Rare invasive inflammatory fibroid polyp presenting as small bowel intussusception: Two case reports and review of the literature

RATIONALE

Inflammatory fibroid polyp (IFP) is a rare benign neoplasm of uncertain etiology and mostly occurs in the stomach, emerging from the submucosal layers. Intussusception causing bowel obstruction due to IFP is even rare. We present 2 cases of IFP in adults, which caused small bowel intussusception and broke through the submucosa uncommonly.

PATIENT CONCERNS

This article reports 2 patients presenting with abdominal pain. One patient was an 81-year-old Chinese man, who presented with a 7-day history of intermittent left abdominal pain. The other patient was a 49-year-old Chinese woman with a 5-day history of intermittent lower abdominal distension pain. Their abdominal computed tomography both demonstrated small bowel intussusception.

DIAGNOSES

The 2 patients were diagnosed with small bowel intussusception.

INTERVENTIONS

Both patients underwent surgical resection of a segment of the small intestine. During the old man's operation, a 2.5 cm × 3.5 cm polypoid tumor was found in the jejunum, at a distance of 60 cm from the ligament of Treitz. During the women's operation, a 3.6 × 3.7 cm polypoid lesion was found in the ileum, which protruded into, and completely occluded the lumen.

OUTCOMES

The 2 patients had an uneventful recovery, being discharged about 1 week postoperatively without any postoperative complications. Morphologically, the old man's intraluminal intestinal mass had invaded muscularis propria, and was negative for CD34 immunohistochemically, creating difficulties in diagnosing IFP. The woman's intraluminal intestinal mass had infiltrated into the serosal layer. Ultimately, the pathological diagnosis for both patients was IFP.

LESSONS

We described 2 rare cases of small bowel intussusception caused by IFP. IFP commonly involves only the submucosa, rarely breaks through the submucosa, and invades the muscularis propria and subserosa layer. Its invasive nature is extremely rare and may provide additional evidence to support the neoplastic nature of IFP. Besides, a differential diagnosis is essential When an IFP is negative for CD34 expression.

A Woman With Persistent Abdominal Pain in the Setting of a Solitary Fibrous Adrenal Tumor

Background/Objective

We present a case of a woman with persistent abdominal pain, leading to the discovery of a rare solitary fibrous tumor (SFT) in the adrenal gland. The rarity of adrenal SFTs and their diagnostic challenges make this case noteworthy. The objective of this report is to describe a patient with an adrenal SFT, highlighting the unique diagnostic approach and management considerations for this rare condition.

Case Report

A 35-year-old woman presented with chronic abdominal pain and was referred to the endocrinology clinic for evaluation of an adrenal incidentaloma. Computed tomography imaging revealed a 4 cm homogeneous right adrenal mass, with precontrast Hounsfield units of 1 and an absolute contrast washout of 60%. A prior computed tomography scan from 6 years earlier showed a 1.5 cm adenoma with similar characteristics. Despite normal hormonal levels, the tumor's growth and the patient's symptoms prompted surgical referral. The patient underwent robotic-assisted laparoscopic right adrenalectomy. Pathological examination identified a well-circumscribed SFT, measuring 3.7 × 3.6 × 2.9 cm.

Discussion

Adrenal SFTs are rare, typically hormonally inactive, well-circumscribed masses that often present with abdominal pain. While more common in the pleura, adrenal SFTs can mimic other benign adrenal lesions on imaging, complicating diagnosis. Histopathology is essential for accurate diagnosis, and surgical resection remains the main treatment.

Conclusion

This case highlights the diagnostic challenges of adrenal SFTs, which can mimic other benign lesions. Despite significant growth, the tumor was histologically benign with low malignancy risk. Clinicians should consider adrenal SFTs in the differential diagnosis of incidental adrenal masses with atypical imaging features.

Application and effect evaluation of microsurgical resection combined with intensity-modulated radiation therapy in the treatment of intracranial solitary fibrous tumor/hemangiopericytoma

Intracranial solitary fibrous tumor (SFT) and hemangiopericytoma (HPC) are rare mesenchymal tumors with significant vascularization, often misdiagnosed as meningiomas. Surgical resection is the primary treatment, with postoperative radiotherapy increasingly recognized for its role in improving recurrence-free survival. However, standard radiotherapy regimens remain undefined. We retrospectively analyzed clinical data from 12 patients diagnosed with SFT/HPC who underwent surgical resection and postoperative intensity-modulated radiotherapy. Clinical information, imaging findings, treatment methods, and outcomes were reviewed. Surgical resection achieved complete or subtotal tumor removal in all cases. Postoperative radiotherapy was administered to 8 patients. During follow-up, 3 patients experienced tumor recurrence, necessitating reoperation, while 1 patient died due to complications. Those who received radiotherapy showed a trend towards reduced recurrence. Surgical resection remains the cornerstone of SFT/HPC treatment, with adjuvant radiotherapy potentially improving outcomes. However, individualized treatment strategies and long-term follow-up are crucial due to the tumor's propensity for recurrence. Further research is needed to optimize treatment approaches and enhance patient survival and quality of life.

A rare case of dedifferentiated intracranial solitary fibrous tumor with chondrosarcomatous differentiation

This report details a rare case of a 30-year-old female presenting with neurological symptoms, including headaches, seizures, and left-sided weakness. Imaging revealed a mass in the right parafalcine region of her brain. Surgical resection identified a tumor with two distinct components. The first component exhibited characteristics of a classic solitary fibrous tumor (SFT) with typical fibroblastic cells and branching blood vessels. The second component showed high-grade sarcoma with chondrosarcomatous differentiation, a rare feature in SFT. Immunohistochemistry confirmed dedifferentiation with decreased STAT6 expression in the sarcomatous areas compared to the conventional SFT. This case highlights the challenges of managing dedifferentiated SFTs, especially in the brain, where surgical limitations increase risks. Despite the rarity of this presentation, it emphasizes the importance of recognizing this variant for appropriate diagnosis and management.

Intracranial solitary fibrous tumour with rhabdomyosarcomatous differentiation: A diagnostic challenge of a rare presentation

INTRODUCTION AND IMPORTANCE

Solitary fibrous tumors (SFTs) are rare mesenchymal neoplasms, initially described in the pleura but capable of arising in various anatomical locations, including the central nervous system. Dedifferentiation, characterized by the transformation of a low-grade tumor into a high-grade sarcoma, is an uncommon phenomenon in SFTs, especially in the intracranial region.

CASE PRESENTATION

A 31-year-old male visited the neurology outpatient department with complaints of frequent headaches, seizures, speech difficulties, and weakness on the left side of his body. MRI was done which showed a relatively well defined T1 isointense and T2 hypointense extra-axial mass lesion in the right frontal lobe. Histopathological analysis confirmed the diagnosis of dedifferentiated SFT, marked by distinct fibroblastic differentiation and areas of high-grade sarcomatous transformation (rhabdomyosarcoma). Immunohistochemically, areas with fibroblastic differentiation showed strong and diffuse positivity for CD99, STAT6, vimentin and focal BCL-2 High-grade sarcomatous area was positive for vimentin, desmin and Myo-D1 and was negative for GFAP, EMA, PR, S-100, SMA and CD-34. It also showed focal positivity for STAT-6. The final diagnosis of intracranial solitary fibrous tumor with rhabdomyosarcomatous differentiation was made. At 2 months of follow-up, the patient is doing well.

CLINICAL DISCUSSION

Given the rarity of dedifferentiation in intracranial SFTs, there is limited consensus on optimal management strategies. En bloc resection remains the primary treatment approach, though the unpredictable behaviour of dedifferentiated SFTs complicates prognosis. This case underscores the importance of integrating clinical, radiological, and pathological findings for accurate diagnosis and discusses the need for further research into effective therapeutic options for dedifferentiated SFTs, particularly in challenging intracranial cases.

