Skip to main content
SpringerLink
Log in

Head and neck solitary fibrous tumors: a rare and challenging entity

  • Head and Neck
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

The objective of this study is to analyze the outcome of treatment for solitary fibrous tumors (SFTs) in the head and neck area. SFTs present as slow-growing masses, often with local compressive symptoms that are difficult to distinguish from other soft-tissue tumors. SFTs are commonly treated using local excision without adjuvant therapy. To date, only heterogeneous small series have been published, documenting the treatment results and outcome with these tumors. Retrospective study of patients with histopathologically confirmed SFT treated at two tertiary referral hospitals between 2004 and 2014. Eight men and four women with histologically confirmed SFT were identified in the records. Their age range was 37–82 years (mean 57.8 years). The mean follow-up period for eight patients was 6.75 years (range 1–24 years). Four patients were lost to follow-up. Sublocalizations were neck (n = 3), orbit (n = 2), paranasal sinus (n = 2), cheek (n = 2), hard palate (n = 1), parotid gland (n = 1), and tongue (n = 1). The first-line treatment for all of the tumors identified was surgical excision. In four cases, the surgical margins were narrow or unclear due to piecemeal resection in the paranasal sinus and orbit (n = 3) or a tumor location deep in the parapharyngeal space (n = 1). Recurrences developed in two of these cases (in the orbit and parapharyngeal space), and the other two patients were lost to follow-up. Radiotherapy and chemotherapy were not administered as first-line treatments. Overall, the local recurrence rate (n = 2/8) was 25 %. The disease-specific survival rate was 100 %. These results are consistent with the literature data and show that safe surgical excision, without opening of the tumor capsule, reduces the risk of local recurrence and leads to a favorable outcome. Tumors in the head and neck often represent a surgical challenge, and wide surgical margins are rarely possible due to the complex three-dimensional anatomic compartments in the region. Head and neck surgeons should therefore be aware that there is an increased risk of recurrence in these patients; tightly scheduled follow-up visits are mandatory for at least 10 years, if not longer. Radiotherapy only appears to be an option in patients with unresectable tumors or when wide surgical excision would cause severe functional morbidity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Klemperer P, Rabin CB (1931) Primary neoplasms of the pleura: a report of 5 cases. Arch Pathol 11:385–412

    Google Scholar 

  2. Bilbey JH, Müller NL, Miller RR, Nelems B (1988) Localized fibrous mesothelioma of pleura following external ionizing radiation therapy. Chest 94:1291–1292

    Article  CAS  PubMed  Google Scholar 

  3. Clagett OT, McDonald JR, Schmidt HW (1952) Localized fibrous mesothelioma of the pleura. J Thorac Surg 24:213–230

    CAS  PubMed  Google Scholar 

  4. Cobanoglu A, Reinhard JJ Jr (1982) Localized fibrous mesothelioma of the pleura: two case reports. Del Med J 54:273–276

    CAS  PubMed  Google Scholar 

  5. Dervan PA, Tobin B, O’Connor M (1986) Solitary (localized) fibrous mesothelioma: evidence against mesothelial cell origin. Histopathology 10:867–875

    Article  CAS  PubMed  Google Scholar 

  6. Doucet J, Dardick I, Srigley JR, van Nostrand AW, Bell MA, Kahn HJ (1986) Localized fibrous tumour of serosal surfaces. Immunohistochemical and ultrastructural evidence for a type of mesothelioma. Virchows Arch A Pathol Anat Histopathol 409:349–363

    Article  CAS  PubMed  Google Scholar 

  7. Katz S (1955) Localized fibrous mesothelioma of the pleura. GP 12:119

    CAS  PubMed  Google Scholar 

  8. Kim H, Damjanov I (1983) Localized fibrous mesothelioma of the liver. Report of a giant tumor studied by light and electron microscopy. Cancer 52:1662–1665

