Top

Published in:

01-12-2013 | Bone and Soft Tissue Sarcomas

Extrathoracic Location and “Borderline” Histology are Associated with Recurrence of Solitary Fibrous Tumors After Surgical Resection

Authors: Breelyn A. Wilky, MD, Elizabeth A. Montgomery, MD, Angela A. Guzzetta, MD, Nita Ahuja, MD, Christian F. Meyer, MD, PhD

Published in: Annals of Surgical Oncology | Issue 13/2013

Abstract

Background

Most solitary fibrous tumors (SFTs) are cured by complete resection, but many recurrent and metastatic SFTs do not respond to treatment and are fatal. Malignant histology, defined by England’s pathologic criteria, is strongly associated with recurrence, but some benign SFTs still behave aggressively. Several studies have suggested that extrathoracic SFTs have a worse prognosis. We reviewed thoracic and extrathoracic SFTs from our institution to determine if extrathoracic location is associated with recurrence, independent of malignant histology.

Methods

With IRB approval, we retrieved patient pathology reports from the Johns Hopkins Surgical Pathology database between 1991 and 2011 and included 83 SFT patients in our analysis. Patient history and outcomes were obtained from the medical record and primary care physicians. Predictors of recurrence were analyzed by univariate and multivariate analysis and survival determined by the Kaplan–Meier method.

Results

Of the 83 patients, 59 had extrathoracic SFTs in neurologic (n = 24), extremity or head/neck (n = 13), or visceral/intraabdominal (n = 22) sites. A total of 74 SFTs were classified benign and 9 as malignant. Of the 14 recurrences, 13 occurred in extrathoracic SFTs; only 7 were classified as malignant. Multivariate analysis confirmed that malignant histology had the strongest association with recurrence, but extrathoracic location also independently predicted recurrence. A total of 20 benign SFTs possessed 1 or more of England’s criteria but to an insufficient degree for malignant classification. These “borderline” SFTs were more likely to recur than benign SFTs without these features.

Conclusions

Extrathoracic and “borderline” SFTs with any of England’s criteria have a higher risk of recurrence.

Robinson L. Solitary fibrous tumor of the pleura. Cancer Control. 2006;13:264–9.PubMed

Brunnemann R, Ro J, Ordonez N, Mooney J, El-Naggar A, Ayala A. Extrapleural solitary fibrous tumor: a clinicopathologic study of 24 cases. Mod Pathol. 1999;12:1034–42.PubMed

Chen H, Zeng X, Wu J, Dou YF, Wang Y, Zhong P, et al. Solitary fibrous tumor of the central nervous system: a clinicopathologic study of 24 cases. Acta Neurochir. 2012;154:237–48.PubMedCrossRef

Cranshaw I, Gikas P, Fisher C, Thway K, Thomas J, Hayes A. Clinical outcomes of extra-thoracic solitary fibrous tumours. Eur J Surg Oncol. 2009;35:994–8.PubMedCrossRef

Erdag G, Qureshi H, Patterson J, Wick M. Solitary fibrous tumors of the skin: a clinicopathologic study of 10 cases and review of the literature. J Cutan Pathol. 2007;34:844–50.PubMedCrossRef

Gold JS, Antonescu CR, Hajdu C, Ferrone CR, Hussain M, Lewis JJ, et al. Clinicopathologic correlates of solitary fibrous tumors. Cancer. 2002;94:1057–68.PubMedCrossRef

Hasegawa T, Matsuno Y, Shimoda T, Hasegawa F, Sano T, Hirohashi S. Extrathoracic solitary fibrous tumors: their histological variability and potentially aggressive behaviour. Hum Pathol. 1999;30:1464–73.PubMedCrossRef

Musyoki F, Nahal A, Powell T. Solitary fibrous tumor: an update on the spectrum of extrapleural manifestations. Skeletal Radiol. 2012;41:5–13.PubMedCrossRef

Herawi M, Epstein J. Solitary fibrous tumor on needle biopsy and transurethral resection of the prostate: a clinicopathologic study of 13 cases. Am J Surg Pathol. 2007;31:870–6.PubMedCrossRef

10.

O’Regan E, Vanguri V, Allen C, Eversole L, Wright J, Woo S. Solitary fibrous tumor of the oral cavity: clinicopathologic and immunohistochemical study of 21 cases. Head Neck Pathol. 2009;3:106–15.PubMedCrossRef

11.

Westra W, Gerald W, Rosai J. Solitary fibrous tumor: Consistent CD34 immunoreactivity and occurrence in the orbit. Am J Surg Pathol. 1994;18:992–8.PubMedCrossRef

12.