CONCLUSION

This case report presents a unique instance of an intracranial dedifferentiated SFT with rhabdomyosarcomatous dedifferentiation, highlighting the significant diagnostic challenges posed by this rare entity.

Solitary fibrous tumor of the gallbladder: a case report

BACKGROUND

Primary solitary fibrous tumors (SFTs) of the gallbladder are rare. Here, we report the case of a patient who underwent surgical treatment for a primary SFT originating in the gallbladder.

CASE PRESENTATION

A 48-mm gallbladder tumor was detected in a 70-year-old man using abdominal ultrasonography at a primary hospital, and he was subsequently referred to our department. A 50-mm enhanced tumor in the gallbladder was identified using computed tomography. Magnetic resonance imaging revealed a smooth-marginated tumor with hyperintensity on T2-weighted imaging. 18F-Fluorodeoxyglucose positron emission tomography confirmed high-level fluorodeoxyglucose uptake in the gallbladder tumor in the early phase without increasing uptake in the later phase. Surgical resection was planned to evaluate the tumor diagnosis. Initially, we performed open cholecystectomy with wedge resection of the gallbladder bed. Intraoperative pathological examination suggested gallbladder cancer; therefore, we performed radical surgery, including resection of the common bile duct, extended radical lymphadenectomy, and choledochojejunostomy. Ultimately, the final pathological examination revealed an SFT originating from the gallbladder with a negative surgical margin. Postoperatively, the patient developed bile leakage that was treated with tube drainage. The patient recovered satisfactorily and was discharged on postoperative day 20. At 24 months postoperatively, the patient was in good general condition without recurrence.

CONCLUSIONS

We report a rare case of a primary SFT originating in the gallbladder. Clinicians should be aware that SFT can be found in the gallbladder, and when it is difficult to make a preoperative diagnosis, surgical treatment should be considered.

NAB2::STAT6 fusions and genome-wide DNA methylation profiling: Predictors of patient outcomes in meningeal solitary fibrous tumors

Meningeal solitary fibrous tumors (SFT) are rare and have a high frequency of local recurrence and distant metastasis. In a cohort of 126 patients (57 female, 69 male; mean age at surgery 53.0 years) with pathologically confirmed meningeal SFTs with extended clinical follow-up (median 9.9 years; range 15 days-43 years), we performed extensive molecular characterization including genome-wide DNA methylation profiling (n = 80) and targeted TERT promoter mutation testing (n = 98). Associations were examined with NAB2::STAT6 fusion status (n = 101 cases; 51 = ex5-7::ex16-17, 26 = ex4::ex2-3; 12 = ex2-3::exANY/other and 12 = no fusion) and placed in the context of 2021 Central Nervous System (CNS) WHO grade. NAB2::STAT6 fusion breakpoints (fusion type) were significantly associated with metastasis-free survival (MFS) (p = 0.03) and, on multivariate analysis, disease-specific survival (DSS) when adjusting for CNS WHO grade (p = 0.03). DNA methylation profiling revealed three distinct clusters: Cluster 1 (n = 38), Cluster 2 (n = 22), and Cluster 3 (n = 20). Methylation clusters were significantly associated with fusion type (p < 0.001), with Cluster 2 harboring ex4::ex2-3 fusion in 16 (of 20; 80.0%), nearly all TERT promoter mutations (7 of 8; 87.5%), and predominantly an "SFT" histologic phenotype (15 of 22; 68.2%). Clusters 1 and 3 were less distinct, both dominated by tumors having ex5-7::ex16-17 fusion (respectively, 25 of 33; 75.8%, and 12 of 18; 66.7%) and with variable histological phenotypes. Methylation clusters were significantly associated with MFS (p = 0.027), but not overall survival (OS). In summary, NAB2::STAT6 fusion type was significantly associated with MFS and DSS, suggesting that tumors with an ex5::ex16-17 fusion may have inferior patient outcomes. Methylation clusters were significantly associated with fusion type, TERT promoter mutation status, histologic phenotype, and MFS.

Case report: A rare case of malignant solitary fibrous tumor in an adult with an epithelioid pattern in the occipital region

We illustrated a rare case of malignant solitary fibrous tumor (MSFT) with epithelioid morphology in the occipital region of a 59-year-old female, in which a rare NAB2ex7-STAT6 exon15/16 double fusion subtype was detected by the Next-generation sequencing (NGS) and STAT6 immunohistochemistry (IHC) was diffusely and strongly positively expressed, without recurrence after 20 months of postoperative follow-up. The morphological and molecular genetic aspects and the differential diagnosis are described, and the relevant literature was assessed in order to broaden our understanding and diagnostic capability of this malignancy.

Doege-Potter syndrome due to a solitary fibrous tumor of the pleura: a case report

BACKGROUND

Doege-Potter syndrome is a rare paraneoplastic phenomenon associated with solitary fibrous tumors of the pleura (SFTPs). It is characterized by the presence of severe, sustained, and treatment-refractory hypoglycemia. Hypoglycaemia, which may be the sole symptom at disease onset, is mediated by the secretion of high-molecular-weight insulin-like growth factor (IGF-2). Most tumors exhibit benign behavior, with a 100% survival rate at 5 years. However, 10% of these tumors may display aggressive behavior with local or metastatic recurrence. We present a clinical case of a patient with a benign solitary fibrous tumor of the pleura who presented with symptomatic hypoglycemia and required pulmonary and pleural surgical resection to control the paraneoplastic phenomenon.

CASE PRESENTATION

A Hispanic 46-year-old man presented with a 15-day history of transient alterations in consciousness worsened by fasting. The relevant medical history included obstructive sleep apnea treated with continuous positive air pressure (CPAP) and previous smoking. In-hospital studies revealed noninsulinemic hypoglycemia and a benign SFTP. Complete surgical resection was performed while the patient received dextrose fluids and corticosteroids perioperatively for hypoglycemia. Subsequently, the hypoglycemia resolved, and the patient was followed-up without disease recurrence.

CONCLUSION

Doege-Potter syndrome is challenging to recognize. However, effective treatment can be achieved with a high survival rate. Raising awareness among healthcare professionals about the recognition of this paraneoplasic syndrome patients will improve diagnostic suspicion, biochemical confirmation, the development of diagnostic and therapeutic guidelines, and the creation of predictive indices for aggressive presentations requiring closer monitoring.

A giant solitary fibrous tumor of the abdominal pelvic cavity: A case report and literature review

RATIONALE

Solitary fibrous tumor (SFT) is a rare mesenchymal tumor, especially the giant one from the abdominal pelvic cavity. We report on a rare case of a giant SFT of the abdominal pelvic cavity to review the existing literature in detail to improve the diagnosis and treatment of SFT.

PATIENT CONCERNS

The patient is a 52-year-old female who presented with 2 weeks of abdominal distension. Abdominal magnetic resonance imaging showed a giant mass (>20 cm) in the abdominal pelvic cavity, considered a mesenchymal tumor. She denies a history of tumor disease.

DIAGNOSES

A whole abdomen bulge and a mass of about 18 cm × 10 cm on the right side and middle side were found in the physical examination after admission. Abdominal enhanced computed tomography revealed a giant cystic-solid mass located on the middle and right side of the abdominal pelvic cavity, measuring approximately 20.4 cm × 11.7 cm, with multiple cystic changes and necrosis and compression of adjacent organs and tissues, and marked inhomogeneous enhancement.

INTERVENTIONS

The patient underwent an open abdominal pelvic cavity giant tumor operation to achieve a radical resection, and did not undergo chemotherapy or radiotherapy.

OUTCOMES

The patient underwent open complete resection of a giant abdominal pelvic tumor with no complications and was diagnosed as SFT according to the pathology, immunohistochemistry showed that the tumor tested positive for CD34(+), STAT-6(+), and Ki-67 (10%). Abdominal computed tomography scans were performed 6 months after resection, and no signs of recurrence or metastasis were found.