    Article  CAS  PubMed  Google Scholar 

  9. Nathan H, Seiden D (1978) Localized fibrous mesothelioma of the pleura. Int Surg 63:161–165

    CAS  PubMed  Google Scholar 

  10. Said JW, Nash G, Banks-Schlegel S, Sassoon AF, Shintaku IP (1984) Localized fibrous mesothelioma: an immunohistochemical and electron microscopic study. Hum Pathol 15:440–443

    Article  CAS  PubMed  Google Scholar 

  11. Scharifker D, Kaneko M (1979) Localized fibrous “mesothelioma” of pleura (submesothelial fibroma): a clinicopathologic study of 18 cases. Cancer 43:627–635

    Article  CAS  PubMed  Google Scholar 

  12. Stout AP (1950) Solitary fibrous mesothelioma of the peritoneum. Cancer 3:820–825

    Article  CAS  PubMed  Google Scholar 

  13. Stout AP, Himadi GM (1951) Solitary (localized) mesothelioma of the pleura. Ann Surg 133:50–64

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Weilbaecher TG, Sarma DP (1984) Localized fibrous mesothelioma of the pleura. J Surg Oncol 25:67–70

    Article  CAS  PubMed  Google Scholar 

  15. Gengler C, Guillou L (2006) Solitary fibrous tumour and haemangiopericytoma: evolution of a concept. Histopathology 48:63–74

    Article  CAS  PubMed  Google Scholar 

  16. Witkin GB, Rosai J (1991) Solitary fibrous tumor of the upper respiratory tract. A report of six cases. Am J Surg Pathol 15:842–848

    Article  CAS  PubMed  Google Scholar 

  17. Alawi F, Stratton D, Freedman PD (2001) Solitary fibrous tumor of the oral soft tissues: a clinicopathologic and immunohistochemical study of 16 cases. Am J Surg Pathol 25:900–910

    Article  CAS  PubMed  Google Scholar 

  18. Dorfman DM, To K, Dickersin GR, Rosenberg AE, Pilch BZ (1994) Solitary fibrous tumor of the orbit. Am J Surg Pathol 18:281–287

    Article  CAS  PubMed  Google Scholar 

  19. Zukerberg LR, Rosenberg AE, Randolph G, Pilch BZ, Goodman ML (1991) Solitary fibrous tumor of the nasal cavity and paranasal sinuses. Am J Surg Pathol 15:126–130

    Article  CAS  PubMed  Google Scholar 

  20. Kohmura T, Nakashima T, Hasegawa Y, Matsuura H (1999) Solitary fibrous tumor of the paranasal sinuses. Eur Arch Otorhinolaryngol 256:233–236

    Article  CAS  PubMed  Google Scholar 

  21. Pasquini E, Cantaroni C, Salfi N, Tamburini G, Marchi C, Sciarretta V (2003) Endoscopic treatment of an ethmoidal solitary fibrous tumour. J Laryngol Otol 117:889–891

    Article  PubMed  Google Scholar 

  22. Jeong AK, Lee HK, Kim SY, Cho KJ (2002) Solitary fibrous tumor of the parapharyngeal space: MR imaging findings. AJNR Am J Neuroradiol 23:473–475

    PubMed  Google Scholar 

  23. Benlyazid A, Lescanne E, Lefrancq T, Fetissoff F, Beutter P (1998) Solitary fibrous tumor of the larynx: report of a case. J Laryngol Otol 112:286–289

    Article  CAS  PubMed  Google Scholar 

  24. Ferreiro JA, Nascimento AG (1996) Solitary fibrous tumor of the major salivary glands. Histopathology 28:261–264

    Article  CAS  PubMed  Google Scholar 

  25. Kie JH, Kim JY, Park YN, Lee MK, Yang WI, Park JS (1997) Solitary fibrous tumor of the thyroid. Histopathology 30:365–412

    Article  CAS  PubMed  Google Scholar 

  26. Ito H, Fukuda M, Imamura Y, Fuse H (2008) A malignant solitary fibrous tumor in the retroperitoneum. Int J Clin Oncol 13:173–175

