Solitary Fibrous Tumor of the Pancreas

Excerpt

A 59-year-old man with a past medical history significant for metabolic syndrome (mild arterial hypertension, type 2 diabetes, and dyslipidemia) was referred for left pancreatectomy. He was incidentally discovered by an abdominal ultrasound with a 4-cm tumor located at the pancreatic body. An abdominal computed tomography and a magnetic resonance imaging found a well-defined round tumor located at the pancreatic body without any sign of vascular involvement (Fig. 1). A DOTATATOC- PET-scan did not reveal any hyperfixation on the tumor. Chromogranin A was elevated at 569 μ/l (normal values < 100 μ/l). Given the suspicion of pancreatic neuroendocrine tumor, the patient underwent a left pancreatectomy with splenic vessels and spleen preservation with an uneventful postoperative course. Macroscopic examination found a solid white tumor with well-defined margins (Fig. 1). The tumor was made of spindle-shaped cells with elongated nuclei infiltrating the normal pancreatic tissue. Mitoses were 2 per 10 high-power fields. Proliferative index by KI-67 was 7% and immunohistochemically, the tumor cells were positive for CD-34, bcl-2, and stat 6 (Fig. 2). The final diagnosis was consistent with a solitary fibrous tumor of the pancreas (SFT). Solitary fibrous tumors are mesenchymal tumors typically located to the pleura. Kidney, peritoneum, liver, and salivary glands represent less frequent involved organs¹. Solitary fibrous tumors involving the pancreas have been described in less than 20 patients, usually as incidentally discovered in women². SFTs present as well-defined masses with firm and whitish aspect. Tumoral cells are typically round-to-spindle with variable amount of mitoses. Surgery represents the mainstay of the treatment for SFTs. After resection, clinical follow-up is highly recommended because of uncertain biological behavior.

…