LESSONS

The clinical symptoms and imaging features of giant abdominal pelvic cavity SFT are not typical. Preoperative diagnosis is difficult and has the potential for malignancy. Based on the results of the current study, there is no standard treatment strategy around the world and the therapeutic effect of radiation therapy and chemotherapy is relatively limited. Thus, complete surgical resection and close clinical follow-up are advocated.

Solitary fibrous tumor within the mesorectum: literature review based on a case report of resection by transanal minimally invasive surgery (TAMIS)

PURPOSE

Solitary fibrous tumors (SFT) are a rare entity of in majority benign neoplasms. Nevertheless, up to 20% of cases show a malignant tendency with local infiltration or metastasis. Commonly arising in the thoracic cavity, only few cases of SFT of the mesorectal tissue have been reported in the literature. Complete surgical resection, classically by posterior approach, is the treatment of choice. The purpose of this review is to demonstrate the safety and suitability of transanal minimally invasive surgery (TAMIS) as a surgical approach for the resection of benign pararectal solid tumors.

METHODS

We report the case of a 52-year-old man who was diagnosed incidentally with SFT of the distal mesorectum. Resection by TAMIS was performed. Based on this case, we describe the steps and potential benefits of this procedure and provide a comprehensive review of the literature.

RESULTS

Histopathology confirms the completely resected SFT. After uneventful postoperative course and discharge on day four, follow-up was recommended by a multidisciplinary board by clinical examination and MRI, which showed a well-healed scar and no recurrence up to 3 years after resection.

CONCLUSION

SFT of the mesorectum is a very rare entity. To our knowledge, this is the first report on a TAMIS resection for SFT, demonstrated as a safe approach for complete resection of benign pararectal solid tumors.

Solitary Fibrous Tumor of the Kidney With Pure Round Cell Features: A Case Report With Review of Literature

Solitary fibrous tumor (SFT) is a rare mesenchymal neoplasm known to occur at various soft tissue and visceral locations. Kidney is a rarely reported site for these tumors. Most of the SFTs described in the kidney exhibit a classical CD34-positive patternless spindle cell histology. Focal round cell morphology is seldom reported. Herein, we describe a 48-year-old male patient with renal SFT. This tumor had pure round cell morphology with a CD34-/STAT6+ immunophenotype. Fluorescent in situ hybridization and a multiplexed sequencing assay performed on an Illumina® HiSeq 4000 platform revealed NAB2 and STAT6 gene rearrangement. Renal tumors with round cell morphology are diagnostically challenging and SFT is not often considered in the differential diagnosis of a round cell tumor of the kidney. Moreover, a CD34-negative profile can be rather confounding while diagnosing such lesions. In such scenarios, a strong nuclear STAT6 immunostaining is extremely helpful in clinching the diagnosis. SFT should always be considered in the differential diagnosis of round cell tumors of the kidney due to significant diagnostic and therapeutic implications.

Ultrastructural differences between synovial sarcoma and solitary fibrous tumor: comparative study in adult patients from the National Cancer Institute of Mexico

Synovial sarcoma (SS) and solitary fibrous tumor (SFT) are entities with considerable morphological and immunohistochemical similarities that sometimes show a non-confirmatory profile (TLE1 negative, CD34 and focal or negative STAT6 and lack of specific fusion IHC markers), in which the utility ultrastructure is unknown. A cross-sectional, retrospective, analytical, nonexperimental study was carried out by the Department of Pathology of the National Cancer Institute of Mexico (INCan) e from January 1, 2009 to December 31, 2018. With 17 SFT cases with diffuse or focal CD34 and STAT6 positivity and 18 cases of SS with positive FISH molecular test t(X:18) breakapart were studied by electron microscopy of fresh glutaraldehyde fixed or paraffin-embedded tissue. The ultrastructural findings with a significant difference present in the SS were tandem tight junctions, desmosomes and abundance of dilated rough endoplasmic reticulum (RER) cisternae (p < 0.001, 0.003, and 0.001, respectively); while in the (SFT) the presence of abundant glycogen, basal lamina, long and slender cytoplasmic processes, pinocytic vesicles, hemidesmosomes, and/or dense plaques, collagen skein, and microvilli-like buds (p = 0.028, 0.005, and <0.001 for the last five). We then infer that the five distinctive markers of the SFT are the collagen skeins intermingled with cellular processes in a shape of "squid can," and the pinocytic vesicles as they were not observed in any case of SS. Conversely, tandem junctions were not found in any SFT case. Although the presence of multivesicular buds in the SFT was not significant, it had not been previously described.

Head to head comparison of 68Ga-DOTA-FAPI-04 vs 18F-FDG PET/CT in the evaluation of primary extrapulmonary tumors in the chest

OBJECTIVE

We conducted a prospective study using 18F-flurodeoxyglucose (18F-FDG) and 68Ga-DOTA-FAPI-04 (fibroblast-activation protein inhibitor, 68Ga-FAPI) PET/CT to diagnose, differentiate, and stage primary extrapulmonary tumors of the thorax.

METHODS

Fifty-four participants were undergoing 18F-FDG and 68Ga-FAPI PET/CT and divided into the benign, intermediate, and malignant based on pathology. The maximum standardized uptake value (SUVmax), the tumor-to-blood pool ratio, and tumor-to-liver ratio were compared for primary tumors, lymph nodes, and metastases between the two modalities by two independent samples t tests. One-way ANOVA was used to compare the uptake of 18F-FDG or 68Ga-FAPI among the three groups.

RESULTS

Fifty-four participants were confirmed to have 71 primary lesions, 56 metastatic lymph nodes, and 43 metastatic lesions. 18F-FDG PET/CT could both effectively distinguish malignant lesions from non-malignant lesions, accuracies of 87.32% (p < 0.001). 68Ga-FAPI PET/CT effectively differentiated benign lesions from the non-benign, accuracy being 91.55% (p < 0.001). The accuracies of 18F-FDG and 68Ga-FAPI for detecting lymph node metastasis were 77.22% (61/79) and 87.34% (69/79) (p = 0.096). The uptake of 68Ga-FAPI in metastatic lymph nodes was significantly higher than that of the nonmetastatic (p < 0.001). The detection rate of 68Ga-FAPI PET/CT for metastatic lesions was significantly higher than that of 18F-FDG, 100% (43/43) vs. 53.49% (23/43) (p < 0.001). Compared with 18F-FDG PET/CT, 68Ga-FAPI PET/CT changed the treatment strategy of 7.4% (4/54) participants.

CONCLUSION

68Ga-FAPI PET/CT is valuable in the diagnosis and differentiation of primary extrapulmonary tumors and superior to 18F-FDG PET/CT for evaluating lymph node and distant metastasis.

CLINICAL RELEVANCE STATEMENT

The application of 68Ga-FAPI PET/CT in primary extrapulmonary chest tumors is valuable, which is reflected in diagnosis, differentiation and exploration of lymph node metastasis and distant metastasis.

KEY POINTS

• 68Ga-FAPI PET/CT is valuable in the diagnosis, differentiation, and staging of primary extrapulmonary tumors. • 68Ga-FAPI PET/CT is superior to 18 F-FDG PET/CT for evaluating lymph node and distant metastasis.

Risk factors for recurrent disease after resection of solitary fibrous tumor: a systematic review

Introduction

Solitary fibrous tumor (SFT) is a rare soft tissue tumor found at any site of the body. The treatment of choice is surgical resection, though 10%-30% of patients experience recurrent disease. Multiple risk factors and risk stratification systems have been investigated to predict which patients are at risk of recurrence. The main goal of this systematic review is to create an up-to-date systematic overview of risk factors and risk stratification systems predicting recurrence for patients with surgically resected SFT within torso and extremities.

Method

We prepared the review following the updated Prisma guidelines for systematic reviews (PRISMA-P). Pubmed, Embase, Cochrane Library, WHO international trial registry platform and ClinicalTrials.gov were systematically searched up to December 2022. All English studies describing risk factors for recurrence after resected SFT were included. We excluded SFT in the central nervous system and the oto-rhino-laryngology region.