    Article  PubMed  Google Scholar 

  27. Cox DP, Daniels T, Jordan RC (2010) Solitary fibrous tumor of the head and neck. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 110:79–84

    Article  PubMed  Google Scholar 

  28. Schürch W, Skalli O, Lagacé R, Seemayer TA, Gabbiani G (1990) Intermediate filament proteins and actin isoforms as markers for soft-tissue tumor differentiation and origin. III. Hemangiopericytomas and glomus tumors. Am J Pathol 136:771–786

    PubMed  PubMed Central  Google Scholar 

  29. Agaimy A, Barthelmess S, Geddert H, Boltze C, Moskalev EA, Koch M, Wiemann S, Hartmann A, Haller F (2014) Phenotypic and molecular distinctness of sinonasal haemangiopericytoma compared to solitary fibrous tumour of the sinonasal tract. Histopathology 65:667–673

    Article  PubMed  Google Scholar 

  30. Fletcher CDM, Bridge JA, Lee JC (2013) Extrapleural solitary fibrous tumour. In: Fletcher CDM, Bridge JA, Hogendoorn PCW, Mertens F (eds) WHO classification of tumours of soft tissue and bone, 4th edn. IARC Press, Lyon, pp 80–82

    Google Scholar 

  31. Guillou L, Fletcher JA, Fletcher CDM, Mandahl N (2002) Extrapleural solitary fibrous tumor and hemangiopericytoma. In: Fletcher CDM, Unni KK, Mertens F (eds) Pathology and genetics of tumours of soft tissue and bone. IARC Press, Lyon, pp 86–90

    Google Scholar 

  32. Furusato E, Valenzuela IA, Fanburg-Smith JC, Auerbach A, Furusato B, Cameron JD, Rushing EJ (2011) Orbital solitary fibrous tumor: encompassing terminology for hemangiopericytoma, giant cell angiofibroma, and fibrous histiocytoma of the orbit: reappraisal of 41 cases. Hum Pathol 42:120–128

    Article  PubMed  Google Scholar 

  33. Schulz B, Altendorf-Hofmann A, Kirchner T, Katenkamp D, Petersen I, Knösel T (2014) Loss of CD34 and high IGF2 are associated with malignant transformation in solitary fibrous tumors. Pathol Res Pract 210:92–97

    Article  CAS  PubMed  Google Scholar 

  34. Knösel T, Schulz B, Katenkamp K, Katenkamp D, Petersen I (2010) Solitary fibrous tumor and haemangiopericytoma: what is new? Pathologe 31:123–128 (German)

    Article  PubMed  Google Scholar 

  35. Ide F, Obara K, Mishima K, Saito I, Kusama K (2005) Ultrastructural spectrum of solitary fibrous tumor: a unique perivascular tumor with alternative lines of differentiation. Virchows Arch 446:646–652

    Article  PubMed  Google Scholar 

  36. Barnes L, Eveson JW, Reichart P, Sidransky D (eds) (2005) World Health Organization classification of tumours. Pathology and genetics of head and neck tumours. IARC Press, Lyon

    Google Scholar 

  37. Chan JKC (1997) Solitary fibrous tumour—everywhere, and a diagnosis in vogue. Histopathology 31:568–576

    Article  CAS  PubMed  Google Scholar 

  38. Gold JS, Antonescu CR, Hajdu C, Ferrone CR, Hussain M, Lewis JJ, Brennan MF, Coit DG (2002) Clinicopathologic correlates of solitary fibrous tumors. Cancer 94:1057–1068

    Article  PubMed  Google Scholar 

  39. Alawi F, Stratton D, Freedman PD (2001) Solitary fibrous tumor of the oral soft tissues: a clinicopathologic and immunohistochemical study of 16 cases. Am J Surg Pathol 25:900–910

    Article  CAS  PubMed  Google Scholar 

  40. Mentzel T, Bainbridge TC, Katenkamp D (1997) Solitary fibrous tumour: clinicopathological, immunohistochemical, and ultrastructural analysis of 12 cases arising in soft tissues, nasal cavity and nasopharynx, urinary bladder and prostate. Virchows Arch 430:445–453

