The many faces of solitary fibrous tumor; diversity of histological features, differential diagnosis and role of molecular studies and surrogate markers in avoiding misdiagnosis and predicting the behavior

• Published in: Diagnostic pathology 2021-04, Vol.16 (1), p.32-32, Article 32
• Main Authors: Tariq, Muhammad Usman, Din, Nasir Ud, Abdul-Ghafar, Jamshid, Park, Yong-Koo
• Format: Article
• Language: English
• Subjects: Abdomen; Adolescent; Adult; Age; Aged; Aged, 80 and over; Biomarkers, Tumor - analysis; Biomarkers, Tumor - genetics; Bone tumors; CD34; Child; Dermatofibrosarcoma protuberans; Diagnosis; Diagnosis, Differential; Diagnostic Errors; Differential diagnosis; Female; Gastrointestinal cancer; Gene Fusion; Genetic aspects; Hemangiopericytoma; Humans; Immunohistochemistry; Lipoma; Liposarcoma; Male; Markers; Medical prognosis; Metastasis; Middle Aged; Molecular Diagnostic Techniques; Morphology; Mutation; NAB2-STAT6; Neoplasia; Neoplasms; Peripheral nerves; Predictive Value of Tests; Prognosis; Repressor Proteins - genetics; Review; Sarcoma; Schwann cells; Sheaths; Soft tissues; Solitary fibrous tumor; Solitary Fibrous Tumors - chemistry; Solitary Fibrous Tumors - genetics; Solitary Fibrous Tumors - secondary; Solitary Fibrous Tumors - surgery; Staghorn, fusion transcript; STAT-6; Stat6 protein; STAT6 Transcription Factor - genetics; Synovial sarcoma; Tissues; Transcription; Tumors; Young Adult
• ISSN: 1746-1596; 1746-1596
• DOI: 10.1186/s13000-021-01095-2

Solitary Fibrous Tumor (SFT) is a distinct soft tissue neoplasm associated with NAB2-STAT6 gene fusion. It can involve a number of anatomic sites and exhibits a wide spectrum of histological features. Apart from diversity in morphological features seen even in conventional SFT, two histologic variants (fat-forming and giant cell-rich) are also recognized. In addition, a malignant form and dedifferentiation are well recognized. Owing to diverse histological features and involvement of diverse anatomic locations, SFT can mimic other soft tissue neoplasms of different lineages including schwannoma, spindle cell lipoma, dermatofibrosarcoma protuberans, liposarcoma, gastrointestinal stromal tumor (GIST), malignant peripheral nerve sheath tumor (MPNST), and synovial sarcoma. SFT is classified as an intermediate (rarely metastasizing) tumor according to World Health Organization Classification of Tumors of Soft tissue and Bone, 5th edition. The management and prognosis of SFT differs from its malignant mimics and correct diagnosis is therefore important. Although SFT expresses a distinct immunohistochemical (IHC) profile, the classic histomorphological and IHC profile is not seen in all cases and diagnosis can be challenging. NAB2-STAT6 gene fusion has recently emerged as a sensitive and specific molecular marker and its IHC surrogate marker signal transducer and activator of transcription 6 (STAT6) has also shown significant sensitivity and specificity. However, few recent studies have reported STAT6 expression in other soft tissue neoplasms. This review will focus on describing the diversity of histological features of SFT, differential diagnoses and discussing the features helpful in distinguishing SFT from its histological mimics.