Surgical outcomes and clinical courses of solitary fibrous tumors of pleura.

AIM: This study's aim is to define the clinicopathological and surgical outcomes, clinical courses, and results of long-term follow-up of cases that underwent surgical treatment for solitary fibrous tumors of the pleura (SFTp). SUBJECTS AND METHODS: Clinical and long-term follow-up records of 16 consecutive patients who had surgery for SFTp between 2006 and 2016 were reviewed in the retrospective chart review. There were nine males (56%) and seven (44%) females with an average age of 60.5 ± 17.1 (range 30-87 years). Etiological factors, diagnostic procedures, clinical and surgical outcomes, 5-year overall survival (OS), and disease-free survival (DFS) in these patients were researched. RESULTS: There was no remarkable common etiological factor. Nine of the cases were asymptomatic. Other symptoms were chest pain, dyspnea, cough and hypertrophic osteoarthropathy, respectively. Thoracotomy for the removal of pleural mass was carried out in 15 (94%) cases. Additional resection procedures included the chest wall resection in two cases and lobectomy in two. Video-assisted thoracoscopic surgery (VATS) resection was performed in one (6%) case. Complete surgical excision was performed in 74% of cases. Nineteen percent of cases were malignant SFTp (mSFTp). One of the mSFTp cases died in the 19th month after the diagnosis. The mean follow-up time was 50.6 ± 34.2 months (2--114 months). Mean survival of mSFTp patients was 40.6 ± 19.08 months (19--55 months) and that for benign SFTp (bSFTp) was 52.9 ± 37.05 months (2--114 months). Five-year OS--DFS were 93.5% and 74%, respectively. CONCLUSION: SFTp is an uncommon benign neoplasm but it can have malignant features. Even in the case of recurrence, the main treatment is total surgical excision. Oncologic treatments can be tried in unresectable and metastatic cases. VATS can be used in surgical total excision for small diameter and appropriate tumors. Understanding the nature of these tumors, immunohistochemical, and genetic studies may be a guide in future.

Fibrous stroma is associated with poorer prognosis in lung squamous cell carcinoma patients.

INTRODUCTION: Cancer tissue is composed of various stromal cells forming cancer-specific microenvironments. Peritumoral stroma is reportedly composed of activated fibroblasts that can influence the biological properties of tumor cells, mainly their local aggressiveness and their ability. The aim of this study was to examine whether the histological properties of peritumoral stroma are correlated with squamous cell carcinoma (SqCC) aggressiveness and clinical outcome. METHODS: A series of 220 pathological stage I lung SqCC were categorized into two types according to the histological properties of the peritumoral stroma, "fibrous stroma type" (n = 85), and "thin stroma type" (n = 135), and compared the prognostic significance. Furthermore, we compared the immunohistochemical properties of the SqCC cells surrounded by "fibrous stroma" with those of the SqCC cells surrounded by "thin stroma." RESULTS: The prognosis of the patients with fibrous stroma-type tumors was significantly poorer than that of the thin stroma type with regard to both recurrence-free survival (p = 0.005) and overall survival (p = 0.008). A multivariate analysis showed that the presence of a fibrous stroma was an independent prognostic factor (p = 0.030). Compared with the SqCC cells with a thin stroma, the SqCC cells with a fibrous stroma exhibited reduced expression of E-cadherin (55.9 versus 126.0, p < 0.001) and an increased expression of laminin-5γ2 (94.6 versus 25.0, p = 0.001), matrix metalloproteinase-7 (26.0 versus 3.50, p = 0.009), and c-Met (64.0 versus 36.5, p = 0.033). CONCLUSION: SqCC with a fibrous stroma displayed higher invasive phenotype and were associated with a significantly poor prognosis. The current results suggest that the microenvironment created by both SqCC cells and the peritumoral fibroblasts may facilitate cancer aggressiveness.

Solitary fibrous tumors of the head and neck: a clinicopathologic and radiologic review.

