Liver Solitary Fibrous Tumour with Local Recurrence and Metastasis: A Case Report Download PDF

Journal Name : SunText Review of Case Reports & Images

DOI : 10.51737/2766-4589.2022.045

Article Type : Case Report

Authors : Xiao Z, Xiaotong X, Yanyan G, Yongyan D and Liheng M

Keywords : Solitary fibrous tumour; Hepatic neoplasm; Malignancy; Metastasis; Case

Abstract

Solitary fibrous tumour (SFT) of the liver is an extremely rare tumour, and only four cases of liver SFT with local recurrence and metastasis have been reported in the English scientific literature. In this report, we discuss a case of a 66-year-old woman who was misdiagnosed as hepatic cellular carcinoma (HCC). The patient successfully underwent a resection of the tumour, and the diagnosis was confirmed as SFT on histopathology. However, the patient developed a local recurrence and pulmonary metastasis. Our case shows that primary malignant SFT may occur in the liver and long-term follow-up is advised.


Introduction

The solitary fibrous tumour (SFT) is a rare spindle-cell neoplasms arising from mesenchymal soft tissue? which occurs most frequently in pleura [1], occasionally the peritoneum [2] and other anatomic location. However, the liver SFT is exceedingly rare and only 4 cases of liver SFT with local recurrence and metastasis have been reported in English scientific literature [3]. Liver SFT may be easily misdiagnosed because it has nonspecific laboratory examination and imaging performance. Herein, we report a malignant tumour of the liver histologically diagnosed as SFT with local recurrence and pulmonary metastasis.


Case Presentation

A 66-year-old woman presented with upper abdominal pain, anorexia, and weight loss for one month, was referred to our hospital on August 13, 2019. The patient described no nausea, no vomiting, no fever, nor jaundice or evidence of infectious history such as hepatitis and tuberculosis. On physical examination, the abdomen was soft; a slight-painful liver edge descended to 9 cm below the right costal margin. There were no abnormalities in laboratory examinations. Serum tumour markers (CA199, AFP, and CEA) were all negative. Computed tomography (CT) scan revealed a large mass in the right lobe of liver measuring 12.9×14.3×13.2 cm (Figure 1). On magnetic resonance (MR) scan, the mass was predominantly low signal at T1WI (high signal represents haemorrhage) and inhomogeneous hyper intensity on T2WI (the liquid-liquid level was revealed). Diffusion weighted imaging (DWI) showed diffusion restriction. Contrast-enhanced T1-weighted MR imaging of gadopentetic acid (GD-DTPA) showed heterogeneous enhancement in the arterial phase and persistent enhancement in the portal and late phases (Figure 2). The resection specimen was unclear and measured 22 × 18 × 13cm in size with the liver metastasis in the caudate lobe. Postoperative pathology confirmed a malignant solitary fibrous tumour of the liver (Figure 3). Histological examination: Ki67 (40% +), Vimentin (+), Desmin (+), CD34 (-), CD99 (+), Hep (-), S-100 (-), SOX10 (-), STAT-6 (+). The patient recovered well and was discharged on 5 September 2019. Thereafter, a CT examination was performed every 6 months and there was no evidence of recurrence. However, on May 21, 2021, tumour recurrence and a new pulmonary metastasis (left lung metastasis) were found at re-examination (Figure 4). The patient was discharged after symptomatic treatment and followed up was done for one year with no further symptoms reported.



Discussion

Solitary fibrous tumour (SFT) is a rare neoplasm originating from mesenchymal cells, first reported by Klemperer and Rabin in 1993 [4,5]. SFTs have been described in different tissues and organs, most often in the pleura, as well as in the peritoneum, respiratory tract, mediastinum, lung and others [6,7].


Figure 1: Abdominal computed tomography scan of the tumor. (A) Non-contrast computed tomography image showing a large mass with an unclear border and irregular morphology in the right lobe of the liver. (B) Moderate inhomogeneous enhancement was found in the arterial phase, with an obviously enhanced staghorn shape vessel. (C) Further enhancement was found in the portal phase. The right branch of the portal vein was compressed, and the boundary was unclear. (D) During the late phase, the lesion had iso-enhancement comportment. No enhancement was observed in the necrotic area.

Figure 2: MRI findings of malignant solitary fibrous tumor of the liver. (A) T2WI showed a heterogeneous hyperintense lesion with an unclear margin and irregular morphology in the right lobe of the liver. Liquid-liquid level and hemosiderin deposition were seen in the lesion. (B) T1WI showed hypointensity, internal hemorrhage showed patchy high intensity. (C-E) GD-DTPA enhanced scan showed inconsistent enhancement in the arterial phase and persistent enhancement in the portal and late phases. No enhancement was observed in the necrotic area. (F) DWI demonstrated restricted diffusion.