Clinical Oncology: Case Reports

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Case Report, Clin Oncol Case Rep Vol: 8 Issue: 7

Solitary Fibrous Tumor of the Pelvis: A Case Report and Literature Review

Pelegrina Manzano Amalia*1,2, Monllau Font Vanesa1, Puértolas Pérez Alejandro2, Domingo Amela Anna3, Merlo Mas Josep1, Rodríguez Blanco Manuel1

1Department of Surgery, ServiDigest Clinic, Hospital del Pilar, 08006 Barcelona, Spain

2Department of Medicine and Life Sciences, Universitat Pompeu Fabra, 08003 Barcelona, Spain

3Pathological Anatomy Laboratory, Atrys Health, 08025 Barcelona, Spain

*Corresponding Author:
Pelegrina Manzano Amalia
Department of Surgery, ServiDigest Clinic, Hospital del Pilar, 08006 Barcelona, Spain
E-mail: apelegrina@hmar.cat

Received: April 18, 2025; Manuscript No: COCR-25-164632; Editor Assigned: May 8, 2025; PreQC: COCR-25-164632(PQ); Reviewed: May 28, 2025; QC No: COCR-25-164632(Q); Revised: June 10, 2025; Manuscript No: COCR-25- 164632(R); Published: July 30, 2025, DOI: 10.4172/cocr.8(7).423

Citation: Amalia PM, Vanesa MF, Alejandro PP, Anna DA, Josep MM, et al. (2025) Solitary Fibrous Tumor of the Pelvis a Case Report and Literature Review. Clin Oncol Case Rep 8(7):423

Abstract

Solitary fibrous tumor (SFT) is a rare mesenchymal neoplasm, occasionally arising in the retroperitoneal or pelvic cavities. Periprostatic SFTs are especially uncommon and can mimic primary prostatic neoplasms. While often benign, they may behave unpredictably. We report a case of a 76-year-old male with a large periprostatic SFT managed surgically, and we review the literature. Histopathological and immunohistochemical features confirmed the diagnosis, and risk stratification classified the tumor as intermediate risk. This case underscores the importance of accurate diagnosis, complete surgical resection, and long-term follow-up due to potential recurrence.

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Keywords

Solitary Fibrous Tumor; Periprostatic; Pelvic Tumor; Mesenchymal Neoplasm; Surgical Resection; Immunohistochemistry; Risk Stratification

Introduction

Solitary fibrous tumors (SFTs) are rare spindle-cell neoplasms of mesenchymal origin, originally described by Klemperer and Rabin in 1931 [1]. Initially associated with the pleura, they are now recognized in extrapleural sites including the prostate [2]. Their incidence is <1/million [3], and origin from submesothelial mesenchymal cells may explain their diverse localization [4]. Retroperitoneal and pelvic SFTs are extremely rare, with fewer than 40 prostatic cases described [5,6]. SFTs exhibit spindle cells within a collagenous stroma and a staghorn vascular pattern. Immunohistochemistry (IHC) typically shows CD34, STAT6, Bcl-2, and CD99 positivity [7-9]. Recent genetic studies have identified a chromosomal rearrangement involving NAB2-STAT6 fusion on chromosome 12q13 [7-9], which appears to be a defining molecular feature of SFTs.

Prostatic SFTs can be misdiagnosed due to their similarity to other spindle-cell tumors [7-10]. Most follow a benign course, but 20% show malignant behavior [11]. Katsuno et al. estimated that ~6% of SFTs are pelvic in origin [5,12,13]. No standardized management exists; surgical resection is the mainstay [14-21].

Case Presentation

A 76-year-old male with no relevant history presented with an incidental pelvic mass on ultrasound. PSA was normal. CT and MRI revealed a large encapsulated pelvic tumor (100 × 90× 83 mm) with heterogeneous features and close contact with the prostate and bladder. The lesion caused displacement of both structures, raising suspicion of sarcoma. No lymphadenopathy was noted [Figure 1].