OBJECTIVE: To describe the clinicopathologic and radiologic features of solitary fibrous tumors of the head and neck. DESIGN: Retrospective analysis. SETTING: Tertiary referral center that performs head and neck surgical oncology. PATIENTS: Twelve patients with solitary fibrous tumors of the head and neck identified from the pathology and soft tissue tumor databases at Memorial Sloan-Kettering Cancer Center, New York, NY, from 1990 to 2004. All cases were reviewed by 3 experienced pathologists, 1 of whom is an experienced soft tissue tumor pathologist. The diagnosis was confirmed by microscopic features on hematoxylin-eosin staining and by positive staining for CD34 and Bcl2 on immunohistochemical analysis. Tumors were scored for mitotic activity, cellularity, nuclear pleomorphism, necrosis, and the presence of a malignant component. Details on patient characteristics, tumor characteristics, previous treatment and surgery, adjuvant treatment, and outcome were recorded from clinical records. RESULTS: Solitary fibrous tumors occurred in patients over a wide age range (27-78 years; median age, 52 years). Seven patients (58%) were women, and 5 (42%) were men. Most tumors presented as a slow-growing painless mass with a duration ranging from 2 months to 5 years. The tumors ranged from 1 x 1 cm to 6 x 5 cm. Patients presented with a subcutaneous mass of the scalp or face in 4 cases, intraoral mass in 4, sinonasal mass in 3, and paraspinal mass in 1. Computed tomographic and/or magnetic resonance imaging scans of 7 of the 12 patients showed well-circumscribed tumors that enhanced strongly with contrast. Treatment for all of the patients was surgical resection. Pathologic findings showed that 9 tumors were benign and 3 were malignant. Three patients had a positive surgical resection margin. All patients were alive at a median follow-up of 8 months (range, 1-76 months). Local recurrence occurred in 1 patient who had positive surgical margins 3 years after the initial surgery. CONCLUSIONS: Solitary fibrous tumors of the head and neck region are rare and most commonly benign. The diagnosis depends on microscopic and immunohistochemical features, although imaging may help. Patients with these tumors can be safely treated with local excision, but tumors with positive margins require close follow-up over several years owing to the potential for late local recurrence.

Solitary fibrous tumors of the pleura: surgical outcome and clinical course.

BACKGROUND: The aim of this study was to define more precisely the surgical outcome and clinical course of solitary fibrous tumors of the pleura. METHODS: We conducted a retrospective review of the clinical records of patients who had undergone surgical resection for benign and malignant solitary fibrous tumors of the pleura during a 10-year period (1993 to 2003). RESULTS: Sixty-three patients were enrolled in the study (men, 29; women, 34; mean age, 49.6 years). Thirty-six patients (57.1%) were symptomatic at the time of diagnosis. Resection was performed through a thoracotomy (n = 37), by means of video-assisted thoracoscopy (n = 22), or through a sternotomy (n = 4). Mass excision only was performed in 34 cases, and en bloc excision including adjacent structures was performed in 29 cases. Forty-four cases (69.8%) were benign and 19 (30.2%) were malignant. Local recurrences occurred in three cases and distant metastases in eight. Recurrences occurred only in malignancy. Symptomatic presentation and the impression of a nonpleural tumor by imaging study were found to be related to a malignant pathologic diagnosis. The radiologic impression of solitary fibrous tumors of the pleura was also related to mass excision only. CONCLUSIONS: For malignant cases, complete surgical resection may be insufficient for the cure. Therefore, further study should be performed to define the role of preoperative and postoperative systemic treatment.

Fibrous tumors of the pleura.

Fibrous tumor of the pleura is a rare tumor arising from mesenchymal cells underlying the visceral or parietal pleura. The tumor may have benign or malignant histological features, but these do not always predict the clinical behavior of the tumor. In most cases, the tumor appears pedunculated, and simple resection of the tumor is curative even if significant cellular atypia is present. In contrast, some tumors with a broad base of attachment may recur and occasionally become malignant. Complete surgical resection is the mainstay of therapy for both benign and malignant fibrous tumors of the pleura. When resection is incomplete or impossible, external radiation therapy with or without chemotherapy is recommended.