Mesentery solitary fibrous tumor with postoperative recurrence and sarcomatosis: A case report and review of literature

Abstract

Background: Solitary fibrous tumors are rare neoplasms of mesenchymal origin. They are often of low malignant potential and rarely metastasize. They frequently arise from the pleura and can occur at any soft tissue site in the body. However, these tumors rarely develop in the mesentery, peritoneal cavity or peritoneum.

Case summary: We report on a scarce case of solitary fibrous tumor of the rectal mesentery showing sarcomatosis about 4 years after previous tumor resection. This 69-year-old male had no clinical symptoms but was transferred to our hospital because of a suspected tumor recurrence from follow-up abdominal computed tomography. Tumor markers (CEA, CA 19-9 and CA 125) were within the normal range. Open laparotomy showed sarcomatosis, and pathology confirmed its mesenchymal origin and diagnosis as the solitary fibrous tumor. Our case may be the second recurrent mesentery solitary fibrous tumor reported to date, and the only one with progression to sarcomatosis. There has been no evidence of recurrence in follow-up at the 28^th mo after extensive intra-operative peritoneal lavage and cytoreductive surgery.

Conclusion: Although there are few risk factors of cancer recurrence in this patient, careful long-term follow-up after cytoreductive surgery is necessary.

Keywords: Case report; Cytoreductive surgery; Extensive intra-operative peritoneal lavage; Recurrence; Sarcomatosis; Solitary fibrous tumor of rectum mesentery.

Figure 1

Image of abdominal computed tomography. Suspected carcinomatosis or sarcomatosis was noted in the pelvis with no evident ascites.

Figure 2

Intestine specimen after extended radical right hemicolectomy. Multiple whitish tumor nodules seeding over the visceral peritoneum of the partial ileum and colon.

Figure 3

Image of an ileum specimen. Multiple whitish tumor nodules seeding over the visceral peritoneum of the distal ileum.

Figure 4

Microscopic features. The heterogeneous cell population comprised of mostly spindle cells with fibrous collagen proliferation as well as various other cell populations exhibiting patternless or storiform growth. No tumor necrosis, nuclear polymorphism, or cellular atypia was noted. The nuclear mitotic index was 4 mitoses/50 high-power fields (A: × 100 original magnification; B: × 400 original magnification).

Figure 5

Immunohistochemical staining. A-E: The lesion showed diffuse strong staining for CD34 (× 400 original magnification) (A); CD99 (× 400 original magnification) (B); Bcl-2 (× 400 original magnification) (C); mildly positive immunoreactivity for p53 (× 400 original magnification) (D); and a Ki-67 mitotic proliferative index of approximately 5% (× 100 original magnification) (E).

Figure 6

Image of the pelvis during operation. Multiple whitish nodules were noted to be seeded over the parietal peritoneum and visceral peritoneum of the partial ileum and colon as well as the urinary bladder, with no ascites in the pelvis.

Figure 7

Peritonectomy during cytoreductive surgery. Total anterior parietal peritonectomy, bilateral subphrenic peritonectomy, and complete pelvic peritonectomy (including the visceral peritoneum covering the urinary bladder) were performed.