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Massive malignant solitary fibrous tumor arising from the bladder serosa: a case report.

Dozier J, Jameel Z, McCain DA, Hassoun P, Bamboat ZM - J Med Case Rep (2015)

Bottom Line: The inferior vena cava was compressed, and the mass extended inferiorly to his upper pelvis abutting the superior dome of his bladder.The histological features combined with immunophenotyping were suggestive of a malignant solitary fibrous tumor that grossly appeared to be growing from the bladder serosa, specifically the intraperitoneal superior dome of the bladder.Malignant solitary fibrosis tumors of the urinary bladder, however, are very rare.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Division of Surgical Oncology, Hackensack University Medical Center, 20 Prospect Avenue, Hackensack, NJ, 07601, USA. Dozierjm@njms.rutgers.edu.

ABSTRACT

Introduction: Solitary fibrous tumors are rare neoplasms of mesenchymal origin. They are often of low malignant potential and rarely metastasize. While they frequently arise from the pleura, they can occur at any soft tissue site in the body. We present a case of a large (28 × 21 cm) malignant solitary fibrous tumor arising from the bladder serosa. In addition, the clinicopathologic features, differential diagnosis, cytogenetics and management of this rare disease are discussed, along with a review of the existing literature on this topic.

Case presentation: An otherwise healthy 41-year-old Caucasian man presented with weight loss and progressive abdominal bloating. A subsequent computed tomography scan of his chest, abdomen and pelvis revealed a 26.8 × 21 cm intra-abdominal mass occupying most of his abdominal cavity. The inferior vena cava was compressed, and the mass extended inferiorly to his upper pelvis abutting the superior dome of his bladder. He underwent operative resection and the resected mass measured 28 × 21 × 18 cm and weighed 4.8 kg. The cut surface revealed a gray-white mass with an ill-defined whorled-like pattern, with randomly assorted tan fleshy nodules. A histologic evaluation revealed variable, alternating hypercellular and hypocellular areas, with areas of necrosis. The tumor cells varied from spindle to epithelioid within a hyalinized stroma. In the hypercellular areas, the tumor cells showed moderate atypia with high mitotic activity. The histological features combined with immunophenotyping were suggestive of a malignant solitary fibrous tumor that grossly appeared to be growing from the bladder serosa, specifically the intraperitoneal superior dome of the bladder. Our patient is currently eight months post-surgery without evidence of recurrence.

Conclusions: Extrapleural occurrences of solitary fibrosis tumors are being increasingly observed. Malignant solitary fibrosis tumors of the urinary bladder, however, are very rare. As there are no pathognomonic features of malignancy, surgical resection is often both diagnostic and therapeutic, as was the case in our report.

No MeSH data available.


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Coronal section computed tomography scan with intravenous contrast showing a large mass abutting the urinary bladder with engorged pelvic veins.
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Fig1: Coronal section computed tomography scan with intravenous contrast showing a large mass abutting the urinary bladder with engorged pelvic veins.

Mentions: A 41-year-old otherwise healthy male presented to the emergency department at Hakensack University Medical Center, NJ with abdominal pain and abdominal fullness that had progressively worsened over the course of the last year. He also reported constipation, urinary frequency, dyspnea on exertion and a 25-pound weight loss. A subsequent computed tomography (CT) scan of his chest, abdomen and pelvis revealed a 26.8 × 21cm intra-abdominal mass occupying most of his abdominal cavity (Figure 1). The inferior vena cava was compressed, and the mass extended inferiorly to the upper pelvis, abutting the superior dome of his bladder. There was no evidence of metastatic disease in his chest. Given the size of the mass and his worsening abdominal pain, the decision was made for him to undergo surgical resection.Figure 1


Massive malignant solitary fibrous tumor arising from the bladder serosa: a case report.

Dozier J, Jameel Z, McCain DA, Hassoun P, Bamboat ZM - J Med Case Rep (2015)

Coronal section computed tomography scan with intravenous contrast showing a large mass abutting the urinary bladder with engorged pelvic veins.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4358716&req=5

Fig1: Coronal section computed tomography scan with intravenous contrast showing a large mass abutting the urinary bladder with engorged pelvic veins.
Mentions: A 41-year-old otherwise healthy male presented to the emergency department at Hakensack University Medical Center, NJ with abdominal pain and abdominal fullness that had progressively worsened over the course of the last year. He also reported constipation, urinary frequency, dyspnea on exertion and a 25-pound weight loss. A subsequent computed tomography (CT) scan of his chest, abdomen and pelvis revealed a 26.8 × 21cm intra-abdominal mass occupying most of his abdominal cavity (Figure 1). The inferior vena cava was compressed, and the mass extended inferiorly to the upper pelvis, abutting the superior dome of his bladder. There was no evidence of metastatic disease in his chest. Given the size of the mass and his worsening abdominal pain, the decision was made for him to undergo surgical resection.Figure 1

Bottom Line: The inferior vena cava was compressed, and the mass extended inferiorly to his upper pelvis abutting the superior dome of his bladder.The histological features combined with immunophenotyping were suggestive of a malignant solitary fibrous tumor that grossly appeared to be growing from the bladder serosa, specifically the intraperitoneal superior dome of the bladder.Malignant solitary fibrosis tumors of the urinary bladder, however, are very rare.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Division of Surgical Oncology, Hackensack University Medical Center, 20 Prospect Avenue, Hackensack, NJ, 07601, USA. Dozierjm@njms.rutgers.edu.

ABSTRACT

Introduction: Solitary fibrous tumors are rare neoplasms of mesenchymal origin. They are often of low malignant potential and rarely metastasize. While they frequently arise from the pleura, they can occur at any soft tissue site in the body. We present a case of a large (28 × 21 cm) malignant solitary fibrous tumor arising from the bladder serosa. In addition, the clinicopathologic features, differential diagnosis, cytogenetics and management of this rare disease are discussed, along with a review of the existing literature on this topic.

Case presentation: An otherwise healthy 41-year-old Caucasian man presented with weight loss and progressive abdominal bloating. A subsequent computed tomography scan of his chest, abdomen and pelvis revealed a 26.8 × 21 cm intra-abdominal mass occupying most of his abdominal cavity. The inferior vena cava was compressed, and the mass extended inferiorly to his upper pelvis abutting the superior dome of his bladder. He underwent operative resection and the resected mass measured 28 × 21 × 18 cm and weighed 4.8 kg. The cut surface revealed a gray-white mass with an ill-defined whorled-like pattern, with randomly assorted tan fleshy nodules. A histologic evaluation revealed variable, alternating hypercellular and hypocellular areas, with areas of necrosis. The tumor cells varied from spindle to epithelioid within a hyalinized stroma. In the hypercellular areas, the tumor cells showed moderate atypia with high mitotic activity. The histological features combined with immunophenotyping were suggestive of a malignant solitary fibrous tumor that grossly appeared to be growing from the bladder serosa, specifically the intraperitoneal superior dome of the bladder. Our patient is currently eight months post-surgery without evidence of recurrence.

Conclusions: Extrapleural occurrences of solitary fibrosis tumors are being increasingly observed. Malignant solitary fibrosis tumors of the urinary bladder, however, are very rare. As there are no pathognomonic features of malignancy, surgical resection is often both diagnostic and therapeutic, as was the case in our report.

No MeSH data available.


Related in: MedlinePlus