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Year : 2014  |  Volume : 57  |  Issue : 4  |  Page : 648-650
Solitary fibrous tumour (SFT) of the residual tongue, post partial glossectomy for carcinoma

1 Department of Histopathology, Max Healthcare Institute Limited, New Delhi, India
2 ENT practice, New Delhi, India

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Date of Web Publication11-Oct-2014

How to cite this article:
Abrari A, Bakshi V. Solitary fibrous tumour (SFT) of the residual tongue, post partial glossectomy for carcinoma. Indian J Pathol Microbiol 2014;57:648-50

How to cite this URL:
Abrari A, Bakshi V. Solitary fibrous tumour (SFT) of the residual tongue, post partial glossectomy for carcinoma. Indian J Pathol Microbiol [serial online] 2014 [cited 2022 Jan 25];57:648-50. Available from: https://www.ijpmonline.org/text.asp?2014/57/4/648/142710


We report this case of a Solitary fibrous tumour (SFT), in the residual tongue, post-partial glossectomy for squamous carcinoma.

A 56-year-old male patient was status post partial glossectomy, for squamous cell carcinoma of left lateral tongue border (well differentiated, grade I tumour, 0.8 cm maximum diameter, with a depth of invasion of 0.3 cm, no perineural invasion, no lympho- vascular invasion and 17 ipsilateral lymph nodes obtained on supraomohyoid neck dissection, negative for metastases, pT1N0). No adjuvant radiation had been administered.

The present tumor appearing in the posterior midline, was sub-mucosal, spherical, smooth surfaced and measured 1.5 × 1.0 × 0.8 cm 3 . A complete excision with at least 0.5 cm margins of resection, was performed. Histology revealed a circumscribed, un-encapsulated tumor, composed of a profusion of spindled to plump ovoid cells, not differing much, one from the other. Blood vessels, many irregulary branched, and some invested with collagenous collarettes were prominent within the tumor. Zones of sclerotic ''keloid like'' collagen were noted. High anaplasia, tumoral necrosis, tumor giant cells, chevrons or storiform patterns, significant inflammation, non-collagen matrix, aberrant mitoses were not present. Mitotic figures were typical and very occasional (<1/10 high power fields) [Figure 1].
Figure 1: Composite showing the characteristic low power histology of solitary fibrous tumor with proliferating spindled /ovoid cells punctuated with branching vasculature (a, b); some of the vessels are invested with prominent collarettes (b). Sclerotic zones with so-called ''keloidal'' collagen (c). High power emphasizing monotony of the proliferating cells with banal nuclei (d)

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An elaborate immunoperoxidase evaluation undertaken showed the tumor cells to be diffusely positive for CD34, Vimentin, and focally, weakly for Bcl2 and CD99 [Figure 2]. AE1/AE3 (pan CK), CK5, CK6, 34BE12, EMA, S-100, SMA, DESMIN, Caldesmon, HMB45, P63, C-KIT, Factor XIIa, CD31 and Factor VIII were negative; with the last two decorating vascular endothelia.
Figure 2: Composite showing tumor cells marked with CD34 (a), interspersed with blood vessels outlined by CD 31 by (b); a high proportion of p53 nuclear marking (c) and patchy weak staining with BCL2 (d)

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Despite innocuous cytonuclear attributes, and low mitotic index, p53 marking of upto 70% nuclei was observed.

Pathologic diagnosis of a solitary fibrous tumor (SFT) was rendered. A recommendation for close clinical surveillance was notified in the histology report, based on the high p53 positivity of the tumour cells, predicating the possibility of recurrence.

The patient remained well, without evidence of disease, after 14 months follow up.

Spindle cell lesions of the head and neck region would rightfully include a plethora of mesenchymal and non-mesenchymal derived proliferations. Among others - Nodular fasciitis, cellular angiofibroma, nerve sheath tumors, perineurinoma, smooth muscle tumors, myoepitheliomas, spindle cell hemangioma, fibroblastoma, fibrous histiocytoma, melanocytic lesions, monophasic spindle cell synovial sarcomas and spindle cell carcinomas are the commoner differential considerations. SFT deserves inclusion in this list, in this era of increasingly recognized extrapleural SFTs, having different prognostic and management implications. Assiduous histologic evaluation, immunoperoxidase studies and clinical context will resolve the diagnosis in these instances [Table 1]. The occurrence metachronous to partial glossectomy for squamous cell carcinoma, in this patient, appears more than a fortuitous association. Some workers have proposed that trauma may be a contributory element in at least some cases of oral SFT. [1],[2],[3],[4]
Table 1: Differential diagnoses of Solitary Fibrous Tumor

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In our surmise, a post-traumatic origin is too simplistic an explanation in the present context. It is far more likely that the stromal fibroblast (also known as the carcinoma associated fibroblast - CAF) which is an integral constituent of neoplasia - was subjected to similar pro-neoplastic influences as the preceding squamous cell carcinoma progenitors and after a clinical lag, progressed to form the SFT. As putative support to this observation, it is being accepted that CAFs display altered phenotypes, which serve their primary pro-carcinogenic roles and also stimulate their own proliferation. [5] The high p53 IHC positivity observed in the tumor cells of the present SFT, likely flags their true biologic potential and underpins the importance of stringently close follow-up in this patient.

   References Top

Alawi F, Stratton D, Freedman PD. Solitary fibrous tumor of oral soft tissues: A clinicopathologic and immunohistochemical study of 16 cases. Am J Surg Pathol 2001;25:900-10.  Back to cited text no. 1
O'Regan EM, Vanguri V, Allen CM, Eversole LR, Wright JM, Woo SB. Solitary fibrous tumor of the oral cavity: Clinicopathologic and immunohistochemical study of 21 cases. Head Neck Pathol 2009;3:106-15.  Back to cited text no. 2
Thompson LD, Miettinen M, Wenig BM. Sinonasal-type hemangiopericytoma: A clinicopathologic and immunophenotypic analysis of 104 cases showing perivascular myoid differentiation. Am J Surg Pathol 2003;27:737-49.  Back to cited text no. 3
Perez-Ordonez B, Koutlas IG, Strich E, Gilbert RW, Jordan RC. Solitary fibrous tumor of the oral cavity: An uncommon location for a ubiquitous neoplasm. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;87:589-93.  Back to cited text no. 4
Menon LG, Picinich S, Koneru R, Gao H, Lin SY, Koneru M, et al. Differential gene expression associated with migration of mesenchymal stem cells to conditioned medium from tumor cells or bone marrow cells. Stem Cells 2007;25:520-8.  Back to cited text no. 5

Correspondence Address:
Dr. Andleeb Abrari
Senior consultant in Histopathology, Max Healthcare Institute Limited, New Delhi - 110 017
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0377-4929.142710

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  [Figure 1], [Figure 2]

  [Table 1]

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