Head and neck solitary fibrous tumors: a rare and challenging entity

Abstract

The objective of this study is to analyze the outcome of treatment for solitary fibrous tumors (SFTs) in the head and neck area. SFTs present as slow-growing masses, often with local compressive symptoms that are difficult to distinguish from other soft-tissue tumors. SFTs are commonly treated using local excision without adjuvant therapy. To date, only heterogeneous small series have been published, documenting the treatment results and outcome with these tumors. Retrospective study of patients with histopathologically confirmed SFT treated at two tertiary referral hospitals between 2004 and 2014. Eight men and four women with histologically confirmed SFT were identified in the records. Their age range was 37-82 years (mean 57.8 years). The mean follow-up period for eight patients was 6.75 years (range 1-24 years). Four patients were lost to follow-up. Sublocalizations were neck (n = 3), orbit (n = 2), paranasal sinus (n = 2), cheek (n = 2), hard palate (n = 1), parotid gland (n = 1), and tongue (n = 1). The first-line treatment for all of the tumors identified was surgical excision. In four cases, the surgical margins were narrow or unclear due to piecemeal resection in the paranasal sinus and orbit (n = 3) or a tumor location deep in the parapharyngeal space (n = 1). Recurrences developed in two of these cases (in the orbit and parapharyngeal space), and the other two patients were lost to follow-up. Radiotherapy and chemotherapy were not administered as first-line treatments. Overall, the local recurrence rate (n = 2/8) was 25 %. The disease-specific survival rate was 100 %. These results are consistent with the literature data and show that safe surgical excision, without opening of the tumor capsule, reduces the risk of local recurrence and leads to a favorable outcome. Tumors in the head and neck often represent a surgical challenge, and wide surgical margins are rarely possible due to the complex three-dimensional anatomic compartments in the region. Head and neck surgeons should therefore be aware that there is an increased risk of recurrence in these patients; tightly scheduled follow-up visits are mandatory for at least 10 years, if not longer. Radiotherapy only appears to be an option in patients with unresectable tumors or when wide surgical excision would cause severe functional morbidity.

Solitary Fibrous Tumors of the Head and Neck

“…Prior studies report recurrence in 2 of 13 (48), 0 of 11 (32), 1 of 12 (49), 2 of 8 (50), or 2 of 29 (51) head and neck SFTs, though these smaller series had predominantly shorter median follow-up. Even among a consecutive series of 9 histologically malignant solitary fibrous tumors of the head and neck reported by Yang et al only 3 recurred (52), still less than the 36% we observed.…”

Update on Select Benign Mesenchymal and Meningothelial Sinonasal Tract Lesions

“…Therefore, there is an overall good behavior with low local recurrence rate, different from other anatomic sites [39]. Although not reported in the sinonasal tract, SFTs in patients [55 years, with large tumors ([15 cm), with necrosis, increased mitotic activity and/or pleomorphism or incomplete resection are designated as ''malignant'' or ''dedifferentiated'' SFT [40,41], associated with metastasis and disease-specific mortality [42]. Treatment of sinonasal tract SFTs is usually by complete excision or by wide excision.…”

A Rare Case of a Recurrent Giant Solitary Fibrous Tumor of the Ciliary Body of the Orbit

“…Safe surgical excision without breaching of the tumour capsule is considered essential to reduce the risk of local recurrence [10]. There is no conclusive evidence supporting the role of adjuvant radiotherapy or chemotherapy.…”

“…Although local excision is usually curative, orbital SFT has occasionally been reported to recur and rarely metastasize [10]. Bernardini et al [11] reported 8 recurrences in his review of 42 cases of orbital SFTs.…”