Malignant solitary fibrous tumor of the pancreas with systemic metastasis: A case report and review of the literature

Table 1 Clinical features of pancreatic solitary fibrous tumors

Ref.	Age/Sex	Chief complaint(s)	Size (cm)	Location	Arterial-CT	Venous-CT	T1-MRI	T2-MRI	Tumor marker
Lüttges et al[13]	50/female	Incidental	5.5	Body	Enhanced	Enhanced	NA	NA	Negative
Chatti et al[14]	41/male	Abdominal pain	13.0	Body	Enhanced	Enhanced	Hypointense	Hyperintense	Negative
Gardini et al[15]	62/female	Abdominal pain	3.0	Head	Enhanced	Enhanced	NA	NA	Negative
Miyamoto et al[10]	41/female	Abdominal pain	2.0	Head-body	Enhanced	Enhanced	NA	NA	Negative
Kwon et al[16]	54/male	Incidental	4.5	Body	Enhanced	Enhanced	Hypointense	Hyperintense	Negative
Srinivasan et al[17]	78/female	Back pain, weight loss	5.0	Body	Enhanced	Enhanced	NA	NA	Negative
Chetty et al[18]	67/female	Incidental	2.6	Head	Enhanced	Enhanced	NA	NA	Negative
Ishiwatari et al[19]	58/female	Incidental	3.0	Head	Enhanced	Enhanced	Hypointense	Hyperintense	Negative
Sugawara et al[20]	55/female	Incidental	7.0	Head	Enhanced	Enhanced	Hypointense	Hyperintense	Negative
Azadi et al[6]	57/male	Incidental	3.1	Tail	Enhanced	Enhanced	Hypointense	Hyperintense
Santos et al[21]	40/male	Incidental	3.0	Body	NA	NA	NA	NA	Negative
Tasdemir et al[11]	24/female	Epigastric pain	18.5	Head	Enhanced	Enhanced	NA	NA	Negative
van der Vorst et al[22]	67/female	Abdominal pain	2.8	Head	Enhanced	NA	NA	NA	Negative
Chen et al[23]	49/female	Abdominal pain	13.0	Head	Enhanced	Enhanced	NA	NA	Negative
Hwang et al[24]	53/female	Incidental	5.2	Head	Enhanced	Enhanced	Hypointense	Hyperintense	Negative
Baxter et al[25]	54/female	Abdominal pain	3.5	Head	NA	N.A	NA	NA	CEA, CA19-9
Estrella et al[3]	52/female	Obstructive jaundice	15.0	Head	Hetero-geneous	Hetero-geneous	NA	NA	Negative
Han et al[26]	77/female	Jaundice	1.5	Head	Enhanced	Enhanced	Hypointense	Hyperintense	Negative
Murakami et al[27]	82/male	Hypokalemia, hypertension, edema	6.0	Tail	Hetero-geneous	Hetero-geneous	Hypointense	Hyperintense	Negative
Paramythiotis et al[28]	55/male	Abdominal pain	3.6	Body	Enhanced	Enhanced	Hypointense	Hyperintense	Negative
Spasevska et al[29]	47/male	Epigastric pain and jaundice	3.5	Head	Enhanced	Enhanced	N.A	N.A	CA19-9
Oana et al[30]	73/male	Abdominal discomfort	7.5	Head	Enhanced	Enhanced	Hypointense	Hyperintense	Negative
Current case	48/male	Hypoglyce-mia	6.5	Body	Enhanced	Enhanced	Hypointense	Hyperintense	Negative

CT: Computed tomography; MRI: Magnetic resonance imaging; NA: Not applicable.

