Publication in American Journal of Surgical Pathology

Am J Surg Pathol. 2017 Dec;41(12):1642-1656. doi: 10.1097/PAS.0000000000000940.

Solitary Fibrous Tumors of the Head and Neck: A Multi-Institutional Clinicopathologic Study.

Smith SC1, Gooding WE, Elkins M, Patel RM, Harms PW, McDaniel AS, Palanisamy N, Uram-Tuculescu C, Balzer BB, Lucas DR, Seethala RR, McHugh JB.

Author information

1

*Departments of Pathology and Surgery, VCU School of Medicine, Richmond, VA †Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA §Biostatistics Facility, University of Pittsburgh Cancer Institute **Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA ∥Department of Pathology, SUNY Upstate Medical University, Syracuse, NY Departments of ‡Pathology ¶Dermatology ††Oral and Maxillofacial Surgery, University of Michigan Health System, Ann Arbor #Department of Urology, Henry Ford Health System, Detroit, MI.

Abstract

Solitary fibrous tumors (SFTs) of the head and neck are uncommon. Lesions previously diagnosed in the head and neck as hemangiopericytomas (HPCs), giant cell angiofibromas (GCAs), and orbital fibrous histiocytomas (OFHs) are now recognized as within the expanded spectrum of SFTs. To better understand the clinicopathologic profile of head and neck SFTs, we performed a multi-institutional study of 88 examples. There was no sex predilection (F:M ratio 1.2), and the median patient age was 52 years (range: 15 to above 89 y). The sinonasal tract and orbit were the most common sites involved (30% and 25%), followed by the oral cavity and salivary glands (15% and 14%). Original diagnoses included HPC (25%), SFT (67%), and OFH (6%), with 1 SFT and 1 OFH noted as showing GCA-like morphology. On review, the predominant histologic pattern was classic SFT-like in 53% and cellular (former HPC-like) in 47%; lipomatous differentiation (8%) and GCA-like pattern (7%) were less prevalent. Subsets demonstrated nuclear atypia (23%), epithelioid morphology (15%), or coagulative necrosis (6%). Infiltrative growth (49%) and osseous invasion (82%) were prevalent among evaluable cases. Of the 48 SFTs with follow-up (median: 43 mo), 19 showed recurrence (40%). Of these, 4 patients were alive with disease and 4 dead of disease. Size and mitotic rate were negative prognosticators using a joint prognostic proportional hazards regression model. Three patients experienced metastasis, to lungs, parotid, bone, and skull base, including one case showing overtly sarcomatous "dedifferentiation." As a group, SFTs present in a wide anatomic and morphologic spectrum in the head and neck. Only rare examples metastasize or cause death from disease. However, the fairly high local recurrence rate underscores their aggressive potential and highlights the importance of prospective recognition.

PMID:

 

28877055

 

PMCID:

 

PMC5680135

 [Available on 2018-12-01]

 

DOI:

 

10.1097/PAS.0000000000000940