Solitary fibrous tumor of the bladder: A rare cause of bladder outlet obstruction in an adult male

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Abstract

Introduction

Solitary fibrous bladder tumors are extremely uncommon, with only a few cases reported. These fibroblastic mesenchymal neoplasms are typically benign, indolent, and slow growing.

Case presentation

A 44‐year‐old male patient with obstructive uropathy was referred to our unit for workup. Ultrasonography and MRI of the pelvis showed a large, well‐circumscribed bladder mass, also visualized cystoscopically. This mass was excised en bloc using the Pfannenstiel approach. Histopathological and immunohistochemical analyses revealed a solitary fibrous tumor.

Conclusion

The management of SFTs can be challenging due to the lack of established guidelines. Hence, we offered our patient long‐term follow‐up. Twelve months postoperatively, no recurrence or metastases were found on the follow‐up imaging.

Related collections

Most cited references 16

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Nuclear expression of STAT6 distinguishes solitary fibrous tumor from histologic mimics.

Leona A Doyle, Marina Vivero, Christopher Dm Fletcher … (2014)

Solitary fibrous tumor (SFT) is composed of spindled to ovoid cells in a patternless architecture with prominent stromal collagen and hemangiopericytoma-like vessels. Some tumors show hypercellularity, nuclear atypia, and significant mitotic activity; the latter feature in particular often portends an aggressive clinical course. SFT can sometimes be difficult to distinguish from other benign mesenchymal tumors and sarcomas. The most characteristic (albeit nonspecific) immunohistochemical finding in SFT is CD34 expression. A NAB2-STAT6 gene fusion, resulting in a chimeric protein in which a repressor domain of NGFI-A binding protein 2 (EGR1 binding protein 2) (NAB2) is replaced with a carboxy-terminal transactivation domain from signal transducer and activator of transcription 6, interleukin-4 induced (STAT6), was recently identified as a consistent finding in SFT. However, as these genes are located in close proximity on 12q13, this fusion can only rarely be detected by conventional chromosomal banding or fluorescence in situ hybridization analysis. Nuclear expression of the carboxy terminal part of STAT6 is a consistent finding in SFT of the meninges (so-called 'meningeal hemangiopericytoma'). We investigated STAT6 expression by immunohistochemistry in SFTs and other soft tissue tumors arising outside the central nervous system to validate the diagnostic utility of this novel marker. Whole-tissue sections of 231 tumors were evaluated, including 60 cases of SFT as well as other benign and malignant mesenchymal neoplasms and sarcomatoid mesotheliomas. Fifty-nine of 60 SFT cases (98%) showed nuclear expression of STAT6, which was usually diffuse and intense. All other tumor types were negative for STAT6, except for three dedifferentiated liposarcomas and one deep fibrous histiocytoma, which showed weak staining. In conclusion, STAT6 is a highly sensitive and almost perfectly specific immunohistochemical marker for SFT and can be helpful to distinguish this tumor type from histologic mimics.

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Somatic and visceral solitary fibrous tumors in the abdomen and pelvis: cross-sectional imaging spectrum.

Alampady Shanbhogue, Srinivasa R Prasad, Naoki Takahashi … (2015)

Solitary fibrous tumors (SFTs) are a unique group of mesenchymal neoplasms of fibroblastic or myofibroblastic origin. These tumors were originally described as "benign fibrous mesotheliomas" of the pleural cavity and were erroneously thought to be confined to the serosal surfaces (due to a putative mesothelial or submesothelial origin). It is now established that SFTs are ubiquitous neoplasms with both pleural and extrapleural distribution. Extrapleural SFTs commonly occur in middle-aged adults and manifest as asymptomatic, slow-growing, large tumors. Fewer than 5% of patients with SFTs present with symptomatic hypoglycemia. SFTs are histopathologically diverse with a variable admixture of fibroblasts or myofibroblasts, numerous thin-walled vessels, and dense fibrosis. Tumors previously categorized as hemangiopericytomas are now considered cellular variants of SFTs. At imaging, SFTs demonstrate remarkable heterogeneity, with variable degrees of enhancement, necrosis, or hemorrhage. Although most extrapleural SFTs have a benign clinical course, 10%-15% of these tumors demonstrate aggressive behavior in the form of recurrence or malignancy. © RSNA, 2011.

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Solitary fibrous tumor in the pelvic cavity with hypoglycemia: report of a case.

Y Yoshino, Kazuyoshi Katayanagi, Katsuya Morita … (2004)

A case of solitary fibrous tumor (SFT) in the pelvic cavity with hypoglycemia is reported. The patient was a 60-year-old man who was referred to our hospital for a closer examination of hypoglycemia. Computed tomography demonstrated a mass, measuring 14 x 9 cm in size, in the pelvic cavity. Magnetic resonance imaging showed the mass to have a low signal intensity on T1-weighted images and a high intensity on T2-weighted images. Laparotomy revealed no peritoneal dissemination nor lymph node metastasis. An en bloc excision of the tumor was performed with a good recovery, and the hypoglycemia disappeared. Histologically, the tumor was composed of spindle-shaped and oval cells in sarcoma, based on a moderate mitotic rate and cellularity. Immunohistochemically, the tumor was positive for CD34 and negative for keratin, alpha-smooth muscle actin, desmin, S100 protein, c-kit protein, and epithelial membrane antigen. Based on these findings, the tumor was diagnosed to be malignant SFT in the pelvic cavity.

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Author and article information

Contributors

Jeff John:

ORCID: https://orcid.org/0000-0002-6139-810X

jeffveenajohn@gmail.com

Journal

Journal ID (nlm-ta): IJU Case Rep

Journal ID (iso-abbrev): IJU Case Rep

Journal ID (doi): 10.1002/(ISSN)2577-171X

Journal ID (publisher-id): IJU5

Title: IJU Case Reports

Publisher: John Wiley and Sons Inc. (Hoboken )

ISSN (Electronic): 2577-171X

Publication date (Electronic): 19 November 2024

Publication date Collection: January 2025

Volume: 8

Issue: 1 ( doiID: 10.1002/iju5.v8.1 )

Pages: 11-14

Affiliations

[ ¹ ] Division of Urology, Department of Surgery Frere Hospital and Walter Sisulu University East London South Africa

[ ² ] JWD Pathology Inc Cape Town South Africa

[ ³ ] Division of Anatomical Pathology University of Cape Town Cape Town South Africa

[ ⁴ ] Division of Urology, Department of Surgery Groote Schuur Hospital and University of Cape Town Cape Town South Africa

Author notes

[*] [* ] Correspondence: Jeff John MBChB, MMED, FC Urol (SA), Division of Urology, Department of Surgery, University of Cape Town, Cape Town, South Africa. Email: jeffveenajohn@ 123456gmail.com

Author information

Návan van Jaarsveld https://orcid.org/0000-0003-1039-1562

Jeff John https://orcid.org/0000-0002-6139-810X

Article

Publisher ID: IJU512789 Other ID: IJUCR-2024-0067.R1

DOI: 10.1002/iju5.12789

PMC ID: 11693105

PubMed ID: 39749296

SO-VID: 82586940-8347-49c5-9d31-e2bfa798d974

License:

This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

History

Date received : 30 April 2024

Date accepted : 11 September 2024

Page count

Figures: 4, Tables: 0, Pages: 4, Words: 2348

Custom metadata

source-schema-version-number 2.0

cover-date January 2025

details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:6.5.1 mode:remove_FC converted:01.01.2025