Results

Eighty-one retrospective studies were identified. Different risk factors including age, symptoms, sex, resection margins, anatomic location, mitotic index, pleomorphism, hypercellularity, necrosis, size, dedifferentiation, CD-34 expression, Ki67 index and TP53-expression, APAF1-inactivation, TERT promoter mutation and NAB2::STAT6 fusion variants were investigated in a narrative manner. We found that high mitotic index, Ki67 index and presence of necrosis increased the risk of recurrence after surgically resected SFT, whereas other factors had more varying prognostic value. We also summarized the currently available different risk stratification systems, and found eight different systems with a varying degree of ability to stratify patients into low, intermediate or high recurrence risk.

Conclusion

Mitotic index, necrosis and Ki67 index are the most solid risk factors for recurrence. TERT promoter mutation seems a promising component in future risk stratification models. The Demicco risk stratification system is the most validated and widely used, however the G-score model may appear to be superior due to longer follow-up time.

Systematic Review Registration

CRD42023421358.

Solitary fibrous tumor in the saddle area treated with neuroendoscopic surgery and proton therapy: A case report and literature review

Solitary fibrous tumor (SFT) of the central nervous system is a rare fibroblastic tumor of mesenchymal origin. SFTs in the saddle area are much less common. In January 2022, a 43-year-old female patient was admitted with SFT 3 months following partial resection of a microscopic transsphenoidal saddle area tumor at a different hospital. Magnetic resonance imaging indicated that the unresected part of the tumor was significantly enhanced on T1 enhancement, which strongly indicated a recurrence. Subsequently, the patient underwent transnasal endoscopic saddle area tumor resection at our hospital and the tumor was successfully removed. By using postoperative pathology examination, immunohistochemical analysis of Bcl-2, cluster of differentiation 99, STAT6 and vimentin, and a fusion gene test performed by high-throughput sequencing technology, the SFT was definitively diagnosed. Following 3 months of follow-up, the patient was found to have tumor recurrence in the cavernous sinus and absence of tumor growth in the pituitary fossa. Therefore, the patient received proton therapy and tumor growth was controlled effectively.

Cytopathology of mesenchymal tumors of the thyroid gland: analysis of 12 cases from multinational institutions with review of the literature

INTRODUCTION

Mesenchymal tumors of the thyroid gland are extremely rare. We report the cytomorphologic characteristics of 12 mesenchymal tumors occurring in the thyroid gland and highlight the diagnostic difficulties encountered in their cytologic evaluation.

MATERIALS AND METHODS

The cytopathology and surgical pathology archives from 5 large institutions were searched for thyroid mesenchymal tumors that had an FNA available for review. Clinicopathologic and cytomorphologic characteristics for each case were evaluated.

RESULTS

Twelve cases of mesenchymal tumors occurring in the thyroid were identified in our search. Patient age ranged from 28 to 84 years (median, 60 years). The cases occurred in 7 women and 5 men. The tumor size ranged from 1.4 to 14 cm (median, 3.3 cm). The tumors were as follows: hemangioma (n = 4; 33.3%), angiosarcoma (n = 2; 16.7%), schwannoma (n = 2; 16.7%), solitary fibrous tumor (n = 2, 16.7%), metastatic synovial sarcoma (n = 1, 8.3%) and metastatic pleomorphic rhabdomyosarcoma (n = 1, 8.3%). The cytomorphologic features of the tumors were similar to those of their counterparts occurring in different sites. An accurate diagnosis was achieved in six primary thyroid mesenchymal cases (60%). Five patients (41.7%) underwent total thyroidectomy, and 3 patients received partial thyroidectomy (25%). Three patients (25%) did not receive a thyroidectomy and subsequent surgical information was not available in 1 case (8.3%).

CONCLUSIONS

Mesenchymal tumors of the thyroid are extremely uncommon. Cytologic diagnosis of these tumors is often challenging due to the morphologic overlap with diverse epithelial and non-epithelial thyroid lesions. Ancillary studies such as immunohistochemistry and molecular studies are essential for accurate diagnosis.

Solitary Fibrous Tumor of the Peritoneal Cavity and Greater Omentum: Case Report and Review of the Literature

BACKGROUND

The solitary fibrous tumor is a rare soft tissue mesenchymal tumor which typically arises from the pleura but may be found anywhere in the body. Abdominal localizations are very rare. The solitary fibrous tumor is classified into two forms, pleural and extrapleural, and morphologically they resemble each other. The diagnostics of the tumor is usually accidental because usually there are no clinical symptoms. The main treatment of the solitary fibrous tumor is the surgical removal of the tumor while radiotherapy treatment and chemotherapy outcomes remain unclear due to the rarity of the tumor and lack of data.

CASE PRESENTATION

We report the case of the 32-year-old man who was diagnosed with the solitary fibrous tumor of the peritoneal cavity. Laparotomy was performed. A grayish-white, stiff, coarse-grained tumor about 11 cm in diameter of the greater omentum was found and radical omentectomy with tumor removal were performed. Postoperative course was uneventful and the patient is well with no signs of recurrence on the CT scan of the chest and abdomen and MRI of the pelvis at 6 months after surgery.

CONCLUSIONS

The solitary fibrous tumor is a rare condition. It is a borderline-malignant tumor but may cause serious complications if not treated. Due to the absence of clinical symptoms, the tumor is usually detected accidentally. The radical surgical removal of the tumor is the most optimal treatment.

Resection of a giant thoracic solitary fibrous tumor treated with preoperative arterial coiling followed by a double-level thoracotomy

Solitary fibrous tumor (SFT) are rare pleura neoplasms often localized to middle or inferior hemithorax. A middle-aged woman presents to the emergency department following a motor vehicle accident, the computed tomography scan revealed a giant tumor occupying the entire left pleural cavity with a complete collapse of the left lung and substantial right deviation of heart and mediastinum. Using preoperative arterial coiling followed by a double-level thoracotomy we successfully resected the giant tumor. The SFT weighed ~10 lbs. At 2-month follow-up visit patient reports mild discomfort during strenuous movement/heavy lifting but denies any shortness of breath.

Orbital solitary fibrous tumours: clinicopathological characteristics and recurrence prediction

BACKGROUND

SFTs are thought to have an unpredictable clinical course and currently have no recognized prognostic criterion. Our study aimed to determine the relationship between clinicopathological characteristics and the prognosis of patients with orbital SFTs.

METHODS

The clinicopathological features of these patients were extracted from clinical records. The relationships between these features and prognosis were analysed.

RESULTS

The positive rates of CD34, CD99, Blc2, and STAT6 expression were 90.3%, 90.3%, 83.9%, and 100%, respectively. The tumour recurrence rate was 38.7%. A higher recurrence rate was observed in patients with Ki67 index ≥ 5 (56.25% vs. 20%, P = 0.038).

CONCLUSION

A Ki67 index ≥ 5 was an effective parameter for predicting tumour recurrence of orbital SFTs. Close follow-up is needed for these patients.

Molecular testing of soft tissue tumors

BACKGROUND

The diagnosis of soft tissue tumors is challenging, especially when the evaluable material procured is limited. As a result, diagnostic ancillary testing is frequently needed. Moreover, there is a trend in soft tissue pathology toward increasing use of molecular results for tumor classification and prognostication. Hence, diagnosing newer tumor entities such as CIC-rearranged sarcoma explicitly requires molecular testing. Molecular testing can be accomplished by in situ hybridization, polymerase chain reaction, as well as next generation sequencing, and more recently such testing can even be accomplished leveraging an immunohistochemical proxy.

CONCLUSION

This review evaluates the role of different molecular tests in characterizing soft tissue tumors belonging to various cytomorphologic categories that have been sampled by small biopsy and cytologic techniques.

