Malign soliter fibröz tümör sitolojik bulguları ve ayırıcı tanısı: olgu sunumu

Abstract

Soliter fibröz tümörler (SFT) nadir mezenkimal neoplazmdır. Bu tümör İlk kez 1931 de Klemperer and Rabin tarafından tanımlandı. En sık torasik kavite ve plevrada görülmekle birlikte ekstratorasik organlarda da rapor edilmiştir. Yaklaşık %85-90’ı benigndir. Tanı için biyopsiye oranla daha az invaziv bir teknik olan İnce iğne aspirasyon sitolojisinin artan kullanımı ile sitolojik yaymalarda bu tümörlerle daha sık karşılaşmaktayız. Bu yazıda malign SFT olgusunun sayılı vakada tanımlanmış sitolojik bulgularını ayırıcı tanısı eşliğinde sunmaktayız. 66 yaşında erkek hasta dispne ve sağ üst kadranda dolgunluk hissi şikayetleri ile hastanemizin gastroenteroloji polikliniğine başvurdu. Endoskopik ultrasonografi (EUS) rehberliğinde 22 gauge iğne kullanılarak karaciğerin alt yüzeyinde bulunan heterojen lezyondan (25x20 cm) ince iğne aspirasyon biyopsisi yapıldı. Hücre bloğundan elde edilen preparatlarda, dar sitoplazmalı iğsi / oval şekilli hücreler ve az sayıda inflamatuar hücre içeren kollajenize stromal fragmanların belirgin bir paterne sahip olmadan gelişigüzel dizilmde olduğu görüldü. Doku kesitlerine yapılan immünohistokimyasal (IHC) çalışmalarda, vimentin ve CD34 yaygın pozitif, Bcl-2 soluk pozitif, düz kas aktin, desmin, S100, CD117, DOG1, faktör 8 ve pansitokeratin negatif sonuç elde edildi. Bu bulgularla birlikte hastaya mezenkimal tümör, SFT ile uyumlu tanısı verildi. Literatüde sınırlı sayıda malign SFT olgusu bulunmaktadır. Olgumuz ile literatüre katkı sağladığımıza inanmaktayız.

Keywords

• soliter fibröz tümör,malign,sitopatoloji

Cytological Findings and Differential Diagnosis of Malignant Solitary Fibrous Tumors: A Case Report

Abstract

Solitary fibrous tumors (SFTs) are rare mesenchymal neoplasms. These tumors were first described in 1931 by Klemperer and Rabin. Although SFTs are usually located in the thoracic cavity and pleura, they have been reported in numerous other extrathoracic sites. Nearly 85 to 90% of SFTs are benign. With the increasing use of fine needle aspiration (FNA) cytology in diagnosis, which is a less invasive technique than biopsy, we encounter with cytological smears of these tumors more frequently. Herein, we report a rare case of malignant SFT with relevant cytological findings and differential diagnosis in the light of literature data. 66-year-old male patient was admitted to the gastroenterology outpatient clinic in our center with dyspnea and feeling of abdominal fullness in right upper quadrant. We performed FNA biopsy from the heterogeneous lesion located in the inferior surface of the liver (25x20 cm in size) using 22-gauge needle under the guidance of endoscopic ultrasonography (EUS). Slides derived from the cell block showed spindle/oval-shaped cells with a scanty cytoplasm and a patternless arrangement in the collagenized stromal fragments with a few number of inflammatory cells. Immunohistochemical (IHC) studies using tissue samples demonstrated vimentin and CD34 diffuse positivity, positive pale Bcl-2 staining, smooth muscle actin, desmin, S100, CD117, DOG1, factor 8 and pancytokeratin negativity. Based on these findings, the patient was diagnosed with a SFT of mesenchymal origin. Due to the limited number of data regarding cytological findings of malignant SFTs, our case report contributes to the ongoing body of literature.

Keywords

• solitary fibrous tumor,malignant,cytopathology

References

1. Referans1 1- Klemperer P, Rabin CB. Primary neoplasms of the pleura. Arch Pathol 1931;11:385–412.
2. Referans2- Fletcher CDM, Brigde JA, Hogensoorn PCW, Mertens F: WHO classification of Tumours of Soft Tissue and Bone, Fibroblastic/myofibroblastic tumours, 4. edition, Lyon; 2013:80-2.
3. Referans3- Srinivasan VD , Wayne JD , M Rao MS , Zynger DL. Solitary Fibrous Tumor of the Pancreas: Case Report with Cytologic and Surgical Pathology Correlation and Review of the Literature. JOP J Pancreas 2008; 9:526-30.
4. Referans4- Krishnamurthy V, Suchitha S, Asha M, Manjunath GV. Fine needle aspiration cytology of solitary fibrous tumor of the orbit, J Cytol 2017; 34: 104-106.
5. Referans5- Durak MG, Sağol Ö, Tuna B ve ark. Cystic Solitary Fibrous Tumor of the Liver: A Case Report. tjpath 2013; 217-20.
6. Referans6- Ali SZ, Hoon V, Hoda S, Heelan R, Zakowski MF. Solitary fibrous tumor. A cytologic-histologic study with clinical, radiologic, and immunohistochemical correlations. Cancer 1997;81:116-21.
7. Referans7- Bishop JA, Rekhtman N, Chun J, Wakely PE, Ali SZ. Malignant solitary fibrous tumor: cytopathologic findings and differential diagnosis. Cancer Cytopathol 2010;118:83–9.
8. Referans8- Gray W., Kocjan G, Diagnostic cytopathology: “Domanski HA, Akerman M, Silverman J.: Soft tissue and musculoskeletal system, 3. Edition, London;2010: 768-69.

9. Referans9- Khanchel F, Driss M, Mrad K, Romdhane KB. Malignant solitary fibrous tumor in the extremity: Cytopathologic findings. J Cytol 2012 ;29:139-41.
10. Referans10- Cho EY, Han JJ, Han J, Oh YL. Fine needle aspiration cytology of solitary fibrous tumours of the pleura. Cytopathology 2007 ;18:20-27.
11. Referans11- Yoshida A, Tsuta K, Ohno M, Yoshida M, Narita Y, Kawai A, et al. STAT6 Immunohistochemistry Is Helpful in the Diagnosis of Solitary Fibrous Tumors. Am J Surg Pathol 2014 ; 38: 552-9.