骨盆腔單發性纖維瘤個案報告4例及文獻探討
梅承恩、歐宴泉、裘坤元、賀昊中、王賢祥
台中榮民總醫院 外科部 泌尿外科
Solitary fibrous tumor in pelvis, four case report and literature review
Cheng-En Mei, Yen-chuan Ou, Kun-Yuan Chiu, Hao-Chung Ho, Shian-Shiang Wang
Division of Urology, Department of Surgery , Taichung Veterans General Hospital, Taichung, Taiwan
Purpose: Solitary fibrous tumor (SFT) is not a common tumor in pelvic space. From 2011 to 2017, there were 4 pelvic solitary fibrous tumor was diagnosed. All patients accepted different treatment options. We present these four case about treatment and outcome.
Results:
Case 1: 50 year-old male accepted health exam. Pelvic tumor was noted via CT. HRobotic assisted pelvic tumor resection was done smoothly. Pathology report showed SFT with 2 malignant criteria fit (tumor>5cm, Pleomorphism including round cell or epitheloid feature).
Case 2: 52-year-old female had breast ductal carcinoma in situ, status post partial mastectomy. Pelvic tumor was noted incidentally Laparoscopic pelvic tumor resection was done smoothly. Pathology report showed SFT with 1 malignant criteria fit (Pleomorphism including round cell or epitheloid feature).
Case 3: 94-year-old male had prostate adenocarcinoma, Gleason score 4+3=7, pT1c, status post transurethral resection of the prostate in June 2012. Abdomen computed tomography (CT) follow up in August 2015 showed a well enhanced, 4.6cm mass located at left obturator internus muscle. CT guided biopsy and transarterial embolization (TAE) were performed. Pathology report showed spindle cell tumor, and SFT was first considering. Due to progressed tumor size, TAE was performed again. Follow up CT in showed decreasing tumor size. He was under regular CT follow up.
Case 4: 61-year-old female had difficulty of defecation for about 2 weeks. Physical exam revealed left pelvic side wall tumor, and abdomen CT showed a 11.7 cm mass at low pelvis with central necrosis. Total hysterectomy, bilateral salpingo-oohorectomy and excision of retroperitoneal tumor with left vaginal wall, bladder wall repair were done in May 2013. Pathology report showed malignant solitary fibrous tumor. Follow-up abdomen CT in January 2017 revealed multiple recurrent tumor in pelvic wall. She was referred to Oncologist due to refusing operation again.
Discussion:
SFT is common to be found in the pleura, peritoneum, meninges, and extremities. Surgical intervention is the most common treatment. Radiotherapy is often used for local control. Chemotherapy has poor response for SFT. TAE is often used before surgical intervention to prevent bleeding. There were many way that we can choose to treat SFT. Surgical intervention appears to be the better way for SFT treatment.