Table 2.
SFTL cases with malignant features, local recurrence or metastatic disease
| No. | Author (year) | Age/sex | Rec/Met | Presentation | Lobe | Size (cm) | Mass (g) | Treatment | Histopathology | Tumour markers | IHC | Follow-up |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | Fuksbrumer et al. (2000) [18] | 71/F | Nil | n/a | R | 14–17 | n/a | Resection (UM) | Dense cellularity, increased nuclear atypia, mitoses 8/10 HPF | n/a | CD34+, bcl-2+, V+ | n/a |
| 2 | Yilmaz et al. (2000) [30] | 25/F | Met | Weakness, fatigue, anorexia, vomiting and progressive jaundice | L + R | 32 × 30 | 4500 | Resection (UM) | Cellularity ranged from 20–60%, necrosis, hypervascularity | NAD | V+ | Bone metastasis 1 month postsurgery managed with 6 months of chemo (cyclophosphamide, adriamycin) |
| 3 | Chan et al. (2007) [35] | 70/M | Rec + Met | Hypoglycaemia and progressive jaundice | R | 27 × 24 × 12 | 4400 | Failed TACE 6 weeks preoperatively followed by successful resection (UM) | Mildly atypical spindle cells, highly cellular, plemorphia, necrosis, mitoses > 20 HPF | CA-125 145U/ml (normal < 35 U/ml) | CD34+, CD99+, bcl-2+, V+ | Asymptomatic widespread bilateral lung metastasis and bi-lobar recurrence at 9 months review |
| 4 | Brochard et al. (2010) [51] | 54/M | Rec + Met | RUQ pain and weight loss | R | 17 | n/a | Resection (FM) | Moderately cellular, polymorphic cells, mitoses < 5/10 HPF | GGT 438 IU/ml (normal < 45 U/ml) | CD34+, V+, desmin+, actin+ | Local recurrence 6 years postsurgery managed with resection (findings: necrotic, haemorrhagic, highly cellular, moderately atypical nuclei, mitoses >20/10 HPF, CD34, bcl-2. Negative for desmin and actin). Cranial base metastasis managed by embolization and resection. Retroperitoneal and iliac bone metastasis weeks later, patient died 1 month after |
| 5 | Peng et al. (2011) [52] | 24/F | Met | RUQ discomfort and distention | R | 30 × 17 × 15 | 3750 | TACE few days prior to resection (FM). | Highly cellular, pleomorphic, necrosis, mitoses > 10/HPF | CA-125 abnormal | CD34+, bcl-2+, V+ | Craniotomy 13 days postsurgery for skull base metastases with large residual lesion. Vertebral metastasis 1 month later managed with 4× PEI and 4 rounds of chemo (adriamycin, ifosfamide, mesna). Tumour relapsed and rapidly enlarged with paralysis on 7 months review, patient died 16 months after initial surgery |
| 6 | Belga et al. (2012) [70] | 66/F | Nil | Increase in abdominal girth | R | 14 | n/a | Resection (UM) | Mitoses > 4/10 HPF, necrosis, mild nuclear atypia | NAD | CD34+ | 30 months |
| 7 | Jakob et al. (2013) [72] | 62/F | Nil | Upper abdominal pain and weight loss | L | n/a | n/a | Resection (UM) | High cellularity, cytological atypia, necrosis, mitoses 6/10 HPF | NAD | CD34+, CD99+, bcl-2+ | n/a |
| 8 | Vythianathan and Yong (2013) [74] | 78/M | Nil | Epigastric pain | L | 17 × 13 | n/a | Resection (UM) | Cellular pleomorphism, necrosis, mitoses > 4/10 HPF | n/a | CD34+, CD99+, bcl-2+, V+ | n/a |
| 9 | Song et al. (2014) [75] | 49/M | Nil | Abdominal pain | L + R | 7.6 × 5 × 4.8 | n/a | Resection (UM) | NAD | n/a | CD34+, bcl-2+, V+ | n/a |
| 10 | Du et al. (2015) [56] | 55/F | Rec | Hypoglycaemia and weight loss | L | 15.3 × 15.5 × 15.4 | n/a | Resection (UM) | n/a | NAD | CD34+, bcl-2+ | Local recurrence 5 years postsurgery, resected |
| 11 | Feng et al. (2015) [20] | 52/F | Rec | n/a | R | 12 | n/a | Resection (UM) | Haemorrhage, necrosis | NAD | CD34+ | Local recurrence 2 years postsurgery on L lobe managed with PEI. New lesion 6 months after PEI |
| 12 | Silvanto et al. (2015) [24] | 65/M | Nil | Incidental finding | L | 18 | n/a | Resection (lesion 1–2 mm from margins) | Myxoid changes, infarction, necrosis mitoses 5–7/10 HPF | NAD | CD34+, CD99+, bcl-2+ | 16 months |
| 13 | Maccio et al. (2015) [46] | 74/F | Met | Right abdominal pain and distension | R | 24 × 16 | n/a | Resection (FM) | Nuclear pleomorphism, cytological atypia, necrosis, haemorrhage, mitoses 9/10 HPF | n/a | CD34+, bcl-2+, V+, STAT6+ | Lung, omentum, mesentery and abdominal wall metastasis at 9 months review managed with chemotherapy—patient died 4 months later |
| 14 | Maccio et al. (2015) [46] | 80/F | Met | Dyspnoea, cough, asthenia, abdominal pain | R | 19 × 15 | n/a | Palliative chemotherapy | Highly cellular, pleomorphism, necrosis, haemorrhage, mitoses 7/10 HPF | n/a | CD34+, bcl-2+, V+, STAT6+ | R lung metastasis managed with palliative chemotherapy—patient died 5 months later |
| 15 | Maccio et al. (2015) [46] | 65/M | Met | Abdominal discomfort, vomiting and pain | R | 3 × 2 | n/a | Chemotherapy | Cytological atypia, necrosis, mitoses > 6/10 HPF | n/a | CD34+, bcl-2+, V+, STAT6+ | Bilateral lung metastasis managed with chemotherapy, patient died 5 months later |
| 16 | Present case (2016) | 61/M | Rec + Met | Diarrhoea | R | 15 × 11.5 × 7.5 | n/a | Resection (FM) | Myxoid changes, mitoses > 9/10 HPF | NAD | CD34+, CD99+, bcl-2+ | Extensive local recurrence and pleural metastases 6 years later—palliatively managed. Remains alive 1 month after discharge |
Rec recurrence, Met: metastasis, IHC immunohistochemistry, M male, F female, L left, R right, n/a not available, UM unknown margins, FM free margins, HPF high-power fields, TACE transarterial chemoembolization, RUQ right upper quadrant, NAD no abnormality detected, PEI percutaneous ethanol injection, V vimentin