Solitary Fibrous Tumors of the Head and Neck

Abstract

Solitary fibrous tumors (SFTs) of the head and neck are uncommon. Lesions previously diagnosed in the head and neck as hemangiopericytomas (HPCs), giant cell angiofibromas (GCAs), and orbital fibrous histiocytoma (OFHs) are now recognized as within the expanded spectrum of SFTs. To better understand the clinicopathologic profile of head and neck SFTs, we performed a multi-institutional study of 88 examples. There was no sex predilection (F:M ratio 1.2), and the median patient age was 52y (range 15>89). The sinonasal tract and orbit were the most common sites involved (30% and 25%), followed by the oral cavity and salivary glands (15% and 14%). Original diagnoses included HPC (25%), SFT (67%), and OFH (6%), with one SFT and one OFH noted as showing GCA-like morphology. On review, the predominant histologic pattern was classic SFT-like in 53% and cellular (former HPC-like) in 47%; lipomatous differentiation (8%) and giant cell angiofibroma-like pattern (7%) were less prevalent. Subsets demonstrated nuclear atypia (23%), epithelioid morphology (15%), or coagulative necrosis (6%). Infiltrative growth (49%) and osseous invasion (82%) were prevalent among evaluable cases. Of the 48 SFTs with follow-up (median 77mo, mean 100mo), 19 showed recurrence (40%). Of these, four patients were alive with disease and four dead of disease. Size and mitotic rate were negative prognosticators using a joint prognostic proportional hazards regression model. Three patients experienced metastasis, to lungs, parotid, bone, and skull base, including one case showing overtly sarcomatous “dedifferentiation”. As a group, SFTs present in a wide anatomic and morphologic spectrum in the head and neck. Only rare examples metastasize or cause death from disease. However, the fairly high local recurrence rate underscores their aggressive potential and highlights the importance of prospective recognition.

The Diagnosis and Treatment of Orbital Solitary Fibrous Tumor

“…Through our observations, combined with previous reports, the fairly high local recurrence rate underscores their aggressive potential and highlights the importance of prospective recognition [17] . In our case, 2 patients were found to have relapsed, with the lesions growing more rapidly and more invasive after recurrence.…”

Solitary fibrous tumor of the scrotum: a case report and review of the literature

“…It was first reported by Klemperer and Rabin in 1931 in the pleura. Although the disease most commonly occurs in the pleura, extra-thoracic SFTs have been reported in many sites including the head and neck [10], intracranial and spinal cord meninges [11], eyes [12], thyroid [13], larynx [14], gastrointestinal system [15–17], genitourinary tract [18–20], pelvis [21] and soft tissue [22]. The most common extra-pleural locations are the meninges, followed by subcutaneous tissues of the lower limbs, the retroperitoneum, and the orbit [23].…”

Extremely rare case of intravascular solitary fibrous tumour in the inferior vena cava with review of the literature

“…However, the incidence of extrapleural SFT (ESFT) has been increasing within the last two decades, and approximately more than one-third of literature in English is about ESFTs [9]. Such tumour has been observed at almost every extrapleural anatomic site, including the liver [10], kidney [11], pancreas [12], prostate [13], breast [14], central nervous system [15], reproductive system [16, 17], orbit [18], head and neck [19], pelvis [20], soft tissues in the extremities [21] and retroperitoneum [22]. However, the incidence of intravascular SFT is extremely rare [23].…”