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THE ROLE OF ULTRASONOGRAPHY IN THE DIAGNOSIS OF MALIGNANT

SOLITARY FIBROUS TUMOR

dr. Anggita Putri Kantilaras , SpRad


Radiology Department Faculty of Medicine and Health Science Universitas Muhammadiyah Yogyakarta

Solitary Fibrous Tumor (SFT) is a rare tumor derived from cells that resemble primitive
fibroblasts on connective tissue. SFT components show a mix of connective tissue, cells and
hypervascularization area that consists of many various sizes of blood vessels. Incidence of SFT
is far more frequent in adults age 40-501 and there is no gender predilection1,2 . SFT can related
with hypoglycemia secondary to production insulin like growth factor, osteoarthropathy and
arthralgia.
SFT can be found in the head (mostly in orbita), chest wall, mediastinum, pericardium,
retroperitoneum, abdominal cavity or in rare sites such as meninges, salivary glands, adrenal,
bladder or testis.2 Forty percent case of SFT is found in the subcutaneous layer.3 Although SFT is
a benign tumor because it is a well-defined soft-tissue tumor, 10-15 percent of SFT will have
recurrence and or metastasis.2 According to Thigh Dae Ho Kim, et al, SFT located in the
extremities, especially in the legs have a high possibility of developing malignancy1 .
Ultrasound plays an important role in the diagnosis of a soft-tissue tumor.4 Radiologists
are expected to give useful information for clinician when the diagnosis is made, radiologists can
determine characterization of tumor lesion that can classify the tumor as benign or malignant.4,5
Correct classification is very important because it can help clinician to make decision and allow
optimal treatment for the patient.5

Case Report

A 27-year-old woman, come to Polyclinic Surgery a RS PKU Muhamadiyah Gamping


Yogyakarta on January 26 , 2017 with complaint lumps at the base thigh left part top . Bumps on
first soft and arise 10 months ago with size early amount egg duck . because of patient feel pain
and lumps more enlarged , patient get treatment to RS. Examination physical show a palpable lump
hard and no could driven . Clinic ask ultrasound examination with a clinical diagnosis aneurysm .
Ultrasound examination shows isoechoic solid lesions in subcutaneous region femoral , size 7 cm
x 6 cm, limit firm which deviates artery and femoral veins sinistra to medial direction and within
1.37 cm artery and femoral veins sinistra .

Figure 1. Solid hypoechoic lesions inhomogene in soft tissue of the femur region of the femur
sinistra with component hyperechoic intralesi . Looked invasion mass to m. rectus femoris with forming
corner blunt ( obtus angle ). Color flow mapping obtained hypervascularization in the hyperechoic area .

Do oak side of the tumor the next morning day , looks mass solid with some fat
components with less diameter more 15 cm. Examination histopathology with also san IHC (
immunohistochemistry ) CD 34 and CD 31 show SFT maligna with hemangiopericytom a diagnosis
of malignant epithelioid he mangioendothelioma. On examination microscopic found very tumor
tissue cellular arranged on cells with the cell nucleus round to spindle , granular core chromatin ,
partial tumor solid , in part loose that surrounds rooms that d ibatasi by cells endotel and found
some mitosis.
Figure 2. Network macroscopic patient . Solid tumor yellowish in part soft with some fat components .