Table 2 Immunohistochemical and histological features along with outcomes of pancreatic solitary fibrous tumors

Ref.	Immuno-histochemistry (+)	Histology	Risk assessment	Treatment	Follow-up
Lüttges et al[13]	CD34, CD99, Bcl-2, vimentin	No necrosis or mitoses	Benign	Distal pancreatectomy	Alive and well (20 mo)
Chatti et al[14]	CD34, CD99, Bcl-2, vimentin	“Regular spindle cells”	Benign	Enucleation	Died 3 d postoperatively due to complications
Gardini et al[15]	CD34, CD99, Bcl-2, vimentin, smooth muscle actin (focal)	NA	Benign	Traverso-longmire	Alive and well (16 mo)
Miyamoto et al[10]	CD34, Bcl-2	No necrosis or mitoses	Benign	Laparoscopic enucleation	Alive and well (7 mo)
Kwon et al[16]	CD34, CD99, vimentin	“Typical bland spindle cells”	Benign	Median segmentectomy	NA
Srinivasan et al[17]	CD34, Bcl-2	< 1 mitoses/10 HPFs, no necrosis	Benign	Distal pancreatectomy	Alive and well (7 mo)
Chetty et al[18]	CD34, CD99, Bcl-2	No necrosis or mitoses	Benign	Whipple	Alive and well (6 mo)
Ishiwatari et al[19]	CD34, Bcl-2	Necrosis, no mitoses	Benign	Pancreaticoduodenectomy	Alive and well (42 mo)
Sugawara et al[20]	CD34	No necrosis or mitoses	Benign	Pancreaticoduoden-ectomy	NA
Azadi et al[6]	CD34, Bcl-2, Ki67 < 5%	No malignant features	Benign	Distal pancreatectomy	NA
Santos et al[21]	CD34, beta-catenin	No necrosis or mitoses	Benign	Partial pancreatectomy	NA
Tasdemir et al[11]	CD34, Bcl-2, beta-catenin, vimentin, Ki67 < 2%	1-2 mitoses/10 HPFs	Benign	Enucleation	Alive and well (3 mo)
van der Vorst et al[22]	CD34, CD99, Bcl-2	No necrosis or mitoses	Benign	Enucleation	NA
Chen et al[23]	CD34, Bcl-2, vimentin, CD68, muscle-specific actin	Necrosis, no mitoses	Benign	Whipple	Alive and well (30 mo)
Hwang et al[24]	CD34, Bcl-2, muscle-specific actin, CD10, ER, PR	“Spindle shaped cell with patternless cell deposition”	Benign	Duodenal preserving partial pancreatic head resection	Alive and well (30 mo)
Baxter et al[25]	CD34, Bcl-2	NA	Benign	Whipple	NA
Estrella et al[3]	CD34, Bcl-2, keratin (rare), p16, p53	Nuclear atypia, 17 mitoses/10 HPFs, necrosis	Malignant	Pancreaticoduoden-ectomy	Alive and well (40 mo)
Han et al[26]	CD34, CD99	No necrosis or mitoses	Benign	Ultrasonography-guided needle biopsy	No metastasis or changes in the size after 10 mo
Murakami et al[27]	CD34, Bcl-2, STAT6, ACTH (focal), POMC (focal), NSE (focal)	“Spindle neoplastic cells in fascicular arrangement”	Benign	Distal pancreatectomy	Died 4 mo postoperatively due to sepsis
Paramythiotis et al[28]	CD34, CD99, Bcl-2, vimentin, S100 (focal)	No mitoses	Benign	Distal pancreatectomy	Alive and well (40 mo)
Spasevska et al[29]	CD34, vimentin, CD99, Bcl-2 (focal), nuclear beta-catenin (focal)	No necrosis or mitoses	Benign	Whipple	Died 1 wk postoperatively due to complications
Oana et al[30]	CD34, Bcl-2	No necrosis or mitoses	Benign	Partial pancreatectomy	Alive and well (36 mo)
Current case	CD34, Bcl-2, STAT6, CD31, PHH-3, D2-40 and Ki67 > 10%	Necrosis, 4-5 mitoses/10 HPFs	Malignant	Distal pancreatectomy and hepatic tumor resection	Alive and well (6 mo)

NA: Not applicable.