Solitary Fibrous Tumor in the Round Ligament of the Liver: A Fortunate Intraoperative Discovery

Abstract

Solitary fibrous tumors (SFTs) are mesenchymal neoplasms of fibroblastic origin, most commonly found in the pleura. Numerous extrathoracic locations have been reported during the last 2 decades. Herein, we report the first case of an SFT in the round ligament of the liver. A 46-year-old Caucasian man presented with a 12-month history of abdominal pain. An ultrasonography-guided microbiopsy first revealed a desmoid tumor. After failure of first- and second-line medical treatments (celecoxib and tamoxifen, then imatinib), histological reexamination was suspicious for a low-grade sarcoma. MRI was also suspicious for a malignant process. Hence, surgery was decided. Laparotomy found a huge and well-limited tumor that, unexpectedly, was appended to the round ligament of the liver and free from any other intra-abdominal contact. The tumor was easily removed. Excision was monobloc and macroscopically complete. Histological analysis diagnosed an SFT arising from the round ligament of the liver. No adjuvant treatment was given. Ten months after surgery, the patient is alive without any signs or symptoms of relapse. This is the first report of SFT arising from the round ligament of the liver. It illustrates the difficulty in diagnosing such tumors. Whilst diagnosis of SFT is rare, it should be kept in mind to allow early diagnosis and complete surgical resection, which provide the best chance for recovery.

Solitary fibrous tumour of the liver—report on metastasis and local recurrence of a malignant case and review of literature

“…They describe a favourable outcome on the basis of increased intratumoral necrosis, reduced tumoural enhancement and stabilisation of tumour size based on consecutive MRI scans. Beyer et al [45] describes a case where the SFTL was initially thought to be a desmoid tumour, and the patient was managed with hormone replacement therapy before imatinib was trialled with no effect. The patient eventually underwent surgical resection with no malignant features evident.…”

Spontaneous inflammation and necrosis of the falciform and round ligaments: a case report and review of the literature

“…In the literature, preoperative CT findings were confirmed intraoperatively. These findings included falciform ligament abscess [4], desmoid tumor appended to the round ligament [5], and infiltration of the round ligament [6].…”

“…Tumors of the falciform ligament have rarely been reported. In some cases, tumor from surrounding structures such as invasion of the round ligament by lieberkuhnian adenocarcinoma [11], lymphangioma of the falciform ligament [3], and abdominal desmoid tumor encapsulating the round ligament have also been reported [5].…”

Mesothelial cyst in the liver round ligament: A case report and review of the literature

“…Liver round ligament’s cysts are rare entities. In most cases they are benign lesions such as lipomas [1] , hydatid cysts [2] , abscesses [3] , or mesothelial cysts [4] , [5] , [6] , [7] , [8] ; only a few malignant tumors originating in the round ligament of the liver have been reported [9] , [10] , [11] , [12] . Mesothelial cysts are generally considered developmental disorders, however due to the low incidence of this pathology the true etiology is unclear.…”