Chilosi M, Facchetti F, Dei Tos AD, Lestani M, Morassi ML, Martignoni G, et al. bcl-2 expression in pleural and extrapleural solitary fibrous tumours. J Pathol. 1997;181:362–7.PubMedCrossRef

13.

Cardillo G, Carbone L, Carleo F, Masala N, Graziano P, Bray A, et al. Solitary fibrous tumors of the pleura: an analysis of 110 patients treated in a single institution. Ann Thorac Surg. 2009;88:1632–7.PubMedCrossRef

14.

Okike N, Bernatz P, Woolner L. Localized mesothelioma of the pleura: benign and malignant variants. J Thorac Cardiovasc Surg. 1978;75:363–72.PubMed

15.

England D, Hochholzer L, McCarthy M. Localized benign and malignant fibrous tumors of the pleura: A clinicopathologic review of 223 cases. Am J Surg Pathol. 1989;13:640–58.PubMedCrossRef

16.

Perrot Md, Fischer S, Bründler M, Sekine Y, Keshavjee S. Solitary fibrous tumors of the pleura. Ann Thorac Surg. 2002;74:285–93.CrossRef

17.

Chang YL LY, Wu CT. Thoracic solitary fibrous tumor: clinical and pathological diversity. Lung Cancer. 1999;23:53–60.

18.

Vallat-Decouvelaere A, Dry S, Fletcher C. Atypical and malignant solitary fibrous tumors in extrathoracic locations: evidence of their comparability to intra-thoracic tumors. Am J Surg Pathol. 1998;22:1501–11.PubMedCrossRef

19.

Santos RS, Haddad R, Lima CE, Liu YL, Misztal M, Ferreira T, et al. Patterns of recurrence and long-term survival after curative resection of localized fibrous tumors of the pleura. Clin Lung Cancer. 2005;7:197–201.PubMedCrossRef

20.

Park M, Araujo D. New insights into the hemangiopericytoma/solitary fibrous tumor spectrum of tumors. Curr Opin Onc. 2009;21:327–31.CrossRef

21.

Stacchiotti S, Negri T, Palassini E, Conca E, Gronchi A, Morosi C, et al. Sunitinib malate and figitumumab in solitary fibrous tumor: patterns and molecular bases of tumor response. Mol Cancer Ther. 2010;9:1286–97.PubMedCrossRef

22.

Hajdu M, Singer S, Maki R, Schwartz G, Keohan M, Antonescu C. IGF2 over-expression in solitary fibrous tumours is independent of anatomical location and is related to loss of imprinting. J Pathol. 2010;221:300–07.PubMedCrossRef

23.

Yokoi T, Tsuzuki T, Yatabe Y, Suzuki M, Kurumaya H, Koshikawa T, et al. Solitary fibrous tumour: significance of p53 and CD34 immunoreactivity in its malignant transformation. Histopathology. 1998;32:423–32.PubMedCrossRef

24.

Lu C, Ji Y, Shan F, Guo W, Ding J, Ge D. Solitary fibrous tumor of the pleura: an analysis of 13 cases. World J Surg. 2008;32:1663–8.PubMedCrossRef

25.

Nielsen G, O’Connell J, Dickersin G, Rosenberg A. Solitary fibrous tumor of soft tissue: a report of 15 cases, including 5 malignant examples with light microscopic, immunohistochemical, and ultrastructural data. Mod Pathol. 1997;10:1028–37.PubMed

26.

Sung S, Chang J, Kim J, Lee K, Han J, Park S. Solitary fibrous tumors of the pleura: surgical outcome and clinical course. Ann Thorac Surg. 2005;79:303–7.PubMedCrossRef

27.

Hanau C, Miettinen M. Solitary fibrous tumor: Histological and immunohistochemical spectrum of benign and malignant variants presenting at different sites. Human Pathol. 1995;26:440–9.CrossRef

28.

Insabato L, Siano M, Somma A, Gentile R, Santangelo M, Pettinato G. Extrapleural solitary fibrous tumor: a clinicopathologic study of 19 cases. Int J Surg Pathol. 2009;17:250–4.PubMedCrossRef

29.

Suster S, Nascimento A, Miettinen M, Sickel J, Moran C. Solitary fibrous tumors of soft tissue. A clinicopathologic and immunohistochemical study of 12 cases. Am J Surg Pathol. 1995;19:1257–66.PubMedCrossRef

30.

Tihan T, Viglione M, Rosenblum M, Olivi A, Burger P. Solitary fibrous tumors in the central nervous system: A clinicopathologic review of 18 cases and comparison to meningeal hemangiopericytomas. Arch Pathol Lab Med. 2003;127:432–9.PubMed

31.

