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Case Reports
. 2020 Oct 6;12(10):e10833.
doi: 10.7759/cureus.10833.

Solitary Fibrous Tumor of Pancreas With Unusual Features: A Case Report

Anoshia Afzal  1 , Manuel Maldonado-Vital  1 , Shahbaz Khan  1 , Umar Farooque  2 , Wenyi Luo  1
Affiliations
Case Reports

Solitary Fibrous Tumor of Pancreas With Unusual Features: A Case Report

Anoshia Afzal et al. Cureus. .

Abstract

Solitary fibrous tumor (SFT) is an uncommon fibroblastic neoplasm that is most commonly associated with the pleura but has also been reported in almost all anatomic sites. Although the majority of SFTs are benign, few cases follow a malignant clinical course and may recur and/or metastasize after several years of their original occurrence. Only 16 cases of pancreatic SFTs are reported so far, and only one has metastasized to lung and subcutis. Pancreatic SFT resembles more common neuroendocrine tumor and gastrointestinal stromal tumor (GIST) radiographically and is at times almost indistinguishable from GIST histologically. Diagnosis of SFTs particularly, if attempted on biopsied specimens, can be very challenging due to its rare occurrence and nondescript morphology. It is imperative to understand the pathological spectrum of this entity to avoid misdiagnosis. We report a case of pancreatic SFT in a 43-year-old male with some unusual morphologic and immunohistochemical features including pseudoangiomatous growth pattern, a hypercellular area demonstrating nuclear pleomorphism, and only focal positivity for cluster of differentiation (CD)34. These atypical features can pose even more diagnostic challenge by causing additional confusion with other malignancies like dedifferentiated liposarcoma and vascular tumors. The potential diagnostic pitfalls are discussed.

Keywords: extrapleural; humans; pancreas; patternless pattern; pleomorphism; pleura; solitary fibrous tumor.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Hematoxylin and eosin staining shows a patternless pattern typical of SFT (A and B: 10x; C: 20x) and an atypical pseudoangiomatous area mimicking a vascular tumor (D: 10x).
SFT: Solitary fibrous tumor.
Figure 2
Figure 2. Hematoxylin and eosin staining shows a hypercellular area (A). The tumor cells are diffusely and strongly positive for Bcl 2 (B) and STAT6 (C). CD117 is unusually positive (D).
Bcl: B-cell lymphoma. STAT: Signal transducer and activator of transcription. CD: Cluster of differentiation.
Figure 3
Figure 3. The tumor reveals DOG 1 negativity (A), thus ruled out GIST. ERG is negative in tumor cells (B), and CD31 is only focally positive (C). Ki-67 index demonstrates approximately 10% proliferative index in hypercellular area (D).
DOG: Discovered on GIST. GIST: Gastrointestinal stromal tumors. ERG: Erythroblast transformation-specific-related gene. CD: Cluster of differentiation.
Figure 4
Figure 4. PHH3 is positive in surrounding inflammatory cells but negative in tumor cells (A). The tumor is only focally positive for CD34 (B), which is quite unusual for SFT. The tumor is negative for SOX10 (C) and S100 (D).
PHH3: Phospho-histone-H3. CD: Cluster of differentiation. SFT: Solitary fibrous tumor. SOX: SRY-related HMG-box. HMG: High mobility group.
See this image and copyright information in PMC

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