Solitary fibrous tumour of the liver-report on metastasis and local recurrence of a malignant case and review of literature

Abstract

Background: Solitary fibrous tumours (SFT) are neoplasms of mesenchymal origin that predominantly arise from the pleura. SFT of the liver (SFTL) are a rare occurrence with little number of cases reported in English literature. Malignant cases of hepatic SFT are an even rarer occurrence. For this reason, the prognostic evaluation of SFTLs is unknown and difficult to measure.

Methods: A search on English literature on "Solitary Fibrous Tumour of the Liver" was conducted on common search engines (PubMed, Google). All published articles, case reports and literature reviews and their reference lists were reviewed.

Case report: This paper presents a 61-year-old male who was referred to a tertiary hospital in April 2010 with marked hepatomegaly. USS, CT and MRI scans were suggestive of a neoplasm, and the patient underwent a subsegmental IVb resection in June 2010. The specimen demonstrated histological and immunohistochemical features of malignant SFTL with clear resection margins. The patient was followed up regularly for 3 years with imaging and no suggestion of recurrence. Six years after the initial surgery, the patient represented with worsening right upper quadrant pain and dyspnoea secondary to extensive tumour recurrence adjacent to the resection site and metastatic deposits in the pleura. The patient was managed symptomatically and discharged for community follow-up after palliative involvement.

Conclusions: SFTL are rare with only 84 cases reported in the English Literature including the present case. The average age of patients is 57.1 and occurs in females more than males (1.4:1). Most SFTLs follow a benign course, however, 17.9% of cases displayed malignant histological features. Only three cases including the current case are reported to have both local recurrence and metastasis. Surgical resection remains the mainstay of treatment and appears to be curative of most cases. The rarity of this tumour makes it difficult to evaluate its prognosis and natural course.

Keywords: Hepatic tumours; Hepatobiliary; Malignancy; Mesenchymal neoplasms; Metastasis; Solitary fibrous tumour of the liver.

Fig. 1

Abdominal CT displaying the pedunculated liver lesion arising from segment IV

Fig. 2

Abdominal MRI displaying the liver lesion. a T2WI. b T1WI

Fig. 3

MRI T1WI after contrast. a Arterial phase. b Portal venous phase. c Delayed 2 min. d Delayed 10 min

Fig. 4

CT abdomen of recurrent disease adjacent to resection site. a–b Axial views. c–d Transverse views

Fig. 5

CT chest transverse view displaying right-sided pleural mass associated with significant unilateral pleural effusion