Atypical solitary fibrous tumor of the nose and maxillary sinus

Our plain-English summary of Atypical solitary fibrous tumor of the nose and maxillary sinus, by I. Papadakis, E. Koudounarakis, V. Haniotis, et al (Head & Neck, 2013).

The study

• Authors: I. Papadakis, E. Koudounarakis, V. Haniotis, A. Karatzanis, G. Velegrakis
• Journal: Head & Neck
• Published: 2013;35(3):E77-9
• Type of article: Case report
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Solitary fibrous tumor (SFT) belongs to a group of mesenchymal tumors, also known as benign fibrous mesotheliomas or submesothelial fibromas. SFTs of the sinonasal tract are extremely rare.

Methods: We report a rare case of an atypical SFT of the sinonasal tract presenting with ipsilateral nasal obstruction and recurrent epistaxis. Endoscopy and imaging studies showed a well-circumscribed mass of the nose and the maxillary sinus. The patient underwent total endoscopic resection of the tumor.

Results: Permanent histology and immunohistochemical studies revealed an atypical variant of SFT of the sinonasal tract, with negative surgical margins. The patient did not receive any adjuvant treatment. Postoperative monitoring was uneventful.

Conclusion: In general, these tumors are reported to follow an indolent course. SFTs adopt a biological behavior that cannot be determined as malignant. Total surgical resection of the tumor remains the gold-standard method of treatment.

Copyright © 2011 Wiley Periodicals, Inc.

In plain English

This was a case report from the University of Crete in Iraklion, Greece. It described one patient, a 53-year-old man with recurrent nosebleeds and a 7-month history of nasal blockage and facial pain. A CT scan showed a large, solid mass filling the left nasal cavity and maxillary sinus, with bone remodeling and no other diagnostic features. Surgeons removed the tumor in one piece by endoscopic sinus surgery. Under the microscope it showed atypical features: necrosis, spindling, and more than 4 mitoses per 10 high-power fields. Staining tests set the diagnosis as a solitary fibrous tumor (SFT). SFT is a rare tumor once known by names such as 'benign fibrous mesothelioma.' The authors described it as a tumor of mesenchymal origin, distinct from mesothelioma. The article does not mention asbestos or any other exposure. The patient received no radiotherapy or chemotherapy. Monthly nasal endoscopy and a CT scan at 10 months showed no local recurrence, and his symptoms resolved. The authors concluded that these tumors behave benignly regardless of their microscopic features. They stressed total removal and close follow-up.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One 53-year-old man with recurrent epistaxis (nosebleeds) and a 7-month history of nasal obstruction and facial pain, treated at the University of Crete, Iraklion, Greece. The dates of treatment are not given.
• Main results:
  • CT showed a large, solid mass filling the left nasal cavity and maxillary sinus, with bone remodeling and no other diagnostic radiologic features
  • The patient underwent endoscopic medial maxillectomy with anterior and posterior ethmoidectomy. The tumor was removed en bloc (in one piece).
  • Histology showed a spindle-cell tumor with atypical features of necrosis, spindling, and more than 4 mitoses per 10 high-power fields
  • Immunohistochemistry was diffusely positive for CD34, Bcl-2 and vimentin and negative for CD99 and actin, which set the diagnosis of SFT
  • The patient received no adjuvant radiotherapy or chemotherapy
  • Follow-up included monthly nasal endoscopy and CT after 10 months. It showed no evidence of local recurrence, no complications, and complete resolution of symptoms.
• The authors' conclusion: The authors concluded that the case highlights the diagnostic challenge of SFTs in the head and neck and their benign clinical behavior regardless of histopathologic features. They emphasized total resection with negative margins and close follow-up. They also noted a lack of evidence for benefits of postoperative radiotherapy.

Topics

Medical terms in this study, explained in our Lexicon: Solitary Fibrous Tumor, Mesenchymal Tumor, Mesothelioma, Endoscopy, Histology, Surgical Resection.

Related studies

• Solitary fibrous tumour of the nasal cavity and paranasal sinuses — I. Alobid, L. Alós, et al. (2003)
• Nuclear expression of STAT6 distinguishes solitary fibrous tumor from histologic mimics — L.A. Doyle, M. Vivero, et al. (2014)
• Value of D2-40 in the differential diagnosis of pleural neoplasms with emphasis on its positivity in solitary fibrous tumor — Y. Hu, Q. Yang, et al. (2010)
• Somatic and visceral solitary fibrous tumors in the abdomen and pelvis: cross-sectional imaging spectrum — A.K. Shanbhogue, S.R. Prasad, et al. (2011)
• Solitary fibrous tumor of the nasal cavity and orbit — M. Fukunaga, S. Ushigome, et al. (1995)
• Immunoreactivity for calretinin and keratins in desmoid fibromatosis and other myofibroblastic tumors: a diagnostic pitfall — S. Barak, Z. Wang, et al. (2012)

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