CAP20: Borderline malignant solitary fibrous tumor of the liver: An uncommon occurrence

Borderline Malignant Solitary Fibrous Tumor of the Liver: An Uncommon Occurrence(Poster No. 22)

Anna Sarah Erem, BSc1; Karolin E. Ginting, MD2; Timothy S. Braverman, MD3; Shyam S. Allamaneni, MD.2 1Department of Pathology, Saba University School of Medicine, the Bottom, Saba, Netherlands Antilles; 2Department of Surgery, the Jewish Hospital-Mercy Health, Cincinnati, Ohio; 3Department of Pathology, the Jewish Hospital – Mercy Health, Cincinnati, Ohio.

Solitary fibrous tumor (SFT) of the liver is extremely rare, and those positive for cytokeratin are even rarer, with outcomes that are difficult to assess. Most SFTs are benign, with a very low recurrence/metastatic rate. We present the case of a 79-year-old woman who presented with SFT of the liver. Histologic evaluation at the time of the first surgery showed bland spindle cells with focal hemangiopericytic growth pattern, and areas of hypercellularity and hypocellularity (Figure 11, A and B). The tumor cells were positive for vimentin, BCL-2, CD99 (Figure 11, C), and STAT6 (Figure 11, D) (expected for SFT), but negative for CD34 and focally positive for cytokeratin (unexpected for SFT). In assessing the malignant potential, no necrosis, significant nuclear pleomorphism, or infiltrative margins were observed, but the tumor had plentiful mitoses and increased proliferative activity by Ki-67 staining. Using these factors, the tumor was diagnosed as a borderline SFT with a medium risk of metastasis. Three years later, the patient was admitted for small-bowel obstruction, and multiple liver lesions were detected on CT scan. Core biopsies of these lesions showed pathology and immunohistochemistry similar to those at initial diagnosis, with the exception that the tumor was cytokeratin negative. The patient then underwent chemotherapy. Though surgical excision is the most effective therapy, borderline malignant SFTs require close ongoing monitoring. Prompt tissue diagnosis and chemotherapy were the mainstay treatment in this case. However, current literature suggests that antiangiogenic therapy may be more effective than chemo-radiation.

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