COCR-pelvis

Figure 1: MRI of the pelvis in T2-weighted turbo spin-echo (TSE) sequence. A) Axial view showing a large, encapsulated pelvic mass (8.2 × 11 × 9.1 cm) in close contact with the left aspect of the prostate, with heterogeneous signal intensity and central cystic necrotic areas. B) Sagittal view depicting anterior displacement of the bladder due to the mass effect.

Surgical exploration revealed extensive tumor adherence to pelvic structures. En bloc resection of prostate, seminal vesicles and bladder was required [Figure 2], followed by urinary diversion (Bricker ileal conduit) and protective ileostomy. Intraoperative rectal perforation was repaired. The postoperative course was stable.

COCR-specimen

Figure 2: A) Gross specimen of the periprostatic solitary fibrous tumor after en bloc resection with bladder and prostate. B) Tumor section with prostate segment in the upper portion.

Histopathology showed a well-circumscribed, spindle-cell tumor with low mitotic index, no necrosis or atypia. IHC was positive for CD34 and STAT6 [Figure 3]. Demicco et al.'s model classified it as intermediate-risk [22]. No evidence of disease recurrence was observed at six months; follow-up is ongoing.

COCR-fibrous

Figure 3: Histological and immunohistochemical features of the solitary fibrous tumor. A) Hematoxylin and eosin (H&E) staining showing the transition from prostatic parenchyma (left portion) to a well-demarcated fibrous lesion. A thin connective tissue band, corresponding to the prostatic capsule, separates both areas. B) H&E staining at higher magnification highlighting the characteristic vascular pattern of the tumor, with prominent branching vessels resembling a staghorn configuration. C) Strong nuclear expression of STAT6. D) Diffuse and strong positivity of CD34.

Discussion

SFTs are often indolent but can exhibit aggressive features. Pelvic SFTs represent ~16% of extrathoracic cases [23,24]. Preoperative imaging helps define anatomy, but diagnosis relies on pathology and IHC [8,9,25]. Molecular confirmation via NAB2-STAT6 fusion enhances diagnostic accuracy [9].

Our patient’s tumor lacked malignant features but met criteria for intermediate-risk due to size and age [22]. Similar cases report variability in presentation and outcome [26]. Complete surgical resection (R0/R1) is key, and organ sacrifice should be reserved for invasion [14-27]. In our case, resection of prostate, seminal vesicles and bladder was necessary. The role of adjuvant therapy remains unclear but may be considered in aggressive forms.

For unresectable/metastatic SFTs, systemic therapy includes tyrosine kinase inhibitors like pazopanib, as supported by the GEIS-32 trial [28-32]. ISG15 may serve as a prognostic biomarker [25]. Dedifferentiated SFTs require anthracycline-based chemotherapy or trabectedin with radiotherapy [8,33].

Conclusion

This case adds to the limited literature on per prostatic SFTs. Accurate histological and molecular diagnosis, individualized surgical planning, and long-term follow-up are essential. Future research should refine prognostic tools and explore new therapeutic strategies, particularly for aggressive SFT subtypes [Table 1].