Doege-Potter syndrome associated to metastatic solitary fibrous tumor

Solitary fibrous tumor (SFT) is a rare fibroblastic mesenchymal neoplasm with an estimated annual incidence of 0.35 per 100,000 individuals. Doege-Potter syndrome is a paraneoplastic syndrome related to solitary fibrous tumor clinically characterized by hypoglycemia, occurring in less than 5% of cases. Herein, we report a case of metastatic SFT associated with recurrent severe hypoglycemia. A 43-year-old male with a noncontributory medical history presented with a painless and progressive growing mass in the right thigh. The histological evaluation rendered the diagnosis of SFT, and tumor resection was performed. One year after the operation, on the oncological follow-up, he was admitted to the emergency unit, manifesting an early-morning seizure associated with a severe hypoglycemia. The laboratory findings of non-islet cell tumor hypoglycemia (NICTH) in the background of a relapsed metastatic solitary fibrous tumor were consistent with the diagnosis of Doege-Potter syndrome. Hepatic embolization associated with oral glucocorticoid was an efficient palliative treatment to control the hypoglycemic crisis and allow hospital discharge.

Tumor Fibroso Solitário Primário em Região Pélvica: Relato de Caso

Introdução: O tumor fibroso solitário é uma neoplasia mesenquimal rara, originada de células intersticiais dendríticas CD34 positivas e composta pela justaposição de células fusiformes. Os casos iniciais foram primariamente descritos na região torácica, e o principal sítio, a pleura visceral. Raramente são descritos casos de tumor fibroso solitário extrapleural em região pélvica, demonstrando a possibilidade de múltiplas sítios primários. Relato do caso: Paciente de 38 anos, sexo feminino, previamente saudável e assintomática, procurou orientação médica após uma ultrassonografia pélvica de rotina evidenciar uma imagem heterogênea na região anexial direita, paraovariana, sendo submetida à ressecção cirúrgica da lesão, com diagnóstico de tumor fibroso solitário confirmado por imuno-histoquímica. Discutem-se os aspectos do diagnóstico imuno-histoquímico e do tratamento cirúrgico. Conclusão: Os casos de tumor fibroso solitário em região pélvica podem ser descobertos por meio de ultrassonografia pélvica de rotina. O tratamento cirúrgico, com ressecção ampliada e margens negativas, deve ser o principal objetivo nos casos de tumor fibroso solitário em região pélvica. A obtenção de amostras para análise imuno-histoquímica é recomendada, e a positividade para CD34 e STAT6 aponta o diagnóstico. Recidivas podem ocorrer em até uma década de seguimento, sendo recomendado período longo de acompanhamento pós-cirúrgico.

Clinical characteristics and prognosis of orbital solitary fibrous tumor in patients from a Chinese tertiary eye hospital

BACKGROUND

Solitary fibrous tumor (SFT) is predominant within the pleura but very rare in the orbit, which is why the diagnosis of orbital SFT poses challenges in clinical practice. Accordingly, an integrated approach that incorporates specific clinical features, histological, histopathological, and immunohistochemical (IHC) examinations, and molecular analyses is warranted.

AIM

To retrospectively explore the clinical and imaging characteristics, treatment, outcomes of a series of patients with orbital SFT.

METHODS

We conducted a retrospective review of a series of patients diagnosed with a histopathologic orbital SFT treated at a single institution. All data on demogra/phics, clinical characteristics, imaging, treatment, postoperative histopathological and IHC examinations, and prognosis were collected.

RESULTS

In total, 13 patients were enrolled, 7 (53.8%) of whom had the tumor located in the superomedial quadrant of the orbit. Computed tomography revealed a solitary ovoid lesion in 10 (76.9%) patients and irregular lesion in 3 (23.1%) patients. Magnetic resonance imaging results were as follows: On T1 weighted images, 3 (23.1%) patients had hypointense mixed signals, whereas 10 (76.9%) patients showed isointense mixed signals; on T2 weighted images (T2WI), 3 (23.1%), 4 (30.8%), and 6 (46.2%) patients exhibited hypointense mixed, isointense mixed, and hyperintense signals, respectively. Notably, 12 (92.3%) patients showed significant enhancement, whereas there were patchy slightly enhanced areas in the tumor. All patients were treated by surgery. IHC analysis demonstrated that the tumor cells were immunoreactive for CD34, CD99, STAT-6, and vimentin in all patients. The lesions showed Ki-67 positivity < 5% in 1 (7.7) patient, 5%-10% in 10 (76.9%), and > 10% in 2 (15.4%). Two (15.4%) patients exhibited tumor recurrence.

CONCLUSION

The clinical manifestations and radiologic characteristics of orbital SFT are diverse and not specific. Accurate diagnosis and treatment require detailed radiological and histopathological/IHC evaluation.

Teratocarcinosarcoma-Like and Adamantinoma-Like Head and Neck Neoplasms Harboring NAB2::STAT6: Unusual Variants of Solitary Fibrous Tumor or Novel Tumor Entities?

The archetypal solitary fibrous tumor (SFT) features fibroblastic cells with varying cellularity without any particular architectural arrangement in a collagenous matrix, with staghorn vessels, CD34 and STAT6 expression, and NAB2::STAT6. To date, this fusion is thought to be specific for SFT. With more routine use of fusion gene panels, the histologic diversity of NAB2::STAT6-positive tumors is increasingly appreciated. Here we present four head and neck tumors harboring NAB2::STAT6 but exhibiting remarkably unusual morphologic features for SFT. All cases were pulled from the authors' consultation files. Immunohistochemistry was performed, along with targeted RNA sequencing in all cases, plus DNA next-generation sequencing on two. The cases arose in the nasal cavity (n = 2), retromolar trigone (n = 1) and parapharynx (n = 1), in patients ranging from 39 to 54 (mean, 44). Both nasal cases were biphasic, with a variably cellular collagenized stroma that resembled SFT but also interspersed malignant epithelial and neuroepithelial nests. One of the nasal cases also exhibited overt rhabdomyoblastic differentiation within both components. The two non-nasal cases were comprised of plump, epithelioid cells that were diffusely positive for pan-cytokeratin. One of these cases had prominent cystic change lined by overtly squamous epithelium. STAT6 immunostaining was positive in all cases, although the epithelial/neuroepithelial nests in the sinonasal cases were negative. All cases were confirmed to harbor NAB2::STAT6 by RNA sequencing. The two sinonasal cases were also found to harbor oncogenic mutations. The presented cases highlight a much broader histologic diversity than previously known for neoplasms with NAB2::STAT6. The biphasic nasal cases closely resemble teratocarcinosarcoma, while the epithelioid, cytokeratin-positive cases could be conceptualized as "adamantinoma-like," to borrow terminology already in use for Ewing sarcomas with complex epithelial differentiation. To identify similar cases, pathologists should have a low threshold for using STAT6 immunohistochemistry on any difficult-to-characterize head and neck tumor.

Solitary Fibrous Tumor of the Adrenal Gland

OBJECTIVES

Solitary fibrous tumor (SFT) is a mesenchymal neoplasm that can arise at various anatomic locations. It is characterized by inv12(q13q13)-derived NAB2::STAT6 fusion, resulting in the nuclear expression of STAT6. Primary SFT of the adrenal gland is rare. We launched a multi-institutional collaboration to comprehend the overarching demographics, clinical and follow-up, macroscopic, microscopic, IHC, and FISH features of 9 patients with SFT of the adrenal gland.

METHODS

We added a series of 9 patients to the collection of adrenal SFTs where the clinicopathologic parameters, including clinical presentation, imaging, histopathology, IHC, molecular profiles, and management and follow-up data, were analyzed comprehensively. A modified 4-variable risk stratification model, including age, tumor size, and necrosis, was applied.

