Solitary fibrous tumour of the liver—report on metastasis and local recurrence of a malignant case and review of literature

Abstract

BackgroundSolitary fibrous tumours (SFT) are neoplasms of mesenchymal origin that predominantly arise from the pleura. SFT of the liver (SFTL) are a rare occurrence with little number of cases reported in English literature. Malignant cases of hepatic SFT are an even rarer occurrence. For this reason, the prognostic evaluation of SFTLs is unknown and difficult to measure.MethodsA search on English literature on “Solitary Fibrous Tumour of the Liver” was conducted on common search engines (PubMed, Google). All published articles, case reports and literature reviews and their reference lists were reviewed.Case reportThis paper presents a 61-year-old male who was referred to a tertiary hospital in April 2010 with marked hepatomegaly. USS, CT and MRI scans were suggestive of a neoplasm, and the patient underwent a subsegmental IVb resection in June 2010. The specimen demonstrated histological and immunohistochemical features of malignant SFTL with clear resection margins. The patient was followed up regularly for 3 years with imaging and no suggestion of recurrence. Six years after the initial surgery, the patient represented with worsening right upper quadrant pain and dyspnoea secondary to extensive tumour recurrence adjacent to the resection site and metastatic deposits in the pleura. The patient was managed symptomatically and discharged for community follow-up after palliative involvement.ConclusionsSFTL are rare with only 84 cases reported in the English Literature including the present case. The average age of patients is 57.1 and occurs in females more than males (1.4:1). Most SFTLs follow a benign course, however, 17.9% of cases displayed malignant histological features. Only three cases including the current case are reported to have both local recurrence and metastasis. Surgical resection remains the mainstay of treatment and appears to be curative of most cases. The rarity of this tumour makes it difficult to evaluate its prognosis and natural course.

A Giant Solitary Fibrous Tumor of the Liver with Metastasis and Local Recurrence

“…However, there have been some cases of SFT in patients aged 16-87 years old. These lesions are observed in both sexes and the female/male ratio is 1.4:1 [5,6]. Based on macroscopic examination, hepatic SFT is observable in different sizes, which can range from 0.5 to 35 cm [5][6][7].…”

“…In many patients, these lesions are incidentally found during pathology examination. In this regard, the exclusion of differential diagnosis (i.e., hepatocellular carcinoma, gastrointestinal stromal tumours, leiomyoma, and sarcoma) should be considered [5]. Similar to benign SFT, malignant SFT occurs more commonly in middle-aged and elderly patients, and its frequency in women is higher than in men.…”

“…Long-term prognosis of hepatic SFT is rarely described due to limited data in the literature [2]. One the other hand, there are a few markers such as CD34 and CD99 for the diagnosis of hepatic SFT; Usually, c-Kit (CD117), CD31, cytokeratins, EMA, factor VIII, epithelial membrane antigen, and S100 are reported negative in patients with hepatic SFT [5].…”

“…In the process of diagnosis, the exclusion of other diagnosis is very important, especially regarding the hepatocellular carcinoma, gastrointestinal stromal tumours, leiomyoma, and sarcoma [5]. Although there are no certain clinical symptoms and signs for the diagnosis of hepatic SFT, weight loss, fatigue, and upper abdominal bloating are some signs of these lesions [5]. Long-term prognosis in patients with hepatic SFT has been rarely described due to the rarity of this problem.…”

Radiologic and Pathologic Findings of a Huge Solitary Fibrous Tumor of the Liver with Malignant Transformation: A Case Report

“…The clinical presentations in hepatic SFTs vary from asymptomatic to nausea, vomiting, abdominal fullness, abdominal pain, weight loss, and jaundice (7). It also might present with sign and symptoms of mass effect on adjacent visceral or neurovascular structures.…”