Tuberc Respir Dis.  2011 Jun;70(6):511-515.

A Rare Case of Fat-Forming Variant of Solitary Fibrous Tumor Presenting as a Pleural Mass

• Kim MA
• Lee JH
• Jeong HC
• Koo SW
• Park KM
• Cho SH
• Lee HJ
• Kim EK

Abstract

The fat-forming variant of solitary fibrous tumors (SFTs) is a rare soft tissue neoplasm that was previously referred to as a lipomatous hemangiopericytoma (L-HPC). The most common affected site is deep soft tissue. Here, we present the first case, worldwide, of a fat-forming variant of SFT of the pleura. A 74-year-old man presented with left lower chest pain. Chest radiographs showed a mass-like lesion at the left lower lung field and chest computed tomography revealed a 12 cm fat-containing enhancing mass that was well-separated, lobulated and inhomogeneous. Radiology findings suggested a liposarcoma. Percutaneous needle biopsy was performed and pathological diagnosis of the mass was a fat-forming variant of SFT. Surgical resection was carried out and there has been no recurrence to date. So, a benign fat-forming variant of SFT must be considered as one of the differential diagnoses of lipomatous tumors of the pleura.

Keyword

Solitary Fibrous Tumors; Pleura; Lipoma

MeSH Terms

Aged
Biopsy, Needle
Chest Pain
Diagnosis, Differential
Hemangiopericytoma
Humans
Lipoma
Liposarcoma
Lung
Pleura
Rectal Neoplasms
Recurrence
Soft Tissue Neoplasms
Solitary Fibrous Tumors
Thorax
Hemangiopericytoma
Lipoma
Rectal Neoplasms

Figure

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  Figure 1 Chest radiographs show an increased opacity at the left lower lung field.

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  Figure 2 Chest CT scans reveal large inhomogeneous fat-containing mass in the left lower hemithorax with a mild enhancing soft tissue density portion. CT: computed tomography.

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  Figure 3 Percutaneous needle aspiration biopsy shows a mesenchymal neoplasm with spindle cells, a mature fat component and collagenous stroma suggestive of a solitary fibrous tumor, fat-containing variant (hematoxylin-eosin, original magnification ×100 (A), ×200 (B)). Immunostains show positive results for vimentin (C) and CD34 (D) (all original magnification, ×200).

Reference

1. Fletcher CD. The evolving classification of soft tissue tumours: an update based on the new WHO classification. Histopathology. 2006. 48:3–12.

2. Lee JR, Kim JS, Lee CH, Sohn KR. A case of lipomatous hemangiopericytoma of the nasal cavity. Korean J Otolaryngol-Head Neck Surg. 2001. 44:893–896.

3. Kim MY, Rha SE, Oh SN, Lee YJ, Byun JY, Jung CK, et al. Case report. Lipomatous haemangiopericytoma (fat-forming solitary fibrous tumour) involving the perineum: CT and MRI findings and pathological correlation. Br J Radiol. 2009. 82:e23–e26.

4. Nielsen GP, Dickersin GR, Provenzal JM, Rosenberg AE. Lipomatous hemangiopericytoma. A histologic, ultrastructural and immunohistochemical study of a unique variant of hemangiopericytoma. Am J Surg Pathol. 1995. 19:748–756.

5. Liu X, Zhang HY, Bu H, Meng GZ, Zhang Z, Ke Q. Fat-forming variant of solitary fibrous tumor of the mediastinum. Chin Med J (Engl). 2007. 120:1029–1032.

6. Guillou L, Gebhard S, Coindre JM. Lipomatous hemangiopericytoma: a fat-containing variant of solitary fibrous tumor? Clinicopathologic, immunohistochemical, and ultrastructural analysis of a series in favor of a unifying concept. Hum Pathol. 2000. 31:1108–1115.

7. Gengler C, Guillou L. Solitary fibrous tumour and haemangiopericytoma: evolution of a concept. Histopathology. 2006. 48:63–74.

8. Cameselle-Teijeiro J, Manuel Lopes J, Villanueva JP, Gil-Gil P, Sobrinho-Simões M. Lipomatous haemangiopericytoma (adipocytic variant of solitary fibrous tumour) of the thyroid. Histopathology. 2003. 43:406–408.

9. Pitchamuthu H, Gonzalez P, Kyle P, Roberts F. Fat-forming variant of solitary fibrous tumour of the orbit: the entity previously known as lipomatous haemangiopericytoma. Eye (Lond). 2009. 23:1479–1481.

10. Robinson LA. Solitary fibrous tumor of the pleura. Cancer Control. 2006. 13:264–269.

11. van de Rijn M, Lombard CM, Rouse RV. Expression of CD34 by solitary fibrous tumors of the pleura, mediastinum, and lung. Am J Surg Pathol. 1994. 18:814–820.

12. Theunissen PH, Ariëns AT, Pannebakker MA, Blaauw G. Late recurrence of a hemangiopericytoma with lipomatous components. Pathologe. 1990. 11:346–349.

13. Folpe AL, Devaney K, Weiss SW. Lipomatous hemangiopericytoma: a rare variant of hemangiopericytoma that may be confused with liposarcoma. Am J Surg Pathol. 1999. 23:1201–1207.

14. Ceballos KM, Munk PL, Masri BA, O'Connell JX. Lipomatous hemangiopericytoma: a morphologically distinct soft tissue tumor. Arch Pathol Lab Med. 1999. 123:941–945.

15. Domanski HA. Fine-needle aspiration smears from lipomatous hemangiopericytoma need not be confused with myxoid liposarcoma. Diagn Cytopathol. 2003. 29:287–291.