Cytomorphological spectrum of solitary fibrous tumour: revisited.
CD34
CD99
STAT6
fine needle aspiration cytology
solitary fibrous tumour
Journal
Cytopathology : official journal of the British Society for Clinical Cytology
ISSN: 1365-2303
Titre abrégé: Cytopathology
Pays: England
ID NLM: 9010345
Informations de publication
Date de publication:
11 2022
11 2022
Historique:
revised:
09
06
2022
received:
27
04
2022
accepted:
28
06
2022
pubmed:
3
7
2022
medline:
12
10
2022
entrez:
2
7
2022
Statut:
ppublish
Résumé
Solitary fibrous tumour (SFT) is a tumour of mesenchymal origin. Its diagnosis on cytology is challenging, owing to variation in cellularity, sparsely distributed cellular and stromal components. Cytomorphological findings for this type of tumour have rarely been described in the literature-only a few case reports and the occasional case series have been presented thus far. We present the cytomorphological features of SFT with special emphasis on immunochemical findings. We present cytological data from eight cases of histopathologically proven SFTs. The cytomorphological features, immunochemical markers and differential diagnostic entities on fine needle aspiration cytology are discussed. Fine needle aspiration was performed at various anatomical sites. Cytology smears showed variable cellularity, with tumour cells arranged in loose clusters and as singly scattered cells. Interlacing fascicles with palisading of cells was noted. The cells were predominantly spindle to elongated, having moderate cytoplasm with elongated wavy nuclei. These nuclei had fine to coarse chromatin, with inconspicuous to prominent nucleoli. There was prominent, metachromatically staining, amorphous to fibrillary, collagenous to myxoid matrix material associated with the tumour cells. Other findings included intranuclear pseudo-inclusions, multinucleated giant cells and atypical mitoses. Cytological diagnoses offered varied from 'spindle cell neoplasm' to 'spindle cell sarcoma' or 'suggestive of sarcoma'. Immunocytochemistry (ICC) performed on cell block sections showed positivity for STAT6, CD34 and Bcl-2. Cytological diagnosis of SFT can be challenging. A careful search for characteristic cytomorphological features is diagnostically helpful. The cytomorphology should be interpreted with caution, with an appropriate ICC panel, including STAT6 and CD34.
Sections du résumé
BACKGROUND
Solitary fibrous tumour (SFT) is a tumour of mesenchymal origin. Its diagnosis on cytology is challenging, owing to variation in cellularity, sparsely distributed cellular and stromal components. Cytomorphological findings for this type of tumour have rarely been described in the literature-only a few case reports and the occasional case series have been presented thus far. We present the cytomorphological features of SFT with special emphasis on immunochemical findings.
MATERIALS AND METHODS
We present cytological data from eight cases of histopathologically proven SFTs. The cytomorphological features, immunochemical markers and differential diagnostic entities on fine needle aspiration cytology are discussed.
RESULTS
Fine needle aspiration was performed at various anatomical sites. Cytology smears showed variable cellularity, with tumour cells arranged in loose clusters and as singly scattered cells. Interlacing fascicles with palisading of cells was noted. The cells were predominantly spindle to elongated, having moderate cytoplasm with elongated wavy nuclei. These nuclei had fine to coarse chromatin, with inconspicuous to prominent nucleoli. There was prominent, metachromatically staining, amorphous to fibrillary, collagenous to myxoid matrix material associated with the tumour cells. Other findings included intranuclear pseudo-inclusions, multinucleated giant cells and atypical mitoses. Cytological diagnoses offered varied from 'spindle cell neoplasm' to 'spindle cell sarcoma' or 'suggestive of sarcoma'. Immunocytochemistry (ICC) performed on cell block sections showed positivity for STAT6, CD34 and Bcl-2.
CONCLUSION
Cytological diagnosis of SFT can be challenging. A careful search for characteristic cytomorphological features is diagnostically helpful. The cytomorphology should be interpreted with caution, with an appropriate ICC panel, including STAT6 and CD34.
Substances chimiques
Antigens, CD34
0
Biomarkers, Tumor
0
Chromatin
0
Proto-Oncogene Proteins c-bcl-2
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
688-695Informations de copyright
© 2022 John Wiley & Sons Ltd.
Références
Kallen ME, Hornick JL. The 2020 WHO classification. Am J Surg Pathol. 2021;45(1):e1-e23.
