Giant solitary fibrous tumor of the pelvis successfully treated with preoperative embolization and surgical resection: a case report

Abstract

Solitary fibrous tumors (SFTs) rarely develop in the pelvis. When they do arise, they are usually treated using surgery, although SFTs are often very large by the time of diagnosis, which makes surgical excision difficult. We report a case of a 63-year-old man who was referred to our hospital for the treatment of a giant tumor of the pelvis. Computed tomography (CT) revealed a 30 × 25 × 19 cm sized hypervascular tumor that almost completely filled the pelvic cavity. The diagnosis of SFT was made by CT-assisted needle biopsy. The feeding arteries of the tumor were embolized twice. The first embolization aimed to reduce the tumor volume, while the second one was planned a day prior to the surgery to obtain hematostasis during the operation. Tumor resection was then performed. The blood loss during the operation was 440 ml, and there was no uncontrollable bleeding. The postoperative course was uneventful. No recurrence of SFT was observed during a 2-year follow-up.

Intraoperative modulation of arterial blood flow in a hybrid operating room: A report of three cases

“…In such cases, preoperative arterial embolization has been shown to be safe and effective for the decompression of tumors and reduction in intraoperative hemorrhage. [7][8][9][10]14 In this study, the first patient had a very large and hypervascular pheochromocytoma, while the second and third patients had massive spleens. Consequently, controlling the splenic artery was considered difficult in all cases because of extensive adhesions caused by multiple surgeries.…”

“…High‐risk factors include very large tumor size, restricted range of tumor movement, and uncontrolled feeding arteries. In such cases, preoperative arterial embolization has been shown to be safe and effective for the decompression of tumors and reduction in intraoperative hemorrhage . In this study, the first patient had a very large and hypervascular pheochromocytoma, while the second and third patients had massive spleens.…”

“…The intraoperative modulation of arterial blood flow (eg, arterial embolization) is widely performed to prevent massive intraoperative hemorrhage and unstable circulatory dynamics during the resection of large hypervascular tumors or splenectomy. 3,[7][8][9][10] However, complications of embolization (such as high-grade fever, postembolic pain, pleural effusion, or transient hypertension) may occasionally necessitate the postponement or cancelation of elective surgery. 3,11 In addition, procedures performed in conscious patients may induce procedure-related anxiety or psychological stress prior to surgery.…”

Management of the “Other” retroperitoneal sarcomas

“…[32][33][34][35] There are also some reports on preoperative embolization of the tumor vessels to facilitate resection and to minimize the blood loss, usually performed within 14-28 days before planned surgery. 36,37 As in the case of well-differentiated liposarcomas, low-grade SFTs which recur locally can be resected, and the outcomes are best for patients with isolated lesions, with a slow rate of growth, and with a long disease-free interval. 38 In metastatic/unresectable cases of SFT, conventional chemotherapy can be effective, 39,40 however it seems that the best therapeutic option for patients with advanced SFT are therapies targeted at tumor angiogenesis.…”

“…Patients with SFT can be treated with definitive radiotherapy, and several reports have demonstrated good long‐term local tumor control . There are also some reports on preoperative embolization of the tumor vessels to facilitate resection and to minimize the blood loss, usually performed within 14‐28 days before planned surgery …”