Solitary Fibrous Tumors of Chest: Another Look with the Oncologic Perspective

Abstract

Solitary fibrous tumors are mesenchymal lesions that arise at a variety of sites, most commonly the pleura. Most patients are asymptomatic at diagnosis, with lesions being detected incidentally. Nevertheless, some patients present due to symptoms from local tumor compression (eg. of the airways and pulmonary parenchyma). Furthermore, radiological methods are not always conclusive in making a diagnosis, and thus, pathological analysis is often required. In the past three decades, immunohistochemical techniques have provided a gold standard in solitary fibrous tumor diagnosis. The signature marker of solitary fibrous tumor is the presence of the NAB2-STAT6 fusion that can be reliably detected with a STAT6 antibody. While solitary fibrous tumors are most often benign, they can be malignant in 10-20% of the cases. Unfortunately, histological parameters are not always predictive of benign vs malignant solitary fibrous tumors. As solitary fibrous tumors are generally regarded as relatively chemoresistant tumors; treatment is often limited to localized treatment modalities. The optimal treatment of solitary fibrous tumors appears to be complete surgical resection for both primary and local recurrent disease. However, in cases of suboptimal resection, large disease burden, or advanced recurrence, a multidisciplinary approach may be preferable. Specifically, radiotherapy for inoperable local disease can provide palliation/shrinkage. Given their sometimes -unpredictable and often- protracted clinical course, long-term follow-up post-resection is recommended.

Solitary fibrous tumour of the sigmoid colon mesentery

“…SFT were originally described in the pleura by Klemperer and Rabin in 1931,4 consistent with most series finding a thoracic origin in up to 70% of the cases (80% pleural, 10% mediastinal and 10% intrapulmonary) 5. Today, SFT are known to arise from many extrathoracic tissues including but not limited to head and neck, retroperitoneum, peritoneum, abdomen, meninges, orbit, upper respiratory tract, salivary glands, thyroid, liver, adrenal gland, kidney, spermatic cord, urinary bladder, prostate, uterine cervix, spinal cord and periosteum 4…”

Locally advanced malignant solitary fibrous tumour successfully treated with conversion chemotherapy, operation and postoperative radiotherapy: a case report

“…13,14 Most SFTs are benign, but MSFT, which accounts for 10-20% of all SFTs, has a higher recurrence and metastatic rate, and relatively poor survival. 5,6 Tumour sizes larger than 10 cm appear to be malignant, and the tumour size in the present case was larger than 10 cm, both before and after the conversion chemotherapy, indicating a malignant tumour. Although 18F-FDG PET/CT may be helpful in diagnosing MSFT, its diagnostic utility remains debatable due to its imperfect sensitivity.…”

Single Solitary Fibrous Tumor Brain Metastasis in a Patient with Simultaneous Adenocarcinoma of the Lung: Case Report and Review of the Literature

“…We have previously published clinical outcomes after radiosurgery or whole brain radiation for brain metastasis of various histologic types [19,20]. Radiation therapy is especially utilized in cases with malignant SFT, narrow margins, tumor size greater than 10 cm, and fast-growing tumors [2]. For example, in an analysis of 102 SFT cases, Krengli et al reported that local control was higher in patients who were treated with surgery plus postoperative radiation therapy when compared to surgery alone [21].…”

“…SFTs are most commonly benign, but 10-20% of cases have been reported to be malignant. SFTs usually occur in middle-aged patients and equally in men and women [2]. e most common sites for metastasis are the lungs (61%), pleura (49%), liver (41%), bones (41%), and peritoneum (41%) [3].…”