Strickland KC, Nucci MR, Esselen KM, et al. Solitary fibrous tumor of the uterus presenting with lung metastases: a case report. Int J GynecolPathol. 2016;35(1):25-29.
Ababneh E, Policarpio-Nicolas MLC. Perigastric solitary fibrous tumor (SFT) diagnosed on fine needle aspiration: a case report and review of literature. DiagnCytopathol. 2020;48(12):E27-E32.
Marotti JD, Liu X, Jamot S, Gardner TB, Gordon SR, Kerr DA. Solitary fibrous tumor of the pancreas clinically mimicking a pancreatic neuroendocrine tumor: cytologic pitfalls when a transgastric approach is utilized. DiagnCytopathol. 2021;49(11):E405-E409.
Dermawan JK, Fritchie K. Solitary fibrous tumor. PathologyOutlines.Com Website. https://www.pathologyoutlines.com/topic/softtissuesft.html. Accessed March 10, 2022.
Hornick JL. Limited biopsies of soft tissue tumors: the contemporary role of immunohistochemistry and molecular diagnostics. Mod Pathol. 2019;32(Suppl 1):27-37.
Gupta A, Dwivedi T. A simplified overview of World Health Organization classification update of central nervous system tumors 2016. J Neurosci Rural Pract. 2017;8(4):629-641.
Martin-Broto J, Mondaza-Hernandez JL, Moura DS, Hindi N. A comprehensive review on solitary fibrous tumor: Newinsights for new horizons. Cancers (Basel). 2021;13(12):2913.
Jones VM, Wangsiricharoen S, Cornea V, Bocklage TJ, Ali SZ, Allison DB. Cytopathological characteristics of solitary fibrous tumour involving the pancreas by fine needle aspiration: making an accurate preoperative diagnosis in an uncommon location. Cytopathology. 2022 Mar;33(2):222-229.
Rogers C, Samore W, Pitman MB, Chebib I. Solitary fibrous tumor involving the pancreas: report of the cytologic features and first report of a primary pancreatic solitary fibrous tumor diagnosed by fine-needle aspiration biopsy. J Am Soc Cytopathol. 2020;9(4):272-277.
Krishnamurthy V, Suchitha S, Asha M, Manjunath GV. Fine needle aspiration cytology of solitary fibrous tumor of the orbit. J Cytol. 2017;34(2):104-106.
Gupta N, Barwad A, Katamuthu K, et al. Solitary fibrous tumour: a diagnostic challenge for the cytopathologist. Cytopathology. 2012;23(4):250-255.
Hupp M, Najmuddin M, Dincer HE, Mallery JS, Amin K, Stewart J 3rd. Cytomorphologic features of malignant solitary fibrous tumor with mediastinal involvement sampled by endoscopic and endobronchial ultrasound-guided fine-needle aspiration: a comparison of two cases. DiagnCytopathol. 2019;47(8):821-827.
Tani E, Wejde J, Åström K, Wingmo IL, Larsson O, Haglund F. FNA cytology of solitary fibrous tumors and the diagnostic value of STAT6 immunocytochemistry. Cancer Cytopathol. 2018;126(1):36-43.
Samaddar A, Kakkar A, Sakthivel P, et al. Cytological diagnosis of solitary fibrous tumour of the lacrimal sac: role of immunocytochemistry for STAT6. Cytopathology. 2021;32(1):115-119.
Gold JS, Antonescu CR, Hajdu C, et al. Clinicopathologic correlates of solitary fibrous tumors. Cancer. 2002;94(4):1057-1068.
Pasquali S, Gronchi A, Strauss D, et al. Resectable extra-pleural and extra-meningeal solitary fibrous tumours: a multi-Centre prognostic study. Eur J Surg Oncol. 2016;42(7):1064-1070.
Ronchi A, Cozzolino I, Montella M, et al. Giant cell-rich extrapleural solitary fibrous tumor: cytological findings and differential diagnosis of a rare neoplasm. DiagnCytopathol. 2021;49(3):E113-E118.
Demicco EG, Park MS, Araujo DM, et al. Solitary fibrous tumor: a clinicopathological study of 110 cases and proposed risk assessment model. Mod Pathol. 2012;25(9):1298-1306.
