SUMMARY:Solitary fibrous tumors are rare spindle cell neoplasms that typically occur in the thorax but have been described in various locations within the abdomen and head and neck region. The most common extrapleural site is the oral cavity, but these tumors have been also described in the orbit, nasopharynx, paranasal sinuses, salivary glands, and larynx. [1][2][3] We describe a case of a solitary fibrous tumor of the buccal space successfully treated with percutaneous CT-guided cryoablation.A 64-year-old woman was referred to our tumor ablation service with a complaint of progressive left facial swelling. The patient is from Puerto Rico and underwent an excisional biopsy of a left buccal space mass via a transoral approach approximately 1 year before presentation. A solid, encapsulated soft-tissue tumor was found intraoperatively. There was disruption of the capsule during removal, preventing complete excision. Pathology demonstrated a World Health Organization low-grade solitary fibrous tumor (SFT) of the buccal space with 2-3 mitotic cells per 10 high-power fields, which was CD34 ϩ on immunohistochemical staining. Physical examination at current presentation revealed a firm, mobile, and nontender mass in the left malar soft tissues resulting in facial asymmetry. There was no numbness or facial paralysis. The overlying skin appeared normal. Oropharyngeal examination revealed no evidence of ulceration. Facial CT scan showed an enhancing mass within the left buccal space, which appeared isoattenuated to muscle. There was no calcification or necrosis, nor was there bony destruction of the mandible or maxilla. MR imaging at 0.3T revealed a well-circumscribed solid mass measuring 2.6 ϫ 3.2 ϫ 1.7 cm that was separate from the masseter muscle and that displaced the parotid duct and facial vein medially. The mass was isointense compared with muscle on T1-weighted precontrast images and was heterogeneous in appearance on T2-weighted sequences, containing areas of hyperintensity and hypointensity. There was homogeneous strong enhancement, most consistent with a presumed residual or recurrent SFT (Fig 1). The patient declined surgical reexcision because of the risk of facial nerve injury and for cosmetic reasons and, therefore, elected to have this lesion treated with percutaneous thermal ablation.Written, informed consent was obtained from the patient before the start of the procedure. Coagulation parameters were normal. Percutaneous cryoablation was performed in the supine position via a left transmalar approach with local anesthesia and moderate sedation using intravenous midazolam hydrochloride and fentanyl. CT fluoroscopy was used for imaging guidance. Cryoablation was performed with an argonbased cryoablation system (Endocare, Mountain View, Calif) with 1.7-mm-diameter percutaneous applicators. The applicators have a 3-cm active tip and create a freeze zone of approximately 3 cm (length) by 2 cm (width). Two cryoapplicators were placed simultaneously into the mass in a parallel fashion with the tips approximately...

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