WITHDRAWN: Surgical Resection of a Presacral Solitary Fibrous Tumor with Extension to Iliac Vessels using Karakousis’s Abdominoinguinal Approach: Report of a Rare Case

Abstract

Background: The solitary fibrous tumor (SFT) is a rare tumor of mesenchymal origin, with a reported incidence of 2.8 cases per 100.000 tumors and with distinctive histopathological and immunohistochemical characteristics. It was initially described as a pleural lesion and subsequently, it was found in different organs and tissues. The abdominoinguinal incision described by Karakousis allows a radical reliable approach for abdominal-pelvic tumors in lower quadrants. We present the case of a patient with a presacral STF extending to iliac vessels, which required the Karakouis’s approach for its surgical resection.Case Presentation: Forty-seven-year-old man with pain in lumbosacral region radiating to left leg since 5 months. MRI and CT show evidence of a 10cm-retroperitoneal mass (presacral space) extending to left iliac vessels. The early diagnosis corresponded to a sarcomatous retroperitoneal tumor. It was decided to carry out the abdominal scan through the Karakousis’s approach for surgical resection with permanent neurovascular control. The immunohistochemistry and histopathological study revealed a CD-34 positive spindle-cell neoplasia, vimentin, Bcl-2, and β-catenin, compatible with a SFT. It was categorized as low risk for developing metastasis and death from disease, according to the new criteria for malignancy. At present, the patient is asymptomatic and disease-free at 17 months after surgery.Conclusion: Presacral SFT is a rare entity, with a scant incidence reported regarding this location and long-term treatment. Surgical resection is needed as the immediate treatment.