RESULTS

Our series consisted of 6 male and 3 female patients, ranging in age from 19 to 64 years (mean, 49.3 years). Abdominal pain (4) and fever with abdominal pain (1) were the presenting symptoms in 5 patients. In the remaining 4 patients, the tumors were detected by abdominal imaging for hypertension and diabetes. The size of the tumor ranged from 2 cm to 10.5 cm in maximum dimension. All tumors exhibited the morphology of a spindle cell SFT with a patternless architecture; 3 had a focal storiform arrangement. STAT6 positivity was observed in all tumors, and 7 were positive for CD34. Surgical resection was the primary modality of treatment. No adjuvant therapy was administered. Follow-up ranging from 7 months to 23 months was available for 7 patients. All were alive without disease recurrence or metastasis. Risk stratification placed 8 (88.9%) patients into a low-risk category and 1 into an intermediate-risk category.

CONCLUSIONS

This series is the largest of adrenal SFTs to date. These tumors of the adrenal gland are predominantly spindle cell neoplasms with indolent behavior, with a wide age distribution and a slight male preponderance. Combining our cohort with the previously published cases, the majority of tumors fall into the low-risk category for the propensity to develop metastases. Owing to the rarity and age distribution associated with these tumors, the differential diagnosis is wide and requires a systematic approach for ruling out key differential diagnoses aided by STAT6 IHC.

The 68 Ga-DOTA-FAPI-04 PET/CT for the differential diagnosis of solitary fibroma of pleura from other chest disease with low uptake of 18 F-FDG

OBJECTIVE

We conducted a prospective study using 68 Ga-DOTA-FAPI-04 PET/computed tomography (CT) to differentiate solitary fibromas of pleura (SFP) from other chest similar masses showing low uptake of 18 F-FDG.

METHODS

A prospective study including 13 patients was divided into two groups: five cases of SFP and eight of thoracic lesions resembling SFP on general imaging examination. Except for CT and MRI, all patients underwent both 18 F-FDG and 68 Ga-DOTA-FAPI-04 PET/CT examinations. Compare the differences of lesions in CT net enhancement value and the uptake of 18 F-FDG and 68 Ga-DOTA-FAPI-04 between the two groups. The values of CT and PET/CT for differential diagnosis were calculated by receiver operating characteristic (ROC) curves.

RESULTS

The uptake of 68 Ga-DOTA-FAPI-04 in SFP was significantly higher than the others in chest, SUVmean (8.10 ± 5.57) versus (1.11 ± 0.38); and SUVmax (15.46 ± 8.16) versus (3.96 ± 2.43), and the difference was statistically significant ( P < 0.05). The 68 Ga-DOTA-FAPI-04 could effectively distinguish SFP from other lesions, and the accuracies of SUVmax and SUVmean for differential diagnosis were 92.31 and 100%, the corresponding cutoff value being 7.19 and 2.26. The uptake of 18 F-FDG in SFP was slightly lower than other lesions, SUVmean (1.63 ± 0.30) versus (1.88 ± 1.02); and SUVmax (2.51 ± 0.54) versus (3.60 ± 1.57), and the difference was not statistically significant ( P > 0.05). The SFP showed significant enhancement in the venous phase, but the difference was not statistically significant ( P > 0.05).

CONCLUSION

The 68 Ga-DOTA-FAPI-04 has potential application value in differentiating SFP from lesions with low 18 F-FDG uptake, in addition, 68 Ga-DOTA-FAPI-04 may specifically target SFP.

Misleading Morphologic and Phenotypic Features (Transdifferentiation) in Solitary Fibrous Tumor of the Head and Neck: Report of 3 Cases and Review of the Literature

Solitary fibrous tumor (SFT) is a rare fibroblastic neoplasm with potentially malignant behavior that may develop in any anatomic site and may involve the head and neck (H&N) region as well. Although typical SFT has a relatively characteristic morphology, its morphologic spectrum is extraordinarily broad and also includes rare cases with dedifferentiation or transdifferentiation which result in aberrant morphologic and/or immunohistochemical features. However, since virtually all cases are molecularly characterized by NAB2::STAT6 gene fusions, molecular genetic methods or STAT6 immunohistochemistry can be effectively used in confirming the diagnosis. Herein, we report 3 diagnostically challenging H&N SFT cases with an unusual morphology and/or phenotypes closely mimicking other well-known H&N entities. The tumors originated in the oral minor salivary glands, the base of the tongue, and sinonasal tract and closely resembled hyalinizing clear cell carcinoma of the salivary gland, adenocarcinoma not otherwise specified and biphenotypic sinonasal sarcoma, respectively. All cases were positive for cytokeratins, variably expressed S100 protein, showed diffuse nuclear STAT6 positivity, and harbored NAB2::STAT6 gene fusions.

A Case Report of Rare Sacral Solitary Fibrous Tumor

Huge primary epidural solitary fibrous tumors in the sacrum are a rare clinical entity. The purpose of this article is to present our experience in treating such large and complex neoplasms in a 31-year-old woman. The patient complained of constant nocturnal bilateral hip and lower back pain and unilateral radicular symptoms (numbness, paresthesias) in the left S1/S2 dermatomal distribution. Diagnostic imaging, biopsy, preoperative endovascular embolization, two-staged tumor resection, and lumbosacroiliac fusion were performed. The treatment resolved the patient's neurological symptoms and resulted in overall good postoperative functionality. The patient has been in remission for more than five years despite her refusal of adjuvant radiotherapy.

Soft tissue solitary fibrous tumors of the musculoskeletal system: spectrum of MRI appearances and characteristic imaging features

OBJECTIVE

Solitary fibrous tumors (SFTs) uncommonly occur in the musculoskeletal system, with limited available data on their MRI appearance. This study was performed to assess the MRI features of SFTs in the musculoskeletal system (MSK-SFTs).

MATERIALS AND METHODS

Pre-treatment MRI in 39 patients with pathologically proven SFTs in the trunk or extremities was evaluated. Patient demographics, clinical management and follow-up, and lesion histology were reviewed. MRI features including lesion location, size, morphology, signal characteristics, vascularity, and relationship to major neurovascular structures were assessed.

RESULTS

MSK-SFTs most frequently occurred in the lower extremity (23/39 cases, 59%), deep to fascia (29/39, 74%), and intermuscular (22/29, 76%) in location. The majority of deep lesions were located along a major neurovascular bundle (20/29, 69%). Lesions had well-defined margins (39/39, 100%), multilobulated contours (27/39, 69%), and measured mean 6.9 ± 2.8 cm. The majority of lesions had slightly hyperintense T1 signal (34/39, 87%) and heterogenous intermediate-to-high T2/STIR signal (28/38, 74%). A "pseudo-cerebriform" internal architectural pattern on fluid-sensitive sequences, with internal lobulations and low signal bands/septations, was observed in 63% (24/38) of lesions. Lesions commonly demonstrated prominent intra-lesional (30/39, 75%) and peripheral juxta-lesional flow voids. Local invasion of surrounding structures was uncommon (3/39, 8%). Mitotically active lesions (p = 0.02) and lesions with tumor necrosis (p < 0.01) were larger in size. Tumor necrosis was associated with T1 heterogeneity (p = 0.04). Distant metastasis occurred in 10% (4/39) of patients, all in mitotically active lesions pre-operatively considered at least at intermediate risk of metastasis.

CONCLUSION

MSK-SFTs commonly present as well-defined, hypervascular masses deep to fascia along major neurovascular bundles, with heterogeneous slightly hyperintense T1 signal, intermediate-to-high T2/STIR signal, and prominent macroscopic flow voids.

A female with solitary fibrous tumor pleura mimicking pulmonary sclerosing pneumocytoma in low resource setting: A case report

Background

Solitary fibrous tumor of pleura (SFTP) is a rare condition. Clinical symptoms and non-specific radiological features in both tumors make preoperative diagnosis difficult to establish.

Case presentation

A Javanese 47-year-old female complained of chest pain and shortness of breath which an X-ray and CT-Scan of the thorax showed giant cell metastases in the lung. Signs and symptoms indicate pulmonary sclerosing pneumocytoma (PSP) and the patient underwent thoracic surgery which was first performed with angiographic embolization. Furthermore, an anatomical pathology analysis was performed with suspected SFTP, supported by the IHC test, which found CD34 (+), EMA (−), and S100 (−). Thoracic surgery followed by radiotherapy and chemotherapy is recommended in SFTP patients.

