Solitary fibrous tumor of the upper respiratory tract. A report of six cases

Our plain-English summary of Solitary fibrous tumor of the upper respiratory tract. A report of six cases, by G.B. Witkin, J. Rosai (The American Journal of Surgical Pathology, 1991).

The study

• Authors: G.B. Witkin, J. Rosai
• Journal: The American Journal of Surgical Pathology
• Published: 1991;15(9):842-8
• Type of article: Case report
• Cited by: 175 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

We report six cases of a neoplasm that arose in the upper respiratory tract and had a histological appearance indistinguishable from that of solitary fibrous tumor of the pleura (SFT, so-called fibrous mesothelioma). The patients were adults who presented with nasal obstruction. The lesions lacked the characteristic features of other recognized neoplasms that occur in this region. The tumor cells were immunoreactive for vimentin but not for keratin. The occurrence of SFT in this location further supports the argument that SFT is a tumor of mesenchymal and not mesothelial origin. None of the tumors in this series had the histologic features of malignancy described for SFT in other locations, and there was no aggressive behavior in limited follow-up. Until more cases of SFT in unusual locations have been studied, we recommend that the same criteria used for assessing aggressiveness in SFT of the pleura be applied to them.

In plain English

This article reported six tumors of the nose and nasopharynx that looked under the microscope the same as solitary fibrous tumor of the pleura, sometimes called "fibrous mesothelioma." The cases came from one author's consultation files. The patients were adults aged 30 to 64, three women and three men, all with nasal obstruction. The tumors were typically described as polypoid white masses in the nasal cavity or nasopharynx; none had destroyed bone. The cells looked bland, with few dividing cells and no necrosis. Of three cases stained, cases 1 and 6 reacted for vimentin and case 5 did not. None reacted for keratin or actin. S-100 protein was tested only in case 5, which was also negative. Of five patients with follow-up, four had no evidence of disease 1 to 12 years after surgery, and one had stable tumor after 4 years. The study did not look at asbestos exposure. The authors concluded that the cases add another site for this tumor and support a mesenchymal, not mesothelial, origin. They said there were too few cases to comment on outlook.

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 series (report of six cases)
• Who was studied: Six adults (three female, three male, per Table 1), aged 30 to 64, all with nasal obstruction. Cases were contributed from hospitals in Canada, Mexico, England, Australia, Argentina and Japan. Dates of diagnosis were not given.
• Exposure: No asbestos or other exposure was studied. The study described the tumor's appearance, staining and follow-up. The discussion cites other work for SFT's lack of association with asbestos; that is not a finding of this study.
• Main results:
  • Tumors were typically described as polypoid white masses of the nasal cavity or nasopharynx. No case showed bony destruction.
  • In case 1 there were focally 1-2 mitoses per 10 high-power fields; mitotic figures were inconspicuous in the other cases.
  • Necrosis or hemorrhage were not identified in any of the six cases.
  • Of the three cases stained, tumor cells were reactive for vimentin in cases 1 and 6 but not in case 5.
  • No stained tumor reacted with antibodies to keratin or actin. S-100 protein was tested in case 5 only and was negative.
  • Earlier biopsies had been diagnosed as esthesioneuroblastoma (case 1), reparative process (case 2), and unclassified benign tumor (case 5).
  • Follow-up was available in five cases. Four patients had no evidence of disease or recurrence of symptoms 1 to 12 years after surgery.
  • The fifth patient with follow-up (case 5) had persistent stable tumor 4 years after local resection and tumor embolization.
• The authors' conclusion: The authors concluded that these cases establish another location for SFT and provide additional support for a mesenchymal rather than a mesothelial origin. They recommended that the criteria used for pleural SFT be provisionally applied when evaluating SFT in other locations such as this one.
• Limitations the authors state:
  • The number of cases, especially those with follow-up, was too small to comment on prognosis for SFT of the upper respiratory tract.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Solitary Fibrous Tumor, Neoplasm, Mesothelioma, Pleura.

Related studies

• Asbestos: mechanisms of toxicity and carcinogenicity in the respiratory tract — B. Mossman, W. Light, et al. (1983)
• In vitro approaches for determining mechanisms of toxicity and carcinogenicity by asbestos in the gastrointestinal and respiratory tracts — B.T. Mossman (1983)
• Host and environmental factors enhancing carcinogenesis in the respiratory tract — P. Nettesheim, D.C. Topping, et al. (1981)
• Systematic review and meta-analysis of epidemiological literature evaluating the association between exposure to man-made vitreous fibers and respiratory tract cancers — N. Suder Egnot, S.M. Benson, et al. (2020)
• Solitary fibrous tumor of the mediastinum. A report of 14 cases — G.B. Witkin, J. Rosai (1989)
• Studies on the deposition of inhaled fibrous material in the respiratory tract of the rat and its subsequent clearance using radioactive tracer techniques. 1. UICC crocidolite asbestos — J.C. Evans, R.J. Evans, et al. (1973)

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