Author (year) Tumor Location Age (years) Presentation PSA (ng/mL) Tumor size (cm) Biopsy Treatment Margins Necrosis Mitosis/10 HPF Cellularity Outcome
Current report -2025 Periprostatic 76 (male) Incidental Normal 10 × 9 × 8.3 No CP R0 No 3 Intermediate NR 6 months
Kc et al. (2024)34 Pelvic 46 (female) Persistent lower abdominal pain - 5.8 × 6.3 × 5.7 No Tumor resection + bilateral salpingectomy NA No 1 Low NR 24 months
  Pelvis 68 (male) Acute urinary retention Normal NA Yes Tumor resection NA Yes 1 Intermediate Dead due to cardiac arrest under the surgery
Heger et al. (2024)10 Prostatic 76 (male) Obstructive urinary symptoms Normal NA Yes Radical prostatectomy + lymphadenectomy R0 NA > 4 Intermediate NA
Zhou and Xu (2023)26 Pelvic 15 (male) Numbness in buttock and radiating pain in LL NA 11.5 × 8.8× 7.7 Yes Complete surgical excision R0 NA 7 Intermediate 9 months after surgery tumor recurrence: Imatinib (1 year)
Yilmaz et al. (2023)35 Prostatic 44 (male) Lower abdominal pressure Normal 4.8 × 6.6 Yes Surveillance - No 01-Feb Intermediate No signs of malignancy at 36 months
Peng et al. (2022)5 Prostatic 50 (male) LUTS Normal 4.6 x 3.5 x 2.8 Yes Radical prostatectomy R0 NA NA NA NR 3 months
Gordillo et al. (2022)36 Pelvic 47 (male) Difficulty urinating NA 10.3 x 14 x 16 Yes Tumor resection + APR NA Yes NA NA NA
Ahnou et al. (2021)37 Prostatic 77 (male) LUTS Normal 10.8 × 8.2 × 5.9 Yes Radical prostatectomy + lymphadenectomy R0 Yes < 1 Low NR 6 months
Takeuchi et al (2021)38 Prostatic 43 (male) Incidental Normal 3 x 3.4 Yes Radical prostatectomy R0 NA NA Intermediate NR 24 months
Gilbert et al. (2020)39 Periprostatic 78 (male) Constipation and lower abdominal pain Normal 6.32 x 4.6 NA Tumor resection (prostate sparing technique) R0 NA < 1 Low NR 12 months
Mishra et al. (2020)40 Prostatic 28 (male) Obstructive urinary symptoms NA 5.8 x 6.4 x 6.5 Yes Simple suprapubic prostatectomy + suprapubic cystostomy R0 No < 1 Intermediate NR 168 months
Okubo et al. (2020)41 Prostatic 40 (male) Lower abdominal pain NA 6 x 5 x 4 Yes Tumor resection R0 No NA Low NR 6 months
Bakhshwin et al. (2020)42 Prostatic Median: 62 (4 cases) LUTS (3) and hematuria (1) NA Median: 8.5 (5, 8, 9 and 13) Yes Prostatectomy (1), CP (2), TURP (1) NA (2), R0 (1), R1 (1) Yes (2), no (2) Median: 11.5 (20, 13, 7 and 6) High (2), intermediate (2) NA (1), metastasize at 14 months (1), relapse at 30 months (1), NR 12 months (1)
Matos et al. (2020)12 Prostatic 66 (male) Urinary frequency, urgency and nocturia Normal NA NA Prostatectomy NA NA NA Intermediate NR 60 months
Wada et al. (2019)24 Pelvic 72 (male) Hypoglycemic attack NA 15 × 8 × 8 NA Tumor resection NA Yes 7 High NR 12 months
Mora-Guzmán et al. (2019)43 Pelvic 83 (female) Abdominal discomfort - 7.5 x 5.4 x 4.2 Yes Tumor resection NA Yes 4 NA NR 36 months
Cheng et al. (2019)44 Prostatic 43 (male) Gross hematuria Normal 8 x 4.5 x 3.5 Yes Resection of pelvic tumor through bladder R0 Yes 4 Intermediate NR 24 months
Tanaka et al. (2018)45 Prostatic urethra 68 (male) Urinary frequency and gross hematuria Normal 6 x 5 Yes Tumor resection NA Yes >10 High Local recurrence and lung metastases at 54 months. Palliative care
Ronchi et al. (2017)46 Prostatic 62 (male) Urinary retention and constipation High (5.8) 20 x 10 Yes Prostatectomy R0 Yes 8 Intermediate NR 96 months
Osamu et al. (2017)47 Prostatic 65 (male) Nocturia Normal 10 Yes Prostatectomy R0 Yes <2 Intermediate NR 18 months
