Published online Dec 16, 2023. doi: 10.12998/wjcc.v11.i35.8416
Peer-review started: October 7, 2023
First decision: November 22, 2023
Revised: November 27, 2023
Accepted: December 4, 2023
Article in press: December 4, 2023
Published online: December 16, 2023
Processing time: 67 Days and 15.9 Hours
Solitary fibrous tumor (SFT) is a rare mesenchymal tumor that is most commonly found in the pleura but can also originate from non-pleural sites. Among the non-pleural localizations, the pancreas is extremely rare. In particular, metastasis to the pancreas from the central nervous system (CNS) is extremely rare, with only two cases reported so far. We report a case of recurrence in the pancreas 14 years after the initial complete surgical removal of a tumor in the CNS.
A 68-year-old man with a past medical history of recurrent meningeal hemangiopericytoma, currently referred to as SFT, presented to the hospital with jaundice. The patient was first diagnosed with an 8cm-sized meningeal hemangiopericytoma fourteen years ago and underwent osteoplastic craniotomy. After 16 mo, imaging showed recurrence and he underwent gamma knife radiosurgery (GKRS). 2 years later, imaging showed recurrence again leading to a second GKRS. 5 years later, recurrence was again suspected leading to a second craniotomy. Since then 3 years had passed, and imaging showed a 3.5cm-sized mass lesion on the pancreatic head with obstruction of the pancreatic and bile ducts. Endosonography with fine-needle aspiration biopsy was done preoperatively and aided in the diagnosis of SFT. The patient underwent pylorus-preserving pancreaticoduodenectomy. Pathologic findings of the resected pancreatic specimen, consistent with the previously resected brain specimen, confirmed the diagnosis of SFT.
The rarity and lack of knowledge about SFTs make suspecting and diagnosing this disease challenging. We believe that a report of metastatic pancreatic SFT from the CNS will contribute to a better understanding of this rare disease.
Core Tip: Solitary fibrous tumor (SFT) is a rare mesenchymal tumor most commonly found in the pleura. Among non-pleural localizations, the pancreas is extremely rare. However, if the patient has a known history of primary intracranial SFT and imaging shows a hypervascular, well-encapsulated lesion in distant organs such as the pancreas, metastasis should always be considered. Imaging can be inconclusive, in which cases, endosonography with fine-needle aspiration biopsy can be a safe and effective diagnostic tool preoperatively. There are only two case reports on metastatic SFTs from the central nervous system, and we believe this case will further contribute to a better understanding.