Preoperative embolisation of orbital solitary fibrous tumour

Abstract

Solitary fibrous tumours (SFT) is an encompassing terminology comprising of tumours with proliferating CD34 positive specialised fibroblasts. Orbital SFTs are rare slowly progressive highly vascular neoplasms. Complete surgical excision is considered the mainstay treatment. Incomplete resection is a known risk factor for recurrence and malignant transformation. Recently preoperative embolisation of SFT has shown promising results in reducing the vascularity of these tumours rendering them amenable to complete surgical excision. Less than 10 cases of embolisation of orbital solitary fibrous tumours have been described in literature. Our patient underwent an attempted surgical excision elsewhere with significant intraoperative haemorrhage which precluded its complete excision. Herein, we report successful outcome in a case of hypervascular orbital SFT managed with preoperative embolisation, surgical resection and adjuvant radiotherapy along with a review of relevant literature.

Giant cell-rich solitary fibrous tumour of the lacrimal gland with prominent angiomatoid cystic changes and an underlying NAB2ex3-STAT6ex18 fusion

“…Complete surgical removal of orbital SFT is the mainstay of treatment, sometimes preceded by preoperative embolisation in order to reduce the risk of intraoperative bleeding as recommended by several papers. 25 26 Angiography may be used preoperatively to assess the tumour vascularity and to better plan for the surgery. Incomplete resection of SFT is a risk factor for local recurrences and/or malignant transformation along with the potential to metastasise sometimes many years later.…”

“…Complete surgical removal of orbital SFT is the mainstay of treatment, sometimes preceded by preoperative embolisation in order to reduce the risk of intraoperative bleeding as recommended by several papers 25 26. Angiography may be used preoperatively to assess the tumour vascularity and to better plan for the surgery.…”

Preoperative Endovascular Embolization of Orbital Solitary Fibrous Tumor With 500-700 Micron Tris-Acryl Gelatin Microspheres

“…12 Recently, two cases of SFT in which Onyx was used by intraoperative intratumoral injection or via preoperative transophthalmic arterial route were reported. 13,14 The tumor was removed after piecemeal resection in the first case and after enucleation in the other. 13,14 Endovascular tumor embolization with particulate material has been previously reported in only one case of SFT.…”

Retro-orbital alveolar soft-part sarcoma in a 76-year-old female: case report and review of the literature

“…1 Orbital ASPS is extremely rare, representing only 5%À15% of all cases of ASPS. 2 The average age at presentation of orbital ASPS is 13.5À17.8 years. A recent review of the literature suggests there are fewer than 70 documented cases of primary orbital ASPS.…”

“…4 It is unlikely, however, that a successful orbitotomy could have been performed without prior embolization given the location and vascularity of the tumour. 2 By histopathology, ASPS is characterized as having a nested architecture with fibrous septae. 5 The cells of the tumour can be large and contain abundant granular eosinophilic or clear cytoplasm.…”