Solitary fibrous tumor of bone developing lung metastases on long-term follow-up
- PDF / 1,930,010 Bytes
- 7 Pages / 595.276 x 790.866 pts Page_size
- 56 Downloads / 185 Views
CASE REPORT
Solitary fibrous tumor of bone developing lung metastases on long-term follow-up Cassie Jia 1 & Julia Crim 1 & Andrea Evenski 1 & Lester J. Layfield 1 Received: 1 March 2020 / Revised: 19 May 2020 / Accepted: 25 May 2020 # ISS 2020
Abstract Solitary fibrous tumors are rare mesenchymal neoplasms of fibroblastic or myofibroblastic origin. Primary solitary fibrous tumors arising in bone are extremely rare and rarely metastasize. We present a case of solitary fibrous tumor where the diagnosis was delayed due to a failure to recognize the subtle, lytic lesion underlying a fracture of the left humerus. The patient underwent proximal humeral replacement and was followed closely with imaging of humerus and chest. A small lung metastasis was found on CT scan 38 months later and was resected. Two additional small metastases were found and resected 62 months after initial tumor resection. The purpose of this case report is both to highlight the radiologic challenges which can lead to overlooking a lytic lesion underlying a fracture and to show the importance of long-term follow-up in patients with solitary fibrous tumor. Keywords Solitary fibrous tumor . Pathologic fracture
Introduction The neoplasm which is today known as solitary fibrous tumor (SFT) was first described by Klemperer and Rabin [1] as localized fibrous mesotheliomas arising in pleura and following a generally benign clinical course. Foster and Ackerman [2] described the neoplasms as composed of interlacing bands of spindle cells with no apparent pattern, and subsequent authors reported morphologically identical lesions occurring at sites other than pleura. Many of these neoplasms had a microscopic appearance similar to the hemangiopericytoma pattern described by Stout and Murray [3]. Initially thought to be diagnostic of hemangiopericytoma, the richly vascular pattern composed of both large (staghorn) and small vessels lined by a single layer of endothelial cells has been found to occur
* Cassie Jia [email protected]
in a variety of other neoplasms, both benign and malignant. Today, the use of the term hemangiopericytoma has largely been abandoned, and the majority of neoplasms which were originally classified as low-grade hemangiopericytoma have been assigned to the SFT category [4–6]. SFTs occur at a wide variety of body sites, including the liver, lung, thyroid, thymus, and somatic soft tissues [7, 8]. Primary SFTs arising in bone are extremely rare, and only a few cases have been reported in the literature [6, 9–11]. We report a case of primary SFT in the left humerus in a patient who presented with a spiral fracture after a fall. Recognition that this was a pathologic fracture due to underlying tumor was delayed by 5 months. Metastasis to the lung developed more than 3 years after presentation, with further lung metastases developing more than 5 years after presentation. This case is being reported both to highlight the findings of a subtle, lytic lesion in the setting of a fracture and preexisting osteoporosis and to show the lon
Data Loading...
