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Head and neck solitary fibrous tumors: Diagnostic and therapeutic challenges

Authors

  • Sarah N. Bowe MD,

    Corresponding author
    1. Department of Otolaryngology–Head and Neck Surgery, The Ohio State University Medical Center, Columbus
    • 915 Olentangy River Rd., Suite 4000, Columbus, OH 43212
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  • Paul E. Wakely Jr. MD,

    1. Department of Pathology, The Ohio State University Medical Center, Columbus
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  • Enver Ozer MD

    1. Department of Otolaryngology–Head and Neck Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Comprehensive Cancer Center, The Ohio State University Medical Center, Columbus, Ohio, U.S.A.
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  • Presented at the Triological Society Combined Sections Meeting, Miami, Florida, U.S.A., January 26–28, 2012.

  • The authors have no funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis:

Head and neck solitary fibrous tumors (SFTs) are quite rare, with <200 cases reported in the literature. The purpose of this study was to analyze the diagnostic and therapeutic challenges of this rare disease while reporting the largest head and neck case series.

Study Design:

Retrospective review.

Methods:

Between 1991 and 2011, 13 cases of head and neck SFTs from the pathology database were identified. Demographic, clinical, radiologic, and pathologic data were then abstracted and compiled for review.

Results:

SFT presented nearly equally as asymptomatic slow-growing masses or with local symptoms due to compression. All tumors imaged by computed tomography or magnetic resonance imaging with contrast showed a well-defined strongly enhancing mass. Two patients had evidence of bone erosion on imaging, but no histopathologic features of malignancy. Treatment consisted of surgical resection and in two cases postoperative radiation. Two patients had pathologic findings of malignancy, but are alive without recurrence at 26 and 51 months follow-up. Two patients had recurrence, one with paraspinal disease and grossly positive surgical margins, and another with endoscopic resection and poor margin control.

Conclusions:

SFTs of the head and neck are exceedingly rare and those with aggressive behavior even more so. Diagnosis is often difficult and not definitive until morphologic and immunohistochemical evaluation is performed. In most cases, complete surgical excision is the only necessary treatment. Although in patients with malignant components or positive surgical margins, adjuvant radiation may be beneficial. Regardless, all patients require close clinical follow-up for several years. Laryngoscope, 2012

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