Laparoscopic treatment of a solitary fibrous tumor originating in the cystic plate
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Solitary fibrous tumor (SFT) is a rare mesenchymal tumor originating from the tissue underlying the mesothelial layer of the pleura or mediastinum. Other reported sites include the upper respiratory tract, orbit, thyroid, peritoneum, and central nervous system.
We describe a case of a 7 cm SFT that originated in the cystic plate. A liver tumor was an incidental finding in a 49-year-old woman during a regular radiological checkup for uterine fibroids. Imaging revealed a well-circumscribed solid mass between the gallbladder and liver. Intraoperative laparoscopy identified a soft tumor that had progressively expanded behind the gallbladder which was easily separated from the Laennec’s capsule of the liver. Hematoxylin and Eosin and immunohistochemical staining of the tumor tissue found both tangled and patterned arrangements of spindle cells consistent with a SFT derived from the subserosal layer of the gallbladder.
To the best of our knowledge, this is the first report of a SFT originating in the cystic plate.
KeywordsSolitary fibrous tumor Cystic plate Laparoscopic resection Gallbladder
Solitary fibrous tumor
Solitary fibrous tumor (SFT) is a rare mesenchymal tumor originating from the tissue underlying the mesothelial layer of the pleura or mediastinum . Other reported sites include the upper respiratory tract, orbit, thyroid, peritoneum, and central nervous system [1, 2]. Most patients are asymptomatic because of slow tumor growth. Symptoms generally develop only after the lesion has become very large . Clinical or radiological diagnosis of SFTs is difficult because specific symptoms and signs are lacking, and preoperative fine needle aspiration cytology is not always convincing. Laparotomy and pathological evaluation are usually performed for diagnosis. We describe a rare case of SFT originating in the cystic plate which was successfully removed laparoscopically.
The postoperative course was uneventful. She was discharged on postoperative day 9. Chemotherapy was not considered necessary, and postoperative follow up at 18 months found the patient well without any sign of recurrence. Periodical check-up for uterine fibrosis by gynecologist is also continued.
SFT was first described in 1931 , which is a rare neoplasm primarily occurring in the pleura, but has been reported to originate in other organs [1, 2]. Liver involvement is uncommon , and a SFT originating from in the cystic plate has not been previously reported. Non-specific laboratory values and imaging characteristics make it difficult to distinguish SFTs that develop in the liver parenchyma from other tumors such as hepatocellular carcinoma, leiomyoma, sarcoma, sclerosed hemangioma, and inflammatory pseudotumor . Histopathological evaluation is generally needed to confirm the diagnostic of SFT. CD34-positive fibroblast-like mesenchymal cells or dendritic interstitial cells are useful for diagnosis.
The treatment of SFTs is surgical resection, chemotherapy, and radiation therapy have not been shown to be effective . In the current case, the tumor was diagnosed pathologically to have originated from the cystic plate, which is in continuity with the subserosal layer of the gallbladder. Previous cases of SFT of the liver have been reported to originate from the mesothelial tissues such as Glisson’s sheath or connective tissue, but proliferate as an intrahepatic mass that includes connective tissue, which is why SFTs of the liver have previously been detected as intraparenchymal masses . To our knowledge, the current case is the first report of a SFT that derived from the cystic plate.
The prognosis of SFT is generally favorable, but some cases of malignancy have been reported, with a 10.8% recurrence . As recurrent SFTs progress slowly, observation and possible re-operation can be chosen. Cellular atypia, high cellularity and mitotic rate, tumor necrosis, and positive tumor margins are reported to correlate with local recurrence. Complete resection of a tumor is believed to be the best prognostic indicator , but close follow-up is recommended even after successful resection because of possible recurrence. In the present case, while the tumor was intraoperatively thought to be a benign tumor such as a desmoid tumor, minimal surgical resection was chosen. Two-stage additional hepatectomy with lymphadenectomy of the hepatoduodenal ligament for the potentially residual tumor cells were considered, taking the permanent pathological diagnosis as SFT. Finally, careful follow-up has been chosen, because of the lack of evidence of desirable surgical margin as well as definite adjuvant therapy. Fortunately, she is still doing well until now, 17 months after surgery without any recurrences.
To our knowledge, this is the first report of a SFT originating from the cystic plate. SFT should be included as a rare cause of liver tumors, which long-term follow-up is warranted.
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All authors participated in the conception, design, and conduct of the study, and helped to draft the manuscript. All authors have read and approved the final manuscript.
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