A Rare Case of Solitary Fibrosus Tumor (SFT) of the Nasal Septum

Document Type : Case Report

Authors

Department of Biomedicine, Neuroscience and Advanced Diagnostics, AOUP Paolo Giaccone, University of Palermo, Via del Vespro, 133, 90127 Palermo, Italy.

Abstract

Introduction:
Solitary fibrous tumor (SFT) is a rare mesenchymal tumor that usually arises from the pleura but can also occur in extrapleural sites, such as the sinonasal region. It causes  aspecific symptoms, including nasal obstruction and discharge, postnasal drip, anosmia, epistaxis, and headache. It may be difficult to distinguish these symptoms from those caused by other mesenchymal lesions that usually occur in this site, especially when the tissues undergo iatrogenic damage following surgical removal.
Case Report:
This case report shows a rare right nasal septal solitary fibrous tumor, which was surgically removed using a trans-nasal endoscopic technique. For the first time, the mass was decomposed by a plasma blade, and the implant site was treated by performing a subperiosteal removal of septal mucosa and cartilage. Histopathological examination confirmed the diagnosis of solitary fibrous tumor. Follow-up at three, six, and twelve months showed no signs of relapse.
Conclusions:
Sinonasal SFT is unusual, and it may be difficult to distinguish it from other mesenchymal lesions in this site. In the literature, cases treated with CO2 laser are usually described; however, due to the high cutting temperatures, this can cause thermal damage of the tissues, making histopathological diagnosis difficult. The plasma blade uses pulsed radiofrequency, creating an effective cutting edge while the blade stays near body temperature. Therefore, this device results in atraumatic, scalpel-like cutting sensitivity and electrosurgical-like hemostasis, with minimal bleeding and tissue injury. Its use could, therefore, help both the surgeon in obtaining surgical radicality and the pathologist in the correct histologic classification.

