Background Solitary fibrous tumors (SFTs) are rare tumors, mostly derived from connective tissue mesenchymal cells that arise from the pleura. There are very few reports of primary pancreatic SFT. Preoperative diagnosis is difficult owing to the lack of distinctive radiological findings. We report a case of pancreatic SFT with particularly rare malignant findings. Case presentation A 60-year-old man was referred to the hospital because of a right upper quadrant mass and abnormal liver function test results. Contrast-enhanced computed tomography (CT) showed a well-defined enhanced tumor measuring approximately 8 cm in the pancreatic head. Magnetic resonance imaging (MRI) showed T1WI hypointensity, T2WI hyperintensity, and DWI hyperintensity. The main pancreatic duct and common bile duct were dilated owing to obstruction by the tumor. The following tumor markers were mildly elevated: carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), SPan-1, and DUPAN-2. The histological diagnosis obtained by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) was negative for pancreatic ductal carcinoma, malignant lymphoma and neuroendocrine tumor, suggesting the possibility of mesenchymal tumor, but the diagnosis was not confirmed. The patient was judged suitable for surgery and underwent subtotal stomach-preserving pancreatoduodenectomy with D2 lymph node dissection. On histopathological examination of the resected specimen, infiltrating spindle-shaped cells had proliferated, containing numerous mitotic figures, with necrotic findings inside the tumor. Immunostaining was positive for cluster of differentiation-34 (CD34), B cell CLL/lymphoma-2 (Bcl-2), and signal transducer and activator of transcription (STAT6). On the basis of these findings, a diagnosis of malignant pancreatic SFT was made. The patient remains free of recurrent disease after 12 months of follow-up without adjuvant therapy and he is being carefully followed up as an outpatient. Conclusions We experienced a case of malignant pancreatic head SFT. Immunohistochemical staining of the extracted specimens was useful for diagnosis.

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Background Neurofibroma of the breast is extremely rare, with only a few reported cases. Here, we report a case of solitary neurofibroma of the breast in a 95-year-old woman. Case presentation A 95-year-old woman presented with a palpable mass in the left breast. Mammography revealed a well-defined mass. A 1.6-cm round mass was found in the lower outer quadrant of the left breast on ultrasonography. The internal echo of the tumor was a mixture of relatively uniform hypoechoic areas with posterior enhancement and heterogeneous hyperechoic areas. She underwent a core needle biopsy. The pathological findings revealed a spindle cell lesion with no malignant findings. At 2 months follow-up, repeat breast ultrasonography showed that the mass had enlarged to be 2.7 cm in size. A repeat core needle biopsy, however, revealed no particularly new information. Because the tumor was growing and a definite diagnosis was not made, lumpectomy was performed. We found bland-spindled cells with shredded-carrot collagen bundles. Immunohistochemical antibody markers (S100, SOX10, and CD34) were positive for the spindle cells. Some of the tumors maintained the bilayer nature of luminal cells and myoepithelial cells, which might be the reason for internal heterogeneity on ultrasound. A histological diagnosis of neurofibroma with adenosis was made. At 6 months follow-up, no recurrent lesions were found. Conclusions Ultrasound and pathological images revealed an extremely rare case of neurofibroma combined with adenosis. Tumor resection was performed because it was difficult to make a definitive diagnosis using needle biopsy. Even when a benign tumor is suspected, short-term follow-up is necessary, and if an enlargement is observed, early tumor resection is recommended.

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DepartmentsofGastroenterologicalSurgery 1) ,ImagingDignostics 2) ,andPathology 3) ,HamamatsuMedicalCenter Wereportafemalepatientwhohadundergoneextendedthymectomyforathymomaat53yearsof age.ThetumorwashistopathologicallydiagnosedasTypeB3+B2thymomaaccordingtotheWHOclassification. The patient received left hepatectomy for a liver tumor 9 years after the thymoma surgery. Although recurrent liver tumors were discovered 6 years after the liver resection, they disappeared by chemotherapyandradiationtherapy.Twoyearsaftertheliverrecurrence,agynecologistdiagnosedher tohaveperitonealdisseminationofthethymoma(TypeB3)byabiopsy,whichwaspreoperativelysuspectedofarightovariantumor,butcouldnotberesectedduetoabundantbloodsupply.Wetreatedthis disseminatedtumorbyradiotherapyandthetumorexhibitedcompleteresponse.However,intraperitonealtumorsandalivertumornewlyappearedtwoyearsafterwards.Radiotherapywasveryeffectivefor thosetumors,butnewperitonealandliverlesionspersistedtogrow.Multidrugchemotherapywasadoptedandhasbeencontinued.Morethan21yearsormorethan12yearshaveelapsedafterthethymoma surgeryoraftertheresectionoflivermetastasis,respectively.Therearefewcasesoflivermetastasesof athymomawhichwereoperatedonandthisistheonlyreportedcaseofathymomaofwhichperitoneally disseminatedtumorswereefficientlytreatedbyradiotherapy.Multidisciplinaryapproachincludingsurgicalresectionmightcontributetolong-termsurvivalevenformetastaticthymomapatient.