Fu Zhiyan, Henderson-Jackson Evita B, Centeno Barbara A, Lauwers Gregory Y, Druta Mihaela, Anaya Daniel A, Nakanishi Yukihiro
Department of Pathology, Moffitt Cancer Center, Tampa, FL, USA.
Department of Medical Oncology, Moffitt Cancer Center, Tampa, FL, USA.
Case Rep Pathol. 2023 Feb 9;2023:2271690. doi: 10.1155/2023/2271690. eCollection 2023.
A 73-year-old man with a history of atrial myxoma and basal cell carcinoma presented with unexplained fever. Contrast-enhanced CT abdomen showed a large left hepatic lobe mass with early enhancement and delayed venous washout, concerning for hepatocellular carcinoma. Fine needle aspiration showed numerous spindle cells with malignant nuclear features, suggestive of malignant spindle cell neoplasm. The patient underwent left hepatectomy. The surgical specimen showed a well-circumscribe solid mass (14.6 × 13.0 × 10.0 cm) with necrosis. Histopathological examination revealed a proliferation of spindle tumor cells with characteristic staghorn-shaped blood vessels, frequent mitoses, and necrosis. The tumor cells showed strong and diffuse expression of CD34 and STAT6, confirming the diagnosis of malignant solitary fibrous tumor. Solitary fibrous tumor is a rare fibroblastic tumor characterized by a staghorn vasculature and NAB2-STAT6 gene rearrangement. Solitary fibrous tumor of the liver is a rare occurrence. Although most solitary fibrous tumors behave in a benign fashion, solitary fibrous tumors might act aggressively. This case is unique in that it demonstrates an excellent correlation between radiologic, macroscopic, and microscopic features which can contribute to the improvement of radiologic and pathologic diagnostic accuracy.
一名有心房黏液瘤和基底细胞癌病史的73岁男性出现不明原因发热。腹部增强CT显示左肝叶有一个大肿块,早期强化,静脉期延迟消退,怀疑为肝细胞癌。细针穿刺显示大量具有恶性核特征的梭形细胞,提示为恶性梭形细胞瘤。患者接受了左肝切除术。手术标本显示一个边界清楚的实性肿块(14.6×13.0×10.0 cm),伴有坏死。组织病理学检查显示梭形肿瘤细胞增生,有特征性的鹿角状血管、频繁的有丝分裂和坏死。肿瘤细胞显示CD34和STAT6强弥漫性表达,确诊为恶性孤立性纤维瘤。孤立性纤维瘤是一种罕见的成纤维细胞肿瘤,其特征为鹿角状脉管系统和NAB2 - STAT6基因重排。肝脏孤立性纤维瘤很少见。虽然大多数孤立性纤维瘤表现为良性,但也可能具有侵袭性。该病例的独特之处在于它显示了放射学、大体和显微镜特征之间的良好相关性,这有助于提高放射学和病理学诊断的准确性。