Keywords

Main Subjects


  1. Dispenza F, Immordino A, De Stefano A, Sireci F, Lorusso F, Salvago P, Martines F, Gallina S. The prognostic value of subjective nasal symptoms and SNOT-22 score in middle ear surgery. American Journal of Otolaryngology. 2022 Jul 1;43(4): 103480.
  2. Chmielecki J, Crago AM, Rosenberg M, O'Connor R, Walker SR, Ambrogio L, Auclair D, McKenna A, Heinrich MC, Frank DA, Meyerson M. Whole-exome sequencing identifies a recurrent NAB2-STAT6 fusion in solitary fibrous tumors. Nature genetics. 2013 Feb;45(2):131-2.
  3. 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. doi:10. 1038/ng.2509
  4. Gengler C, Guillou L. Solitary fibrous tumour and haemangiopericytoma: evolution of a concept. Histopathology. 2006;48(1):63-74. doi:10.1111/j. 1365-2559.2005.02290.x
  5. Thompson LDR, Lau SK. Sinonasal Tract Solitary Fibrous Tumor: A Clinicopathologic Study of Six Cases with a Comprehensive Review of the Literature. Head Neck Pathol. 2018;12(4):471-480. doi:10.1007/s12105-017-0878-y
  6. Cantone E, Cavaliere M, Di Lullo AM et al. Immunohistochemical patterns in the differential diagnosis of rhinopharyngeal granulocytic sarcoma. Oncol Lett. 2016;12(4):2777-2781. doi:10.3892/ol. 2016.5009
  7. Sireci F, Lorusso F, Martines F, et al. Guide to management of complications in endoscopic sinus surgery (ESS). Advances in Health and Disease. 2021. Chapter 4, Nova Science Publisher, Inc. New York.
  8. Lorusso F, Dispenza F, Sireci F, et al. A Comparative Double Blind Study of Nasal Dressing Sponge® versus Merocel® as Nasal Pack after Nasal Surgery. Iran J Otorhinolaryngol. 2021; 33(119):369-373.doi:10.22038/IJORL.2021.49606. 2649
  9. Melroy CT, Senior BA. Benign sinonasal neoplasms: a focus on inverting papilloma. Otolaryngol Clin North Am. 2006;39(3):601-617, x. doi:10. 1016/j. otc.2006.01.005
  10. Le QT, Fu KK, Kaplan M et al. Treatment of maxillary sinus carcinoma: a comparison of the 1997 and 1977 American Joint Committee on cancer staging systems. Cancer. 1999;86(9):1700-1711.
  11. Tiwari R, Hardillo JA, Mehta D, et al. Squamous cell carcinoma of maxillary sinus. Head Neck. 2000;22(2):164-169. doi:10.1002/(sici)1097-0347 (200003) 22:2<164::aid-hed8>3.0.co;2-#
  12. Magnani C, Ciambellotti E, Salvi U et al. (The incidence of tumors of the nasal cavity and the paranasal sinuses in the district of Biella, 1970-1986). Acta Otorhinolaryngol Ital Organo Uff Della Soc Ital Otorinolaringol E Chir Cerv-facc. 1989; 9(5):511-519.
  13. Muir CS, Nectoux J. Descriptive epidemiology of malignant neoplasms of nose, nasal cavities, middle ear and accessory sinuses. Clin Otolaryngol Allied Sci. 1980;5(3):195-211. doi:10.1111/j.1365-2273. 1980.tb01647.x
  14. Zyłka S, Bień S, Kamiński B et al. (Epidemiology and clinical characteristics of the sinonasal malignancies). Otolaryngol Pol Pol Otolaryngol. 2008;62(4):436-441. doi: 10.1016/ S0030 - 6657(08)70287-7
  15. Barbieri PG, Lombardi S, Candela A, Festa R. (Nasal sinus cancer registry of the province of Brescia). Epidemiol Prev. 2003;27(4):215-220.
  16. Cavaliere M, Piro E, Mascolo M, et al. Clinical management of extrapleural septal solitary fibrous tumor: A case report. Oncol Lett. 2020;20(3):2465-2468. doi:10.3892/ol.2020.11789
  17. Ashraf MJ, Azarpira N, Khademi B et al. Extramedullary plasmacytoma of the nasal cavity report of three cases with review of the literature. Iran Red Crescent Med J. 2013;15(4):363-366. doi:10.5812/ircmj.2209
  18. Liu TR, Yang AK, Chen FJ, et al. (Extramedullary plasmacytoma in the head and neck: a report of 10 cases and literature review). Ai Zheng Aizheng Chin J Cancer. 2005;24(6):714-717.
  19. Rizzo S, Giunta A a. M, Pennacchi A. Sinonasal and rhinopharyngeal solitary fibrous tumour: a case report and review of the literature. Acta Otorhinolaryngol Ital Organo Uff Della Soc Ital Otorinolaringol E Chir Cerv-facc. 2015;35(6):455-458. doi:10.14639/0392-100X-163813
  20. Fujikura T, Ishida M, Sekine K et al. Solitary fibrous tumor arising from the superior nasal turbinate: a case report. J Nippon Med Sch. 2012; 79(5): 373-6. doi: 10.1272/jnms.79.373. PMID: 23123395.
  21. Janjua A, Sklar M, Macmillan C et al. Endoscopic resection of solitary fibrous tumors of the nose and paranasal sinuses. Skull Base. 2011 Mar; 21(2):129-34. doi: 10.1055/s-0031-1275259. PMID: 22451814; PMCID: PMC3312588.
  22. Eloy PH, Nollevaux MC, Watelet JB et al. Endonasal endoscopic resection of an ethmoidal solitary fibrous tumor. Eur Arch Otorhinolaryngol. 2006 Sep;263(9):833-7. doi: 10.1007/s00405-006-0073-3. Epub 2006 Jun 9. PMID: 16763824.
  23. Hicks DL, Moe KS. Nasal solitary fibrous tumor arising from the anterior cranial fossa. Skull Base. 2004 Nov;14(4):203-7. doi: 10.1055/s-2004-860951. PMID: 16145606; PMCID: PMC1151693.
  24. Bekers EM, van Engen-van Grunsven ACH, Groenen PJTA, et al. Metastatic melanoma mimicking solitary fibrous tumor: report of two cases. Virchows Arch Int J Pathol. 2014;464(2):247-251. doi:10.1007/s00428-014-1542-5
  25. Konstantinidis I, Triaridis S, Triaridis A et al. A rare case of solitary fibrous tumor of the nasal cavity. Auris Nasus Larynx. 2003 Aug;30(3):303-5. doi: 10.1016/s0385-8146(03)00064-6. PMID: 12927298.
  26. Sireci F, Dispenza F, Lorusso F et al. Tumours of Nasal Septum: A Retrospective Study of 32 Patients. Int J Environ Res Public Health. 2022; 19(3):1713. doi:10.3390/ijerph19031713
  27. Canevari FR, Sireci F, Sollini G. Huge Septal Schwannoma: Endoscopic Transnasal Resection Using Disassembling Technique. The Rhinologist. 2017, 4:4-11.