Discussion

The SFTP and PSP have non-specific clinical symptoms and radiological features. Anatomic pathology and IHC test are definitive diagnostic tools from SFTP and PSP. Establishing a preoperative diagnosis of SFTP and PSP is quite difficult. Surgical resection is the treatment of choice for both.

Conclusion

The comparison of SFTP and PSP can be seen results of the anatomical pathology analysis and IHC test.

•

Solitary fibrous tumor of pleura (SFTP) and pulmonary sclerosing pneumocytoma (PSP) are difficult to distinguish in a low-resource setting.

•

SFTP and PSP can be differentiated using an immunohistopathology test (cluster of differentiation 34/CD54 was positive).

•

Management of SFTP and PSP are both similar to surgery (thoracotomy with a subcostal incision).

Prognostic usefulness of a modified risk model for solitary fibrous tumor that includes the Ki-67 labeling index

Background

Predicting the prognosis of patients with solitary fibrous tumor (SFT) is often difficult. The prognostic risk models developed by Demicco et al. are now the standard for evaluating the risk of SFT metastasis in the current World Health Organization classification of soft tissue and bone tumors.

Methods

In this study, we examined the prognostic usefulness of a modified version of the Demicco risk models that replaces the mitotic count with the Ki-67 labeling index. We compared the three-variable and four-variable Demicco risk models with our modified risk models using Kaplan–Meier curves based on data for 43 patients with SFT.

Results

We found a significant difference in metastasis-free survival when patients were classified into low-risk and intermediate/high-risk groups using the three-variable (P = 0.022) and four-variable (P = 0.046) Demicco models. There was also a significant difference in metastasis-free survival between the low-risk and intermediate/high-risk groups when the modified three-variable (P = 0.006) and four-variable (P = 0.022) models were used.

Conclusion

Modified risk models that include the Ki-67 labeling index are effective for prediction of the prognosis in patients with SFT.

Molecular targeted therapy for advanced or metastatic soft tissue sarcoma

Soft tissue sarcomas are a form of rare and heterogeneous neoplasms with high recurrence rate and mortality. Over the past decades, less progress has been achieved. Surgical management with or without adjuvant/neoadjuvant radiotherapy is still the first-line treatment for localized soft tissue sarcomas, and chemotherapy is the additional option for those with high-risk. However, not all patients with advanced or metastatic soft tissue sarcomas benefit from conventional chemotherapy, targeted therapy takes the most relevant role in the management of those resistant to or failed to conventional chemotherapy. Heterogeneous soft tissue sarcomas vary from biological behavior, genetic mutations, and clinical presentation with a low incidence, indicating the future direction of histotype-based even molecule-based personalized therapy. Furthermore, increasing preclinical studies were carried out to investigate the pathogenesis and potential therapeutic targets of soft tissue sarcomas and increasing new drugs have been developed in recent years, which had started opening new doors for clinical treatment for patients with advanced/metastatic soft tissue sarcomas. Here we sought to summarize the concise characteristics and advance in the targeted therapy for the most common subtypes of soft tissue sarcomas.

Solitary Fibrous Tumor of the Prostate: A Case Report and Literature Review

Solitary fibrous tumors (SFTs) usually occur in the pleura and account for two-thirds of all cases; however, SFTs occurring in the prostate are extremely rare. Approximately 25 cases have been reported in the literature to date. This study reports the case of a 43-year-old man referred to our hospital with the chief complaint of a pelvic tumor after careful examination. The tumor marker levels were within normal limits. T2-weighted magnetic resonance imaging revealed a tumor, demonstrating primarily low signal intensity. It showed a capsule-like rim at the left lobe of the prostate, suggesting that the tumor was partially invading the rectal wall. Histopathological examination of needle-core biopsies showed spindle cell neoplasm with small and fusiform cells, strongly expressing signal transducer and activator of transcription 6 (STAT6) with a ramifying vascular network. Therefore, the clinical diagnosis of the patient was SFT of the prostate and robot-assisted radical prostatectomy was performed. Histopathological examination revealed that the tumor was composed of spindle cells with patternless and staghorn patterns. Immunohistochemical analysis showed a strong expression of STAT6. Furthermore, the tumor was partially positive for CD34. Therefore, the patient was diagnosed with SFT of the prostate. Two years after the initial diagnosis, the patient was alive with normal erectile function, continence status, and no evidence of the disease.

An intrathoracic giant tumour and vanishing lung cyst after tumour resection

A 65-year-old woman was brought to the emergency unit with an approximately 6-month history of persistent fever and cough. Chest computed tomography (CT) demonstrated a 16-cm heterogeneous mass with adjacent large cyst (approximately 4.0 cm). The patient underwent CT-guided biopsy, and benign solitary fibrous tumour (SFT) was immunohistochemically diagnosed. As the symptoms were thought to be due to enlargement of the tumour, surgery was deemed necessary, and the tumour was successfully resected. Based on morphological and immunohistochemical examination of the resected specimen, the final diagnosis was dedifferentiated SFT (DSFT). Follow-up CT verified disappearance of the pulmonary cyst. The cyst was speculated to be caused by a check valve mechanism, which may also suggest a rapid growth of the tumour. At the time of writing, 2 years post-operatively, no tumour recurrence has been identified. This represents the first report of intrathoracic giant DSFT with a cystic lesion returning to normal lung parenchyma.

Mesenchymal Tumors of the Mediastinum: An Update on Diagnostic Approach

Mesenchymal tumors of the mediastinum are a heterogenous group of rare tumors with divergent lineages. Mediastinal mesenchymal tumors are diagnostically challenging due to their diversity and morphologic overlap with nonmesenchymal lesions arising in the mediastinum. Accurate histologic diagnosis is critical for appropriate patient management and prognostication. Many mediastinal mesenchymal tumors affect distinct age groups or occur at specific mediastinal compartments. Neurogenic tumors, liposarcoma, solitary fibrous tumor, and synovial sarcoma are common mesenchymal tumors in the mediastinum. Herein, we provide an update on the diagnostic approach to mediastinal mesenchymal tumors and a review of the histologic features and differential diagnosis of common benign and malignant mesenchymal tumors of the mediastinum.

Solitary fibrous tumor of thoracic cavity, extra-thoracic sites and central nervous system: Clinicopathologic features and association with local recurrence and metastasis

Published risk stratification models of solitary fibrous tumor (SFT) have been associated with distant metastases outside the central nervous system (CNS), but have not been studied for tumors occurring in the CNS. In a retrospective review, we identified 72 cases of solitary fibrous tumor or hemangiopericytoma (HPC) diagnosed between January 2011 and December 2020 at our institution. The tumors involved the central nervous system (N = 17), thoracic cavity (N = 28), and extrathoracic sites (N = 27). The risk of local recurrence, distant metastasis, or death at 5 years was 57% (95% CI 23%, 76%) in the CNS, 24% (95% CI 2%, 41%) in the thoracic cavity, and 13% (95% CI 0%, 25%) in extrathoracic sites. By contrast, the risk of distant metastasis or death at 5 years was 13% (95% CI 0%, 29%) in CNS primaries, 5% (95% CI 0%, 14%) in thoracic primaries, and 14% (95% CI 0%, 27%) in extrathoracic primaries. Using the published 3- and 4-variable risk stratification models by Demicco et al., we retrospectively assessed our cases for risk of local recurrence, distant metastasis, and death. For tumors outside the CNS, we show that three- and four-variable risk stratification models were associated with recurrence-free survival in addition to the previously known association with distant metastasis (all P < 0.05). In contrast, inside the CNS, we show that neither risk model is a significantly associated with clinical behavior, and that WHO grade is likely the best available prognostic tool, though none of the differences were significant. The lack of significant differences can be likely explained by the younger median age (47 years vs 61 years) and smaller median tumor size (3.5 cm vs 5.6 cm), downgrading the risk stratification scores in CNS compared to non-CNS primaries. In conclusion, existing risk stratification models of SFT are not associated with clinical behavior for tumors arising inside the CNS, but are associated with local recurrence in addition to distant metastasis outside the CNS.