Daigeler A, Lehnhardt M, Langer S, et al. Clinicopathological findings in a case series of extrathoracic solitary fibrous tumors of soft tissues. BMC Surgery. 2006;6:10.PubMedCrossRef

32.

Morimitsu Y, Nakajima M, Hisaoka M, Hashimoto H. Extrapleural solitary fibrous tumor: clinicopathologic study of 17 cases and molecular analysis of the p53 pathway. APMIS. 2000;108:617–25.PubMedCrossRef

33.

Fukunaga M, Naganuma H, Nikaido T, Harada T, Ushigome S. Extrapleural solitary fibrous tumor: a report of seven cases. Mod Pathol. 1997;10:443–50.PubMed

34.

Mentzel T, Bainbridge T, Katenkamp D. Solitary fibrous tumor: clinicopathological, immunohistochemical, and ultrastructural analysis of 12 cases arising in soft tissues, nasal cavity and nasopharynx, urinary bladder and prostate. Virchows Arch. 1997;430:445–53.PubMedCrossRef

35.

Demicco E, Park M, Araujo D, Fox PS, Bassett RL, Pollock RE, et al. Solitary fibrous tumor: a clinicopathological study of 110 cases and proposed risk assessment model. Mod Pathol. 2012;25:1298–306.PubMedCrossRef

36.

Brozzetti S, D’Andrea N, Limiti MR, Pisanelli MC, De Angelis R, Cavallaro A. Clinical behavior of solitary fibrous tumors of the pleura: an immunohistochemical study. Anticancer Res. 2000;20:4701–6.PubMed

37.

Nakamori M, Oda Y, Kurihara S, Tsuneyoshi M. Clinicopathological and immunohistochemical study of extrapleural and pleural solitary fibrous tumors: A special emphasis on the comparison between ordinary tumors and their malignant variant. Mol Med Rep. 2008;1:797–03.

38.

Bouvier C, Metellus P, de Paula AM, Vasiljevic A, Jouvet A, Guyotat J, et al. Solitary fibrous tumors and hemangiopericytomas of the meninges: overlapping pathological features and common prognostic factors suggest the same spectrum of tumors. Brain Pathol. 2012;22:511–21.PubMedCrossRef

39.

Mosquera J, Fletcher C. Expanding the spectrum of malignant progression in solitary fibrous tumors: a study of 8 cases with a discrete anaplastic component—is this dedifferentiated SFT? Am J Surg Pathol. 2009;33:1314–21.PubMedCrossRef

40.

World Health Organization Classification of Tumours. Pathology and Genetics of Tumours of Soft Tissue and Bone. Fletcher CDM, Unni KK, Mertens F, eds. Lyon: IARC Press; 2002.

41.

Robinson DR, Wu YM, Kalyana-Sundaram S, Cao X, Lonigro RJ, Sung YS, et al. Identification of recurrent NAB2-STAT6 gene fusions in solitary fibrous tumor by integrative sequencing. Nat Genet. 2013;45:180–5.PubMedCrossRef

Title: Extrathoracic Location and “Borderline” Histology are Associated with Recurrence of Solitary Fibrous Tumors After Surgical Resection
Authors: Breelyn A. Wilky, MD
Elizabeth A. Montgomery, MD
Angela A. Guzzetta, MD
Nita Ahuja, MD
Christian F. Meyer, MD, PhD
Publication date: 01-12-2013
Publisher: Springer US
Published in: Annals of Surgical Oncology / Issue 13/2013
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-013-3241-x

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Extrathoracic Location and “Borderline” Histology are Associated with Recurrence of Solitary Fibrous Tumors After Surgical Resection

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 13/2013

Interval Between Neoadjuvant Chemoradiotherapy and Surgery for Esophageal Squamous Cell Carcinoma: Does Delayed Surgery Impact Outcome?

Discordance Between Conventional and Detailed Lymph Node Analysis in Resected Biliary Carcinoma at or Above the Cystic Duct: Are We Understaging Patients?

Esophageal Cancer Associated with Multiple Primary Cancers: Surgical Approaches and Long-term Survival

Perioperative Complications in the Cancer Patient: A Robust Prognostic Factor

Predicting Dysplasia and Invasive Carcinoma in Intraductal Papillary Mucinous Neoplasms of the Pancreas: Development of a Preoperative Nomogram

A Technique for Laparoendoscopic Resection of Posterior Fundic Gastric GISTs Without Need for a Gastrotomy