William Beaumont Hospital Royal Oak, MI, United States
Samiksha Pandey, MBBS, MS, Mitual Amin, MD, Mitchell Cappell, MD, PhD William Beaumont Hospital, Royal Oak, MI
Introduction: Solitary Fibrous Tumor (SFT) is a rare mesenchymal tumor typically originating from pleura or extrapleural site and diagnosed with spindle cells in biopsy and immunohistochemically staining for CD34. We present a case of colonic SFT metastasized to the peripancreatic area, years after surgical removal and imatinib treatment, causing severe pancreatitis.
Case Description/Methods: A 64 year male with a past medical history of SFT of Right colon s/p right hemicolectomy 10 years prior, presented for punching, dull, epigastric abdominal pain associated with nausea and vomiting for 2 weeks. He had dark urine without hematuria and intermittent loose stool without melena, hematochezia. Mild icterus in the sclera and skin was found on physical examination. Laboratory values showed elevated liver function test (LFT) and lipase ( >3500). Computed Tomography of abdomen/pelvis showed heterogeneous mass arising exophytically from the anterior neck of the pancreas. Magnetic Resonance Imaging showed no common bile duct obstruction or dilation. Cancer Antigen 19-9 was elevated but Carcinoembryonic Antigen was normal. Endoscopic Ultrasound demonstrated a well-circumscribed hypoechoic lesion, adjacent to the pancreas. Fine needle biopsy revealed spindle cell neoplasm, consistent with SFT. The immunohistochemistry was positive for CD34, STAT- 6 consistent with SFT, and CD117, Dog -1, c-KIT, Desmin and S-100 negative. CT chest for staging revealed reactive pulmonary nodule and bone scan with no metastasis. He underwent exploratory laparotomy with distal subtotal pancreatectomy, splenectomy, cholecystectomy and distal gastrectomy with Billroth II anastomosis. Mass was found to have risen from the distal stomach extending into the pancreas. Later, he improved clinically and his LFT and Lipase normalized.
Discussion: Metastasis of SFT occurred in the peripancreatic area after 10 years of complete surgical and imatinib (for a year) treatment. Although the metastasized tumor was in the distal stomach, the mass extended into the pancreas causing hyperlipasemia. To our knowledge, this is the first case to report metastatic SFT in the peripancreatic area causing severe pancreatitis. Thus, a prolonged follow-up is needed in patients with a history of SFT, even after the complete treatment.
Figure: Gross image of SFT in Right Colon (Primary site)
Samiksha Pandey indicated no relevant financial relationships.
Mitual Amin indicated no relevant financial relationships.
Mitchell Cappell indicated no relevant financial relationships.
Samiksha Pandey, MBBS, MS, Mitual Amin, MD, Mitchell Cappell, MD, PhD. P2206 - Metastasis of Solitary Fibrous Tumor to the Peripancreatic Area Causing Pancreatitis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.