A Comprehensive Review on Solitary Fibrous Tumor: New Insights for New Horizons

Simple Summary

Solitary fibrous tumor (SFT) is a malignant condition that exhibits different clinical behaviors ranging from low to high aggressive SFT, with dedifferentiated SFT (DD-SFT) being the fastest-growing subtype. Even when surgery alone provides curation rates above 60%, recurrences do occur in a fraction of patients where surgery is unable to provide disease control. Among the systemic therapeutic options, antiangiogenic compounds have shown higher efficacy than chemotherapy by indirect comparisons. Furthermore, rotating different antiangiogenics, at the progression time, has been shown to be effective. The exception is DD-SFT since it is resistant to antiangiogenics but can respond to chemotherapy. This comprehensive review also analyzes the underlying molecular components that play a key role in SFT origin and aggressiveness. The discovery in 2013 of anomalous fusion genes between NAB2 and STAT6 was determinant to increase the knowledge on the molecular drivers in SFT that could be potential targets for future therapies.

Abstract

Solitary fibrous tumor (SFT) is a rare mesenchymal, ubiquitous tumor, with an incidence of 1 new case/million people/year. In the 2020 WHO classification, risk stratification models were recommended as a better tool to determine prognosis in SFT, to the detriment of “typical” or “malignant” classic terms. The risk for metastasis is up to 35–45%, or even greater, in series with a longer follow-up. Over the last few decades, advances in immunohistochemistry and molecular diagnostics identified STAT6 nuclear protein expression and the NAB2–STAT6 fusion gene as more precise tools for SFT diagnosis. Recent evidence taken from retrospective series and from two prospective phase II clinical trials showed that antiangiogenics are active and their sequential use from first line should be considered, except for dedifferentiated SFT for which chemotherapy is the best option. Since the fusion transcript driver’s first description in 2013, new insights have been brought on key molecular events in SFT. This comprehensive review mainly focuses on the superior efficacy of antiangiogenics over chemotherapeutic agents in SFT, provides the current knowledge of key molecules that could co-drive the SFT behavior, and suggests new target candidates that deserve to be explored in preclinical and clinical research in SFT.

Mesenchymal tumours of the gastrointestinal tract

Mesenchymal tumours represent a heterogenous group of neoplasms encopassing benign, intermediate malignancy, and malignant entities. Sarcomas account for approximately 1% of human malignancies. In consideration of their rarity as well as of intrinsic complexity, diagnostic accuracy represents a major challenge. Traditionally, mesenchymal tumours are regarded as lesions the occurrence of which is mostly limited to somatic soft tissues. However, the occurrence of soft tissue tumours at visceral sites represent a well recognized event, and the GI-tract ranks among the most frequently involved visceral location. There exist entities such as gastrointestinal stromal tumours (GIST) and malignant gastointestinal neuroectodermal tumors that exhibit exquisite tropism for the GI-tract. This review will focus also on other relevant clinico-pathologic entities in which occurrence at visceral location is not at all negligible.

Malignant peripheral nerve sheath tumor of the orbit: a case report and review of the literature

Malignant peripheral nerve sheath tumor is a rare tumor which infrequently involves the orbit. They occur most often in the setting of neurofibromatosis 1 (NF1), and therefore the involvement of the orbit without a history of NF1 is even less common. Management of this tumor is fraught with a high rate of recurrences and metastases, with a high mortality rate. Primary surgical excision with tumor-free margins remains the primary treatment, while adjuvant modalities such as radiation and chemotherapy play a more minor role.

Metastatic intracranial solitary fibrous tumors/hemangiopericytomas: description of two cases with radically different behaviors and review of the literature

Solitary fibrous tumor/hemangiopericytoma with primary tumor location in the central nervous system accounts for less than 1% of all central nervous system tumors. Despite the relatively indolent clinical course, extracranial metastases are reported in 28% of cases. In recent years, NAB2-STAT6 gene fusion has been recognized as the pathognomonic molecular feature of solitary fibrous tumor/hemangiopericytoma and STAT6 immunohistochemistry has been shown to be a sensitive and specific surrogate for the identification of the gene fusion in these patients. Here we report two cases of patients who experienced occurrence of diffuse extracranial metastases several years after successful surgery for an intracranial solitary fibrous tumor/hemangiopericytoma. In the first patient, the metastases had maintained similar histological features to the primary tumor; in contrast, in the second case, a dedifferentiation occurred with loss of expression of CD34 and Bcl-2. These different histological features were associated with radically different behaviors. Whereas the first case experienced an indolent course of the disease, the second patient had a rapid disease progression and deterioration of clinical conditions. The molecular imaging findings in these two cases and the role of functional imaging for tumor detection, disease staging and monitoring in this rare cancer are also discussed. Recurrences and metastases maintained high expression of somatostatin receptors confirmed by somatostatin receptor imaging in the first case. In contrast, in the second patient, the abrupt transition into a highly aggressive form was associated with the absence of somatostatin receptors at 111In Pentetreotide scan and intense hypermetabolism at 18F-FDG PET.

Oral Solitary Fibrous Tumor: A Retrospective Clinico-Pathological Study and Long-Term Follow-Up

Background and Objectives: This was a retrospective single-center study to analyze and describe the clinical and histological features of all cases of oral solitary fibrous tumor (SFT). Study design: the study included all consecutive cases of oral SFT diagnosed between 2008-2018 at a single tertiary center. Materials and Methods: Clinical data was retrieved from medical charts. The diagnosis of oral SFT was based upon the morphologic features of the lesions, in routine hematoxylin and eosin (H&E) stained sections and confirmed by immunohistochemical analyses including CD34, CD99, Bcl2, and stains for STAT6. Results: Seven cases of oral SFT were found. Of these, three (42%) were in males and four (58%) in females. The age range was 24-63 years (mean 47 ± 13). Four (58%) lesions were located in the buccal mucosa, two (28%) in the labial mucosa and one (14%) on the floor of the mouth. The diameter ranged between 3-50 mm (mean 22 ± 14 mm). All patients were treated with local excision. Follow-up periods were between 2-74 months (mean 41 ± 27). No recurrences were reported. Conclusions: We present a series of oral SFT, which were all non-aggressive in presentation and did not recur after conservative surgery (local excision) over a relatively long follow-up period.

Case Report: A Review of the Literature on Spinal Intradural Hemangiopericytoma With Spinal Cord Infiltration and a Case Report

Purpose: Primary spinal intradural hemangiopericytoma (HPC) with spinal cord infiltration is rare. The purposes of this study were to investigate the clinical features of intradural HPC with spinal cord infiltration and to explore the related factors affecting tumor recurrence. Methods: We report a case of intramedullary HPC with intramedullary infiltration of the thoracic spine. The relevant literature was searched for with PubMed, and clinical data were extracted from the included studies. Clinical patient data were described and statistically analyzed. Then, Kaplan-Meier (KM) curves were used to describe the relapse-free survival (RFS) of patients in different groups, and the log-rank test was used for evaluation. Results: A total of 11 cases of spinal intradural HPC with spinal cord infiltration were included (including the case described in this report). Further data analysis showed that sex (P = 0.249), age (P = 0.876), tumor location (P = 0.524), and postoperative radiotherapy (P = 0.12) had no significant influence on RFS. The range of tumor resection (P = 0.004) and the WHO grade (P = 0.014) significantly affect the patient RFS. Conclusion: RFS was higher in patients with total tumor resection than in patients with subtotal tumor resection. The patients with lower WHO grade have better RFS. Total tumor resection is the primary objective of surgical treatment of spinal intradural HPC with spinal infiltration. Long-term postoperative follow-up is considered necessary.