Chmielecki J, Crago AM, Rosenberg M, et al. Whole-exome sequencing identifies a recurrent NAB2-STAT6 fusion in solitary fibrous tumors. Nat Genet. 2013;45(2):131-132.
Robinson DR, Wu YM, Kalyana-Sundaram S, et al. Identification of recurrent NAB2-STAT6 gene fusions in solitary fibrous tumor by integrative sequencing. Nat Genet. 2013;45(2):180-185.
Mohajeri A, Tayebwa J, Collin A, et al. Comprehensive genetic analysis identifies a pathognomonic NAB2/STAT6 fusion gene, nonrandom secondary genomic imbalances, and a characteristic gene expression profile in solitary fibrous tumor. Genes Chromosomes Cancer. 2013;52(10):873-886.
Demicco EG, Wani K, Ingram D, et al. TERT promoter mutations in solitary fibrous tumour. Histopathology. 2018;73(5):843-851.
Bertucci F, Bouvier-Labit C, Finetti P, et al. Gene expression profiling of solitary fibrous tumors. PLoS One. 2013;8(5):e64497.
de Saint Aubain Somerhausen N, Rubin BP, Fletcher CD. Myxoid solitary fibrous tumor: a study of seven cases with emphasis on differential diagnosis. Mod Pathol. 1999;12(5):463-471.
Folpe AL, Devaney K, Weiss SW. Lipomatous hemangiopericytoma: a rare variant of hemangiopericytoma that may be confused with liposarcoma. Am J Surg Pathol. 1999;23(10):1201-1207.
Mosquera JM, Fletcher CD. Expanding the spectrum of malignant progression in solitary fibrous tumors: a study of 8 cases with a discrete anaplastic component--is this dedifferentiated SFT? Am J Surg Pathol. 2009;33(9):1314-1321.
Collini P, Negri T, Barisella M, et al. High-grade sarcomatous overgrowth in solitary fibrous tumors: a clinicopathologic study of 10 cases. Am J Surg Pathol. 2012;36(8):1202-1215.
Thway K, Hayes A, Ieremia E, Fisher C. Heterologous osteosarcomatous and rhabdomyosarcomatous elements in dedifferentiated solitary fibrous tumor: further support for the concept of dedifferentiation in solitary fibrous tumor. Ann DiagnPathol. 2013;17(5):457-463.
Vallat-Decouvelaere AV, Dry SM, Fletcher CD. Atypical and malignant solitary fibrous tumors in extrathoracic locations: evidence of their comparability to intra-thoracic tumors. Am J Surg Pathol. 1998;22(12):1501-1511.
Khairwa A, Dey P, Nada R. Fine needle aspiration cytology of malignant solitary fibrous tumour. Cytopathology. 2015;26(6):391-393.
Lee CK, Liu KL, Huang SK. A dedifferentiated solitary fibrous tumor of the parotid gland: a case report with cytopathologic findings and review of the literature. DiagnPathol. 2019;14(1):20.
Ali SZ, Hoon V, Hoda S, Heelan R, Zakowski MF. Solitary fibrous tumor. A cytologic-histologic study with clinical, radiologic, and immunohistochemical correlations. Cancer. 1997;81:116-121.
Clayton AC, Salomão DR, Keeney GL, Nascimento AG. Solitary fibrous tumour: a study of cytologic features of six cases diagnosed by fine-needle aspiration. DiagnCytopathol. 2001;25:172-176.
Gonzalez MF, Husain BH. Solitary fibrous tumour of the submandibular gland: novel insights from clinical practice on a close mimicker of pleomorphic adenoma and a diagnostic challenge for the cytopathologist. Cytopathology. 2021;32(2):261-265.
Sbaraglia M, Bellan E, Dei Tos AP. The 2020 WHO classification of soft tissue Tumours: news and perspectives. Pathologica. 2021;113(2):70-84.
Doyle LA, Vivero M, Fletcher CD, Mertens F, Hornick JL. Nuclear expression of STAT6 distinguishes solitary fibrous tumor from histologic mimics. Mod Pathol. 2014;27(3):390-395.
Schweizer L, Koelsche C, Sahm F, et al. Meningeal hemangiopericytoma and solitary fibrous tumors carry the NAB2-STAT6 fusion and can be diagnosed by nuclear expression of STAT6 protein. Acta Neuropathol. 2013;125(5):651-658.
Dagrada GP, Spagnuolo RD, Mauro V, et al. Solitary fibrous tumors: loss of chimeric protein expression and genomic instability mark dedifferentiation. Mod Pathol. 2015;28(8):1074-1083.
Schneider N, Hallin M, Thway K. STAT6 loss in dedifferentiated solitary fibrous tumor. Int J Surg Pathol. 2017;25(1):58-60.
Dawamneh MF, Amra NK, Amr SS. Low grade fibromyxoid sarcoma: report of a case with fine needle aspiration cytology and histologic correlation. Acta Cytol. 2006;50(2):208-212.
Domanski HA, Mertens F, Panagopoulos I, Akerman M. Low-grade fibromyxoid sarcoma is difficult to diagnose by fine needle aspiration cytology: a cytomorphological study of eight cases. Cytopathology. 2009;20(5):304-314.
Doyle LA, Möller E, Dal Cin P, Fletcher CD, Mertens F, Hornick JL. MUC4 is a highly sensitive and specific marker for low-grade fibromyxoid sarcoma. Am J Surg Pathol. 2011;35(5):733-741.
Patel RM, Downs-Kelly E, Dandekar MN, et al. FUS (16p11) gene rearrangement as detected by fluorescence in-situ hybridization in cutaneous low-grade fibromyxoid sarcoma: a potential diagnostic tool. Am J Dermatopathol. 2011;33(2):140-143.
Wakely PE Jr, Ali SZ, Bishop JA. The cytopathology of malignant peripheral nerve sheath tumor: a report of 55 fine-needle aspiration cases. Cancer Cytopathol. 2012;120(5):334-341.
Kang Y, Pekmezci M, Folpe AL, Ersen A, Horvai AE. Diagnostic utility of SOX10 to distinguish malignant peripheral nerve sheath tumor from synovial sarcoma, including intraneural synovial sarcoma. Mod Pathol. 2014;27(1):55-61.
Le Guellec S, Macagno N, Velasco V, et al. Loss of H3K27 trimethylation is not suitable for distinguishing malignant peripheral nerve sheath tumor from melanoma: a study of 387 cases including mimicking lesions. Mod Pathol. 2017;30(12):1677-1687.
Jo VY, Fletcher CD. Epithelioid malignant peripheral nerve sheath tumor: clinicopathologic analysis of 63 cases. Am J Surg Pathol. 2015;39(5):673-682.
Endo M, Kobayashi C, Setsu N, et al. Prognostic significance of p14ARF, p15INK4b, and p16INK4a inactivation in malignant peripheral nerve sheath tumors. Clin Cancer Res. 2011;17(11):3771-3782.
Magro G, Righi A, Casorzo L, et al. Mammary and vaginal myofibroblastomas are genetically related lesions: fluorescence in situ hybridization analysis shows deletion of 13q14 region. Hum Pathol. 2012;43(11):1887-1893.
Antonescu CR, Sung YS, Zhang L, Agaram NP, Fletcher CD. Recurrent SRF-RELA fusions define a novel subset of cellular Myofibroma/Myopericytoma: a potential diagnostic pitfall with sarcomas with myogenic differentiation. Am J Surg Pathol. 2017;41(5):677-684.
Abbott JJ, Oliveira AM, Nascimento AG. The prognostic significance of fibrosarcomatous transformation in dermatofibrosarcoma protuberans. Am J Surg Pathol. 2006;30(4):436-443.
Lu L, Lao IW, Liu X, Yu L, Wang J. Nodular fasciitis: a retrospective study of 272 cases from China with clinicopathologic and radiologic correlation. Ann DiagnPathol. 2015;19(3):180-185.
Yoshida KI, Machado I, Motoi T, et al. NKX3-1 is a useful immunohistochemical marker of EWSR1-NFATC2 sarcoma and mesenchymal chondrosarcoma. Am J Surg Pathol. 2020;44(6):719-728.
Janeway KA, Liegl B, Harlow A, et al. Pediatric KIT wild-type and platelet-derived growth factor receptor alpha-wild-type gastrointestinal stromal tumors share KIT activation but not mechanisms of genetic progression with adult gastrointestinal stromal tumors. Cancer Res. 2007;67(19):9084-9088.
Ylagan LR, Bhalla S. Fine needle aspiration cytology of a dedifferentiated liposarcoma: report of a case with histologic and immunohistochemical follow-up. Acta Cytol. 2001;45(4):641-644.