病例報告：睪丸之單發性纖維瘤
張琮昕1、李致樵1、林文榮1、邱文祥1,2
1台北馬偕紀念醫院 泌尿科；2國立陽明大學 醫學院
Case Report and Review of Literature: Solitary Fibrous Tumor of Scrotum.
Tsung-Hsin Chang, MD1, Chih-Chiao, Lee, MD1,
Wun-Rong Lin, MD1, Wen-Hsiang Chiu, MD, PHD1,2,
1Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan
2 School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
Case report:
A 48-year-old male presented to our department with complaints of right scrotal mass noted for 2 years. The mass was located over middle-to-right side of scrotum with nodularity and clear perimeters. The tumor increased in size rapidly without obvious pain or other symptoms over the past 3 months. Physical examination revealed that a 4.7cmx8.5cm lobulated tumor mass over the right side of the scrotum, freely movable with clear perimeters and elastic consistency on palpation. The penis and testicles were normal in appearance.
He received scrotal ultrasound examination with color Doppler imaging which showed a hypo-echogenecity extratesticular mass with clear contours and rich in blood flows. Computed tomography (CT) reported a lobulated mass(4.7x8.5cm) with proper enhancement in the midline of scrotum. He received tumor excisional surgery for treatment.
The resected specimen consisted of a firm tumor measuring 7.5x6.3x3.8 cm in size and weighs 76.5 gm. On cutting, there is a well-defined, lobulated, whitish and firm tumor with some mucinous component.
Microscopically, it composes a hyper-cellular tumor with vaguely fascicular growth pattern forming a patternless growth architecture. A few thin-walled, branching (staghorn) vessels are also present in the tumor. Tumor cells show ovoid to short spindle shape with indistinct borders and dispersed chromatin within vesicular nuclei. Immunohistochemically, tumor cells are positive for STAT-6(nuclear) and CD34 while negative for actin, Desmin, CD117 and DOG-1. Based on the morphology, immunohistochemical studies, it is consistent with solitary fibrous tumor (SFT).
The patient is alive and no tumor recurrence was noted during follow-up.
Discussion:
SFT of the scrotum is extremely rare, this is the only second report on SFT of the scrotum. Thus, there is lack of experience of the treatment and clinical behavior of the disease..
Solitary fibrous tumors were originally reported in pleura, but can be found in many sites including bladder, CNS, colon, ear, eye, kidney, liver, mediastinum, nasal, prostate, soft tissue, thyroid, and intrapulmonary masses. It is difficult to diagnose with imaging alone. Treatment often involves surgical resection and diagnosis is made by pathological immunohistochemistry: nuclear expression of STAT6. SFT is often benign but may exists slight chances of malignancy, thus follow up after surgical excision is required.