    Article  CAS  PubMed  Google Scholar 

  41. Wushou A, Miao XC, Shao ZM (2014) Treatment outcome and prognostic factors of head and neck hemangiopericytoma A meta-analysis. Head Neck. doi:10.1002/hed.23812 (Epub ahead of print)

    Google Scholar 

  42. Fukunaga M, Naganuma H, Nikaido T, Harada T, Ushigome S (1997) Extrapleural solitary fibrous tumor: a report of seven cases. Mod Pathol 10:443–450

    CAS  PubMed  Google Scholar 

  43. Briselli M, Mark EJ, Dickersin GR (1981) Solitary fibrous tumors of the pleura: eight new cases and review of 360 cases in the literature. Cancer 47:2678–2689

    Article  CAS  PubMed  Google Scholar 

  44. Brunnemann RB, Ro JY, Ordonez NG, Mooney J, El-Naggar AK, Ayala AG (1999) Extrapleural solitary fibrous tumor: a clinicopathologic study of 24 cases. Mod Pathol 12:1034–1042

    CAS  PubMed  Google Scholar 

  45. Vallat-Decouvelaere AV, Dry SN, Fletcher CD (1998) Atypical and malignant solitary fibrous tumors in extrathoracic locations: evidence of their comparability to intra-thoracic tumors. Am J Surg Pathol 22:1501–1511

    Article  CAS  PubMed  Google Scholar 

  46. England DM, Hochholzer L, McCarthy MJ (1989) Localized benign and malignant fibrous tumors of the pleura. A clinicopathologic review of 223 cases. Am J Surg Pathol 13:640–658

    Article  CAS  PubMed  Google Scholar 

  47. Meyer M, Krause U (1999) Solitary fibrous tumors of the pleura. Chirurg 70:949–952 (German)

    Article  CAS  PubMed  Google Scholar 

  48. Ginat DT, Bokhari A, Bhatt S, Dogra V (2011) Imaging features of solitary fibrous tumors. AJR Am J Roentgenol 196:487–495

    Article  PubMed  Google Scholar 

  49. Liu Y, Tao X, Shi H, Li K (2014) MRI findings of solitary fibrous tumours in the head and neck region. Dentomaxillofac Radiol 43:20130415. doi:10.1259/dmfr.20130415 (Epub 2014 Feb 3)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Ganly I, Patel SG, Stambuk HE, Coleman M, Ghossein R, Carlson D, Edgar M, Shah JP (2006) Solitary fibrous tumors of the head and neck: a clinicopathologic and radiologic review. Arch Otolaryngol Head Neck Surg 132:517–525

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors hereby state that there are no conflicts of interest and nothing to declare.

Author information

Authors and Affiliations

  1. Department of Otorhinolaryngology and Head and Neck Surgery, Mainz University Hospital, Langenbeckstrasse 1, 55101, Mainz, Germany

    Julian Künzel, Sebastian Strieth & Christoph Matthias

  2. Department of Pathology, Mainz University Hospital, Mainz, Germany

    Michael Hainz

  3. Department of Maxillofacial Surgery, Mainz University Hospital, Mainz, Germany

    Thomas Ziebart

  4. Department of Ophthalmology, Mainz University Hospital, Mainz, Germany

    Susanne Pitz

  5. Department of Otorhinolaryngology, University of Göttingen Medical Center, Göttingen, Germany

    Friedrich Ihler

Authors
  1. Julian Künzel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael Hainz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Thomas Ziebart
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Susanne Pitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Friedrich Ihler
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sebastian Strieth
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Christoph Matthias
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Julian Künzel.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Künzel, J., Hainz, M., Ziebart, T. et al. Head and neck solitary fibrous tumors: a rare and challenging entity. Eur Arch Otorhinolaryngol 273, 1589–1598 (2016). https://doi.org/10.1007/s00405-015-3670-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-015-3670-1

Keywords

Search

Navigation