on the cut surface. Light microscopy revealed high cellularity with moderate cytologic atypia. The mitotic count was 5/10 high-power fields. There was no tumor necrosis or lymphovascular invasion. The tumor was CD34-positive and signal transducer and activator of transcription 6-positive. Neither thyroid transcription factor-1 nor cytokeratin expression was detected. The Ki-67 showed intermediate proliferative activity. The final diagnosis was extrapleural SFT of the thyroid gland with a clear resection margin. The patient was discharged without complication three days after the surgery.
CONCLUSION In the literature, extrapleural SFT of the thyroid gland has been reported to behave indolently with the capacity for recurrence and rare metastasis, although surgical resection is the treatment of choice. Understanding this disease entity is important for accurate diagnosis and proper management.
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Affiliation(s)
- Yong Joon Suh
- Department of Breast and Endocrine Surgery, Hallym University Sacred Heart Hospital, Gyeonggi-do 14068, South Korea
| | - Jung Ho Park
- Department of Breast and Endocrine Surgery, Hallym University Sacred Heart Hospital, Gyeonggi-do 14068, South Korea
| | - Jae Hyeon Jeon
- Department of Biomedical Science, Hallym University, Chuncheon 24252, South Korea
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Thompson LDR, Wei C, Rooper LM, Lau SK. Thyroid Gland Solitary Fibrous Tumor: Report of 3 Cases and a Comprehensive Review of the Literature. Head Neck Pathol 2019; 13:597-605. [PMID: 30758754 PMCID: PMC6854167 DOI: 10.1007/s12105-019-01012-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 01/14/2019] [Indexed: 02/07/2023]
Abstract
Solitary fibrous tumors of the thyroid gland are exceptionally rare. In order to further characterize the clinical and pathologic features of solitary fibrous tumor arising at this anatomic site, three cases of thyroid gland solitary fibrous tumor were analyzed in conjunction with 35 cases compiled from the English literature. Thyroid gland solitary fibrous tumors showed an equal sex distribution with a mean age at presentation of 54.4 years (range, 28-88 years). The patients typically presented with an asymptomatic, slow growing neck mass. 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. Two previous reported tumors were considered to be histologically malignant on the basis of increased mitotic activity, profound pleomorphism and tumor necrosis. Immunohistochemically, the tumor cells are variably positive with CD34, bcl-2, and CD99. STAT6 immunohistochemistry, performed on the current cases, demonstrated a strong, diffuse nuclear expression in all tumors. Among 26 patients with available follow up data (mean 47.3 months), one developed local recurrence and distant metastasis. Solitary fibrous tumors occurring in the thyroid gland are uncommon, but can be reliably diagnosed based on the presence of characteristic morphologic features as well as immunohistochemical expression of STAT6 and CD34. The majority of thyroid gland solitary fibrous tumors have exhibited an indolent clinical course, however experience is limited. The rare potential for aggressive clinical behavior requires clinical surveillance.
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Affiliation(s)
- Lester D. R. Thompson
- Southern California Permanente Medical Group, Department of Pathology, Woodland Hills Medical Center, 5601 De Soto Avenue, Woodland Hills, Los Angeles, CA 91365 US
| | - Christina Wei
- Southern California Permanente Medical Group, Department of Pathology, Woodland Hills Medical Center, 5601 De Soto Avenue, Woodland Hills, Los Angeles, CA 91365 US
| | - Lisa M. Rooper
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD US
| | - Sean K. Lau
- Southern California Permanente Medical Group, Department of Pathology, Orange County-Anaheim Medical Center, Anaheim, CA US
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Ghasemi-Rad M, Wang KY, Jain S, Lincoln CM. Solitary fibrous tumor of thyroid: a case report with review of literature. Clin Imaging 2018; 53:105-107. [PMID: 30317135 DOI: 10.1016/j.clinimag.2018.09.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 09/13/2018] [Accepted: 09/17/2018] [Indexed: 12/17/2022]
Abstract
Solitary fibrous tumors are rare spindle cell tumors of mesenchymal origin most commonly found in the pleura and peritoneum. In contrast, extra-serosal locations are rare. We present a 41-year-old female with a progressively enlarging left-sided neck mass of one-year duration with subsequent rapid-onset growth over two months, and was pathologically confirmed to be a benign solitary fibrous tumor of the thyroid gland.
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Affiliation(s)
| | - Kevin Yuqi Wang
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Shilpa Jain
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA
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