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Presented by Pedram Argani, M.D. and prepared by Doreen Nguyen, M.D.
Case 3: This is a 27 year-old female with a parotid mass.
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1. Question
Week 605: Case 3
This is a 27 year-old female with a parotid mass.
Correct
Answer: Solitary fibrous tumor
Histology: This is a bland spindle cell lesion associated with prominent sclerosis. The vessels have a hemangiopericytomatous pattern in many areas. The lesional cells demonstrate strong immunoreactivity for CD34, and strong nuclear labeling for STAT6.
These results support the diagnosis of solitary fibrous tumor.
Discussion: Synovial sarcoma has similar cytology to solitary fibrous tumor; however, it would not label for CD34, and most cases demonstrate greater mitotic activity and slightly more primitive chromatin. Sarcomatoid carcinomas would demonstrate greater nuclear atypia and a malignant epithelial component. Sclerosing epithelioid fibrosarcoma would demonstrate greater cytologic atypia, lack CD34 immunoreactivity, and is associated with gene fusions involving FUS or EWS genes.
Nuclear labeling for STAT6 is a highly specific marker for solitary fibrous tumors. This occurs as a result of NAB2-STAT6 gene fusion which is characteristic of solitary fibrous tumor.
Incorrect
Answer: Solitary fibrous tumor
Histology: This is a bland spindle cell lesion associated with prominent sclerosis. The vessels have a hemangiopericytomatous pattern in many areas. The lesional cells demonstrate strong immunoreactivity for CD34, and strong nuclear labeling for STAT6.
These results support the diagnosis of solitary fibrous tumor.
Discussion: Synovial sarcoma has similar cytology to solitary fibrous tumor; however, it would not label for CD34, and most cases demonstrate greater mitotic activity and slightly more primitive chromatin. Sarcomatoid carcinomas would demonstrate greater nuclear atypia and a malignant epithelial component. Sclerosing epithelioid fibrosarcoma would demonstrate greater cytologic atypia, lack CD34 immunoreactivity, and is associated with gene fusions involving FUS or EWS genes.
Nuclear labeling for STAT6 is a highly specific marker for solitary fibrous tumors. This occurs as a result of NAB2-STAT6 gene fusion which is characteristic of solitary fibrous tumor.