Gao et al (2016)48 Pelvic 58 (male) Incidental NA 5.5 x 2.5 Yes Tumor resection NA NA NA NA Relapse at 24 months: tumor resection + radiotherapy
Yang et al. (2015)49 Prostatic 46 (male) Dysuria, irritative LUTS Normal 6.4 x 5.6 x 5.7 Yes Prostatectomy R0 NA NA Intermediate NR 18 months
Dhameja et al. (2015)50 Prostatic 62 (male) Dysuria, urinary urgency and increased frequency Normal 18 x 12 x 6 Yes CP NA Yes 7 Intermediate NA
Moureau-Zabotto et al. (2012)6 Prostatic 60 (male) Urinary tract obstruction Normal 15 Yes CP R0 Yes 4 High NR 28 months
Katsuno et al. (2011)13 Pelvic 56 (female) Painless - 9 × 7.5 × 5 Yes Trans-sacral approach NA NA NA NA NR 24 months
Galosi et al. (2009)51 Prostatic 60 (male) Urinary tract obstruction Normal 8 Yes Prostatectomy R0 No 1 Low NR 6 months
Nair et al. (2007)52 Prostatic 37 (male) Urinary tract obstruction NA 10 Yes Enucleation R1 NA 1 High NR 24 months
Herawi et al. (2007)53 Prostatic Median: 65* (range 46-75) Urinary tract obstruction NA Median: 10.5 (range 8.5-15) NA TUR (1); Prostatectomy (4); CP (2); pelvic exenteration (2); enucleation (1) NA Yes 0 (5); 3-5 (5) NA NA (4); death at 7 months from unrelated cause (1) NR 1 to 10 years (5)
Oguro et al. (2006)54 Prostatic 35 (male) Urinary tract obstruction Normal 5.2 Yes Enucleation R1 No NA Low Local relapse at 12 months
Vossough et al. (2005)11 Pelvic peritoneum 61 (male) Increased urinary frequency, left flank pain radiating to the scrotum, and deep pelvic pain NA 9 x 6 x 11 NA Tumor resection NA Yes NA High NA
Vodovnik et al. (2005)55 Prostatic 87 (male) Urinary tract obstruction and hematuria Normal > 9 No Emergency hemostatic prostatectomy R1 Yes 15 High Death (first postoperative day)
Grasso et al. (2002)56 Prostatic 21 (male) Urinary tract obstruction NA 2.4 Yes Enucleation NA NA 0 NA NA
Sekine et al. (2001)57 Prostatic 42 (male) Urinary tract obstruction Normal NA Yes Prostatectomy R0 NA 2 High NR 18 months
Pins et al. (2001)58 Prostatic 73 (male) Urinary tract obstruction Normal 6 No Prostatectomy NA No 4 High NR 21 months
  Prostatic 57 (male) None (rectal examination) Normal 10 Yes Prostatectomy R0 No <1 Low NR 15 months
Westra et al. (2000)59 Prostatic 65** (male) Urinary retention NA 11 No CP + RT R2 Yes NA High NR 2 months
  RSV 47 (male) Left groin discomfort NA NA NA Excision of RSV R0 No NA NA NR 15 months
  RSV 46 (male) Hematospermia NA 5 NA Excision of RSV R0 No NA NA NR 8 months
  Bladder 67 (male) Incidental NA 4 NA CP R0 No >10 High NR 9 months
  Bladder 67 (male) Incidental NA NA NA TUR R0 NA NA NA NR 1 month
Kelly & Baxter (1998)60 Prostatic 59 (male) Urinary tract obstruction Normal NA Yes Observation - NA NA NA NA
Takeshima et al. (1997)61 Prostatic 42 (male) Difficult voiding and constipation NA 14×13×11 No CP NA Yes NA NA NR 10 months
Mentzel et al. (1997)62 Prostatic 72 (male) Urinary tract obstruction and pelvic pressure NA No No TUR NA No <2 Low NA

* 10 cases, including the case reported by Westra et al. (2000); ** This case is also included in the report of Herawi et al. (2007); APR: Abdominal-perineal resection of the rectum; MRI: Magnetic resonance imaging; CP: Cystoprostatectomy; HPF: High power field; LL: Lower limbs; LUTS: Lower urinary tract symptoms; NA: Not available; NR: No relapse; PSA: Prostate-Specific Antigen; RSV: Right seminal vesicle; TUR: Transurethral resection; TURP: Transurethral resection of the prostate; RT: Radiotherapy.

Table 1: SFT of